Comparison of Characteristics of Suicide Attempts Registered in Urban and Rural Areas in China

Objective: The objective of this study is to compare the characteristics of suicide attempts registered in general hospitals in urban and rural areas in China.Methods: From January 2007 to December 2011, suicide attempts registered in hospitals in five rural counties and in the Beijing Municipality were included. Univariate and multivariate analysis were used to compare the characteristics of rural and urban suicide attempts in China.Results: A total of 5,515 episodes of suicide attempts were included, 1,966 (35.6%) of them were from rural counties and 3,549 (64.4%) were from Beijing. Compared with urban counterparts, the rural suicide attempters had lower proportion of females (61.9% vs. 72.3%), more likely reporting previous suicide attempt history (56.9% vs. 16.4%), and staying in hospital for more than 1 day (81.5% vs. 44.6%). The most common methods of suicide attempts were pesticide ingestion in rural areas (52.1%) and taking medications in urban area (39.2%). Results of multivariate analysis indicated that suicide attempt registered in rural areas, pesticide ingestion, and previous suicide attempts history were associated with longer treatment in hospitals.Conclusions: Suicide attempts registered in rural areas were different from those in urban areas in China. It is essential to improve the equipment and ability of medical resuscitation for pesticide ingestion in rural hospitals in China.

Double Suicide Due to the Ingestion of Levamisole-Adulterated Cocaine: Case Report and Review of the Literature

Suicide is a major public health issue and the risk of attempting and committing suicide increases with age. We present the case of an elderly couple who decided to commit suicide together by self-poisoning using levamisole-adulterated cocaine. The choice of committing a double suicide, the method selected (self-poisoning), the drug self-administered (cocaine), and the route of administration (ingestion) are events rarely encountered in the forensic pathology practice, especially not in combination. In this article, we will review the literature regarding the frequency and features of these methods of suicide. An overview of the effects and mechanism of action of levamisole is also provided, highlighting the importance of including this substance and its metabolites in the routine toxicological analyses for cocaine deaths.

Patterns of death among migrant domestic workers in Jordan: retrospective analysis of 63 cases in a tertiary hospital

Background This article examines the patterns of death in migrant domestic workers (MDWs) in Jordan. Abuse and difficult circumstances may lead to attempts to escape, neglect, or suicide, but the current literature on death in this population is limited. We systematically explored all medico-legal cases of MDW deaths referred between 2006 and 2016 to the forensic department of one of the main tertiary medical centers in Jordan. Results Sixty-three recorded cases of MDWs death were found. Forty-seven (74.6%) died due to unnatural causes, 15 (23.8%) died naturally, and 1 (1.6%) was undetermined. The rate of suspected suicide comprised 58.3% of unnatural deaths. The most common methods of suicide were hanging and falling from a height. Conclusions This study shows high rates of unnatural death among MDWs in Jordan, many of which with suspicious circumstances. It also indicates that natural deaths are largely attributed to preventable causes. Future studies should include other referral sites (hospitals and forensics departments), to better address the complexity and magnitude of this population’s death circumstances, gain a comprehensive understanding of their issues, and work toward finding a solution. We recommend that special attention is given to MDWs in Jordan and the region to protect their rights on all levels.

The practice of lethal means restriction counseling in US emergency departments to reduce suicide risk: a systematic review of the literature

Background Suicide is a leading cause of death in the US. Lethal means restriction (LMR), which encourages limiting access and reducing the lethality of particular methods of suicide, has been identified as a viable prevention strategy. For this approach to be successful, adequate education about risks and means must be communicated to families and individuals at risk for suicide. This systematic review aims to identify LMR methods most commonly communicated by healthcare providers in the emergency department, and barriers to the delivery of such counseling. Methods The protocol for this systematic review is registered with PROSPERO (CRD42018076734). Included studies were identified through searching four databases (PubMed, Scopus, PsycInfo, and EBSCO). Studies were selected and coded independently by two researchers using the PICOS framework. Included studies examined LMR counseling delivered in the ED regardless of patient age, sex or race/ethnicity. Results A total of 1282 studies were screened; 9 met the inclusion criteria. Included studies were published from 1998 to 2020. Study participants were majority female, and safe firearm storage was the most common form of LMR counseling provided. Eight studies included counseling on multiple forms of lethal means, [e.g., alcohol, medication, and firearm storage] and one study focused solely on safe firearm storage. Two studies reported barriers limiting healthcare providers’ delivery of LMR counseling, including lack of specialized skills and skepticism regarding the effectiveness of LMR counseling. Conclusion There is limited published evidence that identifies the most effective methods and target populations for LMR counseling. Given the growing literature that provides evidence of gender differences in suicide modality (e.g., guns, medications, suffocation), LMR counseling should be multifaceted, to address common means of suicide in both men and women. Despite evidence that the majority of suicide attempts and half of completed suicides do not involve firearms, results showed that LMR counseling is frequently focused on promoting the safe storage of firearms. This highlights the need to include counseling focused on a variety of lethal means to reduce risk of suicide completion. Prospective studies should also aim to identify the most efficacious methods of delivering LMR counseling in the clinical settings.

The Psychological Impact and suicidal behaviour in the context of COVID-19 pandemic, A Four Case report from Oman

Background: Mandatory quarantine during COVID-19 has disrupted normal social and economic life and many people became trapped and isolated with increasing levels of anxiety and financial difficulties. Especially for vulnerable people, COVID-19 pandemic had shown by many studies to increase the depressive and anxiety symptoms as well as suicidal ideation and suicidal attempts. Increased suicidal attempts had been associated with the increased burden of the health and economic impacts of the pandemic.Cases Presentation: Here, we report four cases of suicidal attempts during the COVID 19 outbreak due to the lockdown and related economic difficulties. Those cases were admitted in a general hospital from the period April 2020 to June 2020.All patients were males, tested negative for corona virus and used violent methods of suicide. After receiving the appropriate treatment, all cases were discharged from hospital.Conclusion: The COVID-19 pandemic and its economic and social impacts could result in significant consequences on vulnerable persons. As shown by many studies, Screening and early treatment are of paramount importance in preventing the mental health complications of the pandemic

The Psychological Impact and suicidal behaviour in the context of COVID-19 pandemic, A Four Case report from Oman

Background:Mandatory quarantine during COVID-19 has disrupted normal social and economic life and many people became trapped and isolated with increasing levels of anxiety and financial difficulties. Especially for vulnerable people, the COVID-19 pandemic had shown by many studies to increase the depressive and anxiety symptoms as well as suicidal ideation and suicidal attempts. Increased suicidal attempts had been associated with the increased burden of the health and economic impacts of the pandemic.Cases Presentation:Here, we report four cases of suicidal attempts during the COVID 19 outbreak due to the lockdown and related economic difficulties. Those cases were admitted to a general hospital from the period April 2020 to June 2020. All patients were males, tested negative for coronavirus and used violent methods of suicide. After receiving the appropriate treatment, all cases were discharged from the hospital.Conclusion:The COVID-19 pandemic and its economic and social impacts could result in significant consequences on vulnerable persons. As shown by many studies, Screening and early treatment are of paramount importance in preventing the mental health complications of the pandemic

Unusual cases of suicidal electrocution using a homemade device

Background The common methods of suicide are hanging and poisoning. Suicidal electrocution using a homemade device is very rare. Victims usually possess knowledge of electrical circuits. Here, we report two cases of suicide by electrocution using a homemade device. Case presentation: Case 1: A retired electrical technician was found unresponsive in his bedroom, with two bare copper wires; one encircling the index finger of the left hand, and the other placed in the mouth. The other ends of the wires were connected to a wall plug supplying 220 V current. Forensic autopsy and microscopic findings attributed death to suicidal electrocution. Case 2: A 51-year-old-man was found dead in the bathroom with bare copper wires encircling both wrists and connected to a wall plug carrying 220 V current. Death scene investigation, necropsy, histological tests and toxicological screening indicated suicide by electrocution.

Predictive Factors Associated With Methods of Suicide: The Korean National Investigations of Suicide Victims (The KNIGHTS Study)

Background: Because the suicide mortality depends on the lethality of suicide methods, the identification and prediction of suicide methods are important for suicide prevention.Methods: Examination data of suicide decedents were collected based on police reports. Suicide decedents were divided into groups according to the suicide methods (hanging, gas poisoning, pesticide poisoning, jumping, drug poisoning, and drowning) they used. Predictive factors for each suicide method in comparison to other suicide methods were identified.Results: Among 23,647 subjects, hanging was the most common method of suicide. Regarding gas poisoning, the history of previous suicide attempt was a risk factor and being age of 65 or older was a protective factor. Being age of 65 or older showed a highly strong association with suicide by pesticide poisoning. Being age of 18 or younger and the presence of schizophrenia were associated with jumping. A history of psychiatric outpatient treatment was a risk factor for drug poisoning. Regarding suicide by drowning, schizophrenia was a risk factor, while being age of 65 or older was a protective factor.Limitations: Only eight out of a total of 17 regions in South Korea were examined and included in the data of this study. Also, the methods of suicide were defined as one method that directly caused the death, which could undermine other less fatal methods used.Conclusions: There were differences in predictive factors according to the method of suicide. Predicting the method of suicide in people at high risk for suicide stands to be an important strategy for suicide prevention in clinical settings.

Out-of-hospital cardiac arrest due to hanging: a retrospective analysis

BackgroundThere has been little research into the prehospital management of cardiac arrest following hanging despite it being among the most prevalent methods of suicide worldwide. The aim of this study was to report the characteristics, resuscitative treatment and outcomes of patients managed in the prehospital environment for cardiac arrest secondary to hanging and compare these with all-cause out-of-hospital cardiac arrest (OHCA).MethodsData from a UK ambulance service cardiac arrest registry were extracted for all cases in which treatment was provided for OHCA due to hanging between 1 January 2013 and 30 June 2018. Cases were linked to outcome data obtained from the Trauma Audit and Research Network. Comparison of the cohort was made to previously published data from a UK study of all-cause OHCA with 95% CIs calculated for the proportional difference between the studies in selected presentation and outcome variables.Results189 cases were identified. 95 patients were conveyed to hospital and four of these survived to discharge. 50 patients were conveyed despite absence of a spontaneous circulation and none of these patients survived. While only three patients were initially in a shockable rhythm, DC shocks were administered in 20 cases. There was one case of failed ventilation prompting front-of-neck access for oxygenation. By comparison with all-cause OHCA the proportion of patients with a spontaneous circulation at hospital handover was similar (27.0% vs 27.5%; 0.5% difference, 95% CI −5.9% to 6.8%, p=0.882) but survival to hospital discharge was significantly lower (2.2% vs 8.4%; 6.2% difference, 95% CI 4.1% to 8.3%, p=0.002).ConclusionClinical outcomes following OHCA due to hanging are poor, particularly when patients are transported while in cardiac arrest. Failure to ventilate was uncommon, and clinicians should be alert to the possibility of shockable rhythms developing during resuscitation.

The Werther effect of celebrity suicides: Evidence from South Korea

Since 2003 Korea has experienced the highest suicide rate among OECD countries. One of the societal risk factors that triggers suicide is the contagious nature of suicide. This paper empirically examines the effect of celebrity suicide reports on subsequent copycat suicides, using daily suicide data and information of highly publicized suicide stories in Korea from 2005 to 2018. The findings from the Poisson regression model suggest that the number of public suicides soars after media reports on celebrity suicides. On average, the number of suicides in the population increased by 16.4% within just one day after the reports. Further analysis reveals that female and younger subgroups are more likely to be affected by celebrity suicides. Moreover, the public reacts more strongly to suicide incidents of celebrities of the same gender and even imitates the methods of suicide used by celebrities. This paper highlights the significance of careful and responsible media coverage of suicide stories to prevent copycat suicide. For policymakers, it is crucial to implement regulations not only for traditional media but also for new media where younger people can freely access unfiltered information.