ArticleLiterature Review

Contributing factors to suicide: Political, social, cultural and economic

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Abstract

This review summarizes recent research in four environmental areas affecting risk of deaths by suicide. Politically, the weight of the evidence suggests that laws increasing social welfare expenditures and other policies assisting persons with low incomes (e.g., minimum wage) tend to lower suicide rates. Other legal changes such as those restricting firearms and alcohol availability can also prevent suicides. The social institutions of marriage, as well as parenting, continue to serve as protective factors against suicide, although the degree of protection is often gendered. Religiousness tends to be inversely associated with suicide deaths at the individual level of analysis, but the mediators need exploration to determine what accounts for the association: social support, better mental health, better physical health, less divorce, or other covariates. Cultural definitions of the traditional male role (e.g., breadwinner culture) continue to help explain the high male to female suicide ratio. New work on the "culture of suicide" shows promise. The degree of approval of suicide is sometimes the single most important factor in predicting suicide. At the individual level of analysis, two of the strongest predictors of suicide are economic ones: unemployment and low socio-economic status. Attention is drawn to enhancing the minimum wage as a policy known to lower state suicide rates. Limitations of research include model mis-specification, conflicting results especially when ecological data are employed, and a need for more research exploring moderators of established patterns such as that between religiousness and suicide.

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... Similarly, Stack (15) categorizes influences on suicide into political, social, cultural, and economic dimensions. From a political perspective, increased social welfare and public assistance often correlate with reduced suicide rates (15,16). Socially, marital and parental social institutions remain protective factors against suicide, albeit with gender disparities in their protective effects (17,18). ...
... Additionally, most articles support the view that social isolation causally relates to suicide, while social support serves a protective function against suicide (19). Some studies indicate a correlation between alcohol consumption issues and suicide rates (15,20,21). Culturally, religious beliefs often negatively correlate with suicide rates, but mediating factors require further exploration (15). ...
... Some studies indicate a correlation between alcohol consumption issues and suicide rates (15,20,21). Culturally, religious beliefs often negatively correlate with suicide rates, but mediating factors require further exploration (15). Moreover, Japan' s traditional notion of honorable suicide and modern conservative attitudes toward suicide are considered reasons for high suicide rates (22). ...
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Introduction This study investigates the cost-effectiveness of suicide prevention and intervention (SPI) efforts by prefectural governments in Japan. It represents the first application of a public sector efficiency evaluation model to assess government SPI initiatives. The research aims to identify spatial disparities and dynamic evaluation in SPI efficiency, providing actionable insights for policymakers. Methods We employed a three-stage Modified Slacks-Based Measure of Super Efficiency to evaluate the SPI implementation efficiency of prefectural governments. This approach accounted for exogenous environmental and stochastic factors to isolate actual managerial efficiency. Additionally, the Luenberger productivity index was utilized to analyze the changes in SPI efficiency over time, focusing on the contributions of technological advancements and efficiency improvements. Results The analysis revealed significant spatial disparities in SPI efficiency across prefectural governments. However, a substantial portion of these differences was attributable to exogenous environmental and stochastic factors, indicating relatively limited variations in actual managerial efficiency. The Luenberger productivity index indicated an overall upward trend in SPI productivity, driven primarily by technical change. Conversely, the analysis highlighted a decline in efficiency changes, predominantly due to reduced scale efficiency. Discussion The findings underscore the importance of considering external environmental and stochastic factors when evaluating SPI efficiency. While technical advancements have positively influenced SPI productivity, policymakers should address the deteriorating trend in scale efficiency changes to ensure sustainable improvements in efficiency. Strategies that balance technical change and efficiency enhancements are essential for optimizing local SPI efforts.
... Fatal and non-fatal self-harm represent a global health problem (Knipe et al., 2022;World Health Organisation, 2014, 2021. Whilst most research takes place in highincome settings, an estimated 77% of suicides occur in Low and Middle-Income (LMIC) countries (World Health Organisation, 2021), underscoring the importance of studying suicide and self-harm in these settings (Vijayakumar & Armstrong, 2019). ...
... Indebtedness was highlighted as an important factor associated with suicide rates amongst farmers in India (Kennedy & King, 2014;Merriott, 2016). This mirrors other research (Stack, 2021), including a meta-analysis of 65 studies, which demonstrates a large association between indebtedness and suicide (OR ¼ 7.9; Richardson et al., 2013). Financial hardship was one factor linked to self-harm in Sri Lanka in a study using key informant interviews and focus groups (Konradsen et al., 2006). ...
... The prevalence of financial stress is consistent with research indicating that factors like socio-economic deprivation and indebtedness are linked to self-harm risk (e.g. Richardson et al., 2013;Stack, 2021), including in South Asia (Merriott, 2016;Kennedy & King, 2014), and qualitative research linking self-harm to financial hardship in Sri Lanka (Konradsen et al., 2006). In Pakistan financial stress was also cited as an antecedent for self-harm in 10% of people presenting at a tertiary care hospital (Zakiullah et al., 2008) suggesting it was not an uncommon if not predominant precipitate. ...
Article
Objective: Socioeconomic status deprivation is known to be associated with self-harm in Western countries but there is less information about this association in Low and Middle Income Countries (LMIC). One way of investigating this is to assess the prevalence of indicators of financial stress in people who self-harm. We have assessed the prevalence and correlates of day-to-day financial hardships amongst individual presenting with non-fatal self-harm to hospitals in Sri Lanka. Methods: Data on non-fatal self-harm presentations were collected from an ongoing surveillance project in 52 hospitals in Sri Lanka. A questionnaire captured data on two forms of financial stress: unmet need (i.e., costs and bills that cannot be paid) and required support (i.e., steps taken to cover costs, such as selling belongings). Additional data on demographic, economic and clinical characteristics were also collected. Results: The sample included 2516 individuals. Both forms of financial stress were very common, with pawning/selling items (47%) and asking family or friends for money (46%) in order to pay bills or cover costs being commonly reported. Greater financial stress was associated with being aged 26-55 years, limited education, and low socioeconomic position. Financial stress was greater in women than men after adjusting for other factors. Conclusion: The results indicate that financial stress is commonly reported amongst individuals presenting to hospital with non-fatal self-harm in Sri Lanka, especially women. The research highlights a need to attend to financial stress both within self-harm prevention and aftercare.
... Numerous important studies have examined how psychological, biological, clinical, social, and mental health factors affect suicide (Batty et al., 2018;Ding et al., 2017;Fu et al., 2002;McGirr et al., 2008;Stack 2021;Turecki et al., 2019;Zhang, Xiao & Zhou 2010). The literature on suicide indicates there are numerous factors that influence suicidal ideation, suicide risk, suicide attempts, and suicide. ...
... These factors include but are not limited to: volatile economic conditions (Baudelot and Establet 2008), socioeconomic deprivation (Mok et al., 2012;Platt 2016;Platt et al., 2005), economic instability (i.e., unemployment, housing insecurity, and financial debt) and substance abuse related to economic circumstances (Coope et al., 2014;Gunnell et al., 2003;Haw et al., 2015). In a meta-analysis of the social factors that can affect suicide from the sociological perspective, Stack (2021) finds that laws that increase spending on social welfare programs, assist low-income individuals, and provide restrictions on firearms and alcohol availability are associated with lower suicide rates. Greater social support systems, higher quality mental and physical health, and fewer incidents of divorce are associated with lower suicide rates. ...
... Cross-national research has also discovered that gender can influence suicide rates (Freeman et al., 2017;Poudel-Tandukar et al. 2011;Yur'yev et al., 2013) in varying ways depending on economic conditions and circumstances. Cross-national studies have found that certain religious beliefs (Stack 1983(Stack , 2021Stack and Laubepin 2019) and individualization (Lenzi, Colucci, and Minas 2011) are associated with variations in suicide rates. Among the large body of scholarship on suicide, one important area of research focuses on the relationship between social isolation and suicide. ...
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Previous valuable research has examined the effect individual-level social and psychological factors have on suicidality. However, scholarship has yet to investigate the role civil society participation plays in suicide rates cross-nationally. Thus, this study examines the effect civil society participation has on suicide rates in 156 countries from varying levels of development from 2000 – 2019 from Africa, Asia, Europe, Latin America, the Middle East, and North America. When including standard controls and controlling for potential endogeneity, the findings indicate that civil society participation, both political and non-political, has a negative and statistically significant effect on suicide rates. The results suggest that both political and non-political forms of civil society participation may produce positive social and psychological benefits that are associated with lower suicide rates.
... A recent systematic review of the social determinants of mental disorders presents a conceptual framework comprising demographic, economic, neighborhood, environmental events, and social and cultural domains [10]. Regarding macroeconomic indicators, the unemployment rate [11,12], community deprivation levels [13], regional income levels [14], and the allocation of assistance for low-income groups [12] are correlated with suicidal behaviors and mortality. Neighborhood characteristics, including overcrowding in urban areas [15], the percentage of vacant houses, and access to parks [16], are associated with community suicide mortality rates. ...
... A recent systematic review of the social determinants of mental disorders presents a conceptual framework comprising demographic, economic, neighborhood, environmental events, and social and cultural domains [10]. Regarding macroeconomic indicators, the unemployment rate [11,12], community deprivation levels [13], regional income levels [14], and the allocation of assistance for low-income groups [12] are correlated with suicidal behaviors and mortality. Neighborhood characteristics, including overcrowding in urban areas [15], the percentage of vacant houses, and access to parks [16], are associated with community suicide mortality rates. ...
... Additionally, male suicides are more prominently affected by contextual determinants, including macrosocietal and economic factors, than female suicides [38][39][40][41]. Some studies have explained men's vulnerability to suicide within the cultural context, where the traditional hegemony of masculinity (gender role expectations) increases maladaptive coping strategies, such as alcohol abuse, in stressful situations and reluctance to seek help, consequently raising the suicide risk in men [12,42,43]. Even though there is no regional concentration of women's suicide, given that the sex differences in suicidal progress pathways and effect factor mechanisms [44], further research on female suicidal behavior is necessary. ...
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Background Suicide mortality remains a global health concern, and community characteristics affect regional variations in suicide. This study investigated spatially clustered patterns of suicide mortality rates in South Korea and evaluated the impact of community factors on suicide. Methods Suicide mortality rates were estimated by sex, age group, and district, using the 2021 Cause of Death Statistics in South Korea from the MicroData Integrated Service. Community-determinant data for 2021 or the nearest year were collected from the Korean Statistical Information Service. The spatial autocorrelation of suicide by sex and age was examined based on Global Moran’s I index. Geographically weighted regression (GWR) was used to discern the influence of community determinants on suicide. Results Suicide mortality rates were significantly higher among men (40.64 per 100,000) and adults over the age of 65 years (43.18 per 100,000). The male suicide mortality rates exhibited strong spatial dependence, as indicated by a high global Moran’s I with p < 0.001, highlighting the importance of conducting spatial analysis. In the GWR model calibration, a subset of the community’s age structure, single-person household composition, access to mental healthcare centers, and unmet medical needs were selected to explain male suicide mortality. These determinants disproportionately increased the risk of male suicide, varying by region. The GWR coefficients of each variable vary widely across 249 districts: aging index (Q1:0.06–Q3:0.46), single-person households (Q1:0.22–Q3:0.35), psychiatric clinics (Q1:-0.20–Q3:-0.01), and unmet medical needs (Q1:0.09–Q3:0.14). Conclusions Community cultural and structural factors exacerbate regional disparities in suicide among men. The influencing factors exhibit differential effects and significance depending on the community, highlighting the need for efficient resource allocation for suicide. A regionally tailored approach is crucial for the effective control of the community’s mental health management system.
... Suicide is a global problem, and in Sweden approximately 1500 individuals die by suicide every year [1]. A number of risk factors for suicide have been identified including mental health disorders [2], somatic illness [3], unemployment and low socio-economic status [4]. Occupation and work-related factors also appear to influence the risk of suicide [1,5,6]. ...
... Construction work is physically demanding and can be challenging and dangerous which may lead to both musculoskeletal disorders and occupational injuries [27]. These physical risks may lead to both physical and mental health problems [4]. Occupational injuries are associated with elevated rates of suicide, which can be mediated by pain, loss of work role, reduction of income, adverse experiences with disability support processes, and more [9]. ...
... A recent study on distress in the construction industry found that some individuals may hide their distress, thus requiring that someone else notices the signs [21]. A systematic literature review of work and suicide [4,5] found some support for the relation between leadership constructs and suicidal ideation, but pointed out that this research is still in its infancy. Previous research has found that interventions aiming to improve leaders' mental health awareness have been effective in increasing intentions to promote mental health at work [38,39], and this is an explicit action recommendation in the WHO Guidelines on work and mental health [40]. ...
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Objective The aim of the study was to explore perceptions of mental ill health, suicidal behaviour and working conditions among male construction workers, in order to gain an in-depth understanding of these phenomenon and to identify relevant avenues for workplace interventions. Method Data were collected in individual and group interviews, and 43 individuals from the Swedish construction industry, workers, union representative and managers, participated in the study. Inductive thematic analysis was used to analyse the data. Results Five main themes were found: Difficult to talk about mental health, Demanding working environment affects mental health, Substance abuse among construction workers, Importance of management, and Need for routines and social support in the workplace. Many participants reported that there was a stigma related to mental health. Suicides that had occurred among colleagues were perceived to come out of the blue. The working environment in the construction industry was perceived to have a negative effect on mental health, and it was reported that the management played an important role in both the cause and prevention of mental health problems. Conclusions The results from this Swedish study are in accordance with previous international research regarding a macho culture, stigma of mental health and a demanding working environment in the construction industry. The study adds to existing knowledge by highlighting that suicides were perceived to be very unexpected, that poor physical health affected mental health and that many participants did not know how to deal with mental health issues in the workplace.
... Studies have shown that the majority of completed suicides are firearm-related, accounting for one in two suicides in males and one in three among females [19][20][21][22][23]. Reducing the suicide rate, therefore, requires restriction of access to the most lethal means [24][25][26]. Laws and policies that reduce access to firearms are needed to reduce completed suicides [27][28][29]. Studies have shown that states with laws that restrict access to firearms have a lower rate of suicide compared to those that do not have such laws, with no increase in suicide from other methods [30][31][32][33]. ...
... Public health prevention approaches have consistently recognized the importance of health in all policies [66]. Educational and economic policies such as debt forgiveness and those that improve income may, therefore, have a profound impact on suicide prevention [28]. ...
... The rising trend in violent deaths, suicide, and homicide reported in the study may be related to climate change [88,89]. There have been studies that report an increase in suicide and homicide in summer [28,90]. Over the 20-year period, temperature levels during the summer rose steadily, and this may influence suicide and homicide rates [91]. ...
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Background: Violent deaths, including suicides and homicides, pose a significant public health challenge in the United States. Understanding the trends and identifying associated risk factors is crucial for targeted intervention strategies. Aim: To examine the trends in suicides and homicides over the past two decades and identify demographic and contextual predictors using the Center for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System online database. Methods: A retrospective analysis of mortality records from 2000 to 2020 was conducted, utilizing multivariate regression analyses. Covariates included age, race, sex, education, mental health conditions, and time period. Age-adjusted rates were employed to assess trends. Results: Over the 20 years, there was an upward trajectory in suicide rates, increasing from approximately 10/100,000 to over 14/100,000 individuals, which is a notable increase among American Indians (100.8% increase) and individuals aged 25 years and younger (45.3% increase). Homicide rates, while relatively stable, exhibited a significant increase in 2019-2020, with African Americans consistently having the highest rates and a significant increase among American Indians (73.2% increase). In the multivariate regression analysis, Individuals with advanced education (OR= 1.74, 95% CI= 1.70 - 1.78), depression (OR = 13.47, 95% CI = 13.04 - 13.91), and bipolar disorder (OR = 2.65, 95% CI = 2.44 - 2.88) had higher odds of suicide. Risk factors for homicide include African Americans (OR = 4.15, 95% CI = 4.08 - 4.23), Latinx (OR = 2.31, 95% CI = 2.26 - 2.37), people aged 25 years and younger, and those with lower educational attainment. Conclusion: This study highlights the changing demographic pattern in suicides and homicides in the United States and the need for targeted public health responses. Means restriction, universal suicide screening, addressing mental health stigma, and implementing broad interventions that modify societal attitudes toward suicide and homicides are essential components of a comprehensive strategy.
... A history of psychological disorders also increases suicide risk, particularly depression and substance use disorders (İlgün et al., 2020). Political factors, such as lack of marriage protections or the high availability of firearms in one's community, further increase suicide risk (Stack, 2021). Multiple reviews have also identified economic factors, such as recently experiencing a financial crisis, as predictive of STB (García de la Garza et al., 2021;Stack, 2021). ...
... Political factors, such as lack of marriage protections or the high availability of firearms in one's community, further increase suicide risk (Stack, 2021). Multiple reviews have also identified economic factors, such as recently experiencing a financial crisis, as predictive of STB (García de la Garza et al., 2021;Stack, 2021). This evidence suggests that a person's health and the health of their community interact in complex ways to drive suicide risk. ...
Article
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Suicide is a growing public health concern in the United States, with increasing rates for marginalized communities. The majority of suicidology research has failed to adequately address the elevated rates of suicidal ideation and behavior for these vulnerable populations. Emerging research from the last 30 years shows that suicide drivers differ for African American, Asian American, Latinx, and lesbian, gay, bisexual, transgender, or queer individuals. While some factors confer risk for all individuals (psychopathology, prior attempts), other factors confer risk to individuals from some groups, but not others. The cultural model of suicide explains how these cultural risk and protective factors impact suicide risk for marginalized individuals. The Cultural Assessment for Risk of Suicide (CARS) was developed to specifically assess these risk and protective factors. Although existing guidelines for suicide risk assessment and intervention mention the importance of these factors, they do not explain how to integrate them into risk formulation or safety planning with clients at risk for suicide. This article will provide guidance on how to integrate this theoretical model for suicide risk assessment and intervention with clinical practice. A case example will provide step-by-step procedures for integrating general and culturally specific suicide risk factors, assessing risk using the CARS, and using a CARS score profile to write a safety and treatment plan.
... Stone et al. found that 45% of suicide decedents in 2018 had a known mental health condition [39]. Several life stressors are also related to suicide risk, including financial strain [39], eviction and housing loss [40], and career stress or job loss [41]. Additionally, persons with family, intimate partner, health, and criminal and civil legal problems are at greater risk of suicide [42]. ...
... Previous suicide attempt and history of self-harm [43] and method of suicide [41] are also strong predictors of suicide [36,44]. Estimates indicate that between 25% and 50% of completed suicides are preceded by an earlier suicide attempt [38]. ...
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Research highlights racial and ethnic disparities in suicide, but Asian American suicide receives very little attention in the literature. This is the first comprehensive, large-scale, nationally representative study of completed suicide among Asian Americans in the United States. Descriptive and multilevel regression techniques compared the risk factors for completed suicide across 227,786 Asian American, White, African American, Hispanic, and American Indian suicide decedents from 2003 to 2019. Results indicated that Asian American suicide decedents were significantly less likely than their counterparts to have several risk factors for suicide. Asian Americans were less likely to be male, uneducated, and unmarried. Asian Americans were less likely to use alcohol and drugs, to have mental health problems, and to die by firearm, relative to other suicide methods. Asian Americans were less likely to have a history of prior suicide attempts, to have intimate partner problems, and to have criminal legal problems. Conversely, Asian Americans were more likely to reside in places with higher levels of concentrated disadvantage, residential instability, racial and ethnic heterogeneity, and population density. The results underscore the need for race-specific suicide prevention strategies that, for Asian Americans in particular, take into account cultural values and barriers to help-seeking behavior.
... Moreover, divorcees generally have poorer eating habits and lack healthy physical exercise habits (Bourassa et al., 2019). All such behaviors are associated with physical health problems (Sbarra et al., 2011;Shor et al., 2012;Stack, 2021). Third, divorce is related to a heightened risk of ex-partner conflict, constituting a major interpersonal stressor (Zineldin, 2019). ...
... Second, as expected, heavy alcohol consumption, a lack of physical exercise, and being overweight all increased divorcees' risk for physical health problems. Research has shown that divorced people sometimes try to alleviate divorce-related stress by developing unhealthy habits such as alcohol consumption (Shor et al., 2012;Stack, 2021). Also, having a partner generally encourages more healthy lifestyle habits, such as physical exercise. ...
... Addressing these factors in a unified manner is crucial to mitigating their combined impact and improving outcomes for individuals at risk. 67,69 Interestingly, while lower levels of education have traditionally been associated with increased lifetime suicide risk, 70 our multivariable analysis revealed a paradoxical finding: individuals with higher educational attainment in the WV population were more likely to report lifetime suicide risk. One plausible explanation could be that educational attainment has less variability across the state. ...
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Introduction Suicide rates in the United States have increased over the past two decades, with rural areas, particularly the Appalachian Region, facing unique challenges that elevate suicide risk. These include economic hardships, social isolation, and limited access to mental health services. Purpose This study addresses critical gaps in understanding lifetime suicide risk in West Virginia (WV), a predominantly rural state entirely within the Appalachian Region. By identifying the factors driving urban-rural differences in suicide risk, this research seeks to inform interventions tailored to the state's distinct needs and provide insights applicable to the broader Appalachian Region Methods Using 2021 Mountain State Assessment of Trends in Community Health (MATCH) survey data, we examined socioeconomic and related factors associated with lifetime suicide risk in WV, measured by the first item of the Suicide Behaviors Questionnaire-Revised (SBQ-R). Logistic regression models identified significant risk and protective factors. Models were stratified by rural residence using 2023 Rural-Urban Continuum Codes (RUCC) to examine rural-urban disparities, given WV’s predominantly rural yet urban-diverse geography. Results In the weighted sample (N=372,665), 27.5% reported lifetime suicide risk. Those with suicidal thoughts were younger (median age 41), unmarried, in poorer health, and often enrolled in Medicaid. Despite WV’s rural profile, 60.21% of respondents resided in urban-classified counties. Rural residents showed lower odds of suicidal thoughts or behaviors (aOR = 0.87), but factors such as substance use (aOR = 3.75), unmarried status (aOR = 1.51), and mental health disorders (aOR = 2.93) were significant risk factors. Implications Suicide risk factors in WV differ from broader suicidology findings, underscoring the need to address substance use, chronic pain, and mental health in prevention strategies. Further research is needed to explore regional differences in the Appalachian Region for better-targeted interventions.
... Alcohol data are taken from the WHO global alcohol database. The link between female labor force participation and suicide has been the subject of growing literature in recent decades Stack, 2021). These studies suggest a negative relationship between women's labor force participation and the suicide rate of both men and women, suggesting that the well-being of men and women is improved by the accumulation of women's roles. ...
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Suicide rates have increased in several high-income countries in recent decades. The reasons for these increases are unclear. Suicide is a complex public health problem in contemporary societies. At the same time, ICTs significantly affect virtually all aspects of human life. However, despite its importance, there are no empirical studies that examine the effect of ICT access on suicide rates. Therefore, this paper investigates the extent to which access to ICTs affects suicide rates in a sample of 35 OECD countries over the period 2000–2019. The results of the analysis, which remain robust to a battery of controls, reveal that greater access to ICTs is associated with an increase in suicide mortality. Consistent with economic theory, this influence varies by gender. Furthermore, our analysis shows that the effect of ICTs on suicide rates is stronger during post-financial crisis periods. Based on this outcome, it is recommended that policies that better regulate access to ICTs while maintaining their usage are what policymakers should prioritize and pursue.
... These older adults people often face problems such as widowhood, deteriorating physical health, and loss of social roles, which are recognized risk factors for suicide. In some European countries, suicide is historically or culturally viewed as a personal choice, and societal attitudes toward suicidal behavior are relatively tolerant (58). Similarly, in the Americas, many people who live alone place a high value on individualism and free will, which can influence their perspectives on suicide (59,60). ...
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Suicide, a global health concern, can be influenced by living arrangements. Hence, the objective of this systematic review was to assess the extent of the association between living alone and suicidal behaviors. We conducted a comprehensive search across eight databases for prospective studies. Hazard ratios (HR) and 95% confidence intervals were pooled using Stata software. Nine large-scale prospective studies with 3,663,205 participants proved eligible. The results of the meta-analysis showed that the pooled prevalence of living alone was 32%. Living alone was associated with suicide attempts and suicide death even after adjusting for all potential confounding factors (AHR = 1.45, 95% CI: 1.13–1.77; AHR = 1.27, 95% CI: 1.06–1.48). Compared to people who live with others, living alone increases the risk of suicide behaviors. Given the anticipated global rise in suicide rates and the growing prevalence of living alone, it is recommended to explore this issue on a broader scale. Systematic review registration: PROSPERO, identifier: CRD42023464684, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023464684.
... Second, though the current study focused on the likelihood of a suicide attempt, consideration of policy and environmental impacts should extend not only to the prevention of suicide attempts but also in considering the experience of suicidality as a whole (Stack, 2021). Specifically, policy makers and researchers would benefit from examining suicidality in a more comprehensive light inclusive of factors including but not limited to means, frequency, circumstance, and more (Klonsky et al., 2016). ...
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Suicide among transgender and gender diverse (TGD) people in the United States remains a critical public health concern. Previous literature has examined key individual-level factors that decrease the likelihood of suicide among TGD people, such as social support, gender-affirming care, and education. Further, research has consistently suggested disparities in suicidal behavior among TGD people based on race and ethnicity. Despite the recent prioritization of the health of TGD people, the impact of legislation on suicide attempts among TGD people remains relatively unknown. The current study seeks to fill this gap by examining the association between TGD-related policies and suicide attempts and the moderating effect of race/ethnicity using large nationwide data. Data from both the Movement Advancement Project National Equality Map and the 2015 United States Transgender Survey were used. Initial results revealed a significant direct relationship among race/ethnicity, TGD-related policies (health and safety and nondiscrimination), and the likelihood of reporting a suicide attempt in the past 12 months. While controlling for covariates, race/ethnicity significantly moderated the relationship between both types of policies and the likelihood of suicide attempts in the past 12 months. The current results underscore that protective and inclusive TGD-related policies may be an important protective factor in reducing the likelihood of suicide attempts in TGD people across racial/ethnic groups.
... Conceptually, suicidal behavior is a complex and multifactorial phenomenon whose delineation, assessment, prevention, intervention, and postvention require a comprehensive approach focused on the individual's life meaning and suffering in their biographical context and, therefore, social and cultural , 2023aGarcía-Haro et al., 2018;Hawton & Prikis, 2017;Stack, 2021). According to Coppersmith et al. (2023), approximately 9% of the population has suicidal thoughts at some point in their lives. ...
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Suicide is a preventable public health and social problem. Suicidal behavior is a complex and multifactorial phenomenon whose characterization, assessment, prevention, intervention, and postvention require a comprehensive approach focused on the meaning in a person’s life and ttheir suffering in their biographical, social and cultural context. It is an extraordinarily variable phenomenon over time and highly dependent on contextual elements. Method: This editorial includes the social determinants of this phenomenon, key aspects linked to the dehumanization of healthcare settings, the problems of iatrogenic harm in universal prevention programs for schoolchildren and adolescents, and good clinical practices collected in the scientific literature. Results: The editorial highlights the importance of research for the prevention of suicidal behavior from any intervention level, whether educational, community, social, or health, as all are involved in prevention. Conclusions: The goal is to help improve the biographical circumstances of people with suicidal behaviors and the meaningfulness of their lives. This must be done through a collective scaffolding in which the most vulnerable can ask for help when they need it, as well as guide themselves towards life circumstances worth living.
... State of residence is one such risk factor, with suicide risk varying by a factor of three across states. 10 This variation has been associated with state demographics, 11 welfare policies, 12 minimum wage laws, 13 firearm and alcohol availability and firearm laws, 14 among other state differences. ...
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Background Veterans have higher suicide rates than matched non-veterans, with firearm suicides being especially prevalent among veterans. We examined whether state firearm laws and state firearm ownership rates are important risk factors for suicide among veterans. Methods US veteran’s and demographically matched non-veteran’s suicide rates, 2002–2019, are modelled at the state level as a function of veteran status, lethal means, state firearm law restrictiveness, household firearm ownership rates and other covariates. Results Marginal effects on expected suicide rates per 100 000 population were contrasted by setting household firearm ownership to its 75th versus 25th percentile values of 52.3% and 35.3%. Ownership was positively associated with suicide rates for both veterans (4.35; 95% credible interval (CrI): 1.90, 7.14) and matched non-veterans (3.31; 95% CrI: 1.11, 5.77). This association was due to ownership’s strong positive association with firearms suicide, despite a weak negative association with non-firearm suicide. An IQR difference in firearm laws corresponding to three additional restrictive laws was negatively associated with suicide rates for both veterans (−2.49; 95% CrI: −4.64 to –0.21) and matched non-veterans (−3.19; 95% CrI: −5.22 to –1.16). Again, these differences were primarily due to associations with firearm suicide rates. Few differences between veterans and matched non-veterans were found in the associations of state firearm characteristics with suicide rates. Discussion Veterans’ and matched non-veterans’ suicide risk, and specifically their firearm suicide risk, was strongly associated with state firearm characteristics. Conclusions These results suggest that changes to state firearm policies might be an effective primary prevention strategy for reducing suicide rates among veterans and non-veterans.
... Since the 1997 financial crisis, economic difficulties such as unemployment, academic pressure, and cultural difficulties such as isolation of the elderly have contributed significantly to suicide. [42][43][44][45][46] Therefore, it is more important to develop treatment guidelines that reflect these characteristics. However, in the search conducted by this research team, there were very few studies including RCTs, systematic reviews, and meta-analyses that addressed the suicide prevention effect of psychiatric treatment in Korea. ...
Article
Objective Suicide is a significant public health issue, with South Korea having the highest suicide rate among Organisation for Economic Cooperation and Development countries. This study aimed to develop clinical guidelines for suicide prevention in psychiatric patients in Korea using the ADAPTE methodology.Methods The development process involved a comprehensive review of literature, expert consultations, and consensus-building using the Nominal Group Technique and Delphi method. The guidelines focus on evidence-based psychiatric treatments, including both pharmacological and non-pharmacological approaches, tailored to the Korean context. Key findings underscoring the need for standardized treatment protocols for patients with major psychiatric disorders, including bipolar disorder, major depressive disorder, and schizophrenia.Results The guidelines incorporate treatments like lithium, clozapine, atypical antipsychotics, electroconvulsive therapy, and cognitive behavioral therapy, which have shown effectiveness in suicide prevention. Applicability and acceptability within Korea’s healthcare system were addressed, ensuring feasibility given the country’s medical insurance coverage and accessibility. The guidelines were validated through expert reviews and Delphi rounds, achieving consensus on the final recommendations.Conclusion The developed guidelines provide a structured, evidence-based approach to reducing suicide rates among psychiatric patients in Korea. Future research will focus on expanding these guidelines to include screening protocols for high-risk groups.
... The copyright holder for this this version posted September 27, 2024 8 provides a comprehensive analysis of the environmental factors associated with suicide, highlighting the impact of political, social, cultural, and economic influences. It emphasizes the protective role of social institutions such as marriage, parenting, and religiousness, as well as the influence of economic factors such as unemployment and low income on suicide risk. ...
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In the realm of medical research, particularly in the study of suicide risk assessment, the integration of machine learning techniques with traditional statistics methods has become increasingly prevalent. This paper used data from the UNC EHR system from 2006 to 2020 to build models to predict suicide-related death. The dataset, with 1021 cases and 10185 controls consisted of demographic variables and short-term informa- tion, on the subject's prior diagnosis and healthcare utilization. We examined the efficacy of the super learner ensemble method in predicting suicide-related death lever- aging its capability to combine multiple predictive algorithms without the necessity of pre-selecting a single model. The study compared the performance of the super learner against five base models, demonstrating its superiority in terms of cross-validated neg- ative log-likelihood scores. The super learner improved upon the best algorithm by 60% and the worst algorithm by 97.5%. We also compared the cross-validated AUC's of the models optimized to have the best AUC to highlight the importance of the choice of risk function. The results highlight the potential of the super learner in complex predictive tasks in medical research, although considerations of computational expense and model complexity must be carefully managed.
... Similarly, the association between employment status and suicide attempts was found to be more salient in men. Other studies elaborated that a low household income was significantly associated, directly or indirectly, with suicide attempts (Berkelmans et al. 2021;Stack 2021;Tran and Morrison 2020). Major reasons behind high suicide attempt in Pakistan are domestic violence, lack of awareness and mental issues, lack of collaboration, financial issues and failure in achieving life goals. ...
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In contrast to suicide as a rational decision, this study tests suicide as an irrational decision from the perspective of behavioral economics through a social constructionist approach using multiple qualitative datasets. The study explores important constructs such as; incomplete information, the role of emotions, unstable preferences, dependency on others in terms of preferences and decision-making and socio-economic causes. The findings disclose that the ratio of suicide is higher in females than males and the majority of the respondents are under the age of thirty-five in the Northern district of Chitral, Pakistan. Based on the social construct, it has been confirmed that suicide is an irrational decision. The study concludes that rational choice fails to be a better predictor of decisions like suicide. The study also provides some policy recommendations to prevent the suicide rate in district Chitral and gives some future research directions.
... Uma das Ciências que contribui com o estudo fenomenológico do suicídio é a Economia, uma vez que a literatura sugere que aspectos econômicos, tais como desemprego e baixo status socioeconômico, são seus mais fortes preditores. Dessa forma, a Economia aborda o tema por meio de associações entre as ocorrências e aspectos como pobreza, flutuações na renda, demografia, educação, saúde, mercado de trabalho, condições de vida e bem-estar (Stack, 2021; Ferreti & Coluccia, 2009). ...
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O presente estudo tem como objetivo analisar como os investimentos com assistência social se relacionam com as taxas de suicídios por 100 mil habitantes, considerando-se a metodologia de dados em painel dinâmico a partir de dados extraídos do Índice Mineiro de Responsabilidade Social para o estado de Minas Gerais no período compreendido entre os anos de 2002 e 2017. O referido estado é o segundo mais populoso do Brasil e corresponde a terceira maior participação no Produto Interno Bruto (PIB) do país. Os resultados sugerem que o aumento dos referidos investimentos possibilita diminuição das taxas de suicídios. Além disso, verifica-se a persistente e discreta elevação das taxas de suicídios entre os anos 2002-2014, quando há aumento muito expressivo, corroborando com a literatura de que as crises econômicas são catalisadoras desse comportamento. Por fim, conclui-se que as políticas assistenciais são importantes mecanismos de proteção aos indivíduos no tocante às variações dos níveis de renda ao longo do tempo, correspondendo a uma forma eficaz de evitar casos de suicídios, sobretudo quando há efeitos econômicos adversos.
... Retrospective analysis of suicide that focused on the causes and determinants of suicide [39][40][41] showed that political factors such as laws restricting access to alcohol and firearms and social welfare expenditures and social factors such as marriage, parenting, and religiousness were found as preventive against suicide, while media coverage of celebrity suicide could have negatively affected vulnerable persons. Economic factors such as unemployment, debt, low income, and economic recessions were identified as strong predictive factors of suicide behavior. ...
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Suicide research is directed at understanding social, economic, and biological causes of suicide thoughts and behaviors. (1) Background: Worldwide, certain countries have high suicide mortality rates (SMRs) compared to others. Age-standardized suicide mortality rates (SMRs) published by the World Health Organization (WHO) plus numerous bibliographic records of the Web of Science (WoS) database provide resources to understand these disparities between countries and regions. (2) Methods: Hierarchical clustering was applied to age-standardized suicide mortality rates per 100,000 population from 2000–2019. Keywords of country-specific suicide-related publications collected from WoS were analyzed by network and association rule mining. Keyword embedding was carried out using a recurrent neural network. (3) Results: Countries with similar SMR trends formed naturally distinct groups of high, medium, and low suicide mortality rates. Major themes in suicide research worldwide are depression, mental disorders, youth suicide, euthanasia, hopelessness, loneliness, unemployment, and drugs. Prominent themes differentiating countries and regions include: alcohol in post-Soviet countries; HIV/AIDS in Sub-Saharan Africa, war veterans and PTSD in the Middle East, students in East Asia, and many others. (4) Conclusion: Countries naturally group into high, medium, and low SMR categories characterized by different keyword-informed themes. The compiled dataset and presented methodology enable enrichment of analytical results by bibliographic data where observed results are difficult to interpret.
... [19]. The etiology of suicidal behaviors is multifaceted, with a complex interplay of psychological, genetic, and environmental and social factors [20,21]. Recently, substance use, including the consumption of nicotine through smoking, has been identified as a risk factor for suicidal behaviors [22][23][24]. ...
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Background The proliferation of electronic cigarettes (e-cigarettes) has presented new challenges in public health, particularly among adolescents and young adults. While marketed as safer than tobacco and as cessation aids, e-cigarettes have raised concerns about their long-term health and psychosocial impacts, including potential links to increased suicidal behaviors. This study aims to evaluate the relationship between e-cigarette use and suicidal behaviors by conducting a systematic review of the current literature. Methods We searched PubMed, Web of Science, and EMBASE for studies up to March 10, 2024, examining the relationship between e-cigarette use and suicidal behaviors. Eligible studies included cross-sectional, longitudinal, retrospective, prospective, and case–control designs. Meta-analysis was performed to calculate pooled odds ratios (ORs). Newcastle Ottawa scale was used to assess the quality of studies. R software (V 4.3) was used to perform the meta-analysis. Results Our analysis included fourteen studies, predominantly from the US and Korea, with participants ranging from 1,151 to 255,887. The meta-analysis identified a significant association between e-cigarette use and an increased risk of suicidal ideation (OR = 1.489, 95% CI: 1.357 to 1.621), suicide attempts (OR = 2.497, 95% CI: 1.999 to 3.996), and suicidal planning (OR = 2.310, 95% CI: 1.810 to 2.810). Heterogeneity was noted among the studies. Conclusion E-cigarette use is significantly associated with the risk of suicidal behaviors, particularly among adolescents. The findings underscore the necessity for caution in endorsing e-cigarettes as a safer smoking alternative and call for more extensive research to understand the underlying mechanisms. Public health strategies should be developed to address and mitigate the risks of suicidal behaviors among e-cigarette users.
... Regarded as the founder of the scientific study of social determinants of suicidal behavior, he postulated that suicide rates increase during periods of rapid social and economic change (Goldney & Schioldann, 2000). Influenced by his work, many researchers have empirically tested several country-level determinants of suicide (for a review, see Stack, 2021). Some studies have empirically investigated the relationship between various economic factors and country-level suicide rates, but no study so far has investigated the effect of market liberalization on suicide. ...
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This research paper investigates the impact of market liberalization on country-level suicide rates using a sample of 96 developing and developed countries from 1980 to 2019. We estimate fixed-effects panel regression models with robust standard errors clustered at the country level and conduct a variety of robustness checks, including using different estimators and disaggregating the data. We consistently find that the aggregate Economic Freedom of the World (EFW) measure is not statistically significantly related to within-country variations in age-standardized suicide rates, but some individual components are. Freedom to trade internationally weakly predicts increases in suicide rates, while sound money is associated with decreased suicide rates. The former result is highly vulnerable to different specifications. This study underscores the existence of a complex, non-intuitive relationship between market liberalization and suicide rates, suggesting that both critics and defenders of liberalization might be mistaken in making any unequivocal judgments about the process.
... They also play an essential role in planning interventions. (82)(83)(84) Family Factors: Dysfunctional family environments marked by conflict, lack of support, and poor communication can contribute to emotional distress and suicide (85) Social Isolation and Rejection: Feeling lonely, disconnected, and unsupported can create despair, especially for those with mental health vulnerabilities (86,87) Challenges with Sexual Orientation/Gender Identity: Discrimination, internal conflict, and lack of acceptance can lead to significant psychological stress (88,89). ...
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National Task Force on Mental Health and Well-being of Medical Students 2024 National Task Force on Mental Health and Well-being of Medical Students is now formed to assess mental health and wellbeing of medical students following high stress and burnout episodes. The reality is that medical students are at an increased risk of psychological distress compared to the general population. This is not merely a national phenomenon but a global one. Existing global literature consistently recognizes that 30-40% of medical students report mental health problems. There is high prevalence of anxiety, depressive disorders, suicidal ideation, substance use disorders, as well as stress and burnout in this population, said Dr. Suresh Bada Math, chairman National Task Force Wellbeing and Professor of Psychiatry, Head of Unit-5, Head of Telemedicine Centre, Head of Forensic Psychiatry, Officer-in-charge of NIMHANS Digital Academy, National Institute of Mental Health Neuro Sciences (NIMHANS). Hence, a national task force was set up to assess the mental health and well-being of medical students in India. Initially, the Task Force conducted a comprehensive review of scientific literature, which revealed a significant gap in systematic research on the risk factors and effectiveness of interventions for medical students who attempt or complete suicide.
... For example, suicide rates associated with ambient temperature, 98 although possible of modelling, are sometimes less reliable due to underreporting and misclassification of the cause of death. [155][156][157][158] Therefore, analysing the relationship with climate change can be complex, particularly when estimating the fraction of these outcomes attributable to climate change. 159 ...
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Climate change challenges public health. Effective management of climate-related health risks relies on robust public health surveillance (PHS) and population health indicators. Despite existing global and country-specific indicators, their integration into local PHS systems is limited, impacting decision-making. We conducted a systematic review examining population health indicators relevant to climate change impacts and their suitability for national PHS systems. Guided by a registered protocol, we searched multiple databases and included 41 articles. Of these, 35 reported morbidity indicators, and 39 reported mortality indicators. Using Chile as a case study, we identified three sets of indicators for the Chilean PHS. The high-priority set included vector-, food-, and water-borne diseases, as well as temperature-related health outcomes indicators due to their easy integration into existing PHS systems. This review highlights the importance of population health indicators in monitoring climate-related health impacts, emphasising the need for local contextual factors to guide indicator selection. Funding This research project was partly funded by 10.13039/501100020884ANID Chile and 10.13039/501100000765University College London. None of these sources had any involvement in the research conceptualisation, design, or interpretation of the results.
... As outlined by Case & Deaton, growing mortality from overdose and alcohol misuse have been referred to as deaths of despair [8]. These deaths of despair are indicators of a breakdown in the social fabric of our communities [4,[9][10]. While demographic and clinical characteristics are important factors that in uence these mortality rates, efforts to address factors related to chronic stress, such as social disconnectedness and economic strain, are often di cult, expensive, and take time to show change. ...
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Purpose To examine a comprehensive list of demographic, substance use, economic, and social factors associated with suicidal ideation (SI) among middle-aged adults. Methods Cross-sectional data were obtained from a national sample of middle-aged adults between February and November 2022. The study’s final sample include 1,337 respondents who represented the adult population of persons aged 40–60 years in the United States. Bivariate and multivariate statistics were employed to identify significant factors associated with past year SI, in particular single vs. multiple instances of SI. Results Of the sample, 140 (10.4%) reported SI in the past year. Among those, more than half (60.0%, n = 84) reported SI multiple times in the past year. Multivariable logistic regression indicated that those who were a gender minority, engaged in concurrent substance use, or had financial stressors had significantly higher odds of past SI. Multinomial regression found that concurrent substance use (adjusted odds ratio [aOR] 3.17; 95% confidence interval [CI] 1.76–5.70) and having a lower standard of living than their parents/caregivers (aOR 2.99; 95% CI 1.39–6.41) predicted repeated past year SI whereas higher social support was protective against multiple SI experiences (aOR 0.65; 95% CI 0.55–0.78). Conclusion Gender minorities and those reporting concurrent substance use had the highest odds of past year SI. Findings underscore the need to develop public health and clinical interventions tailored to these highest-risk middle-aged adults in order to prevent suicide.
... Além disso, muitos estudos buscam entender as definições culturais do suicídio, bem como as associações entre redução da taxa de suicídio e fatores como gastos governamentais com assistência social, religiosidade e menores taxas de divórcio. Existem também fatores preditores do suicídio, como a aprovação do ato pelo indivíduo, a taxa de desemprego e o baixo status socioeconômico (Stack, 2021). ...
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Este estudo analisa o impacto dos fatores econômicos nas taxas de suicídio por 100.000 habitan-tes nas microrregiões brasileiras, usando uma abordagem de painel dinâmico espacial. Foram utilizados dados do Sistema de Informações de Mortalidade (SIM) no período de 2006 a 2017. Os resultados identificam clusters de altas taxas de suicídio na região Sul e taxas mais baixas nas regiões Norte e Nordeste. Observou-se uma relação inversa entre uma conjuntura econômica positiva e as taxas de suicídio, indicando que aumentos no Produto Interno Bruto (PIB), empre-gabilidade e maiores investimentos em educação, cultura, previdência, saúde e saneamento têm um impacto negativo nas taxas de suicídio. Além disso, uma conjuntura econômica favorável em microrregiões vizinhas também contribui para a redução das taxas de suicídio. Esses resul-tados enfatizam a necessidade de políticas públicas eficazes para reduzir as taxas de suicídio, especialmente na região Sul do Brasil, com atenção especial durante períodos de instabilidade econômica. ABSTRACT This study investigates the impact of economic factors on suicide rates per 100,000 inhabitants in Brazilian microregions using a dynamic spatial panel approach. Data from the Mortality Information System (SIM) from 2006 to 2017 were used. The results identify clusters of high suicide rates in the South region and lower rates in the North and Northeast regions. An inverse relationship was observed between a positive economic situation and suicide rates, indicating that increases in Gross Domestic Product (GDP), employment, and greater investments in education, culture, social security, health, and sanitation have a negative impact on suicide rates. In addition, a favorable economic situation in neighboring microregions also contributes to the reduction of suicide rates. These results emphasize the need for effective public policies to reduce suicide rates, especially in the South region of Brazil, with special attention during periods of economic instability.
... According to the US Centers for Disease Control and Prevention (CDC), in 2021, there were 48,183 suicides in the US, a figure that escalated to 49,449 in 2022, indicating a 2.6% increase [3]. The complexity of suicide prevention is attributed to its multifaceted causes, including societal (e.g., familial responsibilities), political (e.g., policies on minimum wage), cultural (e.g., stereotypes of masculinity), and economic factors (e.g., unemployment, lower socioeconomic status) [4]. Identified risk factors encompass mental health disorders, substance abuse, chronic pain, a history of suicide in the individual or family, experiences of aggression, access to firearms at home, and recent discharge from incarceration [5][6][7][8][9]. ...
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Background Amidst growing evidence of the intricate link between physical and mental health, this study aims to dissect the relationship between the waist-to-weight index (WWI) and suicidal ideation within a representative sample of the US population, proposing WWI as a novel metric for suicide risk assessment. Methods The study engaged a sample of 9500 participants in a cross-sectional design. It employed multivariate logistic and linear regression analyses to probe the association between WWI and suicidal ideation. It further examined potential nonlinear dynamics using a weighted generalized additive model alongside stratified analyses to test the relationship's consistency across diverse demographic and health variables. Results Our analysis revealed a significant positive correlation between increased WWI and heightened suicidal ideation, characterized by a nonlinear relationship that persisted in the adjusted model. Subgroup analysis sustained the association's uniformity across varied population segments. Conclusions The study elucidates WWI's effectiveness as a predictive tool for suicidal ideation, underscoring its relevance in mental health evaluations. By highlighting the predictive value of WWI, our findings advocate for the integration of body composition considerations into mental health risk assessments, thereby broadening the scope of suicide prevention strategies.
... While the national agency's published rates provide an overall picture of suicides across the nation's states and union territories, they do not distinguish between suicides that took place in rural and urban areas of India. Evidence suggests that suicide rates may vary in rural and urban settings and the reasons may also be different, depending on the sociocultural, economic and political context (Hirsch, 2006;Stack, 2021). These factors may also have a direct or indirect role in preventing suicide (Arya et al., 2018;Vijayakumar et al., 2008). ...
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Background The Indian rural population is recognised as one of the vulnerable segments of the society in terms of reporting suicide. Inconsistencies in the reporting of suicide impede the real suicide case, that in turn hinders efforts to prevent suicide. There are differences in suicide motives in rural areas due to the clear cultural and social borders, that could affect reporting. Very few studies have examined these psychological and sociocultural variables in rural context. Thus, the main goal of the current investigation is to comprehend these aspects and recommend strategies accordingly. Method The present study employed in-depth interviewing using focus group discussions on a sample of 93 participants. Through purposive sampling 12 areas were shortlisted from four districts from Bihar State, India. Only those areas were selected, where suicide had occurred in the last one year. All the twelve discussions were finally transcribed and using the thematic analysis approach qualitative data were analysed. Results Three themes appeared followed by their subthemes. First theme was apprehensions and fears and the subtheme emerged were society's reaction towards suicide and legal procedure. Second theme was religious belief related to suicide and the subthemes were, soul wandering, unfulfilled desire of the soul, and life after death. Third theme was females were more underreported and subtheme emerged i.e., protecting the honour of the family, and laws related to women social issues. Conclusion Findings of this study suggest that psychosocial and cultural factors serve as barrier in reporting and hinders suicide prevention process. This finding indicates that formulating multisectoral approach in reducing community attitude and stigma of rural population towards suicide.
... mas da população/cultura no geral.Os fatores associados ao suicídio podem ser classificados em 4 níveis24 : políticos, sociais, culturais e econômicos. Para os dados dessa pesquisa interessa--nos os aspectos culturais-comportamento midiático, cultura de armas, cultura de uso de álcool e drogas e socialização de gênero-e os sociais-status marital, relações familiares, integração comunitária e religião. ...
Article
Introdução: O suicídio é um fenômeno complexo que representa um problema de saúde pública. Existem grupos que estão em maior risco para o suicídio, mas a estigmatização e o desconhecimento sobre o tema podem interferir na identificação e tratamento. Objetivo: verificar possível relação entre o comportamento suicida, os estigmas relacionados e o conhecimento sobre suicídio. Métodos: Os 29 participantes foram selecionados em duas cidades do interior de Minas Gerais no segundo semestre de 2019. Eles foram divididos em três grupos de acordo com a presença do comportamento suicida. Foram aplicados quatro instrumentos: entrevista semiestruturada com Questionário Sociodemográfico, Self-Reporting Questionnaire, Stigma of Suicide Scale–Short Form, Literacy of Suicide Scale–Short Form. A comparação de subgrupos de interesse foi realizada através do teste Kruskall-Wallis e o grupo estudado nesta pesquisa foi comparado a amostras mais representativas da população em geral. Resultados: Grande parte dos participantes possuía algum diagnóstico de transtorno mental (82,8%). O valor médio da pontuação obtido nos questionários de estigma e conhecimento foi similar entre os subgrupos (p = 0,945 e p = 0,847, respectivamente). Porém foi identificado que o grupo deste estudo apresentou mais estigmas e glorificação do suicídio do que a amostra normativa. Conclusão: O estudo evidenciou pontuação semelhante entre os questionários sobre estigma, isolamento, normalização e conhecimento a respeito do suicídio. A estigmatização do suicídio é um fenômeno social prejudicial, portanto sua compreensão faz-se importante para prevenção e tratamento do comportamento suicida no âmbito da saúde pública.
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Background Corruption, a multifaceted governance issue, impacts public well-being globally. The recent trends reveal a rise in suicide rates across the Americas, while all other regions show declines over twenty years of time. This study investigates corruption’s effect on suicide in 26 American countries, considering moderating factors of unemployment, inflation, and economic growth. Methods This study analysed latest two decades of available data, using stepwise panel regression method to investigate the effects of corruption and economic variables on suicide across income levels. Data were sourced from Transparency International, World Bank and the World Health Organization. Initially, unit root tests and CUSUM plots were used to ensure the stability and stationarity of the dataset, and model specification were validated through F test, LM test and Hausman test to select the ideal econometric model - POLS, REM, or FEM for the study. Results A strong suicide rate persistence revealed, particularly in high-income countries, where the lagged suicide variable showed a coefficient of 0.8063 (p < 0.001). Corruption significantly impacted suicide rates in upper-middle-income countries (coefficient = -0.0268, p < 0.05), with higher corruption perceptions scores correlating with lower suicide rates. Additionally, unemployment acted as a significant moderator, intensifying the corruption’s adverse impact on suicide with a coefficient of 0.0022 (p < 0.001) in upper-middle income nations. Economic growth demonstrated a minor protective effect, particularly in high-income regions, with an interaction coefficient of -0.0005 (p < 0.1), suggesting slight suicide reduction linked to economic stability. Conclusion This study found that corruption, unemployment, and economic growth significantly influence suicide rates across the Americas. Corruption exacerbates suicide risks in upper-middle-income countries, while unemployment amplifies this effect. Economic growth offers a slight protective effect, particularly in high-income regions, suggesting that economic stability may help mitigate suicide rates.
Article
South Korea has the highest suicide rate in the world, while Bangladesh, China, Hong Kong, Japan, Sri Lanka and Taiwan also report relatively high suicide rates. The reasons behind the higher suicide rates in these countries remain a complex issue. Conversely, Muslim countries such as Iran, Pakistan, Saudi Arabia and Turkey had relatively lower suicide rates in the world. This study aims to identify the key reasons behind the high suicide rates. Therefore, analysis revealed that there are gender impacts and economic factors that cause suicide trends mainly in South Korea, Japan, Sri Lanka and Asia. Using quantitative methodology and secondary data, the study first performed a comparative analysis of suicide rates in three selected countries, identifying trends and underlying reasons. Next, the study performed an econometric analysis using time series panel data from 2000 to 2019, focusing on a sample of 12 Asian countries. This analysis utilized pooled ordinary least-squares estimation, panel fixed effects and random effects estimation, accompanied by the Hausman test. Key findings indicate that there is an increasing trend in the suicide rate in South Korea, while there are decreasing trends in Japan and Sri Lanka. Remarkably, the study observed that the female suicide rate is higher than the male suicide rate in South Korea, while in Japan and Sri Lanka, it is the opposite. Moreover, the empirical results show that unemployment, inflation and remittances are significant economic factors influencing the suicide rate in Asia. Specifically, remittances have a significantly negative impact on suicide rates, whereas unemployment and inflation have a significantly positive effect.
Article
In this paper, we investigate similarities of suicide rates in Europe, which are available as interval time series. For this aim, a novel spatio-temporal hierarchical clustering algorithm for interval time-series data is proposed. The spatial dimension is included in the clustering process to account for possible relevant information such as weather conditions, sunlight hours and socio-cultural factors. Our results indicate the presence of six main clusters in Europe, which almost overlap with the sunlight hours distribution. Differences between male and female suicide rates are also investigated.
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Élaboré dans le cadre de l’Observatoire national du suicide, le présent article vise à présenter une synthèse des données épidémiologiques et réfl exions sociologiques sur les comportements suici- daires en France et en Europe ainsi que leurs principaux déterminants sociaux. Pour approcher les conduites suicidaires, très intriquées à la thématique de la santé mentale, plu- sieurs types d’indicateurs statistiques peuvent être mobilisés qui ne répondent pas tous aux mêmes dynamiques : nombres et proportions de suicides, tentatives de suicide, automutilations non suici- daires et pensées suicidaires. Ces phénomènes sont des faits sociaux autant qu’ils répondent à une grande souffrance subjective. La surveillance épidémiologique dont ils font l’objet permet de dégager des tendances et de pointer des populations particulièrement à risque car ils varient singulièrement selon différentes caractéristiques démographiques et socioéconomiques.
Article
Purpose: Suicide increases in Brazil annually and the population search for spiritual care, as in Spiritism, a religion that attracts people in psychic pain. We sought to identify the factors associated with suicidal ideation among persons with some Level of Spiritism Engagement (LSE), before and during COVID-19. Methods: This cross-sectional analytical research with 848 inhabitants from Ceará, Brazil, with some LSE, was conducted through digital data collection via snowball, with a bivariate (p < 0,30), multivariate (p < 0,30) and multinomial analysis (p < 0,05) of sociodemographic factors, psychic status, psychic care, spiritual belief and LSE related to suicidal ideation. Afterward, a multinomial regression analysis (p < 0.05) was conducted on all significant factors to identify those most strongly associated with suicidal ideation. Results: Risk factors of mild/moderate suicidal ideation were to be single (OR=2,32; CI 1,19-4,52), previous psychotherapy before COVID-19 (OR=1,81; CI 1,10-2,98) and to be spiritist (OR=2,43; CI 1,34-4,38). Risk factors of severe suicidal ideation were: to be single (OR=4,05; CI 1,89-8,69), unemployed (OR=2,93; CI 1,45-5,92), have a regular/bad/worse self-perception of emotional health (OR=4,84; CI 2,55-9,17), previous psychotherapy before COVID-19 (OR=2,57; CI 1,40-4,71) and to be spiritist (OR=2,13; CI 1,00-4,52). Pre-pandemic regular/high/very high LSE was a protective factor for severe suicidal ideation during COVID-19 (OR=0,38; CI 0,16-0,90). Conclusion: Negative self-perception of emotional health, psychotherapeutic follow-up, and identification as spiritist were associated with severe suicidal ideation, which appears to support the notion that spiritism attracts individuals experiencing psychic distress. Despite this disease profile, higher levels of spiritist engagement before the pandemic were protective against severe suicidal ideation during COVID-19, suggesting a potential positive effect of spiritism on mental health.
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Background Corruption, a multifaceted governance issue, impacts public well-being globally. The recent trends reveal a rise in suicide rates across the Americas, while all other regions show declines over twenty years of time. This study investigates corruption’s effect on suicide in 26 American countries, considering moderating factors of unemployment, inflation, and economic growth. Methods This study analysed latest two decades of available data, using stepwise panel regression method to investigate the effects of corruption and economic variables on suicide across income levels. Data were sourced from Transparency International, World Bank and the World Health Organization. Initially, unit root tests and CUSUM plots were used to ensure the stability and stationarity of the dataset, and model specification were validated through F test, LM test and Hausman test to select the ideal econometric model - POLS, REM, or FEM for the study. Results A strong suicide rate persistence revealed, particularly in high-income countries, where the lagged suicide variable showed a coefficient of 0.8063 (p < 0.001). Corruption significantly impacted suicide rates in upper-middle-income countries (coefficient = -0.0268, p < 0.05), with higher corruption perceptions scores correlating with lower suicide rates. Additionally, unemployment acted as a significant moderator, intensifying the corruption’s adverse impact on suicide with a coefficient of 0.0022 (p < 0.001) in upper-middle income nations. Economic growth demonstrated a minor protective effect, particularly in high-income regions, with an interaction coefficient of -0.0005 (p < 0.1), suggesting slight suicide reduction linked to economic stability. Conclusion This study found that corruption, unemployment, and economic growth significantly influence suicide rates across the Americas. Corruption exacerbates suicide risks in upper-middle-income countries, while unemployment amplifies this effect. Economic growth offers a slight protective effect, particularly in high-income regions, suggesting that economic stability may help mitigate suicide rates.
Article
Despite long-standing evidence linking higher unemployment rates to increased suicide rates, a puzzling trend emerged in the United States after the Great Recession: suicide rates continued to rise even as unemployment rates declined. Drawing on theories of social networks and reference groups, we advance the concept of “sameness”—in this case, the extent to which an individual’s employment status aligns with the fate of others in one’s community—to clarify how unemployment rates influence suicide. Constructing a multilevel dataset of U.S. suicide deaths from 2005 to 2017, we find that while unemployed individuals face a higher risk of suicide compared to the employed, this gap diminishes in communities with high local unemployment rates. Moreover, the “sameness” effect extends beyond geographic contexts to temporal ones, as national unemployment spikes reduce suicide risk among the unemployed and diminish the importance of local sameness. Together, these findings suggest a mechanism of “situational awareness,” whereby local and national economic contexts shape the meaning of unemployment, shifting its interpretation from personal failure to system failure and reducing its stigma. Our article offers a novel framework for examining the effects of cross-level interactions in suicide research, highlighting the crucial role of culture as deeply intertwined with social network mechanisms in shaping contextual influence.
Article
Over 180,000 black soldiers served in the Union Army in the American Civil War. They endured horrific deprivation and disease, and also substantial institutional discrimination in such areas as wage and promotion. Nevertheless, most never deserted their duties as soldiers. However, it is not clear what distinguished those who did desert from their counterparts. The present case‐control study fills this gap. It applies social bonds theory to explain desertion among blacks. The general hypothesis is the greater the bonds or stakes to the military unit, the lower the risk of desertion. Data refer to the First Michigan Colored Infantry (First Michigan) and are from the Bentley Historical Library, University of Michigan. They refer to the population of all 189 deserters in the First Michigan and a comparison group of non‐deserters. Available measures of social bonds include substitute status (substitutes received a bounty upon completion of service), receiving a wound (having “skin in the game”), and noncommissioned officer status. In addition, loyalty to family is framed as a risk factor. The dependent variable is desertion, a dichotomy (0,1). Results are adjusted for other measurable variables. A multivariate logistic regression analysis determined that measures of military social bonds were protective factors against desertion. Substitutes were 73% less apt, wounded soldiers 93% less apt, and noncommissioned officers were 79% less apt to desert than their counterparts. However, family bonds were a risk factor. The model correctly classified 77.95% of the cases. The results largely support a social bonds theory of deviance, but also may support views of the conflicting bonds between family and state as increasing desertion. The investigation is the first quantitative study of desertion among blacks in the Civil War.
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Self-harm is when someone hurts themselves on purpose, regardless of the reasons for doing this. Often, shame and stigma stop people from seeking help. Self-harming behaviour increases the risk of death by suicide, and it is a common cause of disability in young people. Currently, people attending health services only represent the tip of the iceberg; the proportion of teenagers self-harming has increased over the past 20 years—this is particularly so for young women and girls. The Lancet Commission on self-harm concludes that our cultures and societies play a major role in driving self-harming behaviours. The public health impact of self-harm has been neglected by governments globally. By delivering transformative shifts in societal attitudes, and initiating radical redesign of mental health care, we can fundamentally improve the lives of people who self-harm. Governments need to act to tackle the societal and commercial determinants of self-harming behaviours. The punishment of people who self-harm must stop. People who self-harm need better access to high-quality, compassionate services for support and treatment. Mainstream and social media outlets need to share information about self-harm responsibly and sympathetically.
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Global suicide rates owing to disaster impacts have been confusing because of varied and unclear results. This study aimed to investigate how suicides have occurred worldwide during disasters. The methodology used included a systematic literature review and comparative analysis. The disaster exacerbation (X, bad human nature, or suicide rate rise) perspective was compared with the disaster resilience (Y, good human nature, or suicide rate fall) perspective to extract disaster ecology (Z, neutral human nature, or suicide rate fluctuation) perspective from international leaders, government officials, researchers, and disaster victims. A major theme was that the four stakeholders would adopt the Z perspective based on the fusion of X and Y perspectives (leading to X+Y=Z), while embracing heterogeneous research, proactive and long-term strategies, education, and so on. This study relied heavily on the large-scale dynamics of suicide rates than previous studies.
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Introduction People with severe mental illness (SMI) have a higher risk of suicide compared with the general population. However, variations in suicide methods between people with different SMIs have not been examined. The aim of this pre‐registered (PROSPERO CRD42022351748) systematic review was to pool the odds of people with SMI who die by suicide versus those with no SMI, stratified by suicide method. Methods Searches were conducted on December 11, 2023 across PubMed, PsycInfo, CINAHL, and Embase. Eligible studies were those that reported suicide deaths stratified by SMI and suicide methods. Studies were pooled in a random‐effects meta‐analysis, and risk of bias was measured by the Joanna Briggs Institute checklist. Results After screening, 12 studies were eligible ( n = 380,523). Compared with those with no SMI, people with schizophrenia had 3.38× higher odds of jumping from heights (95% CI: 2.08–5.50), 1.93× higher odds of drowning (95% CI: 1.50–2.48). People with bipolar disorder also had 3.2× higher odds of jumping from heights (95% CI: 2.70–3.78). Finally, people with major depression had 3.11× higher odds of drug overdose (95% CI: 1.53–6.31), 2.11× higher odds of jumping from heights (95% CI: 1.93–2.31), and 2.33× lower odds of dying by firearms (OR = 0.43, 95% CI: 0.33–0.56). No studies were classified as high risk of bias, and no outcomes had high levels of imprecision or indirectness. Conclusion These findings could inform lethal means counselling practices in this population. Additionally individual, clinical, community and public health interventions for people with SMI should prioritise, where feasible, means restriction including access to heights or drugs to overdose.
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Purpose This study aims to evaluate the changes in the sustainability of fiscal policies in South Africa and selected Southern African Development Community (SADC) countries by employing the Kalman filter and Markov switching model and further overcome the limitations of previous studies by considering the impact of previously neglected variables. Design/methodology/approach The paper utilizes regression analysis, the Kalman filter, and the Markov switching model. By analysing GDP data for SADC countries, regime shifts are estimated, and fiscal sustainability is evaluated. To enhance numerical adaptation, a random walk state space model is incorporated into the conventional Kalman filter. Originality and value This study significantly contributes to academia and the field of economics in South Africa by addressing previous research limitations on fiscal policy sustainability. It incorporates previously omitted variables and employs advanced estimation techniques, such as the random walk-based Kalman filter and Markov switching model, to provide a comprehensive understanding of fiscal sustainability in South Africa and selected SADC countries. The findings offer valuable recommendations for policymakers and government authorities, including the necessity of fiscal consolidation to reduce debt, adherence to specified borrowing ratios, and reforms to increase savings and overall fiscal sustainability in the SADC region. Findings The random walk-based Kalman filter exhibits superior numerical adaptation compared to the conventional approach. An analysis of normalized financial impacts reveals significant variations in fiscal sustainability among SADC countries and different GDP categories. Countries with higher GDPs generally exhibit greater financial sustainability, while those with lower GDPs face more challenges in this regard. Conclusion Advanced estimation techniques like the random walk-based Kalman filter and Markov switching model offer critical insights into fiscal sustainability in South Africa and the broader SADC region. They further provide a more accurate and comprehensive analysis, revealing significant variations in fiscal stability across different GDP categories.
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Objective To examine the association between reporting on suicides, especially deaths of celebrities by suicide, and subsequent suicides in the general population. Design Systematic review and meta-analysis. Data sources PubMed/Medline, PsychInfo, Scopus, Web of Science, Embase, and Google Scholar, searched up to September 2019. Review methods Studies were included if they compared at least one time point before and one time point after media reports on suicide; follow-up was two months or less; the outcome was death by suicide; and the media reports were about non-fictional suicides. Data from studies adopting an interrupted time series design, or single or multiple arm before and after comparisons, were reviewed. Results 31 studies were identified and analysed, and 20 studies at moderate risk of bias were included in the main analyses. The risk of suicide increased by 13% in the period after the media reported a death of a celebrity by suicide (rate ratio 1.13, 95% confidence interval 1.08 to 1.18; 14 studies; median follow-up 28 days, range 7-60 days). When the suicide method used by the celebrity was reported, there was an associated 30% increase in deaths by the same method (rate ratio 1.30, 95% confidence interval 1.18 to 1.44; 11 studies; median follow-up 28 days, range 14-60 days). For general reporting of suicide, the rate ratio was 1.002 (0.997 to 1.008; five studies; median follow-up 1 day, range 1-8 days) for a one article increase in the number of reports on suicide. Heterogeneity was large and partially explained by celebrity and methodological factors. Enhanced funnel plots suggested some publication bias in the literature. Conclusions Reporting of deaths of celebrities by suicide appears to have made a meaningful impact on total suicides in the general population. The effect was larger for increases by the same method as used by the celebrity. General reporting of suicide did not appear to be associated with suicide although associations for certain types of reporting cannot be excluded. The best available intervention at the population level to deal with the harmful effects of media reports is guidelines for responsible reporting. These guidelines should be more widely implemented and promoted, especially when reporting on deaths of celebrities by suicide. Systematic review registration PROSPERO CRD42019086559.
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In the United States, men die by suicide at 3.5 times the rate of women.¹ One driver of this gender disparity may be high traditional masculinity (HTM), a set of norms that includes competitiveness, emotional restriction, and aggression.² Quantitative studies of HTM are interrelated with discourse on hegemonic masculinity.³ Using norm- and trait-based measures, HTM men were found to have higher suicidal ideation (SI),²,4 but to our knowledge, the association with suicide death has not been tested with a credible measure of HTM.
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Objectives To use the estimates from the Global Burden of Disease Study 2016 to describe patterns of suicide mortality globally, regionally, and for 195 countries and territories by age, sex, and Socio-demographic index, and to describe temporal trends between 1990 and 2016. Design Systematic analysis. Main outcome measures Crude and age standardised rates from suicide mortality and years of life lost were compared across regions and countries, and by age, sex, and Socio-demographic index (a composite measure of fertility, income, and education). Results The total number of deaths from suicide increased by 6.7% (95% uncertainty interval 0.4% to 15.6%) globally over the 27 year study period to 817 000 (762 000 to 884 000) deaths in 2016. However, the age standardised mortality rate for suicide decreased by 32.7% (27.2% to 36.6%) worldwide between 1990 and 2016, similar to the decline in the global age standardised mortality rate of 30.6%. Suicide was the leading cause of age standardised years of life lost in the Global Burden of Disease region of high income Asia Pacific and was among the top 10 leading causes in eastern Europe, central Europe, western Europe, central Asia, Australasia, southern Latin America, and high income North America. Rates for men were higher than for women across regions, countries, and age groups, except for the 15 to 19 age group. There was variation in the female to male ratio, with higher ratios at lower levels of Socio-demographic index. Women experienced greater decreases in mortality rates (49.0%, 95% uncertainty interval 42.6% to 54.6%) than men (23.8%, 15.6% to 32.7%). Conclusions Age standardised mortality rates for suicide have greatly reduced since 1990, but suicide remains an important contributor to mortality worldwide. Suicide mortality was variable across locations, between sexes, and between age groups. Suicide prevention strategies can be targeted towards vulnerable populations if they are informed by variations in mortality rates.
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Objective Higher prevalence of suicide notes could signify more conservatism in accounting and greater proneness to undercounting of suicide by method. We tested two hypotheses: (1) an evidentiary suicide note is more likely to accompany suicides by drug-intoxication and by other poisoning, as less violent and less forensically overt methods, than suicides by firearm and hanging/suffocation; and (2) performance of a forensic autopsy attenuates any observed association between overtness of method and the reported presence of a note. Methods This multilevel (individual/county), multivariable analysis employed a generalized linear mixed model (GLMM). Representing the 17 states participating in the United States National Violent Death Reporting System throughout 2011–2013, the study population comprised registered suicides, aged 15 years and older. Decedents totaled 32,151. The outcome measure was relative odds of an authenticated suicide note. Results An authenticated suicide note was documented in 31% of the suicide cases. Inspection of the full multivariable model showed a suicide note was more likely to manifest among drug intoxication (adjusted odds ratio [OR], 1.70; 95% CI, 1.56, 1.85) and other poisoning suicides (OR, 2.12; 1.85, 2.42) than firearm suicides, the referent. Respective excesses were larger when there was no autopsy or autopsy status was unknown (OR, 1.86; 95% CI, 1.61, 2.14) and (OR, 2.25; 95% CI, 1.86, 2.72) relative to the comparisons with a forensic autopsy (OR, 1.62, 95% CI, 1.45, 1.82 and OR, 2.01; 95% CI, 1.66, 2.43). Hanging/suffocation suicides did not differ from the firearm referent given an autopsy. Conclusions Suicide requires substantial affirmative evidence to establish manner of death, and affirmation of drug intoxication suicides appears to demand an especially high burden of proof. Findings and their implications argue for more stringent investigative standards, better training, and more resources to support comprehensive and accurate case ascertainment, as the foundation for developing evidence-based suicide prevention initiatives.
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The present analysis contributes to the existing literature on religion and suicide in three interrelated ways: (1) providing an analysis of suicide completions whereas most research is based on non-lethal levels of suicidality; (2) assessing the relationship with concrete individual level data on completed suicides instead of aggregated data marked by the ecological fallacy issue; and (3) providing gender specific analyses to determine if the relationship is gendered. METHODS. Data come from the U.S. Public Health Service, National Mortality Followback Survey. They refer to 16,795 deaths including 1385 suicides. Significant others of the deceased were interviewed to measure all variables. The dependent variable is a binary variable where 1 = death by suicide and 0 = all other causes. The central independent variable is an index of religious activities. Controls are included for five categories of confounders (1) psychiatric morbidity; (2) help-seeking behavior; (3) Opportunity factors such as firearms; (4) social integration; and (5) demographics. RESULTS. Multivariate logistic regression analysis determined that controlling for 16 predictors of suicide, a one unit increase in religious activities reduced the odds of a suicide death by 17% for males and by 15% for females. The difference in coefficients is not significant (Z = 0.51). Other significant predictors of suicide deaths included suicide ideation (OR = 8.87, males, OR = 11.48, females) and firearm availability (OR = 4.21, males, OR = 2.83, females). DISCUSSION. Religious activities were found to lower suicide risk equally for both men and women. Further work is needed to assess pathways, including suicide ideation, between religious activities and lowered suicide risk. This is the first U.S. based study to test for a gendered association between religion and suicide at the individual level of analysis.
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Investigating suicides following the death of Robin Williams, a beloved actor and comedian, on August 11th, 2014, we used time-series analysis to estimate the expected number of suicides during the months following Williams’ death. Monthly suicide count data in the US (1999–2015) were from the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER). Expected suicides were calculated using a seasonal autoregressive integrated moving averages model to account for both the seasonal patterns and autoregression. Time-series models indicated that we would expect 16,849 suicides from August to December 2014; however, we observed 18,690 suicides in that period, suggesting an excess of 1,841 cases (9.85% increase). Although excess suicides were observed across gender and age groups, males and persons aged 30–44 had the greatest increase in excess suicide events. This study documents associations between Robin Williams’ death and suicide deaths in the population thereafter.
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Research on religion as a protective factor has been marked by four recurrent limitations: (1) an overemphasis on the United States, a nation where religiosity is relatively high; (2) a neglect of highly secularized zones of the world, where religiousness may be too weak to affect suicide; (3) restriction of religiousness to religious affiliation, a construct which may miss capturing other dimensions of religiousness such as the importance of religion in one's life; and (4) an overwhelming use of the nation as a unit of analysis, which masks variation in religiousness within nations. The present article addresses these limitations by performing a cross-national test of the following hypothesis: The greater the strength of subjective religiousness, the lower the suicide rate, using small units of analysis for a secularized area of the world. All data refer to 162 regions within 22 European nations. Data were extracted from two large databases, EUROSTAT and the European Social Surveys (ESS Round 4), and merged using NUTS-2 (Nomenclature of Statistical Territorial Units) regions as the unit of analysis. Controls are incorporated for level of economic development, education, and measures of economic strain. The results of a multiple regression analysis demonstrated that controlling for the other constructs in the model, religiousness is associated with lower suicide rates, confirming the hypothesis. Even in secularized European nations, where there is a relatively weak moral community to reinforce religion, religiousness acts as a protective factor against suicide. Future work is needed to explore the relationship in other culture zones of the world.
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Can a society’s overall level of happiness change? Until recently, it was widely held that happiness fluctuates around set-points, so that neither individuals nor societies can lastingly increase their happiness. However, data from surveys carried out in Russia from 1982 to 2011 show that happiness fell substantially following the collapse of the Soviet Union, and has begun to rise again only recently. Additional data sources, including suicide rates and indices of negative affect expression, confirm these shifts. Contrary to set-point theory, we find that the recent increase has been driven as much by generational replacement as by mean reversion among individuals. The collapse of communism led to a permanent drop in subjective wellbeing among mid-life cohorts that was subsequently never fully recovered. Happiness can be substantially and permanently impacted by life-events, including those affecting society as a whole, and societal-level happiness can rise or fall over time as a result.
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In the mid-1990s Mexican states began adopting reforms that for the first time criminalized domestic violence. Two separate policies were also adopted which allowed domestic violence to be grounds for divorce and established prevention and assistance programs for victims of domestic violence. I exploit the variation in time and geography to estimate the impact of these three policies on female suicide rates using a difference-in-difference methodology. The results indicate that states that criminalized domestic violence exhibited a 22–34% decrease in suicide rates compared to non-adopting states, but there is no robust evidence that the other two policies had any impact. A battery of tests provides support for the robustness of these findings and indicates that most of the effects are concentrated among married women. Analysis of a cross-sectional, nationally representative survey covering violence against women in Mexico suggests reduction in sexual and physical violence as a possible mechanism behind the reduction in female suicide rates. These findings are consistent with an intra-household bargaining model with asymmetric information and costly conflict which predicts that policies that reduce conflict within the household can reduce female suicides. The results highlight the importance of developing and implementing policies that facilitate reporting and providing access to legal institutions for victims of domestic violence, which can in turn improve a victim’s wellbeing.
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Suicidal thoughts and behaviors (STBs) are major public health problems that have not declined appreciably in several decades. One of the first steps to improving the prevention and treatment of STBs is to establish risk factors (i.e., longitudinal predictors). To provide a summary of current knowledge about risk factors, we conducted a meta-analysis of studies that have attempted to longitudinally predict a specific STB-related outcome. This included 365 studies (3,428 total risk factor effect sizes) from the past 50 years. The present random-effects meta-analysis produced several unexpected findings: across odds ratio, hazard ratio, and diagnostic accuracy analyses, prediction was only slightly better than chance for all outcomes; no broad category or subcategory accurately predicted far above chance levels; predictive ability has not improved across 50 years of research; studies rarely examined the combined effect of multiple risk factors; risk factors have been homogenous over time, with 5 broad categories accounting for nearly 80% of all risk factor tests; and the average study was nearly 10 years long, but longer studies did not produce better prediction. The homogeneity of existing research means that the present meta-analysis could only speak to STB risk factor associations within very narrow methodological limits-limits that have not allowed for tests that approximate most STB theories. The present meta-analysis accordingly highlights several fundamental changes needed in future studies. In particular, these findings suggest the need for a shift in focus from risk factors to machine learning-based risk algorithms. (PsycINFO Database Record
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Objective: To review the association between exposure to interpersonal violence and suicide among women. Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P), this review examined articles identified by using the key terms 'interpersonal violence', 'suicide' and 'death'. Of 5,536 articles identified, 38 met the a priori inclusion criteria. These required that studies examined interpersonal violence, included women and completed suicide was a measured outcome. Results: Thirty-eight studies were identified. These examined suicides among women exposed to interpersonal violence as a victim (n=27) or perpetrator (n=14). A history of interpersonal violence was identified in 3.5-62.5% of female suicides, with many articles finding victims of abuse have an increased risk of death from suicide. Females perpetrating violence may also be at increased the risk of death from suicide. However, several papers have questioned these associations. Further, the contribution of mental illness to this association is unclear. Conclusions: Although the association between suicide and interpersonal violence requires further investigation, being a victim or perpetrator of violence appears to be associated with risk of suicide. Future research should focus on the impact that the type of violence, victim-perpetrator relationship and proximity of violence has on the risk of death from suicide. Implications for Public Health: There may be significant opportunity for targeted suicide prevention strategies among women who have been victims or perpetrators of interpersonal violence.
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Durkheim conceived of suicide as a product of social integration and regulation. Although the sociology of suicide has focused on the role of disintegration, to our knowledge, the interaction between integration and regulation has yet to be empirically evaluated. In this article we test whether more egalitarian gender norms, an important form of macro-regulation, protects men and women against suicidality during economic shocks. Using cross-national data covering 20 European Union countries from the years 1991 to 2011, including the recent economic crises in Europe, we first assessed the relation between unemployment and suicide. Then we evaluated potential effect modification using three measures of gender equality, the gender ratio in labour force participation, the gender pay gap, and women’s representation in parliament using multiple measures. We found no evidence of a significant, direct link between greater gender equality and suicide rates in either men or women. However, a greater degree of gender equality helped protect against suicidality associated with economic shocks. At relatively high levels of gender equality in Europe, such as those seen in Sweden and Austria, the relationship between rising unemployment rates and suicide in men disappeared altogether. Our findings suggest that more egalitarian forms of gender regulation may help buffer the suicidal consequences of economic shocks, especially in men.
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Using previous research, we examined the impact of 4 handgun laws (waiting periods, universal background checks, gun locks, and open carrying regulations) on suicide rates. We used publicly available databases to collect information on statewide laws, suicide rates, and demographic characteristics for 2013. Each law was associated with significantly lower firearm suicide rates and the proportion of suicides resulting from firearms. In addition, each law, except for that which required a waiting period, was associated with a lower overall suicide rate. Follow-up analyses showed a significant indirect effect on overall suicide rates through the proportion of suicides by firearms, indicating that the reduced overall suicide rate was attributable to fewer suicide attempts, fewer handguns in the home, suicide attempts using less lethal means, or a combination of these factors. States that implemented any of these laws saw a decreased suicide rate in subsequent years, whereas the only state that repealed 1 of these laws saw an increased suicide rate. Our results were supportive of a potentially vital role in suicide prevention for state legislation that limits access and exposure to handguns. (Am J Public Health. Published online ahead of print August 13, 2015: e1-e10. doi:10.2105/AJPH.2015.302753).
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To provide a systematic update of the evidence concerning the relationship between economic recession and suicide. A keyword search of Ovid Medline, Embase, Embase Classic, PsycINFO and PsycARTICLES was performed to identify studies that had investigated the association between economic recession and suicide. Thirty-eight studies met predetermined selection criteria and 31 of them found a positive association between economic recession and increased suicide rates. Two studies reported a negative association, two articles failed to find such an association, and three studies were inconclusive. Economic recession periods appear to increase overall suicide rates, although further research is warranted in this area, particularly in low income countries.
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Suicide is a major public health concern and a leading cause of death around the world. How religion influences the risk of completed suicide in different settings across the world requires clarification in order to best inform suicide prevention strategies. A meta-analysis using search results from Pubmed and Web of Science databases was conducted following PRISMA protocol and using the keywords "religion" or "religious" or "religiosity" or "spiritual" or "spirituality" plus "suicide" or "suicidality" or "suicide attempt". Random and fixed effects models were used to generate pooled ORs and I2 values. Sub-analyses were conducted among the following categories: young age (<45yo), older age (≥45yo), western culture, eastern culture, and religious homogeneity. Nine studies that altogether evaluated 2339 suicide cases and 5252 comparison participants met all selection criteria and were included in the meta-analysis. The meta-analysis suggested an overall protective effect of religiosity from completed suicide with a pooled OR of 0.38 (95% CI: 0.21-0.71) and I2 of 91%. Sub-analyses similarly revealed significant protective effects for studies performed in western cultures (OR = 0.29, 95% CI: 0.18-0.46), areas with religious homogeneity (OR = 0.18, 95% CI: 0.13-0.26), and among older populations (OR = 0.42, 95% CI: 0.21-0.84). High heterogeneity of our meta-analysis was attributed to three studies in which the methods varied from the other six. Religion plays a protective role against suicide in a majority of settings where suicide research is conducted. However, this effect varies based on the cultural and religious context. Therefore, public health professionals need to strongly consider the current social and religious atmosphere of a given population when designing suicide prevention strategies.
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Previous individual-level research on the association between the status of divorce and suicide risk has been marked by two recurrent limitations: (a) it is not clear if the timing of divorce (recent vs. distal) affects risk of completed suicides and (b) it is not clear if the association between divorce and suicide completions will withstand controls for a series of risk and protective factors including psychiatric morbidity. The present study addresses these two gaps in the literature. Data are from the National Mortality Follow Back Survey and refer to 13,897 deaths including 1,169 suicides. A model is estimated that controls for major alternative predictors of suicide completions including psychiatric predictors (depression scale) and sociological risk and protective factors (job loss, job demotion, and religiosity). The results of a multivariate logistic regression analysis determined that, controlling for the psychiatric, social, and economic predictors of suicide completions, recent divorce increases the odds of death by suicide 1.6 times, compared with 1.3 times for distal divorce. The study provides the first systematic, U.S.-based results that show that the timing of divorce influences risk of completed suicides independent of depression.
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Numerous studies have reported that suicide rates tend to be affected by temporal variables (month, day of the week, day of the month, holidays). Few authors have provided convincing explanations of these relations, and no one except Durkheim has suspected that they display similarities which indicate that they might have some causal origins in common. This article attempts to look at several temporal correlations as examples of the same underlying dynamics and to offer a theory which helps to organize a traditionally enigmatic body of research.
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Movies play a central role in shaping our understanding of crime and the world generally, helping us define what is good and bad, desirable and unworthy, lawful and illicit, strong and weak. Crime films raise controversial issues about the distribution of social power and the meanings of deviance, and they provide a safe space for fantasies of rebellion, punishment, and the restoration of order. In this, the first comprehensive study of its kind, well-known criminologist Nicole Rafter examines the relationship between society and crime films from the perspectives of criminal justice, film history and technique, and sociology. Dealing with over 300 films ranging from gangster and cop to trial and prison movies, Shots in the Mirror concentrates on works in the Hollywood tradition but also identifies a darker strain of critical films that portray crime and punishment more bleakly.
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Only a small fraction of suicide attempts are fatal. Nonfatal attempts might elicit resources and care from others, enhancing economic prospects for those who survive. I expand the standard utility‐maximizing model of suicide to include a nontrivial probability of survival and the possibility that the utility function may be affected by the suicide attempt. This expanded model predicts that suicide attempts are more likely when future income may be positively affected by the attempt, conditional on survival. Data from the National Comorbidity Survey show that ex post, individuals who made a suicide attempt had higher incomes than peers who seriously considered suicide but who never made a suicide attempt. Moreover, those who reported making the most serious attempts experienced the largest subsequent effects on income.
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Objectives: Alcohol use has several consequences and is one of the variables that increase risk of suicide. This meta-analysis was performed using cohort studies to clarify the association of alcohol use and suicide. Method: Scientific sources were reviewed regarding the keywords. After screening, thirty cohort studies were identified for the meta-analysis. The analysis was performed based on the random effects and subsequent analysis of the subgroups, based on various variables. Result: Analysis of the results showed that there is a relationship between alcohol use and suicide. Risk Ratio (RR) between alcohol use and suicide was 1.65. In men, pooled RR was 1.56 with 95% CI = 1.20–2.03, and in women, the pooled RR was equal to 1.40 with 95% CI = 1.11–1.77. Conclusion: Overall, the findings indicate that alcohol use is a risk factor for suicide. Therefore, it seems that prevention and control of alcohol use can be effective in promoting mental health.
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By providing information on help-seeking resources (HSR), Google's Suicide Prevention Results (SPR) fill a void, because less than 30% of news reports provide such information. This article addresses larger issues on media guidelines and suicide prevention. First, studies on the effects of providing HSR provide little support for a reduction in suicide. Second, research on the effects of other media guidelines often does not report the anticipated reductions in suicide. Third, although research does tend to support an increase in suicide after publicized suicides of celebrities, it does not necessarily happen for all categories of celebrity suicides. Fourth, there has been a lack of integration of (a) research on imitative effects of publicized suicides and (b) content analysis of stories' adherence to guidelines. Fifth, an associated puzzle is that (a) most research findings (64.2%) show no increase in suicide rates after suicide stories, while (b) most content analyses document widespread violations of media guidelines. Apparently, stories often violate media guidelines, but there is often no anticipated increase in suicide deaths. Rigorous research is needed to fully evaluate which media guidelines matter, and to determine the efficacy of Google's SPR program.
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Background Social welfare policies such as the minimum wage can affect population health, though the impact may differ by the level of unemployment experienced by society at a given time. Methods We ran difference-in-differences models using monthly data from all 50 states and Washington, DC from 1990 to 2015. We used educational attainment to define treatment and control groups. The exposure was the difference between state and federal minimum wage in US2015,definedbothbythedatethestatelawbecameeffectiveandlaggedby1year.Modelsincludedstateandyearfixedeffects,andadditionalstatelevelcovariatestoaccountforstatespecifictimevaryingconfounding.Weassessedeffectmodificationbythestatelevelunemploymentrate,andestimatedpredictedsuicidecountsunderdifferentminimumwagescenarios.ResultsTheeffectofaUS2015, defined both by the date the state law became effective and lagged by 1 year. Models included state and year fixed effects, and additional state-level covariates to account for state-specific time-varying confounding. We assessed effect modification by the state-level unemployment rate, and estimated predicted suicide counts under different minimum wage scenarios. Results The effect of a US1 increase in the minimum wage ranged from a 3.4% decrease (95% CI 0.4 to 6.4) to a 5.9% decrease (95% CI 1.4 to 10.2) in the suicide rate among adults aged 18–64 years with a high school education or less. We detected significant effect modification by unemployment rate, with the largest effects of minimum wage on reducing suicides observed at higher unemployment levels. Conclusion Minimum wage increases appear to reduce the suicide rate among those with a high school education or less, and may reduce disparities between socioeconomic groups. Effects appear greatest during periods of high unemployment.
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Suicide is one of the leading causes of death in the United States. The rise in suicide rates is contributing to the recently observed decline in life expectancy. While previous research identified a solid association between economic strain and suicide, little attention has been paid to how specific welfare policies that are designed to alleviate economic strain may influence suicide rates. There is a growing body of research that is using an institutional approach to demonstrate the role of welfare-state policies in the distribution of health. However, this perspective has not been applied yet to the investigation of suicide. In this study, I combine these approaches to analyze the association between two specific policies, Supplemental Nutrition Assistance Program (SNAP) and Earned Income Tax Credit (EITC), and overall and gender-specific suicide rates across the 50 U.S. states between 2000 and 2015. I estimate two-way fixed-effects longitudinal models and find evidence of a robust association between one of these policies - SNAP - and overall and male suicide. After adjusting for a number of confounding factors, higher participation in SNAP is associated with lower overall and male suicide rates. Increasing SNAP participation by one standard deviation (4.5% of the state population) during the study period could have saved the lives of approximately 31,600 people overall and 24,800 men.
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Background: Over 800,000 individuals die as a consequence of suicide annually, and almost two thirds of these deaths are in males. This analysis aimed to explore sex differences in global suicide rates with regards to geographic location, religion and other societal factors. Methods: Data on sex-specific suicide rates were collated for 182 countries in 2015. The exposures of interest were geographical location, majority religion, life expectancy, total fertility rate (TFR), literacy percentage, gender development index and gross domestic product. Results: Both continent and predominant religion were strongly associated with the male:female ratio for deaths from suicide (p < 0.001 for both variables). The highest male:female suicide ratio was observed in the Americas with a median value of 4.0 (interquartile range IQR: 3.0-5.0) and the lowest gender suicide ratios were observed in Africa (2.7, IQR: 2.4-3.3) and Asia (2.7, IQR: 1.8-3.9). The predominantly Christian countries revealed the highest male:female suicide ratio (3.3, IQR: 2.7-4.4) whereas the predominantly Hindu countries revealed the lowest (1.3, IQR 1.3-3.8). The following variables were all positively associated with male:female ratio of suicide mortality: Life expectancy (Spearman's correlation coefficient r = +0.21, p = 0.004), GDP per capita (r = +0.26, p = 0.003), literacy percentage (r = +0.46, p < 0.0001), and Gender Development Index (r = +0.56, p < 0.0001). TFR was negatively associated with sex suicide ratio (-0.30, p < 0.0001). Conclusion: There are significant differences between male and female suicide rates across continents and cultures. Markers of societal development are associated with a higher proportion of male suicides compared to females.
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Importance On March 31, 2017, Netflix released the show 13 Reasons Why, sparking immediate criticism from suicide prevention organizations for not following media recommendations for responsible suicide portrayal and for possible suicide contagion by media. To date, little research has been conducted into the associations between the show and suicide counts among its young target audience. Objective To analyze the changes in suicide counts after the release of 13 Reasons Why. Design, Setting, and Participants For this time series analysis, monthly suicide data for the age groups 10 to 19 years, 20 to 29 years, and 30 years or older for both US males and females from January 1, 1999, to December 31, 2017, were extracted from the Centers for Disease Control and Prevention’s WONDER (Wide-ranging Online Data for Epidemiologic Research) database. Twitter and Instagram posts were used as a proxy to estimate the amount of attention the show received through social media from April 1, 2017, to June 30, 2017. Autoregressive integrated moving average time series models were fitted to the pre–April 2017 period to estimate suicides among the age groups and to identify changes in specific suicide methods used. The models were fitted to the full time series with dummy variables for (1) April 2017 and (2) April 1, 2017, to June 30, 2017. Data were analyzed in December 2018 and January 2019. Main Outcomes and Measures Suicide data before and after the release of the show in 2017. Results Based on social media data, public interest in the show was highest in April 2017 and was negligible after June 2017. For 10- to 19-year-old males and females, increases in the observed values from April to June 2017 were outside the 95% confidence bands of forecasts. Models testing 3-month associated suicide mortality indicated 66 (95% CI, 16.3-115.7) excess suicides among males (12.4% increase; 95% CI, 3.1%-21.8%) and 37 (95% CI, 12.4-61.5) among females (21.7% increase; 95% CI, 7.3%-36.2%). No excess suicide mortality was seen in other age groups. The increase in the hanging suicide method was particularly high (26.9% increase; 95% CI, 15.3%-38.4%). Conclusions and Relevance Caution must be taken in interpreting these findings; however, the suicide increase in youth only and the signal of a potentially larger increase in young females all appear to be consistent with a contagion by media and seem to reinforce the need for collaboration toward improving fictional portrayals of suicide.
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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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Objective To systematically review the methods and findings of previous macro‐level research on the effect of firearms prevalence on suicide rates, and carry out a better state‐level analysis. Methods A cross‐sectional model of suicide rates is estimated with weighted least squares, using direct survey measures of gun prevalence. Results and Conclusion Prior macro‐level research is afflicted by the use of small samples of large heterogeneous units, invalid measures of gun prevalence, and few controls for confounders. The methodologically soundest prior research indicates that gun prevalence affects rates of gun suicides, but not total suicides. The new analysis likewise finds no significant effect of gun prevalence on total suicide rates.
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Using the fifth release of the National Longitudinal Mortality Survey, I examine the role of educational attainment and self-reported health on 6- and 11-year suicide mortality risk in the United States. I first replicate the original results reported by Hamermesh and Soss. . Then, augmenting the Hamermesh model with initial educational attainment and self-reported health status, I find that years of education significantly raises suicide mortality risk in the US after controlling for initial self-reported health. This result is robust to regression specification, replication and the inclusion of covariates.
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Objective: This study evaluated whether risk-based firearm seizure laws in Connecticut and Indiana affect suicide rates. Methods: A quasi-experimental design using annual state-level panel data from the 50 states between 1981 and 2015 was used. When analyses controlled for a range of risk factors for population-level suicide rates, the effects of Connecticut and Indiana’s firearm seizure laws on firearm and nonfirearm suicide rates were evaluated by using the synthetic-control methodology and difference-in-place placebo tests. Sensitivity analyses employed regression-based difference-in-differences analyses with randomization inference. Results: Indiana’s firearm seizure law was associated with a 7.5% reduction in firearm suicides in the ten years following its enactment, an effect specific to suicides with firearms and larger than that seen in any comparison state by chance alone. Enactment of Connecticut’s law was associated with a 1.6% reduction in firearm suicides immediately after its passage and a 13.7% reduction in firearm suicides in the post–Virginia Tech period, when enforcement of the law substantially increased. Regression-based sensitivity analyses showed that these findings were robust to alternative specifications. Whereas Indiana demonstrated an aggregate decrease in suicides, Connecticut’s estimated reduction in firearm suicides was offset by increased nonfirearm suicides. Conclusions: Risk-based firearm seizure laws were associated with reduced population-level firearm suicide rates, and evidence for a replacement effect was mixed.
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Objectives: Societies develop cultural scripts to understand suicide and define conditions under which the act is acceptable. Prior empirical work suggests that such attitudes are important in understanding some forms of suicidal behavior among adolescents and high-risk populations. This study examines whether expressions of suicide acceptability under different circumstances are predictive of subsequent death by suicide in the general U.S. adult population and whether the effects differ over the life course. Method: The study uses 1978-2010 General Social Survey data linked to the National Death Index through 2014 (n = 31,838). Cox survival models identify risk factors for suicide mortality, including attitudinal and cohort effects. Results: Expressions of suicide acceptability are predictive of subsequent death by suicide-in some cases associated with a twofold increase in risk. Attitudes elevate the suicide hazard among older (>55 years) adults but not among younger (ages 33-54) adults. Fully-adjusted models reveal that the effects of attitudes toward suicide acceptability on suicide mortality are strongest for social circumstances (family dishonor; bankruptcy). Discussion: Results point to the role of cultural factors and social attitudes in suicide. There may be utility in measuring attitudes in assessments of suicide risk.
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Background: suicide is a problem with world impact and the leading cause of premature deaths. The study of its distribution over time can bring a changed understanding of parameters attributed to, and the prevention of, suicide. Aim: to identify the temporal pattern of suicide by systematic review. Methods: Pubmed (Medline), LILACS, Virtual Health Library (VHL), Science Direct and Scopus (Elsevier), Web of Science (Thomson Reuters) and PsyNET (APA) were searched, using suicide-related descriptors and terms, for observational epidemiological studies of the temporal distribution of suicide. The review protocol was registered in PROSPERO (CRD42016038470). Limitations: The lack of uniformity in reporting or standardisation of methodology in the studies selected, hindered comparison of populations with similar socioeconomic and cultural profiles, considerably limiting the scope of the results of this review. Results: forty-five studies from 26 different countries were included in this review. Clear seasonal patterns were observed by day of the week, month, season and age-period-cohort effects. Few studies studied by trend, time of day or day of the month. Conclusion: the review findings provide further evidence of substantial temporal patterns influenced by geographic, climatic and social conditions.
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Marital status is an index of the phenomenon of social integration within social structures and has long been identified as an important predictor suicide. However, previous meta-analyses have focused only on a particular marital status, or not sufficiently explored moderators. A meta-analysis of observational studies was conducted to explore the relationships between marital status and suicide and to understand the important moderating factors in this association. Electronic databases were searched to identify studies conducted between January 1, 2000 and June 30, 2016. We performed a meta-analysis, subgroup analysis, and meta-regression of 170 suicide risk estimates from 36 publications. Using random effects model with adjustment for covariates, the study found that the suicide risk for non-married versus married was OR = 1.92 (95% CI: 1.75-2.12). The suicide risk was higher for non-married individuals aged <65 years than for those aged ≥65 years, and higher for men than for women. According to the results of stratified analysis by gender, non-married men exhibited a greater risk of suicide than their married counterparts in all sub-analyses, but women aged 65 years or older showed no significant association between marital status and suicide. The suicide risk in divorced individuals was higher than for non-married individuals in both men and women. The meta-regression showed that gender, age, and sample size affected between-study variation. The results of the study indicated that non-married individuals have an aggregate higher suicide risk than married ones. In addition, gender and age were confirmed as important moderating factors in the relationship between marital status and suicide.
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Objectives Job stressors are known determinants of common mental disorders. Over the past 10 years, there has been evidence that job stressors may also be risk factors for suicidality. The current paper sought to examine this topic through the first comprehensive systematic review and meta-analysis of the literature to date. Methods We used a three-tier search strategy of seven electronic databases. Studies were included if they reported on a job stressor or job-related stress as an exposure and suicide ideation, self-harm, suicide attempt or suicide as an outcome. Two researchers independently screened articles. All extracted effect estimates were converted to log-transformed ORs. Results There were 22 studies that were included in meta-analysis. Overall, exposure to job stressors was associated with elevated risk of suicide ideation and behaviours. The OR for suicide ideation (14 studies) ranged from 1.29 (95% CI 1.15 to 1.44) for poor supervisor and colleague support to 1.96 (95% CI 1.33 to 2.90) for job insecurity. For suicide (six studies), exposure to lower supervisor and collegial support produced an OR of 1.19 (95% CI 1.00 to 1.42), while low job control resulted in an OR of 1.30 (95% CI 1.10 to 1.53). There were only two studies that examined suicide attempt, both of which suggested an adverse effect of exposure to job stressors. Conclusions This study provides some evidence that job stressors may be related to suicidal outcomes. However, as most studies in the area were cross-sectional and obsThe current gold standard for asseservational in design, there is a need for longitudinal research to assess the robustness of observed associations.
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This paper exploits the variation occurring from the different timing of divorce law reforms across the United States to evaluate how unilateral divorce changed family violence and whether the option provided by unilateral divorce reduced suicide and spousal homicide. Unilateral divorce both potentially increases the likelihood that a domestic violence relationship ends and acts to transfer bargaining power toward the abused, thereby potentially stopping the abuse in extant relationships. In states that introduced unilateral divorce we find a 8–16 percent decline in female suicide, roughly a 30 percent decline in domestic violence for both men and women, and a 10 percent decline in females murdered by their partners.
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Although sociological research in the Durkheimian tradition has generally accepted that religious involvement protects against suicide, few studies have examined this theoretical proposition outside Western industrialized settings. Using multilevel models to analyze data from the World Health Organization Mortality Database and the World Values Survey (1981–2007) across 42 countries in seven geographical-cultural regions, this study explores whether religious participation is more protective against suicide in some regions than others and, if so, why. Results indicate that while religious participation is protective in Latin America, eastern Europe, northern Europe, and English-speaking countries, it may aggravate the risk of suicide in East Asia, western Europe, and southern Europe. This regional variation is the result of differences in both the degree of integration/regulation of religious communities and suicide underreporting. Overall, the findings support the network perspective of Durkheim’s classical theory and suggest that researchers should be more cautious about suicide underreporting in less industrialized settings.
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An extensive body of research has demonstrated an association between gun ownership and suicide that extends beyond the effects of a range of covariates. We aimed to expand on extant research by examining the extent to which gun ownership predicts statewide overall suicide rates beyond the effects of demographic, geographic, religious, psychopathological, and suicide-related variables. By extending the list of covariates utilized, considering those covariates simultaneously, and using more recent data, we sought to present a more stringent test. Gun ownership predicted statewide overall suicide rates, with the full model accounting for more than 92% of the variance in statewide suicide rates. The correlation between firearm suicide rates and the overall suicide rate was significantly stronger than the correlation between nonfirearm suicide rates and the overall suicide rate. These findings support the notion that access to and familiarity with firearms serves as a robust risk factor for suicide. Therefore, means safety efforts aimed at reducing accessibility and increasing safe storage of firearms would likely have a dramatic impact on statewide overall suicide rates.
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This study is an extension and cross-national test of the Stream Analogy of Lethal Violence (SALV). The SALV is an integrated theory of homicide and suicide that hypothesizes a relationship between “socially patterned” sources of frustration and lethal violence. By drawing on the insights of General Strain Theory and Institutional Anomie Theory, this study extends the SALV by assessing the impact of “decommodification” on the lethal violence rate. Partial support is found for this modified version of the SALV, as lagged measures of social expenditures are negatively associated with total lethal violence. The findings of this study suggest that social welfare expenditures in OECD nations protect citizens from lethal violence while austerity measures may contribute to greater rates of violent death.
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Both intoxication and chronic heavy alcohol use are associated with suicide. There is extensive population-level evidence linking per capita alcohol consumption with suicide. While alcohol policies can reduce excessive alcohol consumption, the relationship between alcohol policies and suicide warrants a critical review of the literature. This review summarizes the associations between various types of alcohol policies and suicide, both in the United States and internationally, as presented in English-language literature published between 1999 and 2014. Study designs, methodological challenges, and limitations in ascertaining the associations are discussed. Because of the substantial between-states variation in alcohol policies, U.S.-based studies contributed substantially to the literature. Repeated cross-sectional designs at both the ecological level and decedent level were common among U.S.-based studies. Non-U.S. studies often used time series data to evaluate pre-post comparisons of a hybrid set of policy changes. Although inconsistency remained, the published literature in general supported the protective effect of restrictive alcohol policies on reducing suicide as well as the decreased level of alcohol involvement among suicide decedents. Common limitations included measurement and selection bias and a focus on effects of a limited number of alcohol policies without accounting for other alcohol policies. This review summarizes a number of studies that suggest restrictive alcohol policies may contribute to suicide prevention on a general population level and to a reduction of alcohol involvement among suicide deaths.
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Importance Previous studies have linked suicide risk with religious participation, but the majority have used ecologic, cross-sectional, or case-control data. Objective To examine the longitudinal association between religious service attendance and suicide and the joint associations of suicide with service attendance and religious affiliation. Design, Setting, and Participants We evaluated associations between religious service attendance and suicide from 1996 through June 2010 in a large, long-term prospective cohort, the Nurses’ Health Study, in an analysis that included 89 708 women. Religious service attendance was self-reported in 1992 and 1996. Data analysis was conducted from 1996 through 2010. Main Outcomes and Measures Cox proportional hazards regression models were used to examine the association between religious service attendance and suicide, adjusting for demographic covariates, lifestyle factors, medical history, depressive symptoms, and social integration measures. We performed sensitivity analyses to examine the influence of unmeasured confounding. Results Among 89 708 women aged 30 to 55 years who participated in the Nurses’ Health Study, attendance at religious services once per week or more was associated with an approximately 5-fold lower rate of suicide compared with never attending religious services (hazard ratio, 0.16; 95% CI, 0.06-0.46). Service attendance once or more per week vs less frequent attendance was associated with a hazard ratio of 0.05 (95% CI, 0.006-0.48) for Catholics but only 0.34 (95% CI, 0.10-1.10) for Protestants (P = .05 for heterogeneity). Results were robust in sensitivity analysis and to exclusions of persons who were previously depressed or had a history of cancer or cardiovascular disease. There was evidence that social integration, depressive symptoms, and alcohol consumption partially mediated the association among those occasionally attending services, but not for those attending frequently. Conclusions and Relevance In this cohort of US women, frequent religious service attendance was associated with a significantly lower rate of suicide.