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Restriction of access to methods of suicide as a means of suicide prevention
... Postoje rodne i starosne specifičnosti, kod svakog korišćenog metoda suicida smrtnost je veća kod muškaraca i starijih osoba. Generalno, muškarci češće pribegavaju letalnijim sredstvima nego žene (Shenassa, Catlin, Buka, 2003;Hawton, 2005). ...
... Ono što značajno razlikuje ova dva suicidna ponašanja je korišćeni metod, a dostupnost metoda koji je letalan najčešće znači i smrt kao konačni ishod suicidnog akta (Lim, Lee & Park, 2014). Veća rasprostanjenost pokušaja samoubistva među ženama i ostvarenih samoubistava među muškarcima često se objašnjava time što muškarci biraju letalnije metode, kao što su vatreno oružje ili vešanje, za razliku od žena koje češće koriste manje opasna sredstva poput trovanja (Shenassa, Catlin & Buka, 2003;Hawton, 2005). Istraživanja pokazuju da čak i u okviru istog korišćenog metoda postoje rodne razlike, kod svakog korišćenog metoda, fatalni ishod češći je među muškarcima (Cibis et al., 2012;Mergl et al., 2015;Elnour & Harrison, 2008). ...
... Od uticaja je i naklonost neke osobe prema određenom tipu metoda. Muškarci generalno ispoljavaju veću naklonost prema nasilnijim metodima, žene češće biraju manje nasilne metode, ali na ove preferencije utiče i fizička dostupnost sredstava, jer muškarci češće imaju veći pristup određenim nasilnim metodima, dok su ženama dostupniji lekovi (Hawton, 2005). ...
The method of suicide is an important determinant of the outcome of suicidal behavior, and the reduction of the availability of the most frequently used methods has significant preventive potential. This paper analyzes the dynamics of the total number of suicides in Serbia according to method used in the period of 1990-2014, with an emphasis on structural differences by sex and age. The relative participation of certain age groups in the most commonly used suicide methods is indicated based on the calculated values of the relative risk referred to as the age ratio of method of suicide (ARMS). The analysis is based on the data of the Statistical Office of the Republic of Serbia, mostly unpublished.
The results of the analysis show that in Serbia, in the period of 1990-2014, hanging was the most commonly used suicide method (61%). The next in number, but with a significantly smaller share, were suicides by a firearm (13%) and poisoning (8%). The biggest changes were registered with regard to the increase in firearm suicides, which was clearly connected to the beginning of the wars in former Yugoslavia in the early 1990s, but continued during the 2000s. Among men, the three above-mentioned methods were higher (85%), while the most prevalent methods among women were hanging (59%), poisoning (16%) and drowning (8%). Observed by age, the elderly (60+) are the most numerous, regardless of suicide method. The existing differences all relate to the share of certain age groups in the number of suicides by a particular method. There was a significant difference in the relative participation of large age groups in certain methods of suicide. The changes in this respect have been in the direction of reducing existing differences.
... As the dominant method of suicide, hanging accounts for more than 60% of suicide deaths in Japan [11][12][13]. Hanging has been shown to be one of the most lethal suicide methods, with a fatality rate of over 83% [14,15], and small changes in the distribution of methods of suicide can have the potential to drive large changes in the overall rate [16], making action on restricting access to certain methods of hanging a common public health strategy for reducing suicide mortality [17][18][19]. ...
... For an analysis of overall trends, we computed age-adjusted directly standardized suicide rates with the 2010 population of Japan as the standard population [27]. In this research, we divided age into four groups (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29), 60-79, and 80+ years) and compared the trends in suicide by age group and method. ...
Suicide is a major public health concern in Japan. This study aimed to characterize the trends in suicide mortality in Japan by method since 1979. Using data from the Japan vital registration system, we calculated age-standardized rates of suicide mortality separately by sex and method. We conducted a log-linear regression of suicide mortality rates separately by sex, and linear regression analysis of the proportion of deaths due to hanging, including a test for change in level and trend in 1998. While crude suicide rates were static over the time period, age-adjusted rates declined. The significant increase in suicide mortality in 1998 was primarily driven by large changes in the rate of hanging, with suicide deaths after 1998 having 36.7% higher odds of being due to hanging for men (95% CI: 16.3–60.8%), and 21.9% higher odds of being due to hanging for women (95% CI: 9.2–35.9%). Hanging has become an increasingly important method for committing suicide over the past 40 years, and although suicide rates have been declining continuously over this time, more effort is needed to prevent hanging and address the potential cultural drivers of suicide if the rate is to continue to decline in the future.
... The core of suicide prevention strategies is to limit the access to deadly substances (6). This is because impulsive movements to self-harm even in a person with a low willingness to die when using methods with a high risk of death can lead to death (7,8). This is why identifying the most common suicide methods to determine appropriate strategies to limit access to the above deadly methods, as well as to improve the health system's abilities for the proper treatment of those who used these methods for suicide (9). ...
Objective: Suicide is a kind of malicious violence, with the most direct and indirect victims of it being women. Since suicide is a repetitive act, it is important to identify the abundance and types of common violence and the factors leading to it. Therefore, this study examined the season and the most commonly used drug among suicide cases referred to Sina Hospital. Materials and Methods: This descriptive cross-sectional study was performed on all patients who were admitted to Sina Hospital in Tabriz by suicide detection in 1395. At the beginning of the study, a checklist was designed to collect information from the patients ‘files from the patients’ files. The patients were asked about the age, occupation, educational level, type of drug, visitation period, previous intervention and history of psychiatric illnesses. The outcome of the study was also evaluated in this study. Finally, all information was analyzed using SPSS software version 18 and statistical methods. Results: This study was conducted in one from March 2016 to March 2017, and on the data of 1176 suicides. The mean age of the patients was 30.98 ± 13.03 years and 58.9% were female. 52% were single, 4.8% had a positive history of neurological diseases and 11.4% had previous suicidal experiences, 36.66% had only one occurrence of suicidal attempts. The winter with 33.1% of the most commonly visited seasons and benzodiazepines with 34.9% were the most commonly used drug among patients. Finally, 6.5% of the patients died in the hospital. Conclusion: The results of this study showed that benzodiazepine was the most commonly used drug for suicidal patients, and winter showed the highest suicide rate.
... Irritability and anger have previously been shown to be potential clinical factors associated with suicide (Gvion & Apter, 2011;Hendin, Al Jurdi, Houck, Hughes, & Turner, 2010) including in a psychological autopsy study of young men who died by suicide (Rasmussen, Haavind, Dieserud, & Dyregrov, 2014). Impulsivity, similarly, has long been associated with an increased risk of suicide, particularly where methods of high lethality are easy to access (Hawton, 2005), and as suggested above, strategies to reduce access to firearms and pesticides in this region of Pakistan should be considered. ...
Introduction: Ascertaining putative sociodemographic and clinical causes for death
by probable suicide can potentially help implement region‐specific strategies to reduce
suicide rates. In this study, we wanted to investigate methods utilized and the psychosocial and mental health characteristics of youths (aged 12‐26 y) who died by probable suicide.
Method: We examined data from mental health clinical files and forensic reports
and performed qualitative psychological autopsy interview from more than multiple
sources for each youth who died by probable suicide between 1 May and 31
December 2015 in the Khyber Pakhtunkhwa Province of Pakistan.
Results: The two most common methods of probable suicide were by firearm use
and self‐poisoning utilizing pesticides that were significantly associated with male
and female gender, respectively. The most common mental health difficulties were
major depressive disorder and harmful use of psychoactive substances. Other
clinical features particularly evident included thoughts of self‐harm, irritability and
aggression, low self‐esteem, treatment nonadherence, family dispute, and financial
distress.
Conclusion: Efforts to reduce the ease of access to firearms and pesticides may
potentially have a beneficial effect in reducing the suicide rate in this region of
Pakistan.
KEYWORDS: lethal means, mental health, psychological autopsy, suicide, youth
... Os sinais de alerta para o suicídio podem ser definidos como "manifestações comportamentais da precipitação de condições num indivíduo particular: elas são diretamente observáveis, refletem o atual estado do indivíduo e indicam a presença de uma crise suicida" (Van Orden et al., 2006, p. 273). Os sinais de alerta sugerem, assim, a possibilidade de ocorrência de um ato suicida num futuro muito próximoque pode variar de horas a alguns diase, por isso, exigem uma intervenção imediata e eficaz (Hawton, 2010;Rudd, Berman, et al., 2006). Estes sinais caracterizam-se também por serem dinâmicos, episódicos e variáveis (e.g., ideação suicida frequente; plano suicida), o que significa que podem desaparecer com alguma facilidade quando a crise suicida é superada. ...
... Risk factors: 1) Demographic risk factors, 2) The risk factors associated with acute and chronic life events, 3) The risk factors associated with psychiatric disorders (Holmes and Rache, 1967:216;Hawton, 2005;Ozsoy Demirel & Esel, 2003;Sayar, 2002): ...
Background:
Road traffic suicides are common. However, due to the difficulty in distinguishing between motor vehicle crash fatalities and actual suicides, no official figures exist for this method of suicide. Restricting access to means is an important universal or population-based approach to suicide prevention with clear evidence of its effectiveness. However, the evidence with respect to means restriction for the prevention of suicide on roads is not well established. We conducted a systematic review to assess the impact of restrictions on the availability of, or access to, means of suicide on roads.
Objectives:
To evaluate the effectiveness of interventions to restrict the availability of, or access to, means of suicide on roads.
Search methods:
We searched the Cochrane Library, MEDLINE, Embase, PsycINFO, and the Transport Research International Documentation (TRID) Database from the date of database inception to March 2020. We conducted searches of the World Health Organization International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov to identify unpublished and ongoing studies. We applied no date, language, or publication status restrictions to these searches.
Selection criteria:
Eligible studies were randomised or quasi-randomised controlled trials, controlled intervention studies without randomisation, before-after studies, or studies using interrupted time series designs, which evaluated interventions to restrict the availability of, or access to, means of suicide on roads.
Data collection and analysis:
Two review authors screened abstracts and full-text publications against the inclusion criteria. Two review authors planned to independently extract data and assess risk of bias of included studies. However, we identified no studies eligible for inclusion.
Main results:
We identified no studies that met the inclusion criteria for this review.
Authors' conclusions:
This systematic review highlights the paucity of research around road traffic suicides and the need for future robust studies that aim to investigate the effectiveness of interventions to prevent suicide on roads. Suicide ascertainment is a key issue; therefore, clear objective criteria are necessary in order to scale up and study this method more accurately. In the absence of any substantial evidence, we advocate for more awareness on road traffic suicides and its inclusion in future government suicide prevention policies. Further research exploring effective measures, particularly those that do not require driver compliance, are also needed.
Background
Paracetamol is frequently used for intentional self-poisoning, especially in the UK, despite pack size restrictions introduced in 1998. Knowing more about paracetamol self-poisoning may identify further approaches to prevention.
Methods
We used data from the Multicentre Study of Self-harm in England for 2004-2014 to calculate incidence rates of presentations to Emergency Departments following self-poisoning with pure paracetamol alone. National estimates for England for 2011-2014 were extrapolated using indirect age-standardised rates. The characteristics of individuals taking paracetamol overdoses and the size of the overdoses were investigated.
Results
A third of 54,863 intentional overdoses presenting to the five Emergency Departments involved paracetamol without other drugs (N=18,011), taken by 13,171 individuals (63.4% female). The proportion of paracetamol self-poisonings was similar in the three centres. Extrapolation suggested there were approximately 50,000 paracetamol overdoses in England annually during 2011-2014. Females had higher rates of paracetamol overdose than males. Males and older individuals took larger overdoses. Nearly a quarter of individuals (24.2%) consumed more than 32 tablets. Alcohol was involved in 53.7% of paracetamol overdoses.
Limitations
Data were collected in three centres with predominantly urban populations. Extrapolation from local to national rates should be interpreted with caution.
Conclusions
Paracetamol overdose remains a major problem in the UK. It is more common in females and younger patients, but males and older patients consume larger overdoses. Consideration should be given to further restriction in pack sizes and sources of sales, in keeping with those of several other European countries.
Background:
Jumping from a height is an uncommon but lethal means of suicide. Restricting access to means is an important universal or population-based approach to suicide prevention with clear evidence of its effectiveness. However, the evidence with respect to means restriction for the prevention of suicide by jumping is not well established.
Objectives:
To evaluate the effectiveness of interventions to restrict the availability of, or access to, means of suicide by jumping. These include the use of physical barriers, fencing or safety nets at frequently-used jumping sites, or restriction of access to these sites, such as by way of road closures.
Search methods:
We searched the Cochrane Library, Embase, MEDLINE, PsycINFO, and Web of Science to May 2019. We conducted additional searches of the international trial registries including the World Health Organization International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov, to identify relevant unpublished and ongoing studies. We searched the reference lists of all included studies and relevant systematic reviews to identify additional studies and contacted authors and subject experts for information on unpublished or ongoing studies. We applied no restrictions on date, language or publication status to the searches. Two review authors independently assessed all citations from the searches and identified relevant titles and abstracts. Our main outcomes of interest were suicide, attempted suicide or self-harm, and cost-effectiveness of interventions.
Selection criteria:
Eligible studies were randomised or quasi-randomised controlled trials, controlled intervention studies without randomisation, before-and-after studies, or studies using interrupted time series designs, which evaluated interventions to restrict the availability of, or access to, means of suicide by jumping.
Data collection and analysis:
Two review authors independently selected studies for inclusion and three review authors extracted study data. We pooled studies that evaluated similar interventions and outcomes using a random-effects meta-analysis, and we synthesised data from other studies in a narrative summary. We summarised the quality of the evidence included in this review using the GRADE approach.
Main results:
We included 14 studies in this review. Thirteen were before-and-after studies and one was a cost-effectiveness analysis. Three studies each took place in Switzerland and the USA, while two studies each were from the UK, Canada, New Zealand, and Australia respectively. The majority of studies (10/14) assessed jumping means restriction interventions delivered in isolation, half of which were at bridges. Due to the observational nature of included studies, none compared comparator interventions or control conditions. During the pre- and postintervention period among the 13 before-and-after studies, a total of 742.3 suicides (5.5 suicides per year) occurred during the pre-intervention period (134.5 study years), while 70.6 suicides (0.8 suicides per year) occurred during the postintervention period (92.4 study years) - a 91% reduction in suicides. A meta-analysis of all studies assessing jumping means restriction interventions (delivered in isolation or in combination with other interventions) showed a directionality of effect in favour of the interventions, as evidenced by a reduction in the number of suicides at intervention sites (12 studies; incidence rate ratio (IRR) = 0.09, 95% confidence interval (CI) 0.03 to 0.27; P < 0.001; I2 = 88.40%). Similar findings were demonstrated for studies assessing jumping means restriction interventions delivered in isolation (9 studies; IRR = 0.05, 95% CI 0.01 to 0.16; P < 0.001; I2 = 73.67%), studies assessing jumping means restriction interventions delivered in combination with other interventions (3 studies; IRR = 0.54, 95% CI 0.31 to 0.93; P = 0.03; I2 = 40.8%), studies assessing the effectiveness of physical barriers (7 studies; IRR = 0.07, 95% CI 0.02 to 0.24; P < 0.001; I2 = 84.07%), and studies assessing the effectiveness of safety nets (2 studies; IRR = 0.09, 95% CI 0.01 to 1.30; P = 0.07; I2 = 29.3%). Data on suicide attempts were limited and none of the studies used self-harm as an outcome. There was considerable heterogeneity between studies for the primary outcome (suicide) in the majority of the analyses except those relating to jumping means restriction delivered in combination with other interventions, and safety nets. Nevertheless, every study included in the forest plots showed the same directional effects in favour of jumping means restriction. Due to methodological limitations of the included studies, we rated the quality of the evidence from these studies as low. A cost-effectiveness analysis suggested that the construction of a physical barrier on a bridge would be a highly cost-effective project in the long term as a result of overall reduced suicide mortality.
Authors' conclusions:
The findings from this review suggest that jumping means restriction interventions are capable of reducing the frequency of suicides by jumping. However, due to methodological limitations of included studies, this finding is based on low-quality evidence. Therefore, further well-designed high-quality studies are required to further evaluate the effectiveness of these interventions, as well as other measures at jumping sites. In addition, further research is required to investigate the potential for suicide method substitution and displacement effects in populations exposed to interventions to prevent suicide by jumping.
Objective To evaluate the effects on suicidal behaviour of legislation limiting the size of packs of paracetamol and salicylates sold over the counter. Setting UK population, with detailed monitoring of data from five liver units and seven general hospitals, between September 1996 and September 1999. Subjects People who died by suicidal or accidental overdose with paracetamol or salicylates, or who died of undetermined causes; patients admitted to liver units with hepatic paracetamol poisoning; patients presenting to general hospitals with self poisoning after taking paracetamol or salicylates. Main outcome measures Mortality from paracetamol or salicylate overdose; numbers of patients referred to liver units or listed for liver transplant; numbers of transplantations; numbers of overdoses and tablets taken; blood concentrations of the drugs; prothrombin times; sales to pharmacies and other outlets of paracetamol and salicylates. Results Numbers of tablets per pack of paracetamol and salicylates decreased markedly in the year after the change in legislation on 16 September 1998. The annual number of deaths from paracetamol poisoning decreased by 21% (95% confidence interval 5% to 34%) and the number from salicylates decreased by 48% (11% to 70%). Liver transplant rates after paracetamol poisoning decreased by 66% (55% to 74%). The rate of non-fatal self poisoning with paracetamol in any form decreased by 11% (5% to 16%), mainly because of a 15% (8% to 21%) reduction in overdoses of paracetarnol in non-compound form. The average number of tablets taken in paracetarnol overdoses decreased by 7% (0% to 12%), and the proportion involving > 32 tablets decreased by 17% (4% to 28%). The average number of tablets taken in salicylate overdoses did not decrease, but 34% fewer (2% to 56%) salicylate overdoses involved > 32 tablets. After the legislation mean blood concentrations of salicylates after overdose decreased, as did prothrombin times; mean blood concentrations of paracetamol did not change. Conclusion Legislation restricting pack sizes of paracetamol and salicylates in the United Kingdom has had substantial beneficial effects on mortality and morbidity associated with self poisoning using these drugs.
Describes a phenomenological approach to the study of personality factors in drug abuse, emphasizing the problem of compulsion, symptom equivalence, and their effects on life-style. The question of whether certain personality traits are indicative of a predisposition to drug addiction (e.g., object dependency or affect defense), the long-range effects of drugs on personality, and implications for treatment are also examined. (67 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The main focus of the book is on how to help patients who have taken overdoses or injured themselves. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The Golden Gate Bridge is currently the number one suicide location in the world. From the opening day, May 18, 1937 to April 1, 1978, there have been 625 officially reported suicide deaths and perhaps more than 200 others which have gone unseen and unreported. Proposals for the construction of a hardware antisuicide barrier have been challenged with the untested contention that “they'll just go someplace else.” This research tests the contention by describing and evaluating the long-term mortality experience of the 515 persons who had attempted suicide from the Golden Gate Bridge but were restrained, from the opening day through the year 1971 plus a comparison group of 184 persons who made nonbridge suicide attempts during 1956–57 and were treated at the emergency room of a large metropolitan hospital and were also followed through the close of 1971. Results of the followup study are directed toward answering the important question: “Will a person who is prevented from suicide in one location inexorably tend to attempt and commit suicide elsewhere?”
A detailed analysis of suicide rates between 1960 and 1971 for England and Wales and for Scotland confirms that all age-sex subgroups have shown a marked decline in suicide due to domestic gas, corresponding in time to the fall in the CO content. After considering data on the effects of the International Classification of Diseases (ICD) Eighth Revision, accident mortality, some personal characteristics of coal gas suicides, and the use of coal gas in parasuicide it was concluded that a simple casual explantation was likely. Suicide due to non-gas methods has in general increased, markedly so in some groups. It was suggested that neither improved psychiatric services nor voluntary agencies could have produced such changes. The 'compensatory' trend of gas and non-gas suicide rates was indicated for certain age-sex subgroups. The continuing need for suicide research was pointed out, and questions were raised concerning the psychological meaning of the epidemiological data.
It has been suggested that limiting access to firearms could prevent many suicides, but this belief is controversial. To assess the strength of the association between the availability of firearms and suicide, we studied all suicides that took place in the homes of victims in Shelby County, Tennessee, and King County, Washington, over a 32-month period.
For each suicide victim (case subject), we obtained data from police or the medical examiner and interviewed a proxy. Their answers were compared with those of control subjects from the same neighborhood, matched with the victim according to sex, race, and age range. Crude and adjusted odds ratios were calculated with matched-pairs methods.
During the study period, 803 suicides occurred in the two counties, 565 of which (70 percent) took place in the home of the victim. Fifty-eight percent (326) of these suicides were committed with a firearm. After excluding 11 case subjects for various reasons, we were able to interview 80 percent (442) of the proxies for the case subjects. Matching controls were identified for 99 percent of these subjects, producing 438 matched pairs. Univariate analyses revealed that the case subjects were more likely than the controls to have lived alone, taken prescribed psychotropic medication, been arrested, abused drugs or alcohol, or not graduated from high school. After we controlled for these characteristics through conditional logistic regression, the presence of one or more guns in the home was found to be associated with an increased risk of suicide (adjusted odds ratio, 4.8; 95 percent confidence interval, 2.7 to 8.5).
Ready availability of firearms is associated with an increased risk of suicide in the home. Owners of firearms should weigh their reasons for keeping a gun in the home against the possibility that it might someday be used in a suicide.