Structural indicators of suicide: an exploration of state-level risk factors among Black and White people in the United States, 2015–2019

Purpose Death by suicide among Black people in the USA have increased by 35.6% within the past decade. Among youth under the age of 24 years old, death by suicide among Black youth have risen substantially. Researchers have found that structural inequities (e.g. educational attainment) and state-specific variables (e.g. minimum wage, incarceration rates) may increase risk for suicide among Black people compared to White people in the USA. Given the limited understanding of how such factors systematically affect Black and White communities differently, this paper aims to examine these relationships across US states using publicly available data from 2015 to 2019. Design/methodology/approach Data were aggregated from various national sources including the National Center for Education Statistics, the Department of Labor, the FBI’s Crime in the US Reports and the Census Bureau. Four generalized estimating equations (GEE) models were used to examine the impact of state-level variables on suicide rates: Black adults suicide rate, Black youth (24 years and younger) suicide rate, White adult suicide rate and White youth suicide rate. Each model includes state-level hate group rates, minimum wage, violent crime rates, gross vacancy rates, and race-specific state-level poverty rates, incarceration rates and graduation rates. Findings Across all GEE models, suicide rates rose between 2015–2019 (ß = 1.11 – 2.78; ß = 0.91 – 1.82; ß = 0.52 – 3.09; ß = 0.16 – 1.53). For the Black adult suicide rate, state rates increased as the proportion of Black incarceration rose (ß = 1.14) but fell as the gross housing vacancy rates increased (ß = −1.52). Among Black youth, state suicide rates rose as Black incarcerations increased (ß = 0.93). For the adult White suicide rate, state rates increased as White incarceration (ß = 1.05) and percent uninsured increased (ß = 1.83), but fell as White graduation rates increased (ß = −2.36). Finally, among White youth, state suicide rates increased as the White incarceration rate rose (ß = 0.55) and as the violent crime rate rose (ß = 0.55) but decreased as state minimum wages (ß = −0.61), White poverty rates (ß = −0.40) and graduation rates increased (ß = −0.97). Originality/value This work underscores how structural factors are associated with suicide rates, and how such factors differentially impact White and Black communities.

Characteristics of persons who died by suicide in prison in France: 2017–2018

Background In northern countries, suicide rates among prisoners are at least three times higher for men and nine times higher for women than in the general population. The objective of this study is to describe the sociodemographic, penal, health characteristics and circumstances of suicide of French prisoners who died by suicide. Methods This study is an intermediate analysis of the French epidemiological surveillance program of suicides in prison. All suicides in prison in 2017–2018 in France were included in the study. Archival sociodemographic and penal data and specific data on the circumstances of the suicidal act were provided by the National Prison Service. Health data was provided by physicians working in prison using a standardized questionnaire. Results In 2017–2018, 235 prisoners died by suicide. The suicide rate was 16.8/10 000 person-years. Among suicide cases, 94.9% were male, 27.2% were under 30, 25.1% were aged 30 to 39, 27.7% were aged 40 to 49 and 20.0% were 50 or older. At the time of suicide, 48.5% were on custodial remand. Incarceration is associated with a threefold increase in the frequency of anxio-depressive disorders (24.6% in prison versus 8.2% before prison). The week before the suicidal act, 60% of prisoners visited the health unit and a significant event was detected for 61% of all cases. Suicide was less than 1 week after prison entry for 11.9% of prisoners, corresponding to a suicide rate 6.4 (CI95% [4.3 – 9.5]) times higher than for the remaining time in prison, and was more than 1 year after entry for 33.7% of them. Conclusions The high frequency of events the week before suicide in our study suggests that events in prison could play a role in the occurrence of suicides. Comparative studies are needed to further explore the time association between events and suicide in prison. As most of prisoners who died by suicide visited the health unit the week before suicide, the identification of triggering factors could help psychiatrists and other health professionals to assess the short-term risk of suicide and to implement preventive measures.

The Impact of the COVID-19 Pandemic on Suicide Rate Trends in the Tsunami-Disaster-Affected Area Following the Great East Japan Earthquake

Background: People who experienced the Great East Japan Earthquake (GEJE) were expected to have additional levels of psychological burden resulting from the stressful conditions imposed during the coronavirus disease 2019 (COVID-19) pandemic; consequently, suicide rates may increase. Aim: We aimed to carry out continuous monitoring of suicide rates in the affected area following the GEJE under COVID-19 pandemic conditions. Method: This descriptive study monitored the suicide rates of the coastal area of Miyagi Prefecture, where disaster-related mental health activities have been continuing following severe damage caused by the tsunami disaster. An exponential smoothing time-series analysis that converted suicide rates into a smooth trend was conducted. Results: Although the suicide rate in the affected area was higher than the national average in February 2020, it showed a declining trend during the COVID-19 pandemic, while showing an increase trend in the national and non-affected areas. Limitations: Uncertainty about the direct reasons for suicide and the short time-scale observation are the limitations of this study. Conclusion: Although the national suicide rate increased, this was not the case for the affected area. Our findings may provide important lessons for suicide prevention during the COVID-19 pandemic, which needs careful regional monitoring of the state of suicide and of high-risk approaches such as disaster-related mental health activities.

Gender Differences in Suicide Rates of Municipalities in South Korea

Background: South Korea showed the highest suicide rate among the countries in the Organization for Economic Cooperation and Development. Aims: This study aimed to discern the profiles of municipalities according to their suicide rates across the life cycle and gender, and then to identify the unique characteristics of each latent group. Method: This study applied a latent profile modeling to categorize the regions by life cycle suicide rates of their residents. The latent profile analysis (LPA) yielded four latent groups for males and three groups for females. This study explored the unique characteristics of 250 municipalities by latent groups with these groups. Results: The results suggested significant gender differences in the characteristics of localities. For the high adolescent suicide rates groups, there was a higher proportion of urban areas among males while there was a higher proportion of rural regions among females. Limitations: This study analyzed secondary data of municipalities, so the characteristics of each profile of suicide rate could only be identified within this existing data. Conclusions: This paper is one of the first studies to apply the LPA to different latent profiles by life cycle suicide rates.

Entrapment and escape: Exploring the relationship between suicide and emigration in a post-communist country

Background: Suicide rate in Hungary was nearly the highest in the world in the decades preceding the transition of the social system. Shortly after the transition in 1989, a radical decrease in fatal suicides occurred, parallel with a marked increase in emigration. Methods: We analyzed the data published by the Hungarian Central Statistical Office to detect if there was an association between the remarkable drop in suicide rates and the changes in emigration rates from 1995 to 2019. Results: The results of a brief statistical analysis on the correlation between suicide rate and emigration confirmed a strong negative relationship ( r = −.855, p = .00). For more precise results, we applied linear regression analysis, which showed that the emigration rate predicted 73.2% of suicide rate variances with a high predictive value (β = −.983). Conclusion: The study provides a possible explanation through a phenomenological analysis on major life transformations. Relating the arrested flight/cry of pain theory, the theory of rites of passage and double-bind communication resulted a comprehensive and coherent, but not exhaustive explanation on the relationship between suicide and emigration.

National Culture and the Stream Analogy of Lethal Violence

This is the first study to explore the relationship between Inglehart and Baker’s national cultural measures and the stream analogy of lethal violence. Using data for 70 developed and developing countries, the regression analysis indicates that a country with self-expressionism or secularism is likely to have a high suicide rate relative to its homicide rate. In contrast, a country with a survivalism or traditionalism orientation is likely to have a high homicide rate relative to its suicide rate. This study suggests that national culture is related to the direction of lethal violence (i.e., suicide vs. homicide).

Analysis of the Actual Situation of Suicide Among Firefighting Officials

This study analyzed the various methods of and reasons for committing suicide among 90 firefighters within a 10 year period (2010-2019). The study discovered that: the suicide rate per 100,000 people has gradually decreased in the general public and police, while the number of suicides among firefighters continues to increase; the suicide rate arranged in increasing order by province, was Gyeonggi < Seoul < Jeonnam < Gyeongbuk < Busan whereas the suicide rate in terms of the number of staff followed the order of Jeonnam < Ulsan < Chungbuk < Gyeonggi < Seoul; the highest suicide rates were found among firefighters in the Sobangjang (fire sergeant) position, who were in their 40s, and who had served fewer than 10 years; the reasons for committing suicide were family discord, depression, hopelessness, debt, and job stress in that order; those in their 20s and 50s committed suicide due to depression while family discord appeared to be the cause for those in their 30s and 40s. To prevent firefighters from committing suicide, we need to initiate a dedicated psychological counseling organization, run a firefighters’ suicide prevention program at the fire academy, and strengthen the psychological autopsy for firefighters’ suicide and statistics management, etc.

A magyarországi öngyilkossági halálozás változásai a COVID–19-járvány első évében

Összefoglaló. Bevezetés: Az öngyilkosság fő rizikófaktorának a pszichiátriai zavarokat tekintjük. A COVID–19 többek között neuropszichiátriai kórképek kialakulásához is vezethet. Ezen túl a pandémia egyéb velejárói, mint például az izoláció vagy a munkahelyvesztés, a társadalom egészséges tagjaiban is stresszhez, végül pszichiátriai zavarokhoz vezethetnek. Célkitűzés: Vizsgálatunk célja annak a teóriának a tesztelése volt, hogy a fenti tényezők miatt együtt járt-e a járvány a hazai suicid halálozás csökkenő trendjének irányváltásával. Módszer: Vizsgálatunkban a megszakított idősorok elemzésének módszerét használtuk, a becslésekhez kvázi-Poisson-regressziót alkalmazva, hogy összehasonlítsuk a 2010 és 2020 közötti időszak havi bontású adataiból kirajzolódó trendek alapján a járvány időszakában (2020. március–december) „elvárt” öngyilkossági esetszámokat a ténylegesen bekövetkezett esetek számával. Eredmények: A COVID–19-hónapok alatt a férfiak által elkövetett öngyilkosságok száma szignifikánsan, 18%-kal nőtt, ahhoz a trendhez képest, amely a COVID–19 hiányában állt volna elő. A teljes populációban szintén szignifikáns, 16%-os emelkedést lehetett megfigyelni, míg a nők által elkövetett öngyilkosságok száma nem tért el szignifikánsan a pre-COVID–19-időszak trendje alapján elvárt értéktől. Megbeszélés és következtetés: A járvány kitörése utáni időszakban a magyar férfiak szignifikánsan gyakrabban követtek el öngyilkosságot, míg a nőknél az adatok nem tükröztek lényegi változást. A más országokban kivitelezett vizsgálatok eredményei érdekes módon inkább csökkenést vagy nem szignifikáns változást jeleztek, amikor a COVID–19-éra suicid számait az azt megelőző időszakok számaival hasonlították össze. A hazai és a nemzetközi eredmények közti eltérések magyarázata egyelőre még nem ismert, így a téma mindenképpen további vizsgálatokat igényel. Orv Hetil. 2021; 162(41): 1631–1636. Summary. Introduction: Psychiatric disorders are the main risk factors for suicide. COVID-19 may result in the appearance of neuropsychiatric syndromes. Moreover, other corollaries of the pandemic (e.g., isolation, job loss) may lead to increasing stress and, ultimately, psychiatric disorders even among the non-infected population. Objective: We aimed to test the theory of whether the pandemic, due to the aforementioned factors, was associated with the reversal of the declining suicide rate trend in Hungary. Method: To compare the observed number of suicides during the COVID-19 months (March–December 2020) with the expected numbers, we used an interrupted time series model and, for the estimations, quasi-Poisson regression. Expected numbers were calculated based on trends derived from monthly data between 2010 and 2020. Results: During the months of the pandemic, the number of suicides among males rose significantly by 18% compared to the hypothetical trend that would have occurred in the absence of COVID-19. A significant increase (16%) was also observed in the total population. By contrast, the number of female suicides did not differ significantly from the number expected based on the pre-COVID-19 trend. Discussion and conclusion: After the outbreak of the epidemic, Hungarian males committed significantly more suicides, while no relevant changes were observed among females. Interestingly, studies from other countries found either no change or decrease when comparing suicide numbers from the COVID-19 period with the corresponding numbers from the pre-COVID-19 period. The explanation for this discrepancy is still lacking, so further investigations are needed. Orv Hetil. 2021; 162(41): 1631–1636.

Sociodemographic Analysis of Suicide Rates Among Older Adults Living in Ecuador: 1997–2019

Background: Despite most suicides occurring in low-and-middle-income countries (LAMICs), limited reports on suicide rates in older adults among LAMICs are available. In Ecuador, high suicide rates have been reported among adolescents. Little is known about the epidemiology of suicides among older adults in Ecuador.Aim: To examine the sociodemographic characteristics of suicides among older adults living in Ecuador from 1997 to 2019.Methods: An observational study was conducted using Ecuador's National Institute of Census and Statistics database from 1997 to 2019 in Ecuadorians aged 60 and older. International Classification of Diseases 10th Revision (ICD-10) (X60-X84)-reported suicide deaths were included in addition to deaths of events of undetermined intent (Y21-Y33). Sex, age, ethnicity, educational level, and method of suicide were analyzed. Annual suicide rates were calculated per 100,000 by age, sex, and method. To examine the trends in rates of suicide, Joinpoint analysis using Poisson log-linear regression was used.Results: Suicide rates of female older adults remained relatively stable between 1997 and 2019 with an average annual percentage increase of 2.4%, while the male rates increased between 2002 and 2009, 2014 and 2016, and maintained relatively stable within the past 3 years (2017–2019). The annual age-adjusted male suicide rate was 29.8 per 100,000, while the female suicide rate was 5.26 per 100,000 during the study period. When adding deaths of undetermined intent, the annual male rate was 60.5 per 100,000, while the same rate was 14.3 for women. The most common suicide method was hanging (55.7%) followed by self-poisoning (26.0%). The highest suicide numbers were reported in urban districts, men, and those with lower education status.Conclusion: This study contributes to building the baseline for further studies on suicide rates of older adults in Ecuador. Results highlight priority areas of suicide prevention. By examining suicide trends over 23 years, findings can help inform policy and future interventions targeting suicide prevention.

Suicide Rate and Social Environment Characteristics in South Korea: The Roles of Socioeconomic, Demographic, Urbanicity, General Health Behaviors, and Other Environmental Factors On Suicide Rate

Background: Suicide is a serious worldwide public health concern, and South Korea has shown the highest suicide rate among Organisation for Economic Co-operation and Development (OECD) countries since 2003. Nevertheless, most previous Korean studies on suicide had limitations in investigating various social environment factors using long-term nationwide data. Thus, this study aimed to examine how various social environment characteristics are related to the suicide rate on a district-level, using nationwide longitudinal data over 11 years.Methods: We used the district-level age-standardized suicide rate and a total of 12 annual social environment characteristics of socioeconomic, demographic, urbanicity, general health behaviors, and other environmental characteristics from 229 administrative districts in South Korea. A linear mixed-effect model (LMEM) was used to examine the association between the rate of suicide and the social environment indicators selected for the study.Results: In the total population, the indicators “% population aged 65 and older eligible for the basic pension”, “% vacant houses in the area”, “% divorce”, “% detached houses”, and “% current smokers” showed positive associations with the suicide rate. In contrast, “% people who regularly participated in religious activities” and “number of sports facilities per 1,000 persons” showed negative associations with suicide rate. The associations between social environment characteristics and suicide rate were generally more pronounced in males and more urbanised areas, than in females and less urbanised areas; however, associations differed amongst age groups, depending on the social environment characteristic variable under study.Conclusions: This study investigated the complex role of social environments on suicide rate in South Korea and revealed that higher suicide rates were associated with lower values of socioeconomic status, physical exercise, and religious activities, and with higher social isolation and smoking practice. Our results can be used in the development of targeted suicide prevention policies.