Chris Cantor

Lifetime suicide risk in major depression: sex and age determinants

BACKGROUND Recent work has demonstrated that the lifetime suicide risk for patients with DSM IV Major Depression cannot mathematically approximate the accepted figure of 15%. Gender and age significantly affect both the prevalence of major depression and suicide risk. METHODS Gender and age stratified calculations were made on the entire population of the USA in 1994 using a mathematical algorithm. Sex specific corrections for under-reporting were incorporated into the design. RESULTS The lifetime suicide risks for men and women were 7% and 1%, respectively. The combined risk was 3.4%. The male:female ratio for suicide risk in major depression was 10:1 for youths under 25, and 5.6:1 for adults. CONCLUSIONS Suicide in major depression is predominantly a male problem, although complacency towards female sufferers is to be avoided. Diagnosis of major depression is of limited help in predicting suicide risk compared to case specific factors. The male experience of depression that leads to suicide is often not identified as a legitimate medical complaint by either sufferers or professionals. Increasing help-accessing by males is a priority. CLINICAL IMPLICATIONS Patients with a history of hospitalisation; comorbidity, especially for substance abuse; and who are male, require greater vigilance for suicide risk. It may be that for males the threshold for diagnosing and treating major depression needs to be lowered. LIMITATIONS This research is based on a mathematical algorithm to approximate a life-long longitudinal study that identifies community cases of depression. Our findings therefore rely on the validity of the statistics used. Extrapolation is limited to populations with an actual suicide rate of 17/100,000 or less and a lifetime prevalence of major depression of 17% or more.

Access to methods of suicide: what impact?

Objective: The aim of this paper is to explore the conceptual basis of limiting access to potential methods of suicide as a public health measure. Method: A review of the literature was conducted. Results: Both physical availability and sociocultural acceptability are important determinants of choice. There is considerable evidence of an association between method availability and method specific suicide rates. There is also evidence that restriction of method availability is often associated with a reduction in method specific suicide rates. There is some evidence that restrictions on method availability under certain conditions may reduce overall suicide rates. Conclusions: Suicide methods employed by young Australians are changing, with a disturbing rise in frequency of hanging and car exhaust suicides slightly offset by a decline in firearm suicides. Opportunities exist for further reducing firearm suicides and addressing exhaust suicides by practical measures. There are also obvious options for changing prescribing practices with respect to more lethal medications (e.g. tricyclic antidepressants). However, the rise in hanging seems problematic from this perspective and in need of ecological study.

The epidemiology of suicide and attempted suicide among young Australians

OBJECTIVE This paper summarises a report to the NHMRC the objectives of which were to review research into the epidemiology of youth suicide in Australia and identify gaps in research. METHOD Literature searches were conducted. A limited amount of new data analysis was included to shed light on reliability issues of official Australian suicide data. RESULTS The review examined suicide data systems, including issues to do with coroners, the Australian Bureau of Statistics and alternative systems. The epidemiological areas reviewed included: all ages, youth, age and gender, geographical, socioeconomic, marital, indigenous, migrants, suicides in custody and gay and lesbian suicides. CONCLUSION While much is known about the epidemiology of youth suicide, much remains to be clarified. Study of indigenous issues is perhaps the most neglected area; study of family issues may be potentially be the most productive.

Blindness, Fear of Sight Loss, and Suicide

Numerous studies have examined the emotional impact exerted by sight loss. Research has tended to focus on clinical-diagnostic rather than therapeutic-preventive aspects. Blindness and sight restoration have been reported to induce both temporary and longer term psychopathology, usually followed by psychosocial readjustment. However, in some cases, readjustment may not occur and suicide may result. Together with an extensive review of available literature, the authors present cases taken from their psychological autopsy study database. When compared with a hearing-impaired control group, impaired sight alone can acutely affect otherwise psychologically healthy individuals. Ophthalmologists need to be aware of this problem and to develop closer collaboration with mental health professionals. Serious consideration of this problem and definition of clear guidelines may prevent suicidal behaviour.

Cybersuicide: The Role of Interactive Suicide Notes on the Internet

As we approach the new millennium a new dimension in interactive communications has arrived. The internet is one such medium, and while it remains a relatively new form of information sharing, it has not escaped the attention of vulnerable young people. This paper discusses the internet resources on suicide and the issue of interactive suicide notes. Case examples of interactive notes followed by suicide fatalities are used to illustrate the potential influence of the internet on those who wish to share their suicidal ideation with others. Issues to do with modeling, ambivalence, group death wishes, research, and ethics are discussed. Finally, some recommendations are made for further studies.

Suicide trends in eight predominantly English-speaking countries 1960–1989

Suicide rates between 1960 and 1989 were explored for eight predominantly English speaking countries with similar national characteristics. New World countries showed significant similarities but differed from Old World countries. The two North American (NA) New World countries showed more similarity to each other than the two Australasian New World countries. The NA countries showed an unique plateau in the 1980s for males aged 15–29 years. Old World males of all ages showed common rises, suggesting a partial sex-specific influence in the young. However, trends among the 15-to 19-year-olds were significantly different to trensas among the 20-to 29-year-olds in both sexes suggesting a substantial youth-related contribution to the rises. Rates among 15-to 19-year-old females rose in the early 1960s, ahead of males but in parallel with rises among older females, suggesting part of the rise was sex-as opposed to age-related. Although rates among the 15- to 19-year-old females showed little change since 1970, this may be partly a function of sex-related improvements—observable in older females — disguising unfavourable youth-related influences. Possible aetiological factors are suggested but remain speculative. Studies of other nations with common cultural characteristics may clarify trends and aetiological issues. Care should be taken to differentiate sex-from age-related influences.

Misclassification of Suicide – The Contribution of Opiates

The reliability of suicide reporting remains a concern. Problems include procedural deficiencies, ambiguous evidence and the determination of intent. In this study, Queensland Suicide Register (QSR) data were compared to the usual official source – the Australian Bureau of Statistics (ABS). QSR deaths were coded as beyond reasonable doubt, probable and possible. These categories were analysed by methods and demographic variables to determine the nature of difficult-to-classify suicides. QSR suicides exceeded ABS especially for females, ages 25–44, and the methods overdose, drowning and ‘other methods’. Opiate overdoses were most difficult to code. Ambiguous circumstantial information and unclear intent were major impediments. Nations witnessing rising rates of deaths due to drug abuse need to monitor undetermined and accidental deaths as well as suicides.

Suicide, assisted suicide and euthanasia: international perspectives.

Suicide, assisted suicide and euthanasia are elusive and controversial issues worldwide. To discuss such issues from only one perspective may be limiting. Therefore, this paper was written by authors from various regions, each of whom has been asked to reflect on the issues. The countries/cultures are: Australia, China, Cuba, Ireland, India, Japan, Russia, South Africa, The Netherlands, North America (Turtle Island) and United States. Historically and today, suicide is viewed differently. Assisted suicide and euthanasia are equally seen from multifarious perspectives. Highlighting development in the Netherlands, Australias Northern Territory and Japan (ie. the famous Yamanouchi Case), the review shows growing re-examination of the right to die. There appear, however, to be no uniform legal and ethical positions. Further debate and discussion globally is needed to avoid myopic perspectives.

Suicide in the United Kingdom and Ireland

The purpose of this study was to compare epidemiological trends in suicide for the three regions of the United Kingdom (England and Wales, Northern Ireland, and Scotland) and for Ireland from 1960 to 1990. The data on suicide rates were obtained from the World Health Organization statistical base, supplemented by data from the statistical offices of the four regions. While the suicide rates in Ireland, Northern Ireland and Scotland increased during the period under study, English/Welsh suicide rates first declined and then held steady. In Ireland, both male and female suicide rates increased, whereas in the other regions only male suicide rates rose. According to age, in England and Wales, suicide rates rose for male teenagers and young males, while for the other regions male suicide rates increased in general for all age groups. Social indicators (unemployment, marriage and birth rates) were quite successful in predicting male suicide rates in all four regions and in predicting female suicide rates in England and Wales and in Ireland. The results emphasize the importance of studying several regions in epidemiological studies in order to identify which trends are general and which are unique to one nation. In the present study, the epidemiological trends for suicide in England and Wales were quite different from those in the other three regions. In particular, the steady overall suicide rate in England and Wales and the rising suicide rate for young males alone differ from the trends observed in the other regions and raise importante questions about the causes of the social suicide rate in these four regions.

Media and mass homicides

A series of seven mass-homicides occurring in Australia, New Zealand and the United Kingdom 1987--1996 is presented in the context of possible media influences. These crimes are exceptionally rare facilitating study based on similarity, time linkage and statements by the assailants. Time linkage suggests three incidents might have occurred through a modelling process. Statements link two incidents -- one not being linked by time. It is argued that modelling may have occurred over a period as long as ten years. A ripple effect with these incidents generating other serious violence may also have occurred. Researchers of media influences on suicide and homicide need to take into account the constraints on findings, in relation to time frames and ripple effects, imposed by macro research designs. The micro perspective afforded by the study of very rare massive publicity linked events may generate new insights. These findings raise ethical dilemmas for the media.