Attempted and completed suicide in older subjects: results from the WHO/EURO Multicentre Study of Suicidal Behaviour.

OBJECTIVE: The authors present an analysis of findings for the 65 years and over age group from the WHO/EURO Multicentre Study of Suicidal Behaviour (1989-93). METHODS: Multinational data on non-fatal suicidal behaviour is derived from 1518 subjects in 16 European centres. Local district data on suicide were available from 10 of the collaborating centres. RESULTS: Stockholm (Sweden), Pontoise (France) and Oxford (UK) had the highest suicide attempts rates. In most centres, the majority of elderly who attempted suicide were widow(er)s, often living alone, who used predominantly voluntary drug ingestion. Non-fatal suicidal behaviour decreased with increasing age, whereas suicide rates rose. The ratio between fatal and non-fatal behaviours was 1:2, that for males/females almost 1:1. In the years considered, substantial stability in suicide and attempted suicide rates was observed. As their age increased, suicidal subjects displayed only a limited tendency to repeat self-destructive acts. Moreover, there was little correlation between attempted suicide and suicide rates, which carries different clinical implications for non-fatal suicidal behaviour in the elderly compared with younger subjects in the same WHO/EURO study.

[Therapeutic approach to adolescent suicide]. / Approches thérapeutiques du suicide de l'adolescent.

Management of suicidal behaviour in adolescence raises a triple problem: first, one-third of the subjects make repeated suicide attempts, with a clear risk of subsequent death; second, 70% of the patients have no known mental disorders but show psychic suffering requiring appropriate assistance; third, few subjects can themselves request such care, being unable to recognize their disability. Thus, the author suggests classifying the suicidal act among disruptive behaviours that require early detection before any measures can be taken to prevent suicide. The author also asks that hospitals propose adapted treatment to young persons having suicidal behaviour. Aside from physical care, routine emergency room evaluation should be accompanied by a brief hospitalisation in a setting aimed at further evaluation of the crisis and providing mediation for the patient and the family. Such facilities render the act of suicide its deeply critical nature and favour the involvement of all the family members in subsequent therapy.

Attempted suicide in Europe: rates, trends and sociodemographic characteristics of suicide attempters during the period 1989-1992. Results of the WHO/EURO Multicentre Study on Parasuicide.

The World Health Organization/EURO Multicentre Project on Parasuicide is part of the action to implement target 12 of the WHO programme, "Health for All by the Year 2000', for the European region. Sixteen centres in 13 European countries are participating in the monitoring aspect of the project, in which trends in the epidemiology of suicide attempts are assessed. The highest average male age-standardized rate of suicide attempts was found for Helsinki, Finland (314/100,000), and the lowest rate (45/100,000) was for Guipuzcoa, Spain, representing a sevenfold difference. The highest average female age-standardized rate was found for Cergy-Pontoise, France (462/100,000), and the lowest (69/100,000) again for Guipuzcoa, Spain. With only one exception (Helsinki), the person-based suicide attempt rates were higher among women than among men. In the majority of centres, the highest person-based rates were found in the younger age groups. The rates among people aged 55 years or over were generally the lowest. For the majority of the centres, the rates for individuals aged 15 years or over decreased between 1989 and 1992. The methods used were primarily "soft' (poisoning) or cutting. More than 50% of the suicide attempters made more than one attempt, and nearly 20% of the second attempts were made within 12 months after the first attempt. Compared with the general population, suicide attempters more often belong to the social categories associated with social destabilization and poverty.

[The impact of suicide on the caregiver]. / L'impact du suicide sur l'aidant.

Suicide ("the killing of one's self") raises one crucial question: what does the manifest desire of death bring out in oneself and in others? For those providing care and support who are confronted with the voluntary death of a client or patient, the question is particularly difficult to address. Using the story of a suicide in an institution, the authors reveal the nature of defense mechanisms at play within the group of caregivers. Whether it be a traumatic daze, denial, guilt or depression, these individual and collective reactions to the event hinder the mourning process and threaten cohesion within the institution. Members of an "institution in crisis" must try to relieve their tensions by refraining from withdrawal, banalities, being haunted by suicide and implementing pseudo-solutions. The purpose of such an exercise is especially to avoid the cancellation or displacement of necessary thought process about the origins, implications and consequences of a suicide taking place within an institution. The authors discuss the founding principles and guidelines for group exploration of these phenomena. Without this coming-to-terms with the crisis, the authors point out that the institution could find itself in a rut where discussion focuses only on when and where things went wrong, and how it turned its back on a suffering patient.

Epidemiological surveillance of suicides and attempted suicides in Aquitaine, south-west France, using an original computer network of sentinel general practitioners.

To improve the epidemiological study of suicide and attempted suicides in Aquitaine, France, we developed a comprehensive surveillance system based on the input of Sentinel General Practitioners (SGPs). From October 1986 to May 1988, for each case of suicide or attempted suicide, the SGPs reported epidemiological data to our system through a computer network of personal home terminals (Minitels). Data included age, sex, method and result of attempt and antecedents. In an analysis of the relationship between the suicidal method, antecedents and results of suicidal act, the principal findings were a high rate of antecedents of suicide attempts by drug overdoses, hangings and drownings; and no antecedents for attempts by the use of firearms. This may show that the increasing accessibility of firearms is making it more likely that impulsive suicide attempts will be lethal.

Hypnotic overdoses and fairy tales: Snow White and the uses of disenchantment.

In most Western countries, more than two-thirds of attempted suicides are among women suffering from drug overdoses. Explanations for women's use of less violent methods include the wish to avoid disfiguration, the influence of upbringing, and sex differences in cultural expectations. Many women under stress have a weaker intention to die, and their suicidal act is generally less a deliberate search for death than a desire to live another life, indicating a need to escape from a difficult situation. In this respect, the suicidal woman's desire to sleep through an overdose coma is very significant. We call to mind the strength of the kinship between death and sleep. Reinterpreting the fairy tale "Snow White" and making a parallel with some contemporary clinical cases, we show that the illusion of a nondefinitive death is often assimilated, in Western culture, with a step toward rebirth.

Morphologic and functional anatomy of the subclavian veins.

50 jugulo-subclavian venous junctions were removed to study the endovenous structures of the subclavian vein and of this junction. The diameter of the subclavian vein is always less than that of the internal jugular vein. Valvules were constantly found, whereas endovenous structures such as those found in the ilio-caval junctions were very rare. In view of these findings, these structures may be regarded as of embryologic origin.

Metapramine overdose: report of two cases and analytical determinations.

Two metapramine overdoses due to deliberate ingestion are described. The analytical procedures for the determination of metapramine in biological specimens have been reported.