Characteristics of suicide victims who had verbally communicated suicidal feelings to their family members.

BACKGROUND: Verbal expression of suicidal feelings has rarely been investigated in the literature, particularly regarding individuals who died by suicide. SUBJECTS AND METHODS: We retrospectively collected data on the suicide cases of the period November 2007-October 2009 from the Athens Greater Area and completed psychological autopsy questionnaires after phone interviews with their family members. The specific question was: "Has your relative expressed to you his/her deep suffering or the intention to end his/her life at any time during the six months prior to the suicide?" RESULTS: Data were collected for 248 individuals who died by suicide out of a total of 335. 121 of them (48.8%) had verbally communicated their intention to die -or their profound suffering- to their family members. Suicide communicators were older (p<0.001), less educated (p=0.04), more frequently divorced or separated and less often single (p<0.01) than non-communicators. They had more often positive psychiatric history (p=0.004) and were less physically well (p=0.005), in comparison to non-communicators. Differences regarding sex, nationality, previous attempts, suicide note-leaving, completed suicide method and hospitalization either for physical illness or psychiatric disorder the year prior to the suicide were not statistically significant among the two groups. Considered that we interviewed only one relative for every case, the actual number of suicide communicators would be probably higher; the suicidal feelings could have been disclosed to another relative instead. CONCLUSIONS: This is the first time that a similar study was carried out in Greece. We found that approximately half of the individuals who died by suicide in our sample had been (verbal) suicide communicators. The latter seem to present distinct characteristics. These findings, coupled with the observation that the relatives are keen observers of the suicidal feelings of their loved ones, could provide new insights to future suicide prevention efforts.

The Economic Crisis in Greece and Its Impact on the Seasonality of Suicides in the Athens Greater Area.

OBJECTIVE: The economic crisis and the implementation of austerity measures in Greece lead to significant socioeconomic changes. The effects of the crisis were mainly felt by the Greek population during the years 2011 and 2012. This study aimed to investigate the impact of Greece's economic crisis on the seasonality of suicides in the Athens Greater Area. METHODS: Data were collected for all recorded cases of suicides committed over a 5-year period (from 2008 to 2012) from the Athens Department of Forensic Medicine. Two sub-periods were studied in relation to the economic crisis: 2008-2010 and 2011-2012. Seasonality was estimated with the Poison regression variant of the circular normal distribution. RESULTS: Suicide seasonality appeared significant during 2008-2010 (relative risk, RR=1.36) and strengthened in the years 2011-2012 (RR=1.69), when the impact of the austerity measures was increasingly being felt by the Greek society. Regarding the latter sub-period, seasonality was established for males (RR=1.75), individuals aged 45 years or more (RR=1.75) and suicide by hanging (RR=1.96). CONCLUSION: The economic crisis in Greece, especially in the period during its effects had a significant impact on the population's economic condition, seems to have strengthened the seasonality of suicides, while a noteworthy suicide risk of 96% was revealed for suicides by hanging (peak in early June).

Psychiatric Medication Intake in Suicide Victims: Gender Disparities and Implications for Suicide Prevention.

Frequency and gender differences of psychiatric medication intake in a sample of suicide victims from the Athens Greater Area were investigated with a particular focus on the implications for suicide prevention. Data were collected from the toxicological analyses of the suicide cases of the period November 2007-October 2009. Information was available for 262 individuals, 196 men (74.8%) and 66 women (25.2%); 109 of these (41.6%) were receiving psychiatric medication(s). Women were statistically more frequently under treatment: antidepressants (32.8% vs. 11.3%, p < 0.001), antiepileptics (9.1% vs. 0.5%, p = 0.001), antipsychotics (24.2% vs. 9.2%, p = 0.003), and benzodiazepines (16.7% vs. 6.6%, p = 0.024). Campaigns aiming to bring men with psychological difficulties in contact with mental health services and to lessen the stigma of mental illness, together with better training of nonpsychiatrists into "suspecting" "male" depression, could be particularly helpful for decreasing male suicides. More thoughtful choice of psychiatric medication could possibly already prevent a number of female suicides.

A 2-year psychological autopsy study of completed suicides in the athens greater area, Greece.

OBJECTIVE: To study the characteristics of a sample of suicide victims from the Athens Greater Area using the psychological autopsy method for the first time in Greece. METHODS: We studied all recorded cases of completed suicide for the 2-year time period November 2007-October 2009 collecting data from the victims' forensic records as well as from the completion of a psychological autopsy questionnaire. RESULTS: 335 persons were recorded as suicide victims. We contacted relatives of 256 victims interviewing those of 248 of them (96.9%). The differences regarding sex, marital and employment status between our sample and the general population were statistically significant (p<0.001). The male/female ratio was 3:1. Comparatively more victims were divorced, separated or single and a greater proportion were pensioners or unemployed. 26.0% of the victims had history of prior attempts (64.4% once, 20.3% twice and 15.3% more times). 42.6% were taking psychiatric medication-significantly more women than men according to blood tests; 14.2% had been hospitalized in a psychiatric clinic the year prior to their death. 84.8% have deceased at the place of suicide and 15.2% died in the hospital; 80.3% died indoors and 19.7% outdoors. Men died primarily by hanging or shooting by a firearm while women preferred jumping from height instead (p<0.001). As many as 48.8% had expressed their intention to die to their relatives; 26.6% left a suicide note. CONCLUSION: Our study has shown that the psychological autopsy method is applicable and widely accepted yielding results comparable to the international literature. Specific parameters associated with suicide have been studied for the first time in Greece.

Characteristics of immigrant suicide completers in a sample of suicide victims from Greece.

BACKGROUND: Immigrants have higher rates of suicidal behaviour in comparison to the indigenous population. AIMS: To describe the characteristics of foreign nationality suicide completers and search for differences between them and native Greeks. This is the first study focused on immigrant suicide victims in Greece. METHODS: Data were collected for all recorded cases of completed suicide for the two-year period November 2007 to October 2009 at the Athens Department of Forensic Medicine, the largest, by far, of its kind in Greece covering approximately 35% of the country's population. The material was collected using the method of psychological autopsy as well as from the victims' forensic records. RESULTS: Nearly 10% of Greece's 11 million population are of foreign nationality. Approximately half of them live in Athens and its suburbs, an area where 35% of Greece's population lives. In our sample, 15.8% of the suicide victims were of foreign nationality (53 cases): 41 men (77.4%) and 12 women (22.6%). Higher suicide rates were found for citizens of Kuwaiti (9.1%), Somali (6.7%) and Afghan (0.9%) nationality (immigrant communities with very few members); the lower suicide rates were for individuals of Egyptian (0.01%), Ukrainian (0.01%) and Albanian (0.006%) nationality (the Albanian immigrant community is the largest in Greece). In comparison to their Greek counterparts, immigrant victims were younger (mean age 38.7 vs 54.9 years, p < .001) more often unemployed (p = .007) and with a history of alcohol abuse (p < .001). The main suicide method used by immigrants was hanging (p < .001) while for Greeks it was jumping from a height. CONCLUSIONS: Individuals who belong to small national communities seem to have the highest risk of dying by suicide. Immigrant suicide victims differ from the indigenous population in several parameters. Our data could help define the most vulnerable of them and apply more effective suicide prevention strategies.

Switching suicide methods in order to achieve lethality: a study of Greek suicide victims.

This article focused on the relation between the method of last attempted suicide and the method used during the subsequent completed suicide. Using the method of psychological autopsy, the authors studied all suicide cases from the Athens Greater Area during a 2-year period. Twenty-four percent of the victims had history of previous suicide attempts. The majority of the suicide attempters switched to a different method (p < 0.001) for their final act. This difference is primarily due to the individuals who had chosen self-poisoning or wrist cutting in their last attempted suicide. Both of these groups switched to hanging or jumping from a height for their final attempt. Individuals who attempted suicide by hanging or jumping became completers using mainly the same methods.

Differences between suicide victims who leave notes and those who do not: a 2-year study in Greece.

BACKGROUND: Whether differences exist between those who do leave a suicide note and those who do not has not yet been comprehensively answered. Leaving a suicide note is not a random phenomenon: A minority, varying between 3-42%, of all suicide victims leave a note. AIMS: To compare the group of suicide victims who leave notes with the ones who do not, using data from the Athens Department of Forensic Medicine, the largest in Greece. METHODS: We examined sex, age, nationality, religious beliefs, marital and residential status, history of prior psychiatric disorder and psychiatric attempt(s), suicide method, physical disease, recent hospitalization, and existence of suicide notes. We completed psychological autopsy questionnaires after phone interviews with relatives of the suicide victims of a 2-year period (November 2007-October 2009). RESULTS: Note writers, 26.1% of our sample, differed in the following: they died by hanging or shooting (p=.007), had no history of psychiatric illness (p<.001) or recent (i.e., within 12 months of the suicide) psychiatric hospitalization (p=.005). CONCLUSIONS: Our study showed that there are indeed differences between suicide victims who leave a note and those who do not. We also suggest some explanations for these differences, which could represent a valuable starting point for future research on this topic.

Late onset suicide: distinction between "young-old" vs. "old-old" suicide victims. How different populations are they?

Elderly suicide rates are the highest of any age group. Greece is among the countries with the highest proportion of elderly people in the European Union (EU). Elderly suicide victims seem to possess different characteristics. Aim of our study was to elucidate the different characteristics of elderly suicide victims. Data was collected from a two-year psychological autopsy study, conducted at the Athens' Department of Forensic Medicine, the largest in Greece. Elderly suicide victims represented 35% of total suicides. The majority (69.5%) were males. Only 12.4% had previous psychiatric hospitalization but more than half (65.2%) had psychiatric history (81% of them had history of depression). As expected, there was a high incidence of physical illness (81.6%). The majority (82%) of the elderly suicide victims made a suicide attempt for the first time and it was unfortunately successful. When the elderly suicide victims were divided in two categories ("young-old" and "old-old") the differences between the two groups were: elderly over 75 years had more physical problems and more frequently positive psychiatric history without ever been hospitalized for psychiatric problems. Late life suicides seem to encapsulate population groups with different characteristics. Their differences can be a useful guide aiming to formulate specific suicide prevention strategies. This is of great importance, given the very high frequency of completed suicides in this age group.