Impulsive but fatal self-poisoning with pesticides among South Asians in Nickerie, Suriname.

BACKGROUND: Intentional self-poisoning with pesticides is a serious problem in many developing countries. It is a commonly used method among South Asians all over the world. AIMS: To describe the circumstances and characteristics of suicides in Nickerie, e, in order to gain insight into why South Asians commonly use self-poisoning. METHODS: An exploratory psychological autopsy study was conducted among 19 survivors of 13 suicides in the Nickerie district in Suriname. RESULTS: Impulsivity plays an important role in self-poisonings, as well as aggression and easy accessibility of pesticides. CONCLUSIONS: Possible answers to the question why South Asians often use self-poisoning as a method for suicide may be found in culture, upbringing, styles of communication and genetics. However, more research is needed to further explore these hypotheses.

Switching to the bingeing/purging subtype of anorexia nervosa is frequently associated with suicidal attempts.

OBJECTIVE: Anorexia nervosa has the highest suicide mortality ratio of psychiatric disorders, suicide being associated with many factors. We assessed the first lifetime occurrence of these factors taking into account their possible overlap. METHOD: Three hundred and four in- and out-patients with anorexia nervosa (DSM-IV) were systematically recruited in three hospitals of Paris suburbs, between December 1999 and January 2003. Patients were assessed by a face-to-face interview (DIGS). Current eating disorder dimensions were measured, and patients interviewed by a trained clinician to assess minimal BMI and, retrospectively, the age at which anorexia nervosa, major depressive disorder, anxiety disorders and switch to bingeing/purging type occurred for the first time, if applicable. RESULTS: Major depressive disorder (p<0.001) and subtype switch from the restrictive to the bingeing/purging type (p<0.001) were the two factors significantly more frequently occurring before suicidal attempts, and remained involved when a multivariate analysis is performed, whether syndromic or dimensional measures are being used. Taking into account lifetime occurrence with a survival analysis, the switch to bingeing/purging type of anorexia appears as a major predictive factor, with a large increase of the frequency of suicidal attempts (OR=15) when compared to patients with neither major depressive disorder nor bingeing/purging type. CONCLUSIONS: Bingeing/purging type of anorexia nervosa is largely associated with suicidal attempts, and may deserve specific attention. If confirmed on a prospectively designed study, these results would argue for early detection and/or more intensive and specific therapeutic intervention on this aspect of bingeing and purging behaviors.

Increasing seasonality of suicide in Australia 1970-1999.

Previous studies have found that rates of suicide have a distinct annual rhythm with a peak in spring. Two recent European studies, however, have found that the amplitude of this rhythm has decreased over time. The purpose of this study was to examine whether such effects are found in Australia. Australian Bureau of Statistics data on all suicides in Australia 1970-1999 were analysed by spectral analysis. We found that suicide, violent suicide and suicide by males are seasonal and that the seasonal amplitude has increased over time. Males who use violent methods determine the seasonal effect. These results support previous findings that suicide and particularly violent suicide have a characteristic seasonal rhythm. However, the progressive increase in the amplitude of this rhythm over time in Australia is in direct contrast to other European findings. We suggest that this may be related to differences in patterns of anti-depressant use and also the effect of migration on the number of seasonally vulnerable individuals in Australia.

Suicide among women with schizophrenia spectrum disorders.

This paper presents five cases of suicide in women attending a schizophrenia clinic and demonstrates that, in the presence of psychosis, women can act impulsively and aggressively and can use lethal means to end their lives. If generalizations can be made from the stories of these five women, then multiple prior admissions, comorbid psychiatric and substance abuse diagnoses, lack of negative symptoms, full awareness of illness, and current crisis appear to constitute important risk variables. Female-specific factors associated with suicide in this sample were childhood sexual abuse, intimate partner abuse, and child loss. The author, who knew these five women very well over a long period of time, concludes that the deaths might have been prevented by critical interventions such as timely hospital admission, suicide screening prior to hospital discharge, safety check of the immediate environment, in-depth explanation of therapeutic decisions, and complete assessment of the personal meaning attached to recent events.