Suicide

Adolescent substance abuse is a major public health concern. It is associated with an increased incidence of various psychiatric disorders like depressive disorders, anxiety disorders, attention deficit hyperactivity disorder, and conduct disorders and the relationship between mental and behavioral disorders and the substance use problems seems to be bi-directional. Adolescent suicide and substance abuse have a number of risk factors in common. Prevention of suicide requires an individualized comprehensive assessment and management plan aimed at substance use and psychiatric disorders. This would involve a multidisciplinary collaboration and use of pharmacological, psychological and social interventions.

Karojisatsu in Japan: Characteristics of 22 Cases of Work-Related Suicide: Takashi AMAGASA, et al. Mental Clinic Misato-With the rapidly increasing number of work-related suicides in Japan (Karojisatsu, in Japanese), both applications for worker's compensation insurance and civil suits are proliferating. The phenomenon of work-related suicide is examined along with the process and related factors. With informed consent from bereaved families, two certified psychiatrists independently reviewed and summarized 22 insurance and legal reports filed by psychiatrists on employee suicides that were related to heavy workloads. A clinical epidemiologist participated in discussions with psychiatrists to reach a consensus concerning the cause of the suicides. Only one case involved a female. Seventeen had experienced personnel changes, such as a promotion or transfer. Low social support was recognized in 18, high psychological demand in 18, low decision latitude in 17, and long working hours in 19 cases (more than 11 hours per day for 3 months or more, and without a day off in 9). The subjects had depressive episodes by the ICD-10 criteria and showed suicidal signs. Ten of them saw a general practitioner because of unspecified somatic complaints, but no effective measures were taken. None of them had a history of psychiatric consultation or had received mental health education dealing with job stress management. Although causality cannot be made from this case series report, we hypothesize that long working hours, heavy workloads, and low social support may cause depression, which can lead to suicide. Appropriate countermeasures are urgently needed and the present findings suggest some of them are possible.

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the medical superintendent of the Brookwood Asylum, immediately took upon himself the task of unchaining Catherine from what he clearly considered apparel reminiscent of a pre-Conollyite era ofmechanical restraint. In the first few weeks following her admission to Brookwood, he observed that Catherine had responded well to her new physical liberty, behaving placidly, and eating with a sharp knife. "She acts", he confided in his medical casebook, "without exhibiting any suicidal propensities at present." By early 1872, unfortunately, her behaviour deteriorated. Seemingly unprovoked bouts of aggression aimed at both fellow patients and attendants prompted the superintendent to administer morphine and chloral hydrate. Early in 1875, she attempted to strangle herself but appeared soon to recover and during the next six months her behaviour ranged from the diligent to the destructive before she was again transferred (back) to Wandsworth Asylum. Sadly, her persistent attempts to commit self-murder were ultimately successful. A short time after her arrival, she committed suicide by hanging.5

Suicides among marginalised groups are one of the few occasions in which self-harm and suicide are framed as having cultural, social, environmental, historical or structural causes. Suicidology, psychology and public discourse typically understand suicide causality to be grounded in individualised psychic pain and pathology, disavowing the social, cultural, environmental and linguistic contexts. However, public discourse on suicides of 'marginalised' groups such as asylum seekers, Indigenous people and queer/LGBT youth are 'authorised' to be discussed from social perspectives, informing opportunities to rethink suicidality, identity and liveability. Building on recent critical challenges to dominant theories, this article examines some of the ways the suicides of marginalised groups are described in social terms, demonstrating how cultural approaches to relationality, aspiration, performativity and mobility can expand current thinking on suicide cause and prevention.

Asphyxial deaths utilising plastic bags or wrappings occurring over a 20-year period from March 1984 to February 2004 were reviewed at Forensic Science SA, Australia. A total of 45 cases were identified, with three occurring in infants and children (one accidental asphyxia; two homicides). Of the remaining 42 adults the male to female ratio was approximately 1:1 (23 and 19 cases, respectively), with all deaths attributed to suicide. The 42 adult cases represented 1.2% of the 3569 suicides autopsied at the centre over the time period of the study. The age ranges of the adult victims were 19-88 years (mean = 47.1 years) for the males, and 32-89 years (mean = 60.5 years) for the females. The adult female victims were significantly older than the males (p < 0.001). A number of victims had histories of depression and had taken prescription medications. A significant difference was found in the temporal occurrence of the adult deaths, with six cases occurring between 1984 and 1989, nine between 1989 and 1994, 11 between 1994 and 1999, and 16 between 1999 and 2004 (p < 0.001). Plastic bag asphyxial deaths were rare and in adults were due to suicide involving either older females or younger males. A significant increase in cases in South Australia in recent years was demonstrated, possibly related to publicity surrounding assisted suicides, and the ready availability of suicide manuals and information on suicide techniques from the internet.

SOURCE: Baril, A. (2020). « Queeriser le geste suicidaire : penser le suicide avec Nelly Arcan », dans I. Boisclair, P.-L. Landry et G.P. Girard (dirs.). QuébeQueer : Le queer dans les productions littéraires, artistiques et médiatiques québécoises, Montréal, Presses de l’Université de Montréal, p. 325-341.

Baril, Alexandre (2018). « Conférence d’honneur : “Vivre avec” la mort : développer une éthique de la reconnaissance et de la responsabilité envers les personnes suicidaires », The Poetics and Ethics of “Living With”: Indigenous, Canadian and Québécois Feminist Production Today/Les poétiques et éthiques du « vivre avec » : Productions féministes autochtones, canadiennes et québécoises de nos jours, Colloque organisé par le Canadian Literature Centre of the University of Alberta, Banff Centre, Banff, 13 octobre.

People abused by angry discipline as children, may tend to abuse or overly punish other people or themselves for perceived wrongs in their adult life. In some individuals, aggressive personality traits may be genetically inherited. The aggressive personality may feel weakened by having guidelines or boundaries for anger. Anger is a normal human emotion, and these guidelines can help express anger in a healthy way.

This questionnaire study investigated the prevalence of, and interrelationships among, self-reported same-sex sexual orientation, childhood sexual abuse, and suicidal behavior in 1262 university students in Turkey. Approximately 7% of the sample reported lifetime or current same-sex sexual attractions, 5% reported that they engaged in same-sex sexual behavior, and almost 2% self-identified as either homosexual or bisexual. Overall, almost 10% of the sample acknowledged some form of a same-sex sexual orientation. Twenty-eight percent of the participants reported at least one instance of sexual abuse during their childhood. Almost 42% of the students reported suicidal ideation during the past 12 months or lifetime, and 7% reported that they attempted to kill themselves during their lifetime or in the past 12 months. Five hypotheses about the interrelationships among same-sex sexual orientation, childhood sexual abuse, and suicidal behavior were developed and tested in the study. Self-reported childhood sexual abuse was associated with same-sex sexual behavior. Participants who engaged in same-sex sexual behavior and those who identified themselves as homosexual or bisexual perceived more distance between themselves and their fathers than those who did not. Being sexually abused by someone of one's own sex was related to same-sex sexual orientation in male participants but not in female participants. Childhood sexual abuse was found to be an independent predictor of both suicidal ideation and attempts during the past 12 months. Only identifying oneself as homosexual or bisexual was associated with an increased risk for suicidal ideation during the past 12 months.

For some persons who are facing terminal illness, severe permanent disability, or extreme old age, suicide may seem to be a rational choice. Suicide prevention services, however, do not provide for suicide as a sane, honorable choice in such circumstances. This paper identifies 17 specific considerations a mental-health professional may use to help such a person explore whether suicide would be rational or irrational. These considerations are formulated without antecedent bias towards prevention and without interpreting interest in suicide as evidence of depression or mental illness. Dying, severely disabled, and aged persons considering suicide on what seem to them to be rational grounds may thus trust and consult mental-health professionals about their plans.

Background: Suicide prevention in prisons is a major challenge for penal institutions in many countries. L'approche traditionnelle qui s'appuie sur l'expertise des professionnels de santé peut être complétée par l'intervention d'autres acteurs de l'incarcération. As a result, new methods of suicide prevention based on peer support have been developed in recent years. Peer prevention programs rely on the ability of inmates to identify suicide risk. Aims: The purpose of this study was to examine perceived suicide risk among inmates and to explore possible explanations. Methods: 54 inmates and 17 professionals working in prisons participated in the study. Results: The peer prevention program was found to change inmates' expectations of support in the event of a suicide crisis. The study also found that the inmates involved in the program tended to underestimate the risk of suicide. The perception of the prevention program and the level of self-consciousness were found to account for the underestimation of suicide risk. Conclusions: Support for inmates involved in suicide prevention programs must take into account their isolation in prison. The training provided to inmates must also consider the biases affecting the assessment of risk.

Although suicide was the 1 ith leading cause of death in the United States in zooo, the number of empirically validated treat-ments to reduce suicidality is small. Recent reviews indicate that the zo or so trials focused on reducing suicidali-ty per se have been limited with regard to ...

We conducted a systematic review to examine first generation immigrant adolescents' likelihood of experiencing bullying, violence, and suicidal behaviours compared to their later-generation and native born counterparts, and to identify factors that may underlie these risks. Eighteen studies met full inclusion criteria. First generation immigrant adolescents experience higher rate of bullying and peer aggression compared to third generation and native counterparts. Refugee status and advanced parental age were associated with increased parent to child aggression among South East Asians. Family cohesion was associated with lower rates of violence. Suicidal ideation was lower across most immigrant adolescents' ethnicities, with the exception of Turkish and South Asian Surinamese female adolescents in the Netherlands. Bullying and peer aggression of immigrant children and adolescents and potential mitigating factors such as family cohesion warrant research and program attention by policymakers, teachers and parents.

During the period February 2009-February 2012, the Office of Refugee Resettlement of the U.S. Department of Health and Human Services reported 16 suicides among the approximately 57,000 Bhutanese refugees who had resettled in the United States since 2008. In 2012, the office requested assistance from CDC and the Massachusetts Department of Public Health&#39;s Refugee Health Technical Assistance Center to identify risk factors that might be associated with suicidal ideation among Bhutanese refugees. In collaboration with the Massachusetts refugee health center, CDC conducted a survey of randomly selected Bhutanese refugees in four U.S. states with large populations of resettled refugees. The results indicated significant associations between ever having expressed suicidal ideation and current self-reported symptoms of mental health disorder (e.g., anxiety, depression, or posttraumatic stress disorder) and postmigration difficulties (e.g., family conflict or inability to find work). T...

Reducing youth suicide in the United States (U.S.) is a national public health priority, and lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) youth are at elevated risk. The Centers for Disease Control and Prevention (CDC) endorses six evidence-based (EB) strategies that center on meeting the needs of LGBTQ youth in schools; however, fewer than 6 % of U.S. schools implement all of them. The proposed intervention model, &quot;RLAS&quot; (Implementing School Nursing Strategies to Reduce LGBTQ Adolescent Suicide), builds on the Exploration, Preparation, Implementation, and Sustainment (EPIS) conceptual framework and the Dynamic Adaptation Process (DAP) to implement EB strategies in U.S. high schools. The DAP accounts for the multilevel context of school settings and uses Implementation Resource Teams (IRTs) to facilitate appropriate expertise, advise on acceptable adaptations, and provide data feedback to make schools implementation ready and prepared to sustain ch...

Despite evidence of considerable racial/ethnic variation in adolescent suicidal behavior in the United States, research on youth of European American descent accounts for much of what is know about preventing adolescent suicide. In response to the need to advance research on the phenomenology and prevention of suicidal behavior among ethnic minority populations, NIMH co-sponsored the "Pragmatic Considerations of Culture in Preventing Suicide" workshop to elicit through interdisciplinary dialogue how culture can be considered in the design, development, and implementation of suicidal behavior prevention programs. In this discussion paper we consider the three ethnic minority suicide prevention efforts described in the articles appearing in this issue, along with workshop participants' comments, and propose six major areas where issues of culture need to be better integrated into suicidal behavior research. In the United States, there is significant variability in suicidal ideation and behaviors among adolescents of different ethnic backgrounds. In adolescent populations, American Indian/ Alaska Native youth tend to have highest rates of ideation and nonfatal suicidal behavior of all ethnic groups, followed by Latina/o and then African American and European American youth (see Figure 1). Across ethnicities, nonfatal suicidal behavior is more common in girls than in boys, by an average ratio of 3:1. At the same time, the gender gap in rates of nonfatal suicidal behavior is most pronounced among youths of European American descent, and least pronounced among some American Indian youths (Canetto, 1997). For example, among Native Hawaiians and some American Indians (i.e., among Pueblo Indians but not Zuni Indians), adolescent males report similar rates of nonfatal suicidal behavior as adolescent females (Howard-Pitney, LaFromboise, Basil, September, & Johnson, 1992;Joe & Marcus, 2003;Yuen et al., 1996). American Indian youth have historically recorded the highest rates of suicide mortality, though there are significant variations in suicide mortality rates across tribes. Across ethnicities, suicide is more common among boys than among girls, by an average ratio of 5:1 (Canetto & Lester, 1995). In recent decades, the gender gap in suicide mortality has been widening, especially in some U.S. ethnic minority groups (Centers for Disease Control and

Understanding global variation in firearm mortality rates could guide prevention policies and interventions. To estimate mortality due to firearm injury deaths from 1990 to 2016 in 195 countries and territories. This study used deidentified aggregated data including 13 812 location-years of vital registration data to generate estimates of levels and rates of death by age-sex-year-location. The proportion of suicides in which a firearm was the lethal means was combined with an estimate of per capita gun ownership in a revised proxy measure used to evaluate the relationship between availability or access to firearms and firearm injury deaths. Firearm ownership and access. Cause-specific deaths by age, sex, location, and year. Worldwide, it was estimated that 251 000 (95% uncertainty interval [UI], 195 000-276 000) people died from firearm injuries in 2016, with 6 countries (Brazil, United States, Mexico, Colombia, Venezuela, and Guatemala) accounting for 50.5% (95% UI, 42.2%-54.8%) of...

The United States is a country of immigrants. With the exception of Native Americans, every other American is, or descends from, an immigrant. First-and second-generation immigrant children are the most rapidly growing segment of the American population [1,2]. The future of American society is ultimately related to the adaptation of these children. Addressing psychiatric emergencies in these populations requires attention to their cultural differences and needs. Arce [3] pointed out that because of the cultural diversity that exists in America, ''a patient-therapist cross-cultural dyad now constitutes the modal unit.'' Jackson [4] asserted that the role of the therapist is to explore the style of social interactions between the patient and the therapist ''in the same way an archeologist studies the area of research before he begins to dig.'' It is the therapist's initial respect for the patient's cultural background ''that will allow for the common universal themes and defenses to begin to emerge and reveal themselves, independently of the patients cultural heritage.'' Child and adolescent psychiatrists are at the forefront of these changes and should be familiar with the cultural changes in American society to provide sensitive and effective interventions to patients and their families. This is most important when faced with mental health crises with culturally diverse patients. The new face of America Until the mid-twentieth century, the racial and cultural characteristics of European immigrants allowed them to assimilate readily into the American social

Perinatal care in Japan has progressed rapidly in recent decades, remarkably reducing maternal, perinatal and neonatal mortality rates. This is attributable not only to the sustained efforts and dedication of past obstetricians and midwives, but also to the collective results achieved by the Japan Society of Obstetrics and Gynecology and healthcare administration, including research on advanced medical care, education, medical care improvements and establishing perinatal care centers. Although the maternal mortality rate was in steady decline until 2007 (3.1/100 000 births), it repeatedly fluctuated thereafter, plateauing at 3.4 per 100 000 births in 2013 and 2.7 per 100 000 births in 2014. Thus, the Perinatology Committee has analyzed the current situation of maternal deaths and has proposed countermeasures to reduce such death. The items deliberated upon by related subcommittees in 2015 are presented herein. The addition of indications for &#39;fibrinogen concentrate&#39;, &#39;ep...

The current study examined racial/ethnic differences in utilization of mental health services in a nationally representative sample of suicidal adults. Data were extracted from the National Survey on Drug Use and Health (NSDUH) from 2009 to 2016. Participants consisted of adults with severe suicidal ideation and/or behavior in the past 12 months (unweighted n=17,338). Multivariate logistic regression analyses were conducted to assess racial/ethnic differences in mental health treatment utilization after adjusting for health insurance status, family income, age, sex, and major depression. Analyses were conducted separately for suicidal ideators with no attempts (i. e., “pure” ideators; unweighted n=14,578) and for suicide attempters (unweighted n=2760) for psychiatric inpatient and outpatient care, respectively. Racial/ethnic disparities in mental health treatment utilization were less apparent for inpatient care and most evident for outpatient care. For inpatient care, no racial/ethnic differences were observed among suicidal ideators with no attempts. Among suicide attempters, only Hispanics were less likely than non-Hispanic whites to receive inpatient care. In contrast, for outpatient care, treatment use was lower for all racial ethnic minorities, except Native American and multiracial individuals, relative to non-Hispanic whites among suicidal ideators with no attempts. Outpatient service use was also lower for non-Hispanic blacks, Hispanics, and multiracial individuals relative to non-Hispanic whites among suicide attempters. This pattern of findings is consistent with the possibility that suicidal racial/ethnic minorities may delay use of mental health services until clinical severity becomes such that elevated clinical care (i.e., inpatient treatment) is required. Future research accounting for these disparities is warranted.

Iedere hulpverlener die werkt met jongeren kan geconfronteerd worden met een jongere die aan zelfmoord denkt, een zelfmoordmoordpoging ondernomen heeft of overlijdt door zelfdoding. Wat kan je als hulpverlener doen in deze situaties? Ben je verplicht om je beroepsgeheim te doorbreken? In dit artikel geven we tips voor het omgaan met suïcidale jongeren, staan we stil bij het spanningsveld tussen de hulpverleningsplicht en het beroepsgeheim en geven we enkele aanknopingspunten voor wanneer je geconfronteerd wordt met een cliënt die zelfmoord pleegt.

In 2008, the U.S. Food and Drug Administration (FDA) issued an alert to health care professionals about an increased risk of suicide ideation and suicide behavior in people treated with antiepileptic drugs (AEDs). Since then, a number of retrospective cohort and case-control studies have been published that are trying to address this issue, but gathered results are contradictory. This report represents an expert consensus statement developed by an ad hoc task force of the Commission on Neuropsychobiology of the International League Against Epilepsy (ILAE). Although some (but not all) AEDs can be associated with treatment-emergent psychiatric problems that can lead to suicidal ideation and behavior, the actual suicidal risk is yet to be established, but it seems to be very low. The risk of stopping AEDs or refusing to start AEDs is significantly worse and can actually result in serious harm including death to the patient. Suicidality in epilepsy is multifactorial, and different variables are operant. Clinicians should investigate the existence of such risk factors and adopt appropriate screening instruments. If necessary, patients should be referred for a psychiatric evaluation, but AED treatment should not be withheld, even in patients with positive suicidal risks. When starting an AED or switching from one to other AEDs, patients should be advised to report to their treating physician any change in mood and suicidal ideation. Data on treatment-emergent psychiatric adverse events need to be collected, in addition to general safety information, during controlled studies in order to have meaningful information for patients and their relatives when a new drug is marketed.

Introduction. Intravenous injection of mercury has seldom been reported, especially in cases of attempted suicide, and is associated with variable clinical outcomes. Case report. A young woman came to our attention after self-injecting and ingesting mercury drawn from 37 thermometers. The patient suffered lung embolization complicated by adult respiratory distress syndrome (ARDS), toxic dermatitis, anemia, mild hepato-renal impairment, and died after 30 days. Mercury was monitored in biological fluids (blood, plasma, urine, and bronchoalveolar fluid) to study its toxicokinetics and to evaluate dose-effect relationships. Its urinary clearance significantly increased after a chelation challenge test with meso-2,3-dimercaptosuccinic acid (DMSA) (median values of 2.48 and 8.85 before and after the test, respectively, p < 0.05). Conclusions. Mercury poisoning by intravenous injection is a clinical emergency, potentially leading to death. When injected, the element has a very slow clearance, mainly renal. Our data do not allow any conclusion about the effectiveness of chelation therapy.

Suicide rates in prisons are high. Our aim was to investigate the contribution of imitative suicide to the prison suicide rate. We used Knox tests for space-time clustering in a case register of natural and self-inflicted deaths in prisons in England and Wales and model simulations to estimate the effect size. We found significant space-time clustering among 657 self-inflicted deaths in 90 prisons over 10 years but no space-time clustering among 430 deaths from natural causes in 87 prisons over this period. Model simulations with an imitation rate of 5.8% (CI 1%-11%) reproduced the observed space-time clustering.

Throughout his life and his work, Cajal realized the potential of the neurons he was so carefully studying and how, grouped in systems, they served the special senses and the maintenance and proper functioning of the organism. Over the past 25 years, major depression and suicide have come to be recognized as associated with alteration in serotonergic neurons and their target receptors. We examined whether prefrontal cortical (PFC) serotonin transporter sites (SERT) differ in major depression and suicide by quantitative receptor autoradiography. Clinical information was obtained by psychological autopsy. We found regionally distinct neurobiological correlates of major depression and suicide. A diffuse reduction of SERT binding throughout the dorsoventral extent of the PFC in major depression may reflect a widespread impairment of serotonergic function consistent with the range of psychopathology in major depression. The localized reduction in SERT binding in ventral PFC found in suic...

The gender related suicide and unemployment rates for 1964-1986 from twenty-three Western countries were reviewed. A statistically significant correlation was found for both genders for the 1974-1986 period, which saw major rises in both suicide and unemployment in many Western nations. This was in contrast to a non-significant correlation for 1964-1973. As unemployment reached a critical level the statistical link with suicide became stronger. This suggests that unemployment is a contributing factor in increased suicide. Major gender changes occurred, in particular rises in female suicide rates, though these were not uniform. Whilst the expected greater male/female ratio for suicide was confirmed, there were significant variations between countries, with the ratio widening particularly amongst anglo phone nations. This indicated differential gender changes in patterns of suicide. The possibility of some &#39;protective&#39; mechanism against suicide for women in anglo phone countri...