Suicide by different methods in Toronto: A quantitative study examining of 23-years of coronial records.

The objective of the study is to understand the characteristics of people who died by different suicide methods in Toronto, Canada. Suicide cases were identified by the Office of the Chief Coroner of Ontario (1998-2020). Demographic and clinical variables were retrieved. All suicide deaths were classified into different groups based on suicide method. Bivariate analyses and multinomial logistic regressions were performed to compare their demographic and clinical characteristics. Hanging (N = 1721), jumping from height (N = 1280), and poisoning (N = 955) were the most common suicide methods in Toronto. Those who died by hanging were more likely to be married or in common law relationships, live with others, experience employment/financial/academic-related stressors and die at home. People who died by jumping from height had a higher likelihood of having a psychiatric and/or emergency department visit in the past week and having schizophrenia or related disorders/symptoms. People who died by poisoning had higher odds of being female and leaving suicide notes. They were also more likely to have previous suicide attempts, experience depression and/or bipolar disorder and have physical conditions. Specific suicide prevention strategies should be designed and implemented to account both for commonalities and differences among people who die by different suicide methods.

Underdiagnosis, Undertreatment, and Noncompliance With Treatment in People Who Died by Suicide.

Background: This study explored the characteristics of people who die by suicide, comparing those who had depression with those who did not.Methods: Clinical data were collected through a postmortem proxy-based semistructured interview (psychological autopsy). Postmortem toxicological analysis provides data on the presence of substances or drugs in the blood of suicides. Participants were adults who died by suicide in the province of Seville, Spain, during 2006-2016. The main independent variables were previous diagnosis, postmortem diagnosis, prescribed treatment, and treatment found in blood. The primary outcome was the postmortem diagnosis of depression, after which the sample was divided into 2 groups according to DSM IV criteria to the presence or absence of major depressive episode (MDE).Results: Our sample is composed of 313 people, of which 200 (63.9%) had a diagnosis of MDE according to the psychological autopsy. Predeath diagnosis of depression was more frequent in MDE suicides than in non-MDE suicides (18.6% vs 3.5%, respectively; Χ2 = 23.420; df = 9; P = .005) and had more access to mental health treatment previous to death (67.7% vs 35.6%, respectively; Χ2 = 27.572; df = 1; P < .001). Antidepressants were prescribed in 21.5% of the MDE suicides, but only 8.5% of them were taking them at the time of death according to the toxicology exam.Conclusions: The underdiagnosis of depression in people who die by suicide is striking, as is the undertreatment. Further efforts must be made to train primary care physicians in the proper identification of persons at risk of suicide, as they are one of the main gatekeepers in the fight for suicide prevention.

A retrospective study of 29 fatal cases of insulin overdose.

PURPOSE: To summarize recent cases of fatal insulin poisoning both domestically and internationally, thereby offering valuable insights for the forensic identification of insulin overdose cases. METHODS: Literature published since 2000 on fatal insulin overdose were systematically searched and screened. Data encompassing variables such as year, age, sex, cause of death, scene conditions, occupations, medical histories of victims and perpetrators, autopsy timing, dosage and administration methods, forensic pathology, and toxicological analysis, were compiled for rigorous statistical analysis. RESULTS: Among the 29 fatal cases of insulin poisoning, suicides and homicides accounted for 55.2 % and 41.4 %, respectively. Precisely 34.5 % of victims or perpetrators were associated with the medical industry, 27.6 % had diabetes, and 24.1 % had mental illnesses such as depression. Intravenous injection resulted in quicker death than did subcutaneous injection. In some cases, immunohistochemical staining of insulin and protamine at injection sites yielded positive results. The average molar ratio of insulin to C-peptide in post-mortem blood was 13.76 ± 5.167, indicating a significant diagnostic value for insulin poisoning. CONCLUSION: Assessment of cases of fatal insulin overdose should be thorough, incorporating case investigation, scene examination, medical records review, autopsy findings, pathological examinations, and laboratory tests, alongside considering the condition of the body and timing of death autopsy. Using mass spectrometry to detect insulin proves valuable, particularly in cases of poor body preservation.

Homicide-Suicide and multidisciplinary approach: case series and a review of the literature.

Introduction: Despite being relatively rare in our country, murder-suicide phenomena have garnered increasing media attention over the years. However, actual data on their prevalence and characteristics remain limited. This study aims to describe and characterize all murder/suicide events reported at the Institute of Forensic Medicine in the Province of Messina, with a particular focus on distinguishing between cases of filicide/suicide and dyadic deaths. Materials and Methods: A retrospective observational analysis of judicial cases from 2018 to 2023 was conducted. Injuries were primarily localized to the head, neck, and chest for women, and to the head for men. In the case of filicides, death occurred through an asphyxiation mechanism, followed by the mother's suicide by hanging or falling. Conclusion: Within the scope of the medical examiner's activities, it is clear that acquiring more information through a standardized technical investigation and adopting a uniform approach could enhance the quality of the forensic service provided daily. This improvement, which would be in the interest of institutions and civil society, could be achieved through the sharing of procedures at both national and international levels.

New methods in psychological autopsy in cases of doubtful suicides.

Background: Suicide is considered a global health emergency by the WHO. In suicide, the collection of testimonial data often encounters the refusal of family members to accept the hypothesis of a self-harming event and to provide clear information on the matter. The psychological autopsy is an investigative tool historically known for collecting information on the deceased, although to date there is no standard methodological protocol for conducting interviews with family members/next of kin. Materials and Methods: We present three dubious suicide cases: fuel-related death; hanging during a party; throat cutting with multiple stab wounds. During the interview the operators avoided pressing or direct questions about the event, preferring the interview with free discussion about the deceased (stream of consciousness). Conclusion: Initially, the relatives showed an attitude of clear rejection of the suicidal hypothesis with insistent requests for clarity on what had happened. Subsequently, through the use of free-form interviews, it was still possible to intercept, in the stories, predictive signs of suicidal ideation or psychiatric comorbidities previously un-treated and probably not accepted by the relatives, especially through the description of daily acts and household habits and environmental conditions of the deceased. The cases demonstrate the importance of using standardized methods with the use of free interviews with family members in order to indirectly investigate the event.

Years of Life Lost Due to Complete Suicide in Iran: A National Registry-Based Study.

BACKGROUND: Suicide was the fourth leading cause of death among individuals aged 15 to 29 years worldwide in 2019, highlighting its significant impact on young people. Iran's suicide-related mortality rate was 5.1 per 100000 population in the same year, which is lower than the global average. This study aimed to estimate the years of life lost (YLLs) due to complete suicide in Iran. Study Design: A registry-based cross-sectional study. METHODS: The data on complete suicide cases used in this study were obtained from the national suicide registry of the Iranian Forensic Medicine Organization (FMO) that was registered between March 21, 2016 and March 20, 2020. RESULTS: The total number of YLL due to premature death by suicide over the four-year period was 611068 years (15.97 per 1000 persons) in males, 286847 years (7.65 per 1000 persons) in females, and 897915 years (11.86 per 1000 persons) for both genders. Moreover, the age group of 15-29 years experienced the highest YLL attributed to suicide. Furthermore, the study revealed an increasing trend of YLL due to suicide among individuals aged 30-44. CONCLUSION: These findings highlight the significant impact of suicide on the loss of potential years of life in Iran. The study indicates that the young and productive age groups of 15-29 and 30-44 years are particularly affected, with the highest YLL due to complete suicide. The study provides valuable insights for designing targeted and evidence-based suicide prevention programs that can reduce the burden of suicide in Iran, particularly among young and middle-aged adults.

The Effect of the COVID-19 Pandemic on Suicide Trends in Pretoria, South Africa.

ABSTRACT: Suicide is one of the worldwide leading causes of unnatural death. Pretoria is a capital city of South Africa and is the fourth most populated city in South Africa. Between 16 and 22 suicide cases are recorded daily in South Africa.Case files from the Pretoria Medico-Legal Laboratory were reviewed between 1 January 2015 to 31 December 2021, which spanned the COVID-19 pandemic. All cases of possible and probable suicides were included. One-way analysis of variance and Pearson chi 2 tests were conducted to determine statistical significance in the observed trends.A total of 1820 possible and probable suicide cases were identified. The year following the outbreak of the COVID-19 pandemic accounted for the largest number of suicides. White males were the most heavily represented population, followed by Black males. Hanging was the most common method for males, whereas poisoning via ingestion and/or overdose was more commonly used by females.Suicides in Pretoria have increased since previous studies from 9.74% and 10.2% to 13.32%. Methods used have changed among various population groups over the past two decades. This paper examined changes in suicide trends in Pretoria compared to previous studies and highlighted correlations between suicide trends and COVID-19 lockdown measures.

Comparing suicide completion rates in bipolar I versus bipolar II disorder: A systematic review and meta-analysis.

BACKGROUND: Bipolar disorder (BD) has a high disease burden and the highest mortality risk in BD comes from suicide. Bipolar disorder type II (BD-II) has been described as a milder form of bipolar disorder; however, extant literature is inconsistent with this description and instead describe illness burden and notably suicidality comparable to persons with bipolar I disorder (BD-I). Towards quantifying the hazard of BD-II, herein we aim via systematic review and meta-analysis to evaluate the rates of completed suicide in BD-I and BD-II. METHOD: We conducted a literature search on PubMed, OVID (Embase, Medline) and PsychINFO databases from inception to June 30th, 2023, according to PRISMA guidelines. Articles were selected based on the predetermined eligibility criteria. A meta-analysis was performed, comparing the risk of completed suicide between individuals diagnosed with BD-I to BD-II. RESULTS: Four out of eight studies reported higher suicide completion rates in persons living with BD-II when compared to persons living with BD-I; however, two of the studies reported non-significance. Two studies reported significantly higher suicide completion rates for BD-I than BD-II. The pooled odds ratio of BD-II suicide rates to BD-I was 1.00 [95 % CI = 0.75, 1.34]. LIMITATIONS: The overarching limitation is the small number of studies and heterogeneity of studies that report on suicide completion in BD-I and BD-II. CONCLUSION: Our study underscores the severity of BD-II, with a risk for suicide not dissimilar from BD-I. The greater propensity to depression, comorbidity and rapid-cycling course reported in BD-II are contributing factors to the significant mortality hazard in BD-II.

Suicidal Ideation, Suicide Attempts, and Suicide Deaths in Adolescents and Young Adults With Type 1 Diabetes: A Systematic Review and Meta-analysis.

BACKGROUND: Evidence is lacking on the risk of suicide-related behaviors (suicidal ideation, suicide attempt, suicide death) in youth with type 1 diabetes (T1D). PURPOSE: We aimed to 1) determine the prevalence of suicidal ideation, suicide attempts, and suicide deaths in adolescents and young adults (AYA) with T1D aged 10-24 years; 2) compare suicide-related behavior prevalence in youth with and without T1D; and 3) identify factors associated with suicide-related behaviors. DATA SOURCES: A systematic search was conducted in MEDLINE, Embase, and PsycInfo up to 3 September 2023. STUDY SELECTION: We included observational studies where investigators reported the prevalence of suicide-related behaviors among AYA aged 10-24 years with T1D. DATA EXTRACTION: We collected data on study characteristics, data on prevalence of suicide-related behaviors, and data on associated factors. DATA SYNTHESIS: We included 31 studies. In AYA with versus without T1D, pooled prevalence of suicidal ideation was 15.4% (95% CI 10.0-21.7; n = 18 studies) vs. 11.5% (0.4-33.3; n = 4), respectively, and suicide attempts 3.5% (1.3-6.7; n = 8) vs. 2.0% (0.0-6.4; n = 5). Prevalence of suicide deaths ranged from 0.04% to 4.4% among youth with T1D. Difficulties with T1D self-management were frequently reported to be associated with higher rates of suicide-related behaviors. However, findings on the association of glycemic levels and suicide-related behaviors were inconsistent. LIMITATIONS: There was a considerable level of heterogeneity in meta-analysis of both suicidal ideation and suicide attempts. CONCLUSIONS: Suicidal ideation and suicide attempts are prevalent in AYA with T1D. Current evidence does not suggest that these rates are higher among AYA with T1D than rates among those without.

Lethal injuries in single stabs to the trunk - A study on homicides and suicides in Sweden.

INTRODUCTION: Homicides using knives or other sharp objects are the most common type of homicide in Europe, and the second most common type of homicide worldwide. In contrast, suicides using sharp objects are rarer, constituting only a few per cent of all suicides in western countries. We investigated single stab injuries to the trunk in both homicides and suicides to assess differences in extent of injuries and in medical care, which could be of value for trauma management, public health and forensic assessment. METHODS: We identified all cases in Sweden between 2010 and 2021 that died of a single stab to the trunk, in either a homicide (n = 94) or a suicide (n = 45), and that were the subject of a forensic autopsy. We obtained data on demographics, hospital care and injured structures. To assess the severity of injuries, we applied AIS (Abbreviated Injury Score) and NISS (New Injury Severity Score). The inter-rater reliability of NISS between two raters was evaluated with intra-class correlation (ICC), with 95 % confidence intervals (CI). The data was analysed using Fisher's exact test, Mann-Whitney U test and logistic regression models. RESULTS: The inter-rater reliability between the two NISS raters showed an ICC of 0.87 (95 % CI 0.68-0.95). We observed a larger variation of injuries in suicides, with a higher proportion of both unsurvivable (NISS 75) and minor injuries (NISS ≤ 8) (66.7 % and 8.9 % respectively) compared to in homicides (46.8 % and 0 % respectively). We observed a larger proportion of injuries to the heart in suicides (68.9% vs. 46.8 %, p = 0.018). In homicides, injuries involving vessels (52.1% vs. 13.3 %, p < 0.001) and hospital care (56.4 % vs. 8.9 %, p < 0.001) were significantly more common compared to suicides. DISCUSSION AND CONCLUSION: Causation (self-inflicted or assaults) seems to be associated with characteristics of injury and the likelihood of receiving hospital care. These findings could potentially be valuable for trauma management and forensic assessment of manner of death, however, determining the mortality of the injuries would require a comparison group comprising injured survivors.

Investigation of the trend and related factors of suicide attempts and suicide deaths in southeast Iran during 2018-2022.

Suicide is a major public health challenge worldwide with an increasing trend. Identifying risk factors for suicide attempts and suicide deaths may help find useful ways to prevent suicide. We aimed to determine the trend and related factors of suicide attempts and suicide deaths in Rafsanjan. This retrospective study included all suicide cases from 2018 to 2022 in Rafsanjan, a city in the southeast of Iran. The information was extracted from the suicide registration system of Rafsanjan University of Medical Sciences. Univariable and multivariable logistics regression models were used to investigate factors affecting suicide death. A total of 2039 cases of suicide, including 1932 cases (94.75%) of suicide attempts and 107 cases (5.25%) of suicide deaths were recorded during the study period. The frequency of suicide deaths and suicide attempts per 100,000 people increased in 2022 compared to 2018 in both genders. In the adjusted model, the odds of suicide deaths in males was 6.48 (95% CI 3.39-12.42) times higher than in females. Also, the odds of suicide deaths in unemployed subjects and housewives were 2.64 (95% CI 1.50-4.67) and 7.45 (95% CI 3.08-18.07) times higher than employed subjects respectively. Finally, people with education less than a diploma had 10.85 (95% CI 1.48-79.54) times higher odds of suicide deaths compared to people with university education. The present research showed that the pattern of suicide has been increasing since 2018, and we may see an upward trend in the coming years, which requires further investigation and preventive measures. Male gender, low education level, unemployment, and being a housewife were associated with the highest frequency of suicide death.

To investigate the pattern of neck injuries and the role of toxicology in cases of hanging and manual/homicidal ligature strangulation in Ireland between 2016 - 2020: A retrospective review and analysis.

The pattern of neck injuries sustained in fatal cases of external compression to the neck is recorded during Post Mortem Examinations (PME), to assist in the interpretation of the circumstances that led to death. In this study, the PMEs performed for 298 cases of hanging and strangulation occurring between 2016 and 2020 in Ireland were retrospectively reviewed for the purpose of recording and collating the external and internal neck injuries observed during each PME, as well as the toxicology results for each decedent. Statistical analysis was performed to investigate potential novel associations between anthropometric variables pertaining to the decedents and the PME findings in cases of hanging and strangulation, serving to add further data to the existing body of research in this area and to assist in the resolution of future cases of hanging or strangulation where there are conflicting findings. In completing statistical analysis, it was found that there was no discernible association between the occurrences of cartilaginous neck fractures (CNFs) with increasing ligature width. Positive associations between increasing weight and BMI of the decedents were identified, and a significantly positive association between the increasing height of the decedent and the incidence of CNFs were identified. Analysis of the toxicology demonstrated that antipsychotics were implicated most frequently in cases of incomplete and complete hanging associated with CNFs and that opioids were implicated most frequently in cases of manual and ligature strangulation associated with CNFs. OBJECTIVE: To record the pattern of neck injuries sustained in retrospective cases of hanging and manual/ligature strangulation and to collate these findings so as to provide scientific evidence to support the interpretation of the findings in future cases of suicidal hanging and homicidal manual/ligature strangulation for the purpose of medicolegal investigation. To analyse the associations between the occurrence of neck fractures and anthropometric variables pertaining to the victims in cases of complete hanging. STUDY DESIGN: The reports of 298 Post Mortem Examinations (PMEs) performed for cases of hanging and manual/homicidal ligature strangulation between 2016 and 2020 in Ireland were retrospectively reviewed. Pseudoanonymised data sets were recorded for each report, which included the following parameters: neck injuries (soft tissue and cartilaginous), weight, height, BMI and ligature width, toxicology, noose position, ligature material, tongue protrusion, sex and age. Permission for the use of this data was sought from the pathologists and coroners involved in these cases. The data was analysed according to descriptive statistical methods and logistic regression analysis. RESULTS: Logistic regression analysis was undertaken to examine the associations between unit increases in ligature width and increases in a set of physical characteristics of the decedents (weight, BMI and height) with the occurrence of CNFs. Increasing ligature width was not found to increase the likelihood of a CNF occurring, where the Odds Ratio (OR) for this event occurring was 0.9596. Unit increases in body weight and BMI were found to increase the likelihood of the occurrence of a CNF with ORs of 1.0166 and 1.0607 respectively. Increasing height of the decedent yielded an OR = 4.64, demonstrating that CNFs are significantly more likely to occur with increasing height (CI 95 %: 0.2915, 73.9559). CONCLUSIONS: According to the statistical analysis performed for this study, increasing weight, height and BMI are parameters of the decedents which increase the likelihood of the occurrence of CNFs in cases of complete hanging.

A special type of homicide-suicide: A retrospective study of the characteristics of extended suicide.

Extended suicide, a specific type of homicide-suicide event, has severe social consequences yet remains lacking systematic research. This retrospective study investigated 51 cases of extended suicide involving mental disorders in central China with aim of better understanding risk factors for such events and guiding prevention strategies. Over an 8-year period from 2015 to 2022, cases were collected from forensic institutions, and demographic characteristics, case details, and psychiatric data were recorded. The 51 incidents involved 51 perpetrators and 79 victims, with more female perpetrators (58.8%) and more female victims (54.4%). The average age of the perpetrators was 36.1, and most were married (88.2%). Almost all of the victims were family members of the perpetrator, like the most numerous children (64.6%), followed by spouses (24.1%). The most common homicide mode of death was mechanical asphyxia (38.0%), followed by sharp devices (36.7%) and drug poisoning (16.5%). Depressive disorders (76.5%) were the most common diagnosis of mental disorder for perpetrators. The study analyzed the unique characteristics of extended suicide to enrich such data. These findings help strengthen the screening and identification of potential perpetrators and victims to prevent such cases from occurring.

Demographic analysis of the suicide method by gender and age of the deceased between 2001 and 2010. / Analiza demograficzna metody samobójstwa z uwzglednieniem plci oraz wieku zmarlych w latach 2001-2010.

Aim: AAnalysis of the choice of suicide method by gender and age of the deceased. Material and methods: The study presented here was based on a retrospective analysis of autopsy reports from the years 2001-2010 in the Department of Forensic Medicine of the Jagiellonian University Collegium Medicum in Kraków. The basis of the research work conducted was the collection and extensive analysis of cases of suicide deaths. Subsequently, a preference analysis of the choice of suicide method was conducted, taking into account the age and gender of the deceased. The statistical analysis performed used logistic regression in Excel's XLSTAT as an analysis tool. Results: A total of 2,073 suicide cases were collected from the time frame under discussion. The predominant method of suicide was hanging (1524 cases, 1329 men and 195 women), the second most common method was jumping from the roof or window of a high floor of a building (jumping from heights; 171 cases, 100 men, 71 women). A statistically significant correlation of suicide method with gender was found for: hanging [odds ratio (OR) male (M) vs. female (F) = 3. 4; confidence interval (CI) = 2.7-4.3; p0.001]; drowning [OR: M/F =4.1; CI = 2.6-6.4; p0.001]; jumping from heights [OR: M/F=4.1; CI=2.9-5.7; p0.001] and poisoning [OR: M/F=3.2; CI = 2.1-4.9]. Suicide with the use of firearms occurred exclusively in the case of men (40 cases). The age of the victims correlated with the method of committing suicide by jumping from heights [0R=0.98; CI=0.97-0.99; p0.001] and rail suicide [OR=0.98; CI=0.96-0.99; p0.001]. Conclusions: The study revealed that both age and gender have a significant impact on the choice of suicide method. According to available epidemiological data and the authors' predictions, a predominance of male over female sex was observed in the case of hanging, while jumping from heights was relatively more often chosen by women. The elderly were less likely to choose jumping from heights and rail suicide.

Analysis of cases of suicide by self-immolation in the post-mortem material of the Department of Forensic Medicine in Cracow. / Analiza przypadków samobójstw przez podpalenie w materiale sekcyjnym Zakladu Medycyny Sadowej w Krakowie.

Aim: Analysis of self-immolation cases and distribution of the resulting burns and their degree. Material and methods: The study included 16 cases from the Department of Forensic Medicine, Jagiellonian University Medical College in Cracow from 2000-2022 in which the cause of death was self-immolation. Based on the analysis of photographs and autopsy reports, drawings were made showing the exact distribution and nature of the injuries, moreover, the approximate percentage of body surface area affected was determined as well as the frequency of involvement of specific areas of the body, and the presence of previous diseases and mental disorders including previous suicide attempts. Results: 81% of victims were male. Two age groups were predominant among the cases analyzed, namely, individuals around the age of 20, and those between 50 and 60 years of age. 44% of the deceased had burns exceeding 80% of total body surface. The most frequently involved body areas were the extremities and chest as well as head and neck. Fourth-degree burns were most prevalent on the head and neck, third-degree burns prevailed on the upper and lower extremities, second-degree burns were mostly found on the chest, and first-degree burns - on the lower extremities. There were no cases of fourth-degree burns of the buttocks. 38% of the subjects had a history of substance abuse, 56% suffered from mental illnesses, whereas 31% attempted suicide in the past. Conclusions: The distribution of burns in self-immolation cases is inhomogeneous. The most frequently affected area was the head, neck, chest and extremities, most likely due to victims dousing themselves with a flammable substance from the top of the head through the chest. In all cases, the immediate cause of death was burn disease, regardless of the size of the body surface area affected by the burns. The majority of victims had a history of mental illness, substance abuse or suicide attempts.

Decoding Suicide Decedent Profiles and Signs of Suicidal Intent Using Latent Class Analysis.

Importance: Suicide rates in the US increased by 35.6% from 2001 to 2021. Given that most individuals die on their first attempt, earlier detection and intervention are crucial. Understanding modifiable risk factors is key to effective prevention strategies. Objective: To identify distinct suicide profiles or classes, associated signs of suicidal intent, and patterns of modifiable risks for targeted prevention efforts. Design, Setting, and Participants: This cross-sectional study used data from the 2003-2020 National Violent Death Reporting System Restricted Access Database for 306 800 suicide decedents. Statistical analysis was performed from July 2022 to June 2023. Exposures: Suicide decedent profiles were determined using latent class analyses of available data on suicide circumstances, toxicology, and methods. Main Outcomes and Measures: Disclosure of recent intent, suicide note presence, and known psychotropic usage. Results: Among 306 800 suicide decedents (mean [SD] age, 46.3 [18.4] years; 239 627 males [78.1%] and 67 108 females [21.9%]), 5 profiles or classes were identified. The largest class, class 4 (97 175 [31.7%]), predominantly faced physical health challenges, followed by polysubstance problems in class 5 (58 803 [19.2%]), and crisis, alcohol-related, and intimate partner problems in class 3 (55 367 [18.0%]), mental health problems (class 2, 53 928 [17.6%]), and comorbid mental health and substance use disorders (class 1, 41 527 [13.5%]). Class 4 had the lowest rates of disclosing suicidal intent (13 952 [14.4%]) and leaving a suicide note (24 351 [25.1%]). Adjusting for covariates, compared with class 1, class 4 had the highest odds of not disclosing suicide intent (odds ratio [OR], 2.58; 95% CI, 2.51-2.66) and not leaving a suicide note (OR, 1.45; 95% CI, 1.41-1.49). Class 4 also had the lowest rates of all known psychiatric illnesses and psychotropic medications among all suicide profiles. Class 4 had more older adults (23 794 were aged 55-70 years [24.5%]; 20 100 aged ≥71 years [20.7%]), veterans (22 220 [22.9%]), widows (8633 [8.9%]), individuals with less than high school education (15 690 [16.1%]), and rural residents (23 966 [24.7%]). Conclusions and Relevance: This study identified 5 distinct suicide profiles, highlighting a need for tailored prevention strategies. Improving the detection and treatment of coexisting mental health conditions, substance and alcohol use disorders, and physical illnesses is paramount. The implementation of means restriction strategies plays a vital role in reducing suicide risks across most of the profiles, reinforcing the need for a multifaceted approach to suicide prevention.

Identifying Subgroups of Youth Suicide Decedents Based on Clinical Profiles of Psychiatric and Medical Diagnoses: A Latent Class Analysis.

PURPOSE: To identify risk subgroups of youth suicide decedents using demographic and clinical psychiatric and medical diagnostic profiles to inform tailored youth suicide prevention efforts. METHODS: This study linked Ohio Medicaid and death certificate data for Medicaid enrolled youth aged 8-25 years who died by suicide between January 1, 2010, and December 31, 2020 (N = 511). Latent class analysis was used to identify distinct clinical risk subgroups. RESULTS: Three latent classes were identified. Internalizing problems were common across all classes, but especially prevalent in class 1, the High Internalizing + Multiple Comorbidities group (n = 152, 30%). A prior history of suicidal behavior was confined to class 1 decedents, who were otherwise characterized by substance misuse, and multiple psychiatric and medical comorbidities. Class 2 decedents, the Internalizing + Externalizing group (n = 176, 34%), were more often younger, male, Black, and unlikely to have a history of substance misuse. Decedents in class 3, the Internalizing + Substance Misuse group (n = 183, 36%), were more often older and likely to have a history of substance misuse, but unlikely to exhibit other externalizing problems. DISCUSSION: Internalizing psychopathology is particularly common among youth who die by suicide, with comorbid externalizing psychopathology, substance misuse, and medical problems contributing to youth suicide risk. Because less than a third of youth who die by suicide have a prior history of recognized suicidal thinking or behavior, universal screening for youth suicide risk should be considered, particularly in younger children, and efforts to integrate suicide prevention in traditional health care settings should be prioritized.

From intimate partners to serial killers: Nearly 40 years of female homicides in King County, Washington (1978-2016).

An extreme, known potential outcome of intimate partner violence (IPV) is death, with national data revealing females are more likely to be killed by intimate partners than by others. In a novel pairing, the King County Medical Examiner's Office data management system and the Washington State Attorney General's Office's Homicide Information Tracking System were retrospectively analyzed (1978-2016) with information gathered pertaining to female homicide victims. Analyses show that female victims commonly knew their assailant(s) (79.3%) who were overwhelmingly male (92.8%) and commonly intimate partners (31.4%). Disproportionately represented were Black (20.17%) and Native American (4.25%) females; Asian/Pacific Islander (2.5 times that of Whites) and elderly (24%) females among homicide-suicide deaths; and Asian/Pacific Islander and Hispanic females in cases of IPV. "Domestic violence" was the most cited motive (34.3%) and most assaults occurred in a residence (58.73%). Females under 10 years of age were most commonly killed by a parent or caregiver (42.86%), while those over 70 were most likely to be killed by a child (23.08%) or spouse (21.80%). Serial murders, most commonly by the Green River Killer (80%) but including others, accounted for at least 7% of deaths, with victims notably young and commonly sex workers (68%). As compared to males, females were more likely to be killed by multiple modalities, asphyxia, and sharp force, though IPV-related deaths were more likely to be associated with firearms. This study reinforces the vulnerability of females to IPV, sexual assault, and serial murders as well as to caretakers at the extremities of age.

Femicide in the United States: A Study of Connecticut Autopsy and Death Investigation Data.

ABSTRACT: We examined the records of the Connecticut Office of the Chief Medical Examiner for all female homicides from 2012 to 2021 to ascertain the rate of femicide. The investigative data were subcategorized as femicides and nonfemicides. The records included autopsy, toxicology, and investigators' reports. All underwent autopsy examination. The relationship of the perpetrator, cause of death, and special circumstances were examined in conjunction with the United Nations operational criteria. If the death investigation did not identify the suspected perpetrator, news media were searched for a reported homicide or manslaughter arrest. The total number of homicides was 271, and 259 (96%) could be further categorized, of which 181 (70%) were femicides. Differences between the 2 cohorts included causes of death ( P 's < 0.001), age at death ( P < 0.001), and the involvement of murder-suicide ( P < 0.001). No differences were observed for race, and the yearly rate of femicides did not increase during the COVID-19 pandemic.

Mental Health in Elite Athletes: A Systematic Review of Suicidal Behaviour as Compared to the General Population.

BACKGROUND AND OBJECTIVE: Previous systematic reviews on mental health in athletes have found athletes to be at a potentially increased risk for mental health diagnoses compared to the public. Multiple cross-sectional studies have examined suicide behaviour within different athlete populations, but there is a need for a comprehensive review to synthesize and identify risk factors and epidemiology regarding suicide behaviour in the elite athlete population, especially as it compares to the general population. METHODS: A systematic literature search was performed in MEDLINE, EMBASE, Scopus, and Web of Science from 1990 to January 2023. Inclusion criteria included original peer-reviewed research articles examining suicidal ideation, suicide attempt, or suicide completion within elite athlete populations. Exclusion criteria included athletes participating in high-school or Paralympic level sports, studies that did not report results regarding elite athletes and non-athletes separately, and non-peer reviewed work. All studies were screened for inclusion by two independent reviewers. The primary outcome variables extracted from included studies included rates, risk factors, and protective factors for suicide behaviour. The study quality and risk of bias was evaluated for each study using the Joanna-Briggs Institute (JBI) critical appraisal tools. RESULTS: Of the 875 unique studies identified, 22 studies, all of which were cross-sectional in nature, met the inclusion criteria. Seven studies evaluated previous athletes, 13 studies evaluated current athletes, and two studies included a combination of previous and current athletes. Seven studies involved varsity college athletes, nine involved professional athletes of various sports, and six focused on international or Olympic level athletes. The rate of suicidal ideation in professional athletes ranged from 6.9 to 18% across four studies, while the rate in collegiate athletes ranged from 3.7 to 6.5% across three studies. Ten studies compared athletes to the general population, the majority of which found athletes to be at reduced risk of suicidal ideation, suicide attempt, and suicide completion. Only one study found athletes to have increased rates of suicide compared to matched non-athletes. Risk factors for suicide behaviour identified across multiple studies included male sex, non-white race, older age, and depression. Player position, athletic level, sport played, and injuries showed trends of having limited effect on suicide behaviour risk. CONCLUSION: This review suggests that elite athletes generally demonstrate reduced risk of suicidal ideation, suicide attempt, and suicide completion compared to the general population. Coaches should remain aware of specific factors, such as male sex, non-white race, and higher athletic level, in order to better identify at-risk athletes. Limitations of this review include the heterogeneity in the methodology and athlete populations across the included studies. Therefore, future targeted research is essential to compare suicide behaviour between sports and identify sport-specific suicide risk factors. TRIAL REGISTRATION: PROSPERO Registration: CRD42023395990.