Kairi Kolves

Suicide methods in Europe: a gender-specific analysis of countries participating in the ''European Alliance Against Depression''

Objective: To identify the most frequent gender-specific suicide methods in Europe. Design: Proportions of seven predominant suicide methods utilised in 16 countries participating in the European Alliance Against Depression (EAAD) were reported in total and cross-nationally. Relative risk (RR) relating to suicide methods and gender was calculated. To group countries by pattern of suicide methods, hierarchical clustering was applied. Setting and participants: Data on suicide methods for 119 122 male and 41 338 female cases in 2000–4/5 from 16 EAAD countries, covering 52% of European population were obtained. Results: Hanging was the most prevalent suicide method among both males (54.3%) and females (35.6%). For males, hanging was followed by firearms (9.7%) and poisoning by drugs (8.6%); for females, by poisoning by drugs (24.7%) and jumping from a high place (14.5%). Only in Switzerland did hanging rank as second for males after firearms. Hanging ranked first among females in eight countries, poisoning by drugs in five and jumping from a high place in three. In all countries, males had a higher risk than females of using firearms and hanging and a lower risk of poisoning by drugs, drowning and jumping. Grouping showed that countries might be divided into five main groups among males; for females, grouping did not yield clear results. Conclusions: Research on suicide methods could lead to the development of gender-specific intervention strategies. Nevertheless, other approaches, such as better identification and treatment of mental disorders and the improvement of toxicological aid should be put in place.

Is Religiosity a Protective Factor Against Attempted Suicide: A Cross-Cultural Case-Control Study

This cross-cultural study investigates whether religiosity assessed in three dimensions has a protective effect against attempted suicide. Community controls (n = 5484) were more likely than suicide attempters (n = 2819) to report religious denomination in Estonia (OR = 0.5) and subjective religiosity in four countries: Brazil (OR = 0.2), Estonia (OR = 0.5), Islamic Republic of Iran (OR = 0.6), and Sri Lanka (OR = 0.4). In South Africa, the effect was exceptional both for religious denomination (OR = 5.9) and subjective religiosity (OR = 2.7). No effects were found in India and Vietnam. Organizational religiosity gave controversial results. In particular, subjective religiosity (considering him/herself as religious person) may serve as a protective factor against non-fatal suicidal behavior in some cultures.

Suicide in selected occupations in Queensland: Evidence from the State suicide register

Objective: Prior research has suggested an association between suicide and certain occupations. The aim of the present study was to report on suicide rates in selected occupations in Queensland (QLD). Method: Suicide mortality data from the QLD Suicide Register and population data from the Australian Bureau of Statistics were obtained for the period 1990–2006. Suicide rates were calculated for each occupational group and compared to rates within the general population (15–64 year age group) and the employed population of QLD. Results: There was significantly higher risk of suicide for male subjects in the agricultural, transport and construction sectors of QLD. High suicide rates were also found in female nurses, artists, agricultural workers and cleaners, while education professionals (of both genders) appeared at lower risk. Conclusions: The significantly higher suicide rates for employees of the agriculture, construction, and transport industries indicate a need for further research into the occupation-specific conditions and individual or other social–environmental factors that may accentuate suicide risk within these professions. Use of higher quality occupational data is also warranted in future studies.

Suicides in older adults: A case–control psychological autopsy study in Australia

AIM The present study aims to analyse predicting factors of suicide among older adults compared to sudden death controls and middle-aged suicides. METHODS During the period 2006-2008, at two Australian sites, the psychological autopsy method was utilised to investigate suicides of individuals over the age of 35 by interviewing next-of-kin and healthcare professionals. A case-control study design was applied using sudden death cases as controls. Initial information was gathered from coroners offices. Potential informants were approached and interviews were conducted using a semi-structured format. RESULTS In total, 261 suicides (73 aged 60+) and 182 sudden deaths (79 aged 60+) were involved. Older adult suicides showed a significantly lower prevalence of psychiatric diagnoses (62%) when compared to middle-aged suicide cases (80%). In both age groups, subjects who died by suicide were significantly more likely to present a psychiatric diagnosis, compared to controls; however, diagnosis did not remain in the final prediction model for older adults. Hopelessness and past suicide attempts remained in the final model for both age groups. In addition, living alone was an important predictor of suicide in older adults. CONCLUSION Although mood disorders represent an important target for suicide prevention in old age, there should be increased attention for other risk factors including psychosocial, environmental, and general health aspects of late life.

Suicidal ideation and behaviour in the aftermath of marital separation: Gender differences

BACKGROUND The limited studies on the consequences of the separation process on suicidal behaviour seem to indicate that separated people are at increased risk of suicide. AIMS The current study aims to compare suicidality immediately after the separation among males and females, and to analyse possible differences in predictors of serious suicidal ideation. METHOD Separated males and females who had contacted relationship counselling services, help-line services, and a variety of support and self-help groups were asked to participate in the study. Participants were required to be 18 years old or older, and have separated from their married/de facto partner within the previous 18 months but not yet divorced. For categorial variables odds ratios with 95% CI and for continuing variables t-tests were calculated. Multinomial logistic regression was applied to estimate the independent contribution of significant predictors. RESULTS Separated males (n=228) were at an increased risk of developing suicidality during the separation process compared to separated females (n=142), even after adjusting for age, education, employment and children with the separated partner. The psycho-social risk factors identified in the development of serious suicidal ideation were mental health problems (during the previous year), history of suicide attempts and internalised shame. For separated males, significant predictors also included lower education, separation-related shame and stress from legal negotiations, especially about property/financial issues. CONCLUSIONS The findings provide a better understanding of suicidal behaviours in the aftermath of marital or de facto separation. This knowledge could be used in the implementation of future suicide prevention strategies in people who are going through the process of a marital/de facto separation.

Massive increase in injury deaths of undetermined intent in ex-USSR Baltic and Slavic countries: hidden suicides?

Aims: Observed changes in subcategories of injury death were used to test the hypothesis that a sizeable proportion of ‘‘injury deaths of undetermined intent’’ (Y10—Y34 in ICD 10) in the Baltic and Slavic countries after the USSR dissolved in 1991 were hidden suicides. Methods: Using male age-adjusted suicide rates for two distinctly different periods, 1981—90 and 1992—2005, changes, ratios and correlations were calculated. The data were compared with the EU average. Results: After the USSR broke up, the obligation to make a definitive diagnosis became less strict. A massive increase in ‘‘injury deaths of undetermined intent’’ resulted. The mean rate for the second period reached 52.8 per 100,000 males in Russia (the highest rate) and 12.9 in Lithuania (the lowest), against 3.2 in EU-15. The rise from the first to the second period was highest in Belarus (56%) and Russia (44%). The number of injury deaths of undetermined intent was almost equal to that of suicides in Russia in 2005 (ratio 1.0) and Ukraine in 2002 (1.1). In all the countries, especially the Slavic ones, prevalence trends of injury-death subcategories were uniform, i.e. strongly correlated over time. No direct substitution of one diagnosis for another was evident. Conclusions: There is no evidence that the category of ‘‘injury deaths of undetermined intent’’ in the Baltic and Slavic countries hides suicides alone. Aggregate level analysis indicates that accidents and homicides could sometimes be diagnosed as undetermined.

Subjective psychological well-being (WHO-5) in assessment of the severity of suicide attempt

An objective way to measure the severity of suicide attempt is to use different psychometric scales. Aspects of suicide risk like suicidal intent, depression, hopelessness and well-being can be assessed and different practical scales are in use to facilitate the risk assessment procedure. The aims of current study were: 1) to analyse the association between the severity of suicide attempt measured by suicidal intent scale and characteristics of emotional status of suicide attempters measured by depression, hopelessness and well-being scales in different gender and age groups; 2) to test the applicability of well-being measured by the World Health Organisation well-being index (WHO-5) in suicide risk assessment. The data on suicide attempters (n=469) was obtained in Estonia (Tallinn) by the WHO Suicide Prevention—Multisite Intervention Study on Suicidal Behaviours (SUPRE-MISS) methodology. Different psychometric scales were used to measure suicidal intent (Pierce Suicidal Intent Scale) and emotional status (Beck Depression Inventory for depression, Beck Hopelessness Scale for hopelessness, WHO-5 for well-being). All psychometric scales correlated well with each other (P<0.05). Low level of well-being associated with high level of suicidal intent, depression and hopelessness. Suicidal intent correlated the most strongly with well-being. Analysis by gender and age groups revealed also significant correlations with two exceptions only: correlation between suicidal intent and hopelessness did not reach the significant level in males and in older adults (40+). The WHO-5 well-being scale, which is a short and emotionally positively loaded instrument measuring protective factors, can be used in settings without psychological/psychiatric expertise in preliminary suicide risk assessment.

Substance use disorders as risk factors for suicide in an Eastern and a Central European city (Tallinn and Frankfurt/Main).

Cultural and regional differences on the well-known elevated suicide risk in substance use disorders have not been clarified yet. Therefore, the suicide risk associated with substance use disorders in a society of transition and in a socially and economically stable society should be identified and compared. Data from two population-based matched case-control studies were used to analyse the association between alcohol and other substance consumption and the risk of suicide. Data in Frankfurt were obtained by a semi-structured interview including the Structured Clinical Interview for DSM-IV Axis I (SCID-I) in 163 suicides that occurred in 1999 and 2000, and data from Tallinn were collected according to DSM-IV criteria on 156 deceased persons who committed suicide in 1999 by using the psychological autopsy method and in each city in matched population-based control persons by personal interview. In both cities, substance use disorders were significantly associated with suicide. Odds ratios for suicide were higher in Tallinn than in Frankfurt. The highest risk was observed in Tallinn among men with alcohol use disorders, aged 35 to 59 years. Although substance use and, in particular, alcohol use disorders were confirmed as risk factors for suicide in Tallinn and in Frankfurt, the much higher suicide risk associated with alcoholism in Tallinn than in Frankfurt indicates the importance of cultural, socio-political, and regional impact of suicide risk in alcoholism.

Suicide among Russians in Estonia: database study before and after independence

Migration has been reported as an important risk factor for suicide. Immigrants have a higher risk than exists in their countries of origin and than among the native population of their new country.1,2 According to the 1934 population census, before the second world war native Estonians constituted 88.1% of the total population of Estonia. By 1989, however, because of geopolitical changes related to the incorporation of Estonia into the Soviet Union, the Russian minority had grown to about 30%. We examined how the radically changed sociopolitical status of the Russian minority after the dissolution of the Soviet Union was reflected in their suicide rates.

Suicide rates and socioeconomic factors in Eastern European countries after the collapse of the Soviet Union: trends between 1990 and 2008

After the collapse of the Soviet Union the various Eastern European (EE) countries adapted in different ways to the social, political and economic changes. The present study aims to analyse whether the factors related to social integration and regulation are able to explain the changes in the suicide rate in EE. A separate analysis of suicide rates, together with the undetermined intent mortality (UD), was performed. A cross-sectional time-series design and applied a panel data fixed-effects regression technique was used in analyses. The sample included 13 countries from the former Soviet bloc between 1990 and 2008. Dependent variables were gender-specific age-adjusted suicide rates and suicide plus UD rates. Independent variables included unemployment, GDP, divorce rate, birth rate, the Gini index, female labour force participation, alcohol consumption and general practitioners per 100,000 people. Male suicide and suicide or UD rates had similar predictors, which suggest that changes in suicide were related to socioeconomic disruptions experienced during the transition period. However, male suicide rates in EE were not associated with alcohol consumption during the study period. Even so, there might be underestimation of alcohol consumption due to illegal alcohol and differences between methodologies of calculating alcohol consumption. However, predictors of female suicide were related to economic integration and suicide or UD rates with domestic integration.