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Abstract

Introduction Suicide rates among middle-aged men and women in the U.S. have been increasing since 1999, with a sharp escalation since 2007. Purpose To examine whether suicides with circumstances related to economic crises increased disproportionately among the middle-aged between 2005 and 2010. Methods This study used the National Violent Death Reporting System (NVDRS) in 2014 to explore trends and patterns in circumstance and method among adults aged 40–64 years. Results Suicide circumstances varied considerably by age, with those related to job, financial, and legal problems most common among individuals aged 40–64 years. Between 2005 and 2010, the proportion of suicides where these circumstances were present increased among this age group, from 32.9% to 37.5% of completed suicides ( p 65 years ( p Conclusions The growth in the importance of external circumstances and increased use of suffocation jointly pose a challenge for prevention efforts designed for middle-aged adults. Suffocation is a suicide method that is highly lethal, requires relatively little planning, and is readily available. Efforts that target employers and workplaces as important stakeholders in the prevention of suicide and link the unemployed to mental health resources are warranted.

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... After removing duplicates and screening of titles and abstracts, 874 full-text articles were retained for further assessment. Consequently, 62 articles fulfilled the criteria of inclusion for analysis Bjorkenstam et al., 2005;Blakely et al., 2003;Borrell et al., 2017;Charlton, 1995;Chen et al., 2009;Christensen et al., 2007;Corcoran, 2009;Corcoran and Arensman, 2010;De Leo et al., 2013;Doyle et al., 2016;Duberstein et al., 2004;Erlangsen et al., 2008Erlangsen et al., , 2012Fall et al., 2009;Fang et al., 2012;Fazel et al., 2013Fazel et al., , 2014Fukuchi et al., 2013;Heikkinen et al., 1995;Hempstead and Phillips, 2015;Hiyoshi et al., 2018;Im et al., 2011;Inoue et al., 2005;Isometsa et al., 1995;Kimura et al., 2016;Kolves et al., 2006;Koo et al., 2017;Kwan et al., 2005;Lageborn et al., 2017;Lee et al., 2009;Lofman et al., 2011;Lorant et al., 2005;Lundin et al., 2010;Masocco et al., 2008;Massetti et al., 2018;Moustgaard et al., 2013;Na et al., 2019;O'Neill et al., 2018;Osborn et al., 2008;Petrosky et al., 2018;Pirkola et al., 2000;Pompili et al., 2013;Qin, 2011;Rodriguez-Pulido et al., 1992;Rossow and Amundsen, 1995;Sørensen and Fenger, 1992;Stone et al., 2016Stone et al., , 2018Strand et al., 2010;Strid et al., 2014;Sun et al., 2018;Tamosiunas et al., 2005;Tian et al., 2016;Wong et al., 2008;Wyder et al., 2009;Yamauchi et al., 2014Yamauchi et al., , 2016Yeh et al., 2008;Yip et al., 2012;Yip and Thorburn, 2004;Zaheer et al., 2018), of which 48 reported the distribution of exposures and 41 the suicide risk associated with exposure. Nine studies reported the estimates for factors in two domains (De Hempstead and Phillips, 2015;Im et al., 2011;Inoue et al., 2005;Isometsa et al., 1995;Koo et al., 2017;Na et al., 2019;O'Neill et al., 2018;Stone et al., 2018), while one study reported the estimates related to factors in all three domains (Wong et al., 2008). ...
... Consequently, 62 articles fulfilled the criteria of inclusion for analysis Bjorkenstam et al., 2005;Blakely et al., 2003;Borrell et al., 2017;Charlton, 1995;Chen et al., 2009;Christensen et al., 2007;Corcoran, 2009;Corcoran and Arensman, 2010;De Leo et al., 2013;Doyle et al., 2016;Duberstein et al., 2004;Erlangsen et al., 2008Erlangsen et al., , 2012Fall et al., 2009;Fang et al., 2012;Fazel et al., 2013Fazel et al., , 2014Fukuchi et al., 2013;Heikkinen et al., 1995;Hempstead and Phillips, 2015;Hiyoshi et al., 2018;Im et al., 2011;Inoue et al., 2005;Isometsa et al., 1995;Kimura et al., 2016;Kolves et al., 2006;Koo et al., 2017;Kwan et al., 2005;Lageborn et al., 2017;Lee et al., 2009;Lofman et al., 2011;Lorant et al., 2005;Lundin et al., 2010;Masocco et al., 2008;Massetti et al., 2018;Moustgaard et al., 2013;Na et al., 2019;O'Neill et al., 2018;Osborn et al., 2008;Petrosky et al., 2018;Pirkola et al., 2000;Pompili et al., 2013;Qin, 2011;Rodriguez-Pulido et al., 1992;Rossow and Amundsen, 1995;Sørensen and Fenger, 1992;Stone et al., 2016Stone et al., , 2018Strand et al., 2010;Strid et al., 2014;Sun et al., 2018;Tamosiunas et al., 2005;Tian et al., 2016;Wong et al., 2008;Wyder et al., 2009;Yamauchi et al., 2014Yamauchi et al., , 2016Yeh et al., 2008;Yip et al., 2012;Yip and Thorburn, 2004;Zaheer et al., 2018), of which 48 reported the distribution of exposures and 41 the suicide risk associated with exposure. Nine studies reported the estimates for factors in two domains (De Hempstead and Phillips, 2015;Im et al., 2011;Inoue et al., 2005;Isometsa et al., 1995;Koo et al., 2017;Na et al., 2019;O'Neill et al., 2018;Stone et al., 2018), while one study reported the estimates related to factors in all three domains (Wong et al., 2008). Fig. 1 displays the PRISMA flowchart of the selection and inclusion process. ...
... This is particularly true for studies from European countries, where there are high-quality longitudinal register data covering the entire national population Bjorkenstam et al., 2005;Borrell et al., 2017;Charlton, 1995;Christensen et al., 2007;Erlangsen et al., 2008;Fang et al., 2012;Fazel et al., 2014;Isometsa et al., 1995;Osborn et al., 2008;Qin, 2011;Strand et al., 2010). In the recent decade, the U.S. National Violent Death Reporting System (NVDRS) has also become an important source of data for research on midlife suicide (Hempstead and Phillips, 2015;Massetti et al., 2018;Petrosky et al., 2018;Stone et al., 2016Stone et al., , 2018Tian et al., 2016). ...
Article
Suicide is an increasing contributing cause of mortality in middle-aged adults; however, knowledge to guide prevention is limited. This first systematic review and meta-analysis of studies on midlife suicide has provided an overview of published research on this issue and synthesized the evidence on socioeconomic and physical and mental health factors associated with this mortality. Using PRISMA guidelines MEDLINE, Embase, PsycINFO, Scopus and Web of Science were searched for English-language publications that involved persons aged 35 to 65, used individual-level data, and reported prevalence of exposure(s) or relative risks. The search identified 62 studies on midlife suicides and associated factors (28 for SES, 22 for psychiatric disorder and 23 for physical illness). All studies were from high income countries, and most (80.6%) used data from population registries. Meta-analyses showed that the pooled prevalence of exposure in suicide decedents was 57.8% for psychiatric disorder, 56.3% for low income, 43.2% for unemployment, and 27.3% for physical illness. The associated pooled risk ratio was 11.68 (95% confidence intervals: 5.82–23.47) for psychiatric illness of any type, 12.59 (8.29–19.12) for mood disorders, 3.91 (2.72–5.59) for unemployment, 3.18 (2.72–3.72) for being separated or divorced, 2.64 (2.26–3.10) for cancer, 2.50 (0.96–6.38) for central nervous system illness, and 2.26 (1.16–4.41) for low income. In conclusion, midlife suicide is strongly associated with socioeconomic difficulties and physical and psychiatric illnesses that are common in this age population. Future investigations should consider the interactions between risk factors, the intersectionality of sex and ethnicity, and include data from low- and middle-income countries.
... Declines in housing wealth and home foreclosure, declines in the value of investment holdings due to stock market volatility, bankruptcy, and catastrophic financial loss due to fraud are associated with increased risk of mental health conditions, including major depressive disorder and suicide. [42][43][44][45][46][47][48][49][50][51][52] Home foreclosures have also been associated with increased substance use and foregoing needed medical care. 53,54 Furthermore, financial strain has been shown to mediate the association between involuntary job loss and depression. ...
... Previous research has suggested that health effects of wealth-related stress may differ by age group. 28,48 Results from the crossover study were compared with adjusted results from a more traditional between-person regression approach to examine whether the within-person analysis appears to adjust for residual confounding present that may be present in the betweenperson analysis. ...
... Limited previous evidence suggests that negative wealth shocks may be more strongly associated with health outcomes in late middle age. 28,48 Future research replicating this analysis in both younger and older cohorts could explore late middle age as a potential sensitive period. ...
Thesis
There is robust empirical evidence for a link between lower economic status and adverse health outcomes, but little is known about whether a sudden, unplanned loss of assets – a negative wealth shock – has long-term health consequences. Previous research has shown associations between negative wealth shocks and short-term health declines, primarily from losses of housing and investment wealth, with macroeconomic recession presumed to have triggered these shocks. Even during better economic times, however, negative wealth shocks arise frequently from more individualized circumstances, such as high medical expenses, but causal mechanisms linking subsequent health outcomes to these endogenous shocks can be difficult to establish due to the potential for reverse causality and residual confounding. Using data from the Health and Retirement Study, a nationally representative study of US adults aged 50 and older, this dissertation examined markers of short-term changes in stress and health care consumption after negative wealth shock in late middle age, a time of particular vulnerability. Then, differences by whether an individual experienced negative wealth shock in late middle age were assessed for three long-term aging-related trajectories – cognitive decline, physical function limitation accumulation, and all-cause mortality. Design and analytic methods addressed bidirectional and time-dependent causation in the relationship between negative wealth shock and health outcomes. Over 15 percent of late middle-aged adults with existing assets experienced negative wealth shock. The main findings indicated that experiencing a negative wealth shock during late middle age was associated with a higher risk of elevated depressive symptoms, a marker of increased stress, as well as long-term risk of mortality and cognitive decline. However, there was no significant association between negative wealth shock and risk of cost-related medication non-adherence – a marker of reduced health-related consumption, nor accelerated physical function limitation accumulation. With a substantial proportion of the late middle-aged population experiencing negative wealth shock, targeted interventions to prevent of the occurrence of these shocks and the health consequences thereafter may have a large impact on the health of older Americans.
... After removing duplicates and screening of titles and abstracts, 874 full-text articles were retained for further assessment. Consequently, 62 articles fulfilled the criteria of inclusion for analysis Bjorkenstam et al., 2005;Blakely et al., 2003;Borrell et al., 2017;Charlton, 1995;Chen et al., 2009;Christensen et al., 2007;Corcoran, 2009;Corcoran and Arensman, 2010;De Leo et al., 2013;Doyle et al., 2016;Duberstein et al., 2004;Erlangsen et al., 2008Erlangsen et al., , 2012Fall et al., 2009;Fang et al., 2012;Fazel et al., 2013Fazel et al., , 2014Fukuchi et al., 2013;Heikkinen et al., 1995;Hempstead and Phillips, 2015;Hiyoshi et al., 2018;Im et al., 2011;Inoue et al., 2005;Isometsa et al., 1995;Kimura et al., 2016;Kolves et al., 2006;Koo et al., 2017;Kwan et al., 2005;Lageborn et al., 2017;Lee et al., 2009;Lofman et al., 2011;Lorant et al., 2005;Lundin et al., 2010;Masocco et al., 2008;Massetti et al., 2018;Moustgaard et al., 2013;Na et al., 2019;O'Neill et al., 2018;Osborn et al., 2008;Petrosky et al., 2018;Pirkola et al., 2000;Pompili et al., 2013;Qin, 2011;Rodriguez-Pulido et al., 1992;Rossow and Amundsen, 1995;Sørensen and Fenger, 1992;Stone et al., 2016Stone et al., , 2018Strand et al., 2010;Strid et al., 2014;Sun et al., 2018;Tamosiunas et al., 2005;Tian et al., 2016;Wong et al., 2008;Wyder et al., 2009;Yamauchi et al., 2014Yamauchi et al., , 2016Yeh et al., 2008;Yip et al., 2012;Yip and Thorburn, 2004;Zaheer et al., 2018), of which 48 reported the distribution of exposures and 41 the suicide risk associated with exposure. Nine studies reported the estimates for factors in two domains (De Hempstead and Phillips, 2015;Im et al., 2011;Inoue et al., 2005;Isometsa et al., 1995;Koo et al., 2017;Na et al., 2019;O'Neill et al., 2018;Stone et al., 2018), while one study reported the estimates related to factors in all three domains (Wong et al., 2008). ...
... Consequently, 62 articles fulfilled the criteria of inclusion for analysis Bjorkenstam et al., 2005;Blakely et al., 2003;Borrell et al., 2017;Charlton, 1995;Chen et al., 2009;Christensen et al., 2007;Corcoran, 2009;Corcoran and Arensman, 2010;De Leo et al., 2013;Doyle et al., 2016;Duberstein et al., 2004;Erlangsen et al., 2008Erlangsen et al., , 2012Fall et al., 2009;Fang et al., 2012;Fazel et al., 2013Fazel et al., , 2014Fukuchi et al., 2013;Heikkinen et al., 1995;Hempstead and Phillips, 2015;Hiyoshi et al., 2018;Im et al., 2011;Inoue et al., 2005;Isometsa et al., 1995;Kimura et al., 2016;Kolves et al., 2006;Koo et al., 2017;Kwan et al., 2005;Lageborn et al., 2017;Lee et al., 2009;Lofman et al., 2011;Lorant et al., 2005;Lundin et al., 2010;Masocco et al., 2008;Massetti et al., 2018;Moustgaard et al., 2013;Na et al., 2019;O'Neill et al., 2018;Osborn et al., 2008;Petrosky et al., 2018;Pirkola et al., 2000;Pompili et al., 2013;Qin, 2011;Rodriguez-Pulido et al., 1992;Rossow and Amundsen, 1995;Sørensen and Fenger, 1992;Stone et al., 2016Stone et al., , 2018Strand et al., 2010;Strid et al., 2014;Sun et al., 2018;Tamosiunas et al., 2005;Tian et al., 2016;Wong et al., 2008;Wyder et al., 2009;Yamauchi et al., 2014Yamauchi et al., , 2016Yeh et al., 2008;Yip et al., 2012;Yip and Thorburn, 2004;Zaheer et al., 2018), of which 48 reported the distribution of exposures and 41 the suicide risk associated with exposure. Nine studies reported the estimates for factors in two domains (De Hempstead and Phillips, 2015;Im et al., 2011;Inoue et al., 2005;Isometsa et al., 1995;Koo et al., 2017;Na et al., 2019;O'Neill et al., 2018;Stone et al., 2018), while one study reported the estimates related to factors in all three domains (Wong et al., 2008). Fig. 1 displays the PRISMA flowchart of the selection and inclusion process. ...
... This is particularly true for studies from European countries, where there are high-quality longitudinal register data covering the entire national population Bjorkenstam et al., 2005;Borrell et al., 2017;Charlton, 1995;Christensen et al., 2007;Erlangsen et al., 2008;Fang et al., 2012;Fazel et al., 2014;Isometsa et al., 1995;Osborn et al., 2008;Qin, 2011;Strand et al., 2010). In the recent decade, the U.S. National Violent Death Reporting System (NVDRS) has also become an important source of data for research on midlife suicide (Hempstead and Phillips, 2015;Massetti et al., 2018;Petrosky et al., 2018;Stone et al., 2016Stone et al., , 2018Tian et al., 2016). ...
... The method of suicide is clearly influenced by accessibility. However, some research supports that suffocation among those who are middle-aged (40-64 years old) is more likely to be used in suicides that are related to jobs, or economic or legal factors (Hempstead & Phillips, 2015). A total of 65% occurred away from home but again this number may be higher due to those who were incarcerated and it may also explain the small percentage of people who were using substances prior to their deaths (12%). ...
... Their ages ranged from 37 to 72 with an average age of 52. Hempstead and Phillips (2015) found an increase in suicides among middle-aged individuals between the years 2005 and 2010, and they attributed this to deteriorating economic conditions. Many reached out for help. ...
Chapter
The motivations discussed in this chapter represent a very small proportion of individuals in our sample. One group (60 people) committed suicide because of grief issues (31 people), while others felt like a failure in life (22 people). We examined specific patterns that can be seen within both the bereavement and failure categories, which can provide information about risk and protective factors.
... The method of suicide is clearly influenced by accessibility. However, some research supports that suffocation among those who are middle-aged (40-64 years old) is more likely to be used in suicides that are related to jobs, or economic or legal factors (Hempstead & Phillips, 2015). A total of 65% occurred away from home but again this number may be higher due to those who were incarcerated and it may also explain the small percentage of people who were using substances prior to their deaths (12%). ...
... Their ages ranged from 37 to 72 with an average age of 52. Hempstead and Phillips (2015) found an increase in suicides among middle-aged individuals between the years 2005 and 2010, and they attributed this to deteriorating economic conditions. Many reached out for help. ...
Chapter
Full-text available
This chapter examines history and theories of suicide from the early modern period to the present. It examines changes in suicide practices, methods, and motivations. The suicides which occur in America today are consistent with those that occurred in the past. The historical focus will be on the peoples of North America who are of Native American, European, and African for the trends established there. Additionally, theories about who commits suicide and why are explained to establish the current state of the field of suicidology.
... Case and Deaton posit that this self-destructive inclination is borne of a relative stagnation of economic prospects, visà-vis not just more-educated peers, but contrasted with past generations of white Americans of similar educational status, who lived more socially grounded lives with greater economic security. Such findings of adverse labor market outcomes raising the likelihood of suicide abound [9][10][11][12][13][14]. ...
... The ethnicity and perinatal death measures exhibited somewhat similar time trends, both falling markedly prior to 2000, but continuing to decline afterward at a much smaller pace. The time patterns of the marriage, fertility and abortion levels did not, however, correspond closely to the level of suicides, but they did demonstrate somewhat similar behaviors (2) Suicides t = 0 + 1 Whites t + 2 Marriages t + 3 LiveBirths t + 4 PerinatalDeaths t + 5 Abortions t + 6 Rapes t Marri ages per 1000 NYC Resi dents The last two figures (Figs. 8,9) show that from 1973 onward, real per capital income for NYC residents increased fairly steadily, interrupted by several periods of excess unemployment. Peaks in unemployment seemed to correspond to spikes in suicide, suggesting that labor market conditions might be an important determinant of women's self-harm behavior. ...
Article
Full-text available
Purpose After a steady decline in the incidence of suicide in the last 3 decades of the twentieth century, suicide rates in the US and likewise in New York City (NYC) began to rise. A breakdown of the city’s rates by gender reveals that since 2000, suicides among men had held steady while the rate among women had increased in every age group, in divergence from the national pattern of rising rates in both genders. This study considers a broad range of socioeconomic variables to identify those most strongly associated with suicide rates of women in NYC. Method Drawing on 4 decades of data from the Census Bureau’s Current Population Survey, the NYC Department of Health and Mental Hygiene’s Vital Statistics and the Federal Bureau of Investigation’s Uniform Crime Reporting Program, we use an Autoregressive Distributed Lag (ARDL) model to estimate short and long run relationships between suicide rates in women aged 15–44 and a range of socioeconomic factors. Results We find a positive aggregate association between women’s suicide rates and the unemployment rate, the White percentage of the city’s population, the number of forcible rapes reported in the crime statistics, and a negative association between suicide and abortion rates. Conclusions The results of the study suggest that labor market conditions, rather than societal factors such as marriage or fertility rates affect younger women’s suicide rates in NYC. Second, sexual violence against women, found in micro studies to have severe long-term negative effects on victims’ mental health is also positively associated with the aggregate suicide rate. Finally, higher abortion rates correspond with lower suicide rates at the city level, but the mechanisms behind this link are not as clear, since micro studies find little association between unwanted pregnancy termination and mental health.
... The method of suicide is clearly influenced by accessibility. However, some research supports that suffocation among those who are middle-aged (40-64 years old) is more likely to be used in suicides that are related to jobs, or economic or legal factors (Hempstead & Phillips, 2015). A total of 65% occurred away from home but again this number may be higher due to those who were incarcerated and it may also explain the small percentage of people who were using substances prior to their deaths (12%). ...
... Their ages ranged from 37 to 72 with an average age of 52. Hempstead and Phillips (2015) found an increase in suicides among middle-aged individuals between the years 2005 and 2010, and they attributed this to deteriorating economic conditions. Many reached out for help. ...
Chapter
In this chapter we discuss the desire to escape from pain, which represents the largest motivating factor in our sample. For some, that escape was from actual physical or psychological pain. For others, the escape was related to circumstances which they believed were too difficult to overcome. Of 936 people, 658 (70%) were escaping from pain. The source of the pain was psychological (32%), physical (18%), legal (8%), financial (3%), or a combination of many of these things (39%). When cases were sorted into these groups, clear patterns emerged. We discuss our findings related to these categories.
... However, investigators of a 2013 study 13 in which NVDRS data were used to examine the circumstances of death by suicide among physicians found that these decedents were more likely than nonphysicians to have experienced job-related problems before suicide. Moreover, results of a study 18 published in 2015 revealed an increase in suicide rates related to financial and job-related stress among working-age US adults. It is unknown whether this is true of veterinary professionals; however, research over the past decade suggests that professional burnout is common among veterinarians and believed to be increasing, 19,20 and job-related and financial stressors such as emotional strain from balancing human and animal needs and student loan debt have often been cited as risk factors for suicide among veterinarians. 1 In contrast, little is known about how job-related and financial stressors relate to suicide risk among other veterinary professionals, although results of a survey of veterinary technicians and technologists in 2012 indicated that emotional strain and financial issues such as low wages are challenges among these professionals as well. ...
... The proportion of veterinary professionals who had a contributing job or financial problem (7% to 22% for groups with reportable data) varied only slightly from what has been reported among the general population of suicide decedents 40 to 64 years of age in the NVDRS (ie, 16.5% and 16.3%, respectively). 18 Work-related and financial stressors have often been considered leading risk factors for suicide among veterinarians, 1 but our results did not indicate that job and financial stressors are common among veterinarians who die by suicide. Likewise, the proportion of veterinary professionals in our sample with a mental health problem at the time of death (103/177 [58.2%]) was similar to that observed among the general population of suicide decedents (50.1%) according to 2015 NVDRS data. ...
Article
Objective: To analyze data for death of veterinary professionals and veterinary students, with manner of death characterized as suicide or undetermined intent from 2003 through 2014. Sample: Death records for 202 veterinary professionals and veterinary students. Procedures: Decedents employed as veterinarians, veterinary technicians or technologists, or veterinary assistants or laboratory animal caretakers and veterinary students who died by suicide or of undetermined intent were identified through retrospective review of National Violent Death Reporting System records. Standardized mortality ratios (SMRs) and 95% confidence intervals were calculated, and mechanisms and circumstances of death were compared among veterinary occupational groups. Results: 197 veterinary professionals and 5 veterinary students had deaths by suicide or of undetermined intent. Among decedents employed at the time of death, SMRs for suicide of male and female veterinarians (1.6 and 2.4, respectively) and male and female veterinary technicians or technologists (5.0 and 2.3, respectively) were significantly greater than those for the general US population, whereas SMRs for suicide of male and female veterinary assistants or laboratory animal caretakers were not. Poisoning was the most common mechanism of death among veterinarians; the drug most commonly used was pentobarbital. For most (13/18) veterinarians who died of pentobarbital poisoning, the death-related injury occurred at home. When decedents with pentobarbital poisoning were excluded from analyses, SMRs for suicide of male and female veterinarians, but not veterinary technicians or technologists, did not differ significantly from results for the general population. Conclusions and clinical relevance: Results suggested higher SMRs for suicide among veterinarians might be attributable to pentobarbital access. Improving administrative controls for pentobarbital might be a promising suicide prevention strategy among veterinarians; however, different strategies are likely needed for veterinary technicians or technologists.
... Studies investigating the relationship between SES and suicide found SES to be an important risk factor for suicide outcomes (Cubbin et al., 2000a(Cubbin et al., , 2000Hempstead & Phillips, 2015;Lorant et al., 2005;Page, Morrell, Taylor, Carter, & Dudley, 2006;Phillips & Nugent, 2014;Pompili et al., 2014;Stein, Gennuso, Ugboaja, & Remington, 2017). Yet, some of these studies have produced conflicting findings (Cubbin et al., 2000b;Denney, Rogers, Krueger, & Wadsworth, 2009;Lewis & Sloggett, 1998;Lorant et al., 2005;Milner et al., 2015;Page et al., 2006). ...
... Yet, some of these studies have produced conflicting findings (Cubbin et al., 2000b;Denney, Rogers, Krueger, & Wadsworth, 2009;Lewis & Sloggett, 1998;Lorant et al., 2005;Milner et al., 2015;Page et al., 2006). For instance, some studies found no association with SES and suicide (Cubbin et al., 2000b), others associated lower levels of SES with suicide (Cubbin et al., 2000a;Denney et al., 2009;Hempstead & Phillips, 2015;Lewis & Sloggett, 1998;Lorant et al., 2005;Milner et al., 2015;Phillips & Nugent, 2014;Pompili et al., 2014), and one found that suicide rates increased with higher levels of SES (Page et al., 2006). These conflicting findings make it difficult to understand exactly what aspects of SES contribute to suicide (Cubbin et al., 2000a;Denney et al., 2009;Lewis & Sloggett, 1998;Lorant et al., 2005;Milner et al., 2015). ...
Article
Background: Socioeconomic factors have been linked to suicide, but little research has explored the effects of these determinants on suicide risk in US populations. This population-based study assessed socioeconomic determinants of suicide risk to inform suicide assessment and intervention. Method: Secondary analysis of the Monroe County Florida 2016 Behavioral Risk Factor Surveillance Survey suicide behavior questions among adult residents (n = 528). Univariate analysis and logistic regression assessed associations of self-reported socioeconomic status (education, employment, income, housing), health care access , quality of life, substance use, mental illness and suicide risk. Result(s): Among respondents, 7.34% (n = 49, CI = 4.27-10.41) were at risk for suicide. Persons at risk reported more depression (χ 2 [1, n = 417] = 105.5, p = .001), poorer mental health (χ 2 [2, n = 411] = 36.6, p = .001), and more activity limitation due to health (χ 2 [1, n = 408] = 34.3, p = .001) than those not at risk. Persons at risk were more likely to be renting homes (63.5%, n = 19, CI = 43.53-80.52) than persons not at risk (36.9%, n = 86, CI = 28.53-43.29). Limitations: 32% missing data supports replication of study findings using larger data sets. Maximum likelihood estimation handled missing data in regression analyses. Low prevalence of suicide risk required collapsing some conceptually different categories. Conclusion(s): Housing was a stronger socioeconomic predictor of suicide risk than income, employment, or education. This finding supports exploring housing status in suicide assessment and research.
... The method of suicide is clearly influenced by accessibility. However, some research supports that suffocation among those who are middle-aged (40-64 years old) is more likely to be used in suicides that are related to jobs, or economic or legal factors (Hempstead & Phillips, 2015). A total of 65% occurred away from home but again this number may be higher due to those who were incarcerated and it may also explain the small percentage of people who were using substances prior to their deaths (12%). ...
... Their ages ranged from 37 to 72 with an average age of 52. Hempstead and Phillips (2015) found an increase in suicides among middle-aged individuals between the years 2005 and 2010, and they attributed this to deteriorating economic conditions. Many reached out for help. ...
Book
The rate of suicides across all age groups except the elderly is at its highest level in nearly 30 years. Suicide notes have long been thought to be valuable resources for understanding suicide motivation, but up to now the small sample sizes available have made an in-depth analysis difficult. Explaining Suicide: Patterns, Motivations, and What Notes Reveal represents the first large-scale analysis of suicide motivation across multiple ages in the same time period. This was made possible via a unique dataset of all suicide notes collected by the coroner’s office in southwestern Ohio 2000-2009. Based on an analysis of this dataset and those from other European and Oceanic studies, the book identifies top motivations for suicide, how these differ between note leavers and non-note leavers, and what this can tell us about better suicide prevention. The book reveals the extent to which suicide is motivated by interpersonal violence, substance abuse, physical pain, grief, feelings of failure, and mental illness. The book additionally discusses other risk factors, what differentiates suicide attempters from suicide completers, and lastly what might serve as protective factors toward resilience. I can't send you the full text, as this a book that just came out and our publisher wants us to sell copies. But there is a substantial portion of the book on google books. https://books.google.com/books?hl=en&lr=&id=osa_DAAAQBAJ&oi=fnd&pg=PT7&ots=3BjxDYllyX&sig=AJpwbfLXCMelGAgFowRH-Y-BPSg#v=onepage&q&f=false
... The method of suicide is clearly influenced by accessibility. However, some research supports that suffocation among those who are middle-aged (40-64 years old) is more likely to be used in suicides that are related to jobs, or economic or legal factors (Hempstead & Phillips, 2015). A total of 65% occurred away from home but again this number may be higher due to those who were incarcerated and it may also explain the small percentage of people who were using substances prior to their deaths (12%). ...
... Their ages ranged from 37 to 72 with an average age of 52. Hempstead and Phillips (2015) found an increase in suicides among middle-aged individuals between the years 2005 and 2010, and they attributed this to deteriorating economic conditions. Many reached out for help. ...
Chapter
This chapter examines protective factors in greater depth. Books on suicide all examine motivations for suicide, but often do not examine the motivations for living. The mundane and ordinary aspects of life sustain people, and an approach to combatting suicide that recognizes those positive factors builds on what already exists. It is possible to construct communities that promote and foster social support systems, healthy lifestyles, and full use of people’s skills and gifts. This includes finding a reason to live, and that often comes from having responsibility—though not at such a level that it is overwhelming.
... The method of suicide is clearly influenced by accessibility. However, some research supports that suffocation among those who are middle-aged (40-64 years old) is more likely to be used in suicides that are related to jobs, or economic or legal factors (Hempstead & Phillips, 2015). A total of 65% occurred away from home but again this number may be higher due to those who were incarcerated and it may also explain the small percentage of people who were using substances prior to their deaths (12%). ...
... Their ages ranged from 37 to 72 with an average age of 52. Hempstead and Phillips (2015) found an increase in suicides among middle-aged individuals between the years 2005 and 2010, and they attributed this to deteriorating economic conditions. Many reached out for help. ...
Chapter
The 174 individuals who wrote notes actively sought to express their thoughts, desires, or emotions. They wanted to leave instructions, apologies, and explanations. Those direct communications helped inform us as to what motivated them to take their own lives. There are very different characteristics among and between groups of people who kill themselves. Prevention and intervention must be tailored to fit the groups. We summarize our findings as they represent multiple and complex motivations, and offer a simplified template for understanding motivations and risk factors.
... Prior studies have identified an association between financial strain and suicide/suicide attempts. For example, one prior study examined suicide circumstances among those aged 40 to 64 years old and found that job, financial, and legal problems increased from 32.9% to 37.5% from 2005 to 2010 [26]. Research using a national US sample found that financial strain, including unemployment, was associated with an increased odds of attempting suicide of approximately 1.5 [27]. ...
... We also found that depressed mood, alcohol problems, and relationship problems were associated with an increased odds of work-related suicide. These results are consistent with many studies that have found these circumstances associated with overall suicide risk [26,[29][30][31][32]. Although a history of suicide attempt, death of a friend or family member, and prior argument have been associated with suicide risk [33][34][35], we found these circumstances to be negatively associated with work-relatedness of a suicide. ...
Article
Full-text available
Workplaces are critical in suicide prevention because work-related factors can be associated with suicide, and because workplaces can be effective suicide prevention sites. Understanding the circumstances associated with work-related suicides can advance worksite prevention efforts. Data from the United States Centers for Disease Control and Prevention, National Violent Death Reporting System from 2013 to 2017 were used to examine characteristics and circumstances associated with work compared with non-work suicides. Work-related suicides included those indicated as work-related on the death certificate or in which the death investigation mentioned a work problem or work crisis. Of the 84,389 suicides, 12.1% had some relation to the decedent’s work. Males, those aged 21–54, and with at least a college education, were most likely to have work-related suicides. The circumstances most strongly associated with work-related suicide were financial problems (Odds Ratio (OR) = 4.7; 95% Confidence Interval (CI) = 4.5–5.0), prior depressed mood (OR = 2.4; 95% CI = 2.3–2.5), and eviction/loss of home (OR = 1.6; 95% CI = 1.4–1.7). Suicides among healthcare practitioners and management occupations had the highest odds of being work-related. Workplace wellness programs can consider incorporating services, such as financial planning and mental health services, as potentially up-stream approaches to prevent work-related suicide.
... Men's suicide rates in Quebec continue to decrease, even during and after the economic recession of 2007. In the United States, suicide rates increased from 1999 through 2014 for both males and females and for all ages (Curtin, Warner, & Hedegaard, 2016) with a sharp increase in 2007 (Hempstead & Phillips, 2015). A British study argues unemployment is associated with a rise in suicide among men but not among women. ...
Article
Background: The Province of Quebec, Canada (PQ), witnessed a drastic rise in suicide among adult men between 1990 and 2000, followed by a continuous drop since then. At the end of the 1990s, men's suicide became recognized as a social issue, leading to implementation of gender-responsive strategies focusing on positive aspects of masculinity. Many of these strategies received positive assessments. Aims: This article offers a critical overview of the evolution of social responses to men's suicide in PQ. Method: We highlight elements of success with examples of interventions targeting men directly, professionals who work with men, and natural support networks of men. Results: Results and discussion suggest the benefits to shift towards salutogenic, gender-transformative approach to men's suicide prevention. Conclusion: Closing remarks question the current gaps and upcoming challenges in suicide prevention among men.
... The most common mood disorders associated with suicide risk are major depressive episodes and bipolar disorder. A recent study, which explored suicide among individuals aged 34-64 years old in the USA between 2005 and 2010, found that 43.1% of males and 44.9% of females had experienced a depressed mood over that time period (Hempstead and Phillips, 2015). However, it has been suggested that clinicians often fail to identify depressive symptoms in men due to the use of generic diagnostic criteria that may not be sensitive enough to male depression (Oliffe and Phillips, 2008). ...
Technical Report
Full-text available
Middle-aged men and suicide
... In the United States, suicide rates among individuals aged 40-64 years old have increased from 2005 to 2010, and the external circum- stances such as job, financial, and legal problems were closely associated with increased suicide among these middle-aged people. 21 In the England, more suicides were observed both in men and women than expected due to the economic regression between 2008 and 2010. A study by Ben Barr et al found that about 40% of increased suicide among men were attributed to elevated unemployment during this period. ...
Article
Full-text available
Objectives The South Korean government has recently implemented policies to prevent suicide. However, there were few studies examining the recent changing trends in suicide rates. This study aims to examine the changing trends in suicide rates by time and age group. Design A descriptive study using nationwide mortality rates. Setting Data on the nationwide cause of death from 1993 to 2016 were obtained from Statistics Korea. Participants People living in South Korea. Interventions Implementation of national suicide prevention policies (first: year 2004, second: year 2009). Primary outcome measures Suicide was defined as ‘X60-X84’ code according to the ICD-10 code. Age-standardised suicide rates were estimated, and a Joinpoint regression model was applied to describe the trends in suicide rate. Results From 2010 to 2016, the suicide rates in South Korea have been decreasing by 5.5% (95% CI −10.3% to −0.5%) annually. In terms of sex, the suicide rate for men had increased by 5.0% (95% CI 3.6% to 6.4%) annually from 1993 to 2010. However, there has been no statistically significant change from 2010 to 2016. For women, the suicide rate had increased by 7.5% (95% CI 6.3% to 8.7%) annually from 1993 to 2009, but since 2009, the suicide rate has been significantly decreasing by 6.1% (95% CI −9.1% to −3.0%) annually until 2016. In terms of the age group, the suicide rates among women of almost all age groups have been decreasing since 2010; however, the suicide rates of men aged between 30 and 49 years showed continuously increasing trends. Conclusion Our results showed that there were differences in the changing trends in suicide rate by sex and age groups. Our finding suggests that there was a possible relationship between implementation of second national suicide prevention policies and a decline in suicide rate.
... 46 Financial downturn and bankruptcy are associated with both depression and suicide. 47,48 More attention needs to be paid to these treatment-related, psychosocial and financial toxicity factors that increase the risk of suicide among HNC and other cancer survivors. 49,50 ...
Article
Background Cancer survivors face psychosocial issues that increase their risk of suicide. This study examined the risk of suicide across cancer sites, with a focus on survivors of head and neck cancer (HNC). Methods The Surveillance, Epidemiology, and End Results 18‐registry database (from 2000 to 2014) was queried for the top 20 cancer sites in the database, including HNC. The outcome of interest was suicide as a cause of death. The mortality rate from suicide was estimated for HNC sites and was compared with rates for 19 other cancer sites that were included in the study. Poisson regression was used to estimate adjusted rate ratios (aRRs) and 95% confidence intervals (CIs) for 1) HNC versus non‐HNC sites (the other 19 cancer sites combined), and 2) HNC versus each individual cancer site. Models were stratified by sex, controlling for race, marital status, age, year, and stage at diagnosis. Results There were 404 suicides among 151,167 HNC survivors from 2000 to 2014, yielding a suicide rate of 63.4 suicides per 100,000 person‐years. In this timeframe, there were 4493 suicides observed among 4219,097 cancer survivors in the study sample, yielding an incidence rate of 23.6 suicides per 100,000 person‐years. Compared with survivors of other cancers, survivors of HNC were almost 2 times more likely to die from suicide (aRR, 1.97; 95% CI, 1.77‐2.19). There was a 27% increase in the risk of suicide among HNC survivors during the period from 2010 to 2014 (aRR, 1.27; 95% CI, 1.16‐1.38) compared with the period from 2000 to 2004. Conclusions Although survival rates in cancer have improved because of improved treatments, the risk of death by suicide remains a problem for cancer survivors, particularly those with HNC. Cancer 2018;124:00‐00. © 2018 American Cancer Society.
... It was rounded to the nearest integer such that any time within the first 59 minutes of a particular hour was categorized as occurring within that hour. 36 In addition, we created six 4-hour time bins from the hourly information 25,32 . The categories were 00:01-04:00, 04:01-08:00, 08:01-12:00, 12:01-16:00, 16:01-20:00, and 20:01-00:00 32 ; c. Blood alcohol level (BAL) obtained from their post-mortem examination records was recorded in mg/dL. ...
Article
Objective: Alcohol intoxication and dependence are risk factors for suicide, a leading cause of death in the United States. We examined the hours of peak and nadir in completed suicides over a 24-hour period among intoxicated, alcohol-dependent individuals. We also evaluated suicide-related factors associated with intoxication at different times of the day. Methods: We analyzed cross-sectional data from the 2003–2010 National Violent Death Reporting System provided by 16 US states. In the primary database, the deceased individuals’ alcohol-dependent status was classified as “yes” or “no or unknown.” We restricted the analysis to alcohol-dependent individuals with alcohol level data available (N = 3,661). The primary outcome measure was the reported time of death. Secondary outcome measures were predisposing and injury-related factors. Individuals were classified on the basis of their blood alcohol level (BAL) as heavy drinking (BALH [≥ 80 mg/dL]) or non–heavy drinking (BALO [< 80 mg/dL]). The time of injury was divided into 1-hour bins, which were used to compute the incidence of suicide over 24 hours. We also evaluated the association between clinical factors and BALH for each of six 4-hour time periods beginning at 00:01 hours. Results: The majority (73.4%) of individuals showed evidence of alcohol consumption prior to committing suicide. BALH was observed in 60.7% of all individuals. Peak incidences in suicide were identified at 21:00 for BALH and 12:00 for BALO, with nadirs at 05:00 and 03:00 hours, respectively. In a multivariable analysis, between 20:01 and 00:00 hours, BALH was associated with more risk and protective factors than BALO. Conclusions: Identifying critical times and associated risk factors for suicidal behavior may contribute to suicide prevention efforts in intoxicated alcohol-dependent individuals.
... Our data agree with other studies showing a higher incidence of suicide rate in the elderly over the 80s and the youth group [17]. Regarding the 30-59 age group of males, the suicide numbers may be due to their social role or the loss of jobs and economic problems [26], and to the loneliness of living alone [27]. The reasons that lead males in the 80-89 years age group to commit suicide are mainly linked to the condition of living alone and widowing [28] or to the presence of various disabling pathologies [29]. ...
Article
Background: Suicide is a significant cause of mortality affecting each age, gender, and country. In 2018, the Italian National Institute of Statistics (ISTAT) estimated that 3820 people committed suicide, with the highest incidence in males between 35 and 64 years old. The present study aims to report and analyze the data relating to suicides collected by the Institute of Forensic Medicine of Foggia compared to the data presented in the literature. Methods: The present study represents a retrospective analysis of crime scene investigations and autopsies records relating to all suicides from January 2015 to December 2021 referred to the archives of the Institute of Forensic Medicine of Foggia. The analyzed features were: the sex of the victim, method of suicide, age, the season of death, and presence of psychiatric or addiction history. Results: We selected 226 cases of suicide during the period from January 2015 to December 2021, from a total of 1184 deceases. 78% of the victims are men of average age; the most common methods of suicide are hanging and precipitation. Conclusions: The results of this study highlight the importance of personalized and gender-specific interventions and can inform policy-makers in the development of provincial suicide prevention plans and public health interventions. Studying suicidality in a well-defined population can help implement targeted interventions.
... A potential interpretation is that factors that are associated with suicidal ideation are common among people that may potentially be at greater risk to being exposed to police violence (i.e., various forms of social and economic adversity), and the experience of victimization can potentially contribute to that transition from thought to action, although this is currently speculative based on our crosssectional data and in need of replication in a prospective design. While prior research has not specifically examined police abuse in relation to suicide, it was recently shown in the National Violent Death Reporting System data that legal and criminal problems were significant predictors of subsequent suicide in the USA [17]. Given our use of cross-sectional data, it is likewise feasible that people who make suicide attempts are more likely to interact with police and, therefore, more likely to be subject to police victimization. ...
Article
Recent evidence suggests that police victimization is widespread in the USA and psychologically impactful. We hypothesized that civilian-reported police victimization, particularly assaultive victimization (i.e., physical/sexual), would be associated with a greater prevalence of suicide attempts and suicidal ideation. Data were drawn from the Survey of Police-Public Encounters, a population-based survey of adults (N = 1615) residing in four US cities. Surveys assessed lifetime exposure to police victimization based on the World Health Organization domains of violence (i.e., physical, sexual, psychological, and neglect), using the Police Practices Inventory. Logistic regression models tested for associations between police victimization and (1) past 12-month suicide attempts and (2) past 12-month suicidal ideation, adjusted for demographic factors (i.e., gender, sexual orientation, race/ethnicity, income), crime involvement, past intimate partner and sexual victimization exposure, and lifetime mental illness. Police victimization was associated with suicide attempts but not suicidal ideation in adjusted analyses. Specifically, odds of attempts were greatly increased for respondents reporting assaultive forms of victimization, including physical victimization (odds ratio = 4.5), physical victimization with a weapon (odds ratio = 10.7), and sexual victimization (odds ratio = 10.2). Assessing for police victimization and other violence exposures may be a useful component of suicide risk screening in urban US settings. Further, community-based efforts should be made to reduce the prevalence of exposure to police victimization.
... 8 Increased economic hardship has been suggested as a reason for the increase in suicide rates in midlife and may be detected in individuals who present to hospital for self-harm. [9][10][11][12] Few studies have explored self-harm in men and women in midlife in detail. Broader studies that present information on self-harm by age give some indication of the characteristics common in this age-group, such as increased alcohol use 13 and physical health problems. ...
Article
Background In England suicide rates are highest in midlife (defined as age 40–59). Despite a strong link with suicide there has been little focus on self-harm in this age group. Aim To describe characteristics and treatment needs of people in midlife who present to hospital following self-harm. Method Data from the Multicentre Study of Self-harm in England were used to examine rates over time and characteristics of men and women who self-harm in midlife. Data (2000–2013) were collected via specialist assessments or hospital records. Trends were assessed by negative binomial regression models. Comparative analysis used logistic regression models for binary outcomes. Repetition and suicide mortality were assessed by Cox proportional hazards models. Results A quarter of self-harm presentations were made by people in midlife ( n = 24 599, 26%). Incidence rates increased over time in men, especially after 2008 (incidence rate ratio [IRR] 1.07, 95% CI 1.02–1.12, P < 0.01), and were positively correlated with national suicide incidence rates ( r = 0.52, P = 0.05). Rates in women remained relatively stable (IRR 1.00, 95% CI 1.00–1.02, P = 0.39) and were not correlated with suicide. Alcohol use, unemployment, housing and financial factors were more common in men; whereas indicators of poor mental health were more common in women. In men and women 12-month repetition was 25%, and during follow-up 2.8% of men and 1.2% of women died by suicide. Conclusion Self-harm in midlife represents a key target for intervention. Addressing underlying issues, alcohol use and economic factors may help prevent further self-harm and suicide. Declaration of interest K.H. and N.K. are members of the Department of Health's National Suicide Prevention Advisory Group. N.K. chaired the National Institute for Health and Care Excellence (NICE) guideline development group for the longer-term management of self-harm and the NICE Topic Expert Group which developed the quality standards for self-harm services. N.K. also chairs the NICE guideline committee for the management of depression. All other authors declare no conflict of interest.
... There is increasing recognition of working conditions as a potential risk factor for suicidal behaviour but also as an environment for the effective delivery of suicide prevention initiatives [1]. Several large-scale international studies [24,62,63], have shown that the global economic recession was associated with an increase in suicide rates, but the importance of specific work-related factors has been neglected. A more indepth understanding may inform occupational health practice to develop specific work-related mental health and suicide prevention services and health promotion initiatives. ...
Article
Full-text available
Background: Suicide has profound effects on families and communities, but is a statistically rare event. Psychological autopsies using a case-control design allow researchers to examine risk factors for suicide, using a variety of sources to detail the psychological and social characteristics of decedents and to compare them to controls. The Suicide Support and Information System Case Control study (SSIS-ACE) aimed to compare psychosocial, psychiatric and work-related risk factors across three groups of subjects: suicide decedents, patients presenting to hospital with a high-risk self-harm episode, and general practice controls. Methods: The study design includes two inter-related studies; one main case-control study: comparing suicide cases to general practice (GP) controls, and one comparative study: comparing suicide cases to patients presenting with high-risk self-harm. Consecutive cases of suicide and probable suicide are identified through coroners' registration of deaths in the defined region (Cork City and County, Ireland) and are frequency-matched for age group and gender with GP patient controls recruited from the same GP practice as the deceased. Data sources for suicide cases include coroners' records, interviews with health care professionals and proxy informants; data sources for GP controls and for high-risk self-harm controls include interviews with control, with proxy informants and with health care professionals. Interviews are semi-structured and consist of quantitative and qualitative parts. The quantitative parts include a range of validated questionnaires addressing psychiatric, psychosocial and occupational factors. The study adopts several methodological innovations, including accessing multiple data sources for suicide cases and controls simultaneously, recruiting proxy informants to examine consistency across sources. Conclusions: The study allows for the investigation of consistency across different data sources and contributes to the methodological advancement of psychological autopsy research. The study will also inform clinical and public health practice. The comparison between suicide cases and controls will allow investigation of risk and protective factors for suicide more generally, while the comparison with high-risk self-harm patients will help to identify the factors associated specifically with a fatal outcome to a self-harm episode. A further enhancement is the particular focus on specific work-related risk factors for suicide.
... shows that the high suicide mortality among middle-aged and older adults might be due to declining health, chronicity of health conditions, rising healthcare expenditures, and limited financial resources due to unemployment or insufficient retirement income (Choi et al., 2017;Kerr et al., 2017). Another study added that the persistent upward trend in suicide mortality of this age group may be also related to hardship or feelings of failure or hopelessness associated with financial conditions (Hempstead & Phillips, 2015). Physical health and job/financial problems were common contributing stressors among both suicide decedents with and without mental health conditions (Stone et al., 2018). ...
Article
Late-life suicide is a public health issue in the United States, and recent CDC data show that the number of deaths related to suicide in older adults continue to increase. Still, few researchers focus on a theoretical framework for the clinical assessment and care of older adults at risk for suicide. We performed a review and critical analysis of the Tidal Model, using Fawcett and DeSanto-Madeya’s framework, to increase our understanding of the clinical presentation of older adults with suicidal ideation and present strategies for caring for this population. The Tidal Model is a well-structured theory with relevant concepts and propositions founded on a highly patient-centered and pragmatic approach that facilitates its application in late-life suicidality. The model provides a framework for nursing and healthcare practice in psychiatry and mental health with goals and boundaries that help promote a better assessment of the clinical picture of older adults with suicidal ideation.
... According to the World Health Organization (WHO), low-and middle-income countries bear most of the global suicide burden. Suicide is the fourth leading cause of death amongst 15− 29-year-olds, and in recent years there has been a rise amongst older adults (Hempstead and Phillips, 2015). While more than 700,000 people die by suicide every year, for each suicide there are more than 20 suicide attempts (WHO, 2021). ...
Article
Full-text available
Economic uncertainty is a driver of the business cycle. Its leading properties make it a key advanced indicator to assess the impact of socioeconomic factors on suicide for prevention purposes. This paper evaluates the effect of economic uncertainty on suicide rates worldwide. Uncertainty is gauged by a global economic policy uncertainty index. Suicide rates from 183 countries between 2000 and 2019 are matched to annual economic uncertainty, controlling for unemployment and economic growth in a fixed-effects panel model. Overall, the analysis suggests that increases in lagged economic uncertainty, as well as in unemployment and economic growth, may lead to an increased risk of suicide. When replicating the experiment for different regions of the world, the greatest impact of an increase in economic uncertainty can be found in Africa and the Middle East. Given the anticipatory nature of economic uncertainty regarding the evolution of economies, and its relationship with suicide rates, the results highlight the usefulness of uncertainty indicators as tools for the early detection of periods of increased suicide risk and the design of suicide prevention strategies.
... Suicide attempts and suicidal ideation are among the strongest predictors of completed suicide [1,12]. Suicide risk is also elevated in case of job and financial problems, unbearable mental pain, lack of a support system, trauma, stigma, impulsive aggression, hopelessness, living alone, and being faced with loss [1,2,13]. In addition, suicide occurs more often in males than in females [1]. ...
Article
Full-text available
Background: In the Netherlands, suicide rates showed a sharp incline and this pertains particularly to the province of Noord-Brabant, one of the southern provinces in the Netherlands. This calls for a regional suicide prevention effort. Methods/design: Study protocol. A regional suicide prevention systems intervention is implemented and evaluated by a stepped wedge trial design in five specialist mental health institutions and their adherent chain partners. Our system intervention is called SUPREMOCOL, which stands for Suicide Prevention by Monitoring and Collaborative Care, and focuses on four pillars: 1) recognition of people at risk for suicide by the development and implementation of a monitoring system with decision aid, 2) swift access to specialist care of people at risk, 3) positioning nurse care managers for collaborative care case management, and 4) 12 months telephone follow up. Eligible patients are persons attempting suicide or expressing suicidal ideation. Primary outcome is number of completed suicides, as reported by Statistics Netherlands and regional Public Health Institutes. Secondary outcome is number of attempted suicides, as reported by the regional ambulance transport and police. Suicidal ideation of persons registered in the monitoring system will, be assessed by the PHQ-9 and SIDAS questionnaires at baseline and 3, 6, 9 and 12 months after registration, and used as exploratory process measure. The impact of the intervention will be evaluated by means of the RE-AIM dimensions reach, efficacy, adoption, implementation, and maintenance. Intervention integrity will be assessed and taken into account in the analysis. Discussion: The present manuscript presents the design and development of the SUPREMOCOL study. The ultimate goal is to lower the completed suicides rate by 20%, compared to the control period and compared to other provinces in the Netherlands. Moreover, our goal is to provide specialist mental health institutions and chain partners with a sustainable and adoptable intervention for suicide prevention. Trial registration: Netherlands Trial Register under registration number NL6935 (5 April 2018). This is the first version of the study protocol (September 2019).
... The results of this study and many other studies throughout history have confirmed this fact pinpointing the crucial importance of job security. Accordingly, lack of job security, unemployment, or job loss exerts significant impacts on suicide attempt especially in older people who must support a family [33,34]. ...
Preprint
Full-text available
___________________________________________________________________________________________ According to studies conducted in different countries, the establishment of a poison control center has been successful in the reduction of mortality, length of hospital stay, and medical costs, as well as the provision of educational and research opportunities to extend the knowledge of emergency medical care. With this background in mind, a poison control center is urgently needed in the West of Mazandaran given the high population density of nearly 500,000 inhabitants in that region. In an attempt to investigate the necessity of establishing a poisoning center in the West of Mazandaran, this cross-sectional observational study was conducted to describe and analyze the prevalence of self-poisoning among patients referred and admitted to hospitals in Tonekabon and Ramsar within 2005-2015. Data were analyzed in SPSS software version 20. The present study was performed on 7240 subjects, out of whom 42.3% were male and 57.7% were female. The mean of suicide attempts differed significantly between males and females (P<0.05). The highest prevalence was reported as 34.4% in the age range of 20-29 years. In addition, 58.45% of patients were single. Moreover, most suicides were attempted by people without a high school diploma (47.1%), and the lowest rate of suicide attempts was related to those with postgraduate and higher education. In addition, most of the suicide attempts were attributed to the unemployed (32.5%), housewives occupied the second place with 21%, and the lowest rate was observed in the retired (0.6%). According to the results of the current study which are indicative of the high prevalence of suicide attempts by self-poisoning as well as the findings of studies conducted around the world, a poisoning center needs to be established in the west of Mazandaran due to high population density (500,000) in this region.
... In addition, each increase in $10 spent by governments on labour market programmes decreased the effect of a 1% increase in male unemployment on SMRs by 0.026% [91]. These findings were supported by national level studies in Australia, Belgium, England, Greece, Hungary, Spain, Sweden, and the USA [93,95,97,[105][106][107][108][109][110][111][112][113][114][115]. ...
Article
Full-text available
In the wake of a global economic recession secondary to the COVID-19 pandemic, this scoping review seeks to summarize the current quantitative research on the impact of economic recessions on depression, anxiety, traumatic disorders, self-harm, and suicide. Seven research databases (PsycINFO, MEDLINE, Embase, Web of Science: Core Collection, National Library of Medicine PubMed, PubMed Central, and Google Scholar) were searched for keywords returning 3412 preliminary results published since 2008 in Organisation for Economic Coordination and Development (OECD)nations. These were screened by both authors for inclusion/exclusion criteria resulting in 127 included articles. Articles included were quantitative studies in OECD countries assessing select mental disorders (depression, anxiety, and trauma-/stress-related disorders) and illness outcomes (self-harm and suicide) during periods of economic recession. Articles were limited to publication from 2008 to 2020, available online in English, and utilizing outcome measures specific to the disorders and outcomes specified above. A significant relationship was found between periods of economic recession and increased depressive symptoms, self-harming behaviour, and suicide during and following periods of recession. Results suggest that existing models for mental health support and strategies for suicide prevention may be less effective than they are in non-recession times. It may be prudent to focus public education and medical treatments on raising awareness and access to supports for populations at higher risk, including those vulnerable to the impacts of job or income loss due to low socioeconomic status preceding the recession or high levels of financial strain, those supporting others financially, approaching retirement, and those in countries with limited social safety nets. Policy makers should be aware of the potential protective nature of unemployment safeguards and labour program investment in mitigating these negative impacts. Limited or inconclusive data were found on the relationship with traumatic disorders and symptoms of anxiety. In addition, research has focused primarily on the working-age adult population with limited data available on children, adolescents, and older adults, leaving room for further research in these areas.
... 28 Findings from the few studies conducted on middleaged men and suicide have noted that unemployment and financial insecurity, relationship difficulties, and legal issues are primary stressors of middle-aged men's mental health. [28][29][30][31] The accumulation of investment in work and family life, narrowing of social circles, and the propensity for an overreliance on partners for emotional support may result in middle-age men being particularly vulnerable if unemployment and/or relationship problems occur. 28,31,32 While this body of research offers key insights into factors contributing to suicide risk among middle-aged men, it mostly fails to account for a multitude of other social identities ...
... For instance, some single-country studies provide evidence of a link between suicide and unemployment (Chan et al., 2014;Fountoulakis, 2020), and that increases in GDP might be temporally associated with a reduction of suicide rates (Mattei & Pistoresi, 2019). However, there is considerable heterogeneity in population stratification (per sex (Demirci et al., 2020) or age range (Ásgeirsdóttir et al., 2020;Basta et al., 2018;Hempstead & Phillips, 2015;Khang et al., 2005;Pompili et al., 2014)) and in the time periods considered Fountoulakis et al., 2014;Nordt et al., 2015;Soleymani & Yip, 2020) by each study, and this hinders the possibility of conducting robust meta-analyses of these findings. Two important studies (Huikari et al., 2019;Nordt et al., 2015), limited to some countries, evidenced how unemployment rates may affect suicide rates, and this effect may be modulated by gender (Qin et al., 2000(Qin et al., , 2003a, but a worldwide perspective on the association between suicide and unemployment is still lacking. ...
Article
Full-text available
Background Every year, more than 800,000 people die by suicide, three-quarters of which are males. Economic factors influence suicide rates, but a worldwide perspective of their impact according to age and sex is lacking. Method We queried publicly available datasets on economic factors and on suicide rates stratified according to sex and age, from 1991 to 2017, for 175 countries. Thus, we analyzed approximately 21 million deaths by suicide using a multivariable regression model approach. Results Every 1% increase in global unemployment rates is associated with a 1% upsurge in male deaths by suicide (Relative risk (RR) = 1.01 [CI 95% 1.00–1.01] with respect to females) or 5000 excess male deaths. A 1% higher unemployment rate also exerts age-specific effects on suicide rates, since, among adults aged 30–59, the suicide rate is increased by 2–3%. Lastly, for every 1000 US dollar increase in the GDP per capita, suicide rates are reduced by 2% (RR = 0.98 [0.98–0.98]), corresponding to a reduction of 14,000–15,000 suicide deaths per year globally. Conclusions Males who have lost their jobs in adulthood are those at higher risk of suicide and to whom financial support measures should be delivered in a timely manner.
... 28 Findings from the few studies conducted on middleaged men and suicide have noted that unemployment and financial insecurity, relationship difficulties, and legal issues are primary stressors of middle-aged men's mental health. [28][29][30][31] The accumulation of investment in work and family life, narrowing of social circles, and the propensity for an overreliance on partners for emotional support may result in middle-age men being particularly vulnerable if unemployment and/or relationship problems occur. 28,31,32 While this body of research offers key insights into factors contributing to suicide risk among middle-aged men, it mostly fails to account for a multitude of other social identities ...
Article
Full-text available
In many high-income countries, the rate of suicide is highest among middle-aged men. Despite this, few studies have explored the factors that underpin psychological distress and support-seeking among this cohort. This qualitative study used an intersectional approach to account for the plurality of middle-age masculinities and to offer deeper insights into middle-age men’s mental health experiences. Focus groups and interviews were conducted with nine demographic groups of middle-aged men considered ‘at risk’ of suicide in Ireland (n=34). Data collection and data analysis were informed by the principles of grounded theory. A master code list and conceptual maps were developed from which four themes emerged. Theme 1 Reconciling Increasing Expectations with Diminishing Capacities to Achieve at Middle-Age captures various tensions that emanated from expectations on men to have acquired mastery of various gendered norms by middle-age that coincided with a reality of different manifestations of middle-aged vulnerability as well as large scale societal change in Ireland. Theme 2 Isolation at Middle-Age broadly describes a sense of loneliness at middle-age as a result of narrowing social circles, a lack of social outlets, relationship breakdown and living alone. For those men who experienced discrimination, prejudice or racism, their isolation tended to be more deep-rooted and multifaceted and was a particular source of psychological distress. The notion of a ‘double burden’ was central to Theme 3 Barriers to Support Seeking, and encapsulated men’s sense of shame in having to ask for help and ‘failing’ to manage their own problems. Theme 4 Catalysts for Change & Strategies for Improved Self-Care highlights what were seen as the foundations of good mental health for middle-aged men, as well as the value of educational programmes and social contact. The use of an intersectional approach in this study fostered a deeper understanding of the blended identities and wide range of mental health experiences of middle-age men which have informed training and resources currently being implemented under the auspices of ‘Connecting for Life’, Ireland’s strategy to reduce suicide.
... In particular, the housing in Korean society (e.g., types of housing) is closely related to life satisfaction. In previous studies, work environment such as types of employment (permanent position or temporary position), unemployment, and job stress were found to be associated with life satisfaction, and life satisfaction was negatively associated with suicidal ideation [19,20]. ...
Article
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The purpose of this retrospective decisional analysis study is to develop the prediction model of suicidal ideation. We used a Decision Tree Analysis using SPSS 23.0 program to explore predictors of suicide thoughts for 12,015 Korean adults aged 19–98 years. As a result, the most powerful predictor of suicidal ideation was the level of depression. Of people who suspected depression (CESD-11>16), 32.6% experienced suicidal ideation, which is 12 times higher than that of total subjects. The group with the highest rate of suicidal ideation was people who experienced financial difficulties in depression-suspected group and the rate of suicidal thoughts in this group was 56.7%, which was the highest rate. However, in the non-depressive group, the satisfaction of family relationship was the strongest predictor of suicidal ideation. In the non-depressive group, the rate of suicidal thoughts of people with high level of family relationship satisfaction and high level of health satisfaction was 0.6%, which was the lowest rate. The contribution of this study was that it provided the combination of variables to predict the risk groups of adult suicide. This study suggests that researchers and clinicians should consider comprehensively depressive symptoms, family relationships, economic difficulties, and health status to prevent the suicide of adults.
... Cautions against attributing too much effect of the media on suicide has been provided in previous research (Mueller, 2017). There are many risk factors for suicide, such as previous suicide attempts, suicidal ideation, job and financial problems, unbearable mental pain, lack of a support system, trauma, stigma, impulsive aggression, hopelessness, living alone, and being faced with loss (Hawton et al., 1998;Hempstead & Phillips, 2015;WHO, 2014). The predictive power of each individual risk factor of suicideof which media portrayal is solely one -is thus very low (Gvion & Apter, 2012;Powell, Geddes, Deeks, Goldacre, & Hawton, 2000). ...
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Objective To examine the association between the publication and content of suicide-related media reports and actual suicide in Noord Brabant, a province of the Netherlands. Method Between April 2017 and March 2018, a retrospective cross-sectional observational study was conducted on suicide-related media reports and incident data regarding suicides. Linear regression, Mann-Whitney U and negative binomial regression analyses were conducted. Results In Noord-Brabant, a total of 352 people died from suicide during the observation period and 440 reports were identified by using the search terms “suicide”, “self-killing”, and “self-murder”. No associations between media reports and actual suicides were found for any of the analyses performed. Conclusions No indications were found for an association between media coverage of suicide and increases or decreases in actual suicides in Noord-Brabant. The descriptive statistics of this study reveal that the regional and national Dutch media are doing well with respect to not including elements in their reports that could encourage copycat behavior, such as simplifying, romanticizing or dramatizing. They could improve on including protective content, for example, providing supportive background information. A recommendation for further research is to evaluate causal relationships between media and actual suicide. A stepped wedge trial might be needed, as this provides an ethical research design to investigate this issue in a controlled setting. Also, in such a study, other variables influencing the decision to attempt suicide should be taken into account as much as possible.
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Suicide ranks among the 10 leading causes of death, with rates increasing among middle-aged adults. Anger is associated with suicide risk, but few studies have investigated this association in a primarily middle-aged sample. The present study investigated the association between state or trait anger and suicidal ideation among a national sample of 1255 middle-aged adults. Participants (M = 54.5, SD = 11.7; range = 34–84) were from the Midlife in the United States (MIDUS) Biomarker sub-project (2004–2009). In a multivariate model including age, sex, depression symptoms, angry temperament, and externalized anger, only angry temperament significantly predicted suicidal ideation independent of depression symptoms (OR = 1.13, p = .04). The associations between anger subscales and suicidal ideation were not moderated by gender or depression symptoms and were not mediated by interpersonal difficulties. Among middle-aged adults, angry temperament is associated with risk of suicidal ideation, irrespective of gender or depression symptoms. Assessing and addressing angry temperament in treatment may help decrease suicide risk.
Chapter
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Hierarchical Bayes models have been used in disease mapping to examine small scale geographic variation. State level geographic variation for less common causes of mortality outcomes have been reported however county level variation is rarely examined. Due to concerns about statistical reliability and confidentiality, county-level mortality rates based on fewer than 20 deaths are suppressed based on Division of Vital Statistics, National Center for Health Statistics (NCHS) statistical reliability criteria, precluding an examination of spatio-temporal variation in less common causes of mortality outcomes such as suicide rates (SRs) at the county level using direct estimates. Existing Bayesian spatio-temporal modeling strategies can be applied via Integrated Nested Laplace Approximation (INLA) in R to a large number of rare causes of mortality outcomes to enable examination of spatio-temporal variations on smaller geographic scales such as counties. This method allows examination of spatiotemporal variation across the entire U.S., even where the data are sparse. We used mortality data from 2005-2015 to explore spatiotemporal variation in SRs, as one particular application of the Bayesian spatio-temporal modeling strategy in R-INLA to predict year and county-specific SRs. Specifically, hierarchical Bayesian spatio-temporal models were implemented with spatially structured and unstructured random effects, correlated time effects, time varying confounders and space-time interaction terms in the software R-INLA, borrowing strength across both counties and years to produce smoothed county level SRs. Model-based estimates of SRs were mapped to explore geographic variation.
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Introduction: The purpose of this study was to document the association between education and suicide risk, in light of rising suicide rates and socioeconomic differentials in mortality in the U.S. Methods: Differentials and trends in U.S. suicide rates by education were examined from 2000 to 2014 using death certificate data on 442,135 suicides from the National Center for Health Statistics and Census data. Differences in the circumstances and characteristics of suicide deaths by education were investigated using 2013 data from the National Violent Death Reporting System for nine states. Analyses were conducted in 2016. Results: Between 2000 and 2014, men and women aged ≥25 years with at least a college degree exhibited the lowest suicide rates; those with a high school degree displayed the highest rates. Men with a high school education were twice as likely to die by suicide compared with those with a college degree in 2014. The education gradient in suicide mortality generally remained constant over the study period. Interpersonal/relationship problems and substance abuse were more common circumstances for less educated decedents. Mental health issues and job problems were more prevalent among college-educated decedents. Conclusions: The findings highlight the importance of social determinants in suicide risk, with important prevention implications.
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Hierarchical Bayes models have been used in disease mapping to examine small scale geographic variation. State level geographic variation for less common causes of mortality outcomes have been reported however county level variation is rarely examined. Due to concerns about statistical reliability and confidentiality, county-level mortality rates based on fewer than 20 deaths are suppressed based on Division of Vital Statistics, National Center for Health Statistics (NCHS) statistical reliability criteria, precluding an examination of spatio-temporal variation in less common causes of mortality outcomes such as suicide rates (SRs) at the county level using direct estimates. Existing Bayesian spatio-temporal modeling strategies can be applied via Integrated Nested Laplace Approximation (INLA) in R to a large number of rare causes of mortality outcomes to enable examination of spatio-temporal variations on smaller geographic scales such as counties. This method allows examination of spatiotemporal variation across the entire U.S., even where the data are sparse. We used mortality data from 2005-2015 to explore spatiotemporal variation in SRs, as one particular application of the Bayesian spatio-temporal modeling strategy in R-INLA to predict year and county-specific SRs. Specifically, hierarchical Bayesian spatio-temporal models were implemented with spatially structured and unstructured random effects, correlated time effects, time varying confounders and space-time interaction terms in the software R-INLA, borrowing strength across both counties and years to produce smoothed county level SRs. Model-based estimates of SRs were mapped to explore geographic variation. Running head: Mapping Geographic Variation in Mortality Rates
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The aim of this paper is to analyse why the largest percentage of spa, wellness and health tourism customers tend to be middle aged (around 45 on average) and predominantly female. Both academic and popular psychological research indicate that life satisfaction reaches a nadir during the middle years of life during which many adults experience a so-called mid-life crisis. However, it is often the case that people become happier again as they age – the “U-bend” of life theory. The first part of this paper explores a number of studies which support these theories, followed by an analysis of primary research which consisted of 60 e-interviews with professional people aged 40 and over. The final part of the paper considers the implications for the spa, wellness and health tourism industries and makes recommendations for how these sectors can provide the ideal services for their core market of middle-aged and female guests.
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Providing an overview of the myriad ways that we are touched by death and dying, both as an individual and as a member of society, this book will help readers understand our relationship with death. Kastenbaum and Moreman show how various ways that individual and societal attitudes influence both how and when we die and how we live and deal with the knowledge of death and loss. This landmark text draws on contributions from the social and behavioral sciences as well as the humanities, such as history, religion, philosophy, literature, and the arts, to provide thorough coverage of understanding death and the dying process. Death, Society, and Human Experience was originally written by Robert Kastenbaum, a renowned scholar who developed one of the world's first death education courses. Christopher Moreman, who has worked in the field of death studies for almost two decades specializing in afterlife beliefs and experiences, has updated this edition.
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Research from financial stress, disasters, pandemics and other extreme events, suggests that behavioral health will suffer, including anxiety, depression, and posttraumatic stress symptoms. Further these symptoms are likely to exacerbate alcohol or drug use, especially for those vulnerable to relapse. The nature of COVID-19 and vast reach of the virus, leave many unknows for the repercussions on behavioral health, yet existing research suggests that behavioral health concerns should take a primary role in response to the pandemic. We propose a four-step services system designed for implementation with a variety of different groups and reserves limited clinical services for the most extreme reactions. While we can expect symptoms to remit overtime, many will also have longer-term or more severe concerns. Behavioral health interventions will likely need to change overtime and different types of interventions should be considered for different target groups, such as for those that recover form COVID-19, healthcare professionals and essential personnel; and the general public either due to loss of loved ones or significant life disruption. The important thing is to have a systematic plan to support behavioral health and to engage citizens in the prevention and doing their part in recovery by staying home and protecting others.
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This chapter describes geographic trends in opioid mortality in the United States and discusses these trends within the broader contexts of declining U.S. rural health and “deaths of despair.” I elucidate macro-level economic and social explanations for the emergence and perpetuation of the opioid crisis. I discuss geographic variation in the crisis and summarize the consequences for rural families and communities. Some promising upstream strategies for addressing the social and economic determinants of the opioid crisis and other substance problems in the hardest-hit rural communities are proposed. Ultimately, the information presented dispels the myth that the opioid crisis is disproportionately rural and demonstrates that the magnitude of the problem varies considerably across different types of rural places. Furthermore, I urge to view the U.S. opioid problem from within the larger context of economic, family, health, and social problems occurring between and within communities along the rural–urban continuum.
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Introduction: The suicide rate in the U.S. has been increasing in recent years. Previous studies have consistently identified financial stress as a contributing factor in suicides. Nevertheless, there has been little research on the effect of economic policies that can alleviate financial stress on suicide rates. The purpose of this study is to determine whether increases in state minimum wages have been associated with changes in state suicide rates. Methods: A retrospective panel data study was conducted. In 2018, linear regression models with state fixed effects were used to estimate the relationship between changes in state minimum wages and suicide rates for all 50U.S. states between 2006 and 2016. Models controlled for time-varying state characteristics that could be associated with changes in minimum wages and suicide rates. Results: There were approximately 432,000 deaths by suicide in the study period. A one-dollar increase in the real minimum wage was associated on average with a 1.9% decrease in the annual state suicide rate in adjusted analyses. This negative association was most consistent in years since 2011. An annual decrease of 1.9% in the suicide rate during the study period would have resulted in roughly 8,000 fewer deaths by suicide. Analyses by race and sex did not reveal substantial variation in the association between minimum wages and suicides. Conclusions: Increases in real minimum wages have been associated with slower growth in state suicide rates in recent years. Increasing the minimum wage could represent a strategy for addressing increases in suicide rates.
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Background: To better understand and prevent suicide and homicide, the National Center for Injury Prevention and Control of the US Centers for Disease Control and Prevention launched the National Violent Death Reporting System (NVDRS) in six states in 2002. As of 2018, the NVDRS has been expanded to include all 50 states, the District of Columbia and Puerto Rico. The purpose of this review was to assess the research utility of the NVDRS based on studies indexed in major bibliographical databases. Methods: We performed a scoping review of published studies that were based on data from the NVDRS, identified by searching six electronic databases: PubMed, EMBASE, Google Scholar, OVID, Scopus, and Web of Science. We examined the time trend of annual NVDRS-based research output, generated a word cloud using the keywords listed in the publications, and mapped the knowledge domains covered by NVDRS-based studies. Results: Our review included a total of 150 studies published between 2005 and 2018. There was a marked increase in the annual number of NVDRS-based publications, with 120 (80.0%) of the 150 studies published between 2011 and 2018. Overall, 104 (69.3%) studies focused on suicide and 39 (26.0%) on homicide. Of the included studies, 100 (66.7%) were descriptive epidemiology, 31 (20.7%) were risk factor analyses, 9 (6.0%) were evaluations, 7 (4.7%) were trend analyses, and 4 (2.7%) were data quality assessments. Knowledge domain mapping identified two major clusters of studies, one on suicide and the other on homicide. The cluster on suicide was commonly linked to "circumstance," "alcohol" and "substance abuse" and the cluster on homicide was commonly linked to "firearm," "injury," and "gang." The two clusters were interlinked to overlapping networks of keywords, such as "firearm" and "mental health problem." Conclusions: Research utility of the NVDRS has increased considerably in recent years. Studies based on data from the NVDRS are clustered in two knowledge domains - suicide and homicide. The vast potential of the NVDRS for violence research and prevention remains to be fully exploited.
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Background: Existing research suggests that inhibitory control deficits may differentiate individuals who think about suicide from those who make a suicide attempt. However, no available research, to our knowledge, has examined whether suicidal behaviors are associated with disruptions in the ability to determine when inhibitory control is needed or the ability to engage inhibition of an inappropriate or maladaptive behavior. The current study utilized event-related potentials to investigate specific facets of inhibitory control and their associations with suicide attempt history among a heterogeneous clinical sample who reported current suicidal ideation. Methods: Ideators with no past suicide attempts (n = 46) and those with a history of suicide attempts (n = 22) completed a complex go/no-go task. Raw waveforms and temporospatial principal components analysis were used to index conflict detection (i.e., ΔN2) and motor inhibition (i.e., ΔP3a). Behavioral performance indices were also examined. Results: Suicide attempters exhibited deficits in detecting the need for inhibitory control, as indexed by a more positive ΔN2 factor, than did ideating nonattempters, even when accounting for psychiatric comorbidity and age. However, these results only emerged in the principal components analysis-derived latent factor. No differences in behavioral performance or ΔP3a amplitude emerged. Conclusions: A relative inability to detect when to inhibit a maladaptive behavior, but not the ability to engage motor inhibition to stop that behavior, may distinguish suicide ideators who make a suicide attempt from those who do not. However, future research with prospective designs are needed to determine how conflict detection deficits may contribute to the emergence or escalation of a suicidal crisis.
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Introduction: Suicide rates and the proportion of alcohol-involved suicides rose during the 2008-2009 recession. Associations between county-level poverty, foreclosures, and unemployment and suicide rates and proportion of alcohol-involved suicides were investigated. Methods: In 2015, National Violent Death Reporting System data from 16 states in 2005-2011 were utilized to calculate suicide rates and a measure of alcohol involvement in suicides at the county level. Panel models with year and state fixed effects included county-level measures of unemployment, foreclosure, and poverty rates. Results: Poverty rates were strongly associated with suicide rates for both genders and all age groups, were positively associated with alcohol involvement in suicides for men aged 45-64 years, and negatively associated for men aged 20-44 years. Foreclosure rates were negatively associated with suicide rates for women and those aged ≥65 years but positively related for those aged 45-64 years. Unemployment rate effects on suicide rates were mediated by poverty rates in all groups. Conclusions: Population risk of suicide was most clearly associated with county-level poverty rates, indicating that programs addressing area poverty should be targeted for reducing suicide risk. Poverty rates were also associated with increased alcohol involvement for men aged 45-64 years, indicating a role for alcohol in suicide for this working-aged group. However, negative associations between economic indicators and alcohol involvement were found for four groups, suggesting that non-economic factors or more general economic effects not captured by these indicators may have played a larger role in alcohol-related suicide increases.
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We examined the prevalence of self-reported chronic conditions and out-of-pocket spending using the 2005 Medical Expenditure Panel Survey (MEPS) and made comparisons to previously published MEPS data. Our study found that the prevalence of self-reported chronic conditions is increasing among not only the old-old but also people in midlife and earlier old age. The greatest growth occurred in the number of people affected by multiple chronic diseases, a group with sizable out-of-pocket spending. Policymakers should be aware that cost sharing at the point of care can disproportionately burden people with chronic conditions and discourage adherence to drugs that prevent disease progression.
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Research suggests that access to firearms in the home increases the risk for violent death. To understand current estimates of the association between firearm availability and suicide or homicide. PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and Web of Science were searched without limitations and a gray-literature search was performed on 23 August 2013. All study types that assessed firearm access and outcomes between participants with and without firearm access. There were no restrictions on age, sex, or country. Two authors independently extracted data into a standardized, prepiloted data extraction form. Odds ratios (ORs) and 95% CIs were calculated, although published adjusted estimates were preferentially used. Summary effects were estimated using random- and fixed-effects models. Potential methodological reasons for differences in effects through subgroup analyses were explored. Data were pooled from 16 observational studies that assessed the odds of suicide or homicide, yielding pooled ORs of 3.24 (95% CI, 2.41 to 4.40) and 2.00 (CI, 1.56 to 3.02), respectively. When only studies that used interviews to determine firearm accessibility were considered, the pooled OR for suicide was 3.14 (CI, 2.29 to 4.43). Firearm accessibility was determined by survey interviews in most studies; misclassification of accessibility may have occurred. Heterogeneous populations of varying risks were synthesized to estimate pooled odds of death. Access to firearms is associated with risk for completed suicide and being the victim of homicide. None.
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To investigate the impact of the 2008 global economic crisis on international trends in suicide and to identify sex/age groups and countries most affected. Time trend analysis comparing the actual number of suicides in 2009 with the number that would be expected based on trends before the crisis (2000-07). Suicide data from 54 countries; for 53 data were available in the World Health Organization mortality database and for one (the United States) data came the CDC online database. People aged 15 or above. Suicide rate and number of excess suicides in 2009. There were an estimated 4884 (95% confidence interval 3907 to 5860) excess suicides in 2009 compared with the number expected based on previous trends (2000-07). The increases in suicide mainly occurred in men in the 27 European and 18 American countries; the suicide rates were 4.2% (3.4% to 5.1%) and 6.4% (5.4% to 7.5%) higher, respectively, in 2009 than expected if earlier trends had continued. For women, there was no change in European countries and the increase in the Americas was smaller than in men (2.3%). Rises in European men were highest in those aged 15-24 (11.7%), while in American countries men aged 45-64 showed the largest increase (5.2%). Rises in national suicide rates in men seemed to be associated with the magnitude of increases in unemployment, particularly in countries with low levels of unemployment before the crisis (Spearman's rs=0.48). After the 2008 economic crisis, rates of suicide increased in the European and American countries studied, particularly in men and in countries with higher levels of job loss.
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To better understand the determinants of violent deaths, researchers need surveillance systems that include a broad spectrum of information (e.g., victim demographics, event characteristics [date/location of death] and preceding circumstances). Missing information can limit the ability to develop preventive interventions.This study examines the value of using multiple source documents (i.e., death certificates, coroner/medical examiner reports, and police reports) to reduce missing or “unknown” data on violent deaths. When all sources are accessible, more sources should reduce the amount of unknown data. This study finds this to be true only for certain variables, that is, those capturing preceding circumstances.
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The current financial crisis is having a major impact on European economies, especially that of Spain. Past evidence suggests that adverse macro-economic conditions exacerbate mental illness, but evidence from the current crisis is limited. This study analyses the association between the financial crisis and suicide rates in Spain. An interrupted time-series analysis of national suicides data between 2005 and 2010 was used to establish whether there has been any deviation in the underlying trend in suicide rates associated with the financial crisis. Segmented regression with a seasonally adjusted quasi-Poisson model was used for the analysis. Stratified analyses were performed to establish whether the effect of the crisis on suicides varied by region, sex and age group. The mean monthly suicide rate in Spain during the study period was 0.61 per 100 000 with an underlying trend of a 0.3% decrease per month. We found an 8.0% increase in the suicide rate above this underlying trend since the financial crisis (95% CI: 1.009-1.156; P = 0.03); this was robust to sensitivity analysis. A control analysis showed no change in deaths from accidental falls associated with the crisis. Stratified analyses suggested that the association between the crisis and suicide rates is greatest in the Mediterranean and Northern areas, in males and amongst those of working age. The financial crisis in Spain has been associated with a relative increase in suicides. Males and those of working age may be at particular risk of suicide associated with the crisis and may benefit from targeted interventions.
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Although evidence of the effects of the economic crisis on suicides is quite low, a recent article shows that the increase in suicides in England between 2008 and 2010 could be associated with the rise in unemployment. Our study analysed whether this effect was the same for all regions of England, using a conditional model which explicitly allows estimation of regional time trends and the effects of unemployment on suicides at the regional level. Hierarchical mixed models were used to assess both, suicides attributable to the financial crisis and the association between unemployment and suicides. The number and the (age-standardised) rate of suicides, for men and women separately, were the dependent variables. We considered the nine English regions based on the NUTS 2 level. There was an (not statistically significant) increase in the number of suicides between 2008 and 2010. The variation in rates was not statistically significant in England as a whole but there were statistically significant increases and decreases in some regions. Statistically significant associations between unemployment and suicides were only found at regional level. For men, statistically significant unemployment rates were positively associated with age-standardised suicide rates in the South West (0.384), North West (0.260) and North East (0.136), and negatively associated in the East of England (-0.444), East Midlands (-0.236) and London (-0.168). The study provides evidence that, even with statistically significant associations, finding variability, but no clear pattern, between trends and associations and/or numbers and rates might in fact suggest relatively spurious relationships; this is a result of not controlling for confounders.
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Each year in the U.S. more than 7,000 adults aged 60 years and older die of suicide and as the population ages, these numbers are expected to increase. While sex is an important predictor of older adult suicide, differences between males and females are often overlooked due to low occurrence, particularly among women. The National Violent Death Reporting System (NVDRS) bridges this gap by providing detailed information on older adult suicide by sex in 17 US states (covering approximately 26% of the U.S. population). NVDRS data for 2007-2009 were used to characterize male (n = 5,004) and female (n = 1,123) suicide decedents aged 60 years and older, including incident characteristics and circumstances precipitating suicide. Stratification of NVDRS data by sex shows significant differences with regard to the presence of antidepressants (19% and 45% respectively), opiates (18%, 37%), and 14 precipitating circumstances concerning mental health, interpersonal problems, life stressors and a history of suicide attempts. No differences were found for alcohol problems, suicide/other death of family or friends, non-criminal legal problems, financial problems, or disclosure of intent to take their own life. The findings of this study demonstrate the value of using comprehensive surveillance data to understand sex-specific suicide circumstances so that opportunities for targeted prevention strategies may be considered.
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Multiple risk factors contribute to suicides; however, patterns of co-occurrence among these factors have not been fully identified. To assess patterns of known suicide-related risk factors, classify suicide decedents by these patterns, track class proportions during a 6-year period, and characterize decedents across the classes to help focus prevention strategies. Design, Setting, and Latent class analysis was conducted using 2003-2008 data from the National Violent Death Reporting System. The population included 28 703 suicide decedents from 12 US states. The known risk factors included having the following: mental health conditions; a sad or depressed mood; substance abuse problems; medical problems; recent crises; financial, job, and legal problems; intimate partner and other relationship problems; and perpetrated interpersonal violence. Nine distinct patterns of risk factors emerged. Of these classes, 1 only endorsed mental health-related factors and 1 only endorsed alcohol- and substance abuse-related factors; however, 7 classes of decedents had distinct patterns of factors that spanned multiple domains. For example, 5 of these classes had mental health factors with other risks (eg, substance abuse, financial problems, relationship problems, a recent crisis, and medical problems). Two classes had recent crises with relationship problems; one of these classes also had high probabilities for criminal problems and interpersonal violence. Class proportions differed during the 6 years. Differences across classes by demographic and event characteristics were also found. Most suicide decedents could be classified by patterns of risk factors. Furthermore, most classes revealed a need for more connected services across medical, mental health/substance abuse, and court/social service systems. Reducing fragmentation across these agencies and recruiting family, friend, and community support for individuals experiencing mental health problems and/or other stress might significantly reduce suicides.
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We examined the associations of overall and age-specific suicide rates with business cycles from 1928 to 2007 in the United States. We conducted a graphical analysis of changes in suicide rates during business cycles, used nonparametric analyses to test associations between business cycles and suicide rates, and calculated correlations between the national unemployment rate and suicide rates. Graphical analyses showed that the overall suicide rate generally rose during recessions and fell during expansions. Age-specific suicide rates responded differently to recessions and expansions. Nonparametric tests indicated that the overall suicide rate and the suicide rates of the groups aged 25 to 34 years, 35 to 44 years, 45 to 54 years, and 55 to 64 years rose during contractions and fell during expansions. Suicide rates of the groups aged 15 to 24 years, 65 to 74 years, and 75 years and older did not exhibit this behavior. Correlation results were concordant with all nonparametric results except for the group aged 65 to 74 years. Business cycles may affect suicide rates, although different age groups responded differently. Our findings suggest that public health responses are a necessary component of suicide prevention during recessions.
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We examined trends in suicide rates for U.S. residents aged 40 to 59 years from 1979 to 2005 and explored alternative explanations for the notable increase in such deaths from 1999 to 2005. We obtained information on suicide deaths from the National Center for Health Statistics and population data from the U.S. Census Bureau. Age- and gender-specific suicide rates were computed and trends therein analyzed using linear regression techniques. Following a period of stability or decline, suicide rates have climbed since 1988 for males aged 40-49 years, and since 1999 for females aged 40-59 years and males aged 50-59 years. A crossover in rates for 40- to 49-year-old vs. 50- to 59-year-old males and females occurred in the early 1990s, and the younger groups now have higher suicide rates. The post-1999 increase has been particularly dramatic for those who are unmarried and those without a college degree. The timing of the post-1999 increase coincides with the complete replacement of the U.S. population's middle-age strata by the postwar baby boom cohorts, whose youngest members turned 40 years of age by 2005. These cohorts, born between 1945 and 1964, also had notably high suicide rates during their adolescent years. Cohort replacement may explain the crossover in rates among the younger and older middle-aged groups. However, there is evidence for a period effect operating between 1999 and 2005, one that was apparently specific to less-protected members of the baby boom cohort.
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To examine the prevalence of household firearms and firearm-storage practices in the 50 states and the District of Columbia and estimate the number of children exposed to unsafe storage practices. We analyzed data from the 2002 cross-sectional Behavioral Risk Factor Surveillance System survey of 240735 adults from randomly selected households with telephones in the 50 states and the District of Columbia. Nationally, 32.6% of adults reported that firearms were kept in or around their home. The prevalence of adults with household firearms ranged from 5.2% in the District of Columbia to 62.8% in Wyoming (median: 40.8%). The prevalence of adults with loaded household firearms ranged from 1.6% in Hawaii, Massachusetts, and New Jersey to 19.2% in Alabama (median: 7.0%), and the prevalence of adults with loaded and unlocked household firearms ranged from 0.4% in Massachusetts to 12.7% in Alabama (median: 4.2%). Among adults with children and youth <18 years old, the prevalence of loaded household firearms ranged from 1.0% to 13.4% (median: 5.3%), and the prevalence of loaded and unlocked household firearms ranged from 0.3% to 7.3% (median: 2.3%); in each instance, Massachusetts had the lowest prevalence and Alabama had the highest. Findings indicate that approximately 1.69 million (95% confidence interval: 1.57-1.82 million) children and youth in the United States <18 years old are living with loaded and unlocked household firearms. Substantial state variations exist in the prevalence of household firearms and firearm-storage practices. It is vital that surveillance systems such as the Behavioral Risk Factor Surveillance System continue to monitor the prevalence of household firearms and firearm-storage practices so that future interventions to promote safe storage of firearms can be evaluated and more widely implemented based on their efficacy.
Article
Objective We examined trends in suicide rates for U.S. residents aged 40 to 59 years from 1979 to 2005 and explored alternative explanations for the notable increase in such deaths from 1999 to 2005. Methods We obtained information on suicide deaths from the National Center for Health Statistics and population data from the U.S. Census Bureau. Age- and gender-specific suicide rates were computed and trends therein analyzed using linear regression techniques. Results Following a period of stability or decline, suicide rates have climbed since 1988 for males aged 40–49 years, and since 1999 for females aged 40–59 years and males aged 50–59 years. A crossover in rates for 40- to 49-year-old vs. 50- to 59-year-old males and females occurred in the early 1990s, and the younger groups now have higher suicide rates. The post-1999 increase has been particularly dramatic for those who are unmarried and those without a college degree. Conclusions The timing of the post-1999 increase coincides with the complete replacement of the U.S. population's middle-age strata by the postwar baby boom cohorts, whose youngest members turned 40 years of age by 2005. These cohorts, born between 1945 and 1964, also had notably high suicide rates during their adolescent years. Cohort replacement may explain the crossover in rates among the younger and older middle-aged groups. However, there is evidence for a period effect operating between 1999 and 2005, one that was apparently specific to less-protected members of the baby boom cohort.
Article
Do sudden, large wealth losses affect mental health? We use exogenous variation in the interview dates of the 2008 Health and Retirement Study to assess the impact of large wealth losses on mental health among older U.S. adults. We compare cross-wave changes in wealth and mental health for respondents interviewed before and after the October 2008 stock market crash. We find that the crash reduced wealth and increased feelings of depression and use of antidepressant drugs, and that these effects were largest among respondents with high levels of stock holdings prior to the crash. These results suggest that sudden wealth losses cause immediate declines in subjective measures of mental health. However, we find no evidence that wealth losses lead to increases in clinically-validated measures of depressive symptoms or indicators of depression.
Article
Recent data from a random national sample of bankrupt debtors suggests that since 1991, older Americans (aged 55 and over) have experienced the greatest increase in bankruptcy filings. The greatest decrease in filings occurred among debtors 34 and younger. The influence of Baby Boomers on filing rates has moderated substantially.
Article
Evidence from European countries indicates a significant rise in suicides from the economic recession, totalling more than 1000 excess deaths in the UK alone. Among the worst affected economies in Europe, such as Greece, suicides have risen by more than 60% since 2007.2 Thus far, there has been little or no analysis of US mental health data, mostly owing to delays in data availability. Here, we extend our previous analyses of recessions and suicides in Europe to assess trends in all 50 US states. We use data on suicide mortality rates from 1999 to 2010 from the Centers for Disease Control and Prevention. Unemployment data come from the Bureau of Labor Statistics. Time-trend regression models were used to assess excess suicides occurring during the economic crisis -- ie, deaths over and above the level that would be expected if historical trends continued (see appendix for methodological details). Although there are concerns that suicide data are under-reported in the USA, these biases are likely to have been consistent over this relatively short period, although they might lead to a conservative estimate of the mental health effects of the crisis. Looking across US states between 1999 and 2010, we found that the strongest correlation between unemployment and suicides was in Texas (r=0·91), but overall the correlations were statistically indistinguishable between the north, south, east, and west, or when disaggregating states by Democrat and Republican governors (appendix). Small numbers of suicides in small populations limit a state-by-state comparison for all 50 states. Similar patterns were seen if absolute numbers of suicides were used instead of overall rates. Suicide is a rare outcome of mental illness; these data are likely to be the most visible indicator of major depression and anxiety disorders, as seen in primary-care settings in Spain and in the Greek population. The pattern of accelerating suicides noted in the USA mirrors that recorded for economic reasons in Italy. Future research should explore other risk factors such as foreclosures and job and income losses, and modifying factors such as gun control policies, access to the means of self-harm, and vulnerable groups, which could explain the remaining portion of the suicide rise observed during the recession. Our findings have immediate implications for policy. Given that some countries have avoided increases in suicides despite significant economic downturns, there is a clear need to implement policy initiatives that promote the resilience of populations during the ongoing recession. Active labour market programs--projects that immediately help the unemployed find social support and new work opportunities (even part time)--and mental health prevention programs seem to mitigate significantly the negative mental health effects of recessions. The fact that countries such as Sweden have been able to prevent suicide rises despite major recessions reveals opportunities to protect Americans from further risks of suicide during the continued economic downturn. Language: en
Article
Drawing on constructs of masculinity as it relates to both gun ownership and men's health, we use a rich data set, the New Jersey Violent Death Reporting System as well as hospital discharge data, to analyze 3,413 completed male suicides between the years of 2003 and 2009. We test the hypotheses that the use of firearms is more common when physical health problems are cited as suicide circumstances, and that suicide decedents who use firearms have poorer physical health than those who used other methods. Results show that firearms are disproportionately used in male suicides when physical health is listed as a circumstance. Additionally, among suicide decedents with a hospitalization during the 3 years prior to death, those who used firearms were in poorer health than those who used other methods. These findings have implications for prevention efforts, because restricting access to lethal means is an important aspect of suicide prevention.
Article
The current investigation explores the association between rates of household firearm ownership and suicide across the 50 states. Prior ecologic research on the relationship between firearm prevalence and suicide has been criticized for using problematic proxy-based, rather than survey-based, estimates of firearm prevalence and for failing to control for potential psychological risk factors for suicide. We address these two criticisms by using recently available state-level survey-based estimates of household firearm ownership, serious mental illness, and alcohol/illicit substance use and dependence. Negative binomial regression was used to assess the relationship between household firearm ownership rates and rates of firearm, nonfirearm, and overall suicide for both sexes and for four age groups. Analyses controlled for rates of poverty, urbanization, unemployment, mental illness, and drug and alcohol dependence and abuse. US residents of all ages and both sexes are more likely to die from suicide when they live in areas where more households contain firearms. A positive and significant association exists between levels of household firearm ownership and rates of firearm and overall suicide; rates of nonfirearm suicide were not associated with levels of household firearm ownership. Household firearm ownership levels are strongly associated with higher rates of suicide, consistent with the hypothesis that the availability of lethal means increases the rate of completed suicide.
Article
In this influential work, Richard A. Easterlin shows how the size of a generation—the number of persons born in a particular year—directly and indirectly affects the personal welfare of its members, the make-up and breakdown of the family, and the general well being of the economy. "[Easterlin] has made clear, I think unambiguously, that the baby-boom generation is economically underprivileged merely because of its size. And in showing this, he demonstrates that population size can be as restrictive as a factor as sex, race, or class on equality of opportunity in the U.S."—Jeffrey Madrick, Business Week
Article
There is widespread concern that the present economic crisis, particularly its effect on unemployment, will adversely affect population health. We investigated how economic changes have affected mortality rates over the past three decades and identified how governments might reduce adverse effects. We used multivariate regression, correcting for population ageing, past mortality and employment trends, and country-specific differences in health-care infrastructure, to examine associations between changes in employment and mortality, and how associations were modified by different types of government expenditure for 26 European Union (EU) countries between 1970 and 2007. We noted that every 1% increase in unemployment was associated with a 0.79% rise in suicides at ages younger than 65 years (95% CI 0.16-1.42; 60-550 potential excess deaths [mean 310] EU-wide), although the effect size was non-significant at all ages (0.49%, -0.04 to 1.02), and with a 0.79% rise in homicides (95% CI 0.06-1.52; 3-80 potential excess deaths [mean 40] EU-wide). By contrast, road-traffic deaths decreased by 1.39% (0.64-2.14; 290-980 potential fewer deaths [mean 630] EU-wide). A more than 3% increase in unemployment had a greater effect on suicides at ages younger than 65 years (4.45%, 95% CI 0.65-8.24; 250-3220 potential excess deaths [mean 1740] EU-wide) and deaths from alcohol abuse (28.0%, 12.30-43.70; 1550-5490 potential excess deaths [mean 3500] EU-wide). We noted no consistent evidence across the EU that all-cause mortality rates increased when unemployment rose, although populations varied substantially in how sensitive mortality was to economic crises, depending partly on differences in social protection. Every US$10 per person increased investment in active labour market programmes reduced the effect of unemployment on suicides by 0.038% (95% CI -0.004 to -0.071). Rises in unemployment are associated with significant short-term increases in premature deaths from intentional violence, while reducing traffic fatalities. Active labour market programmes that keep and reintegrate workers in jobs could mitigate some adverse health effects of economic downturns. Centre for Crime and Justice Studies, King's College, London, UK; and Wates Foundation (UK).
Article
The overall suicide rate in the U.S. increased by 6% between 1981 and 1986 and declined by 18% between 1986 and 1999. Detailed descriptions of recent trends in suicide are lacking, especially with regard to the method of suicide. Information is needed on the major changes in rates of suicide in specific population groups in recent years (1999-2005). Mortality data came from the Web-based Injury Statistics Query and Reporting System. Suicide trends during 1981-2005 were analyzed by age, race, gender, and method, with an emphasis on increases between 1999 and 2005. Linear regression was used to examine the significance of trends in suicide mortality. The annual percentage change in rates was employed to measure the linear trend in suicide mortality. The suicide rate increased after 1999, due primarily to an increase in suicide among whites aged 40-64 years, whose rate of completed suicide between 1999 and 2005 rose by 2.7% annually for men and by 3.9% annually for women,with increases of 6.3% and 2.3% for poisoning, 2.8% and 19.3% for hanging/suffocation, and 1.5% and 1.9% for firearms for men and women, respectively. Rates did not increase for other age or racial groups [corrected]. The differential increases by age, race, gender, and method underscore a change in the epidemiology of suicide.Whites aged 40-64 years have recently emerged as a new high-risk group for suicide. Although firearms remain the most common method of suicide, the notable increases in suicide by poisoning in men and hanging/suffocation in women deserve prevention attention [corrected].
Article
This paper describes a new surveillance system called the National Violent Death Reporting System (NVDRS), initiated by the United States Centers for Disease Control and Prevention. NVDRS's mission is the collection of detailed, timely information on all violent deaths. NVDRS is a population based, active surveillance system designed to obtain a complete census of all resident and occurrent violent deaths. Each state collects information on its own deaths from death certificates, medical examiner/coroner files, law enforcement records, and crime laboratories. Deaths occurring in the same incident are linked. Over 270 data elements can be collected on each incident. The 13 state health departments of Alaska, Colorado, Georgia, Maryland, Massachusetts, New Jersey, North Carolina, Oklahoma, Oregon, Rhode Island, South Carolina, Virginia, and Wisconsin. Cases consist of violent deaths from suicide, homicide, undetermined intent, legal intervention, and unintentional firearm injury. Information is collected on suspects as well as victims. None. The quality of surveillance will be measured in terms of its acceptability, accuracy, sensitivity, timeliness, utility, and cost. The system has just been started. There are no results as yet. NVDRS has achieved enough support to begin data collection efforts in selected states. This system will need to overcome the significant barriers to such a large data collection effort. Its success depends on the use of its data to inform and assess violence prevention efforts. If successful, it will open a new chapter in the use of empirical information to guide public policy around violence in the United States.
Article
Hanging is one of the most commonly used methods for suicide worldwide. In England and a number of other countries, its incidence has increased over the last 30 years. This review summarizes the published literature on suicide by hanging. The focus is on its epidemiology in England and on identifying potential means of prevention. We searched Medline (1966-2003), Embase (1980-2003), CINAHL (1982-2003) and PsycINFO (1967-2003). As considerable research on suicides occurring in prisons and psychiatric hospitals in England and Wales has been carried out by the National Confidential Inquiry into Suicide and Homicide (Manchester) and the Prison Service's Safer Custody Group, we obtained additional information from these sources. Only a small proportion (around 10%) of hanging suicides occur in the controlled environments of hospitals, prisons, and police custody; the remainder occur in the community. The most commonly used ligatures (rope, belts, flex) and ligature points (beams, banisters, hooks, door knobs, and trees) are widely available; thus prevention strategies focused around restriction of access to means of hanging are of limited value. Around 50% of hanging suicides are not fully suspended--ligature points below head level are commonly used. Case fatality following attempted suicide by hanging is around 70%; the majority (80-90%) of those who reach hospital alive survive. Strategies to reduce suicide by hanging should focus on the prevention of suicide in controlled environments, the emergency management of 'near-hanging' and on the primary prevention of suicide in general. More research is required to better understand the recent rise in popularity of this method.
Article
There are a large number of factors mediating suicide. Many studies have searched for a direct causal relationship between economic hardship and suicide, however, findings have been varied. Suicide data was obtained from the Australian Bureau of Statistics for the period between January 1968 and August 2002. These were correlated with a suite of macroeconomic data including housing loan interest rates, unemployment rates, days lost to industrial disputes, Consumer Price Index, gross domestic product, and the Consumer Sentiment Index. A total of 51845 males and 16327 females committed suicide between these dates. There were significant associations between suicide rates and eleven macroeconomic indicators for both genders in at least one age range. Data was divided into male and female and five age ranges and pooled ages. Analyses were conducted on these 132 datasets resulting in 80 significant findings. The data was generally stronger for indices measuring economic performance than indices measuring consumers' perceptions of the state of the economy. A striking difference between male and female trends was seen. Generally, male suicide rates increased with markers of economic adversity, while the opposite pattern was seen in females. There were significantly different patterns in age-stratified data, with for example higher housing loan interest rates having a positive association with suicide in younger people and a negative association in older age groups. Macroeconomic trends are significantly associated with suicide. The patterns in males and females are very different, and there are further substantial age-related differences.
The accessibility of firearms and risk for suicide and homicide victimization among household members: a systematic review and meta-analysis.
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A shrinking minority: the continuing decline of gun ownership in America
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