Disorder and rehabilitation: The paradox of digital games and vulnerabilities.

BACKGROUND: The impact of digital gaming on human health, both mental and physical, can be both positive and negative. However, excessive gaming can lead to gaming disorders, which are a cause for concern. With the pandemic, online classes became more common, leading to an increase in gaming-related disorders and even suicides. While the combination of education and fun in online gaming can be beneficial, it can also be a risk for gaming disorders and suicide. This study aimed to explore this paradox and provide safety measures to prevent gaming disorders. MATERIALS AND METHODS: A qualitative research methodology with exploratory and discourse analysis was used in the study. Several real-life incidents related to the research were gathered from newspaper research articles, media, and existing theses. The researchers used textual interpretation in secondary sources to identify the paradox of digital games and vulnerabilities. RESULTS: This research article focuses on the various benefits and harmful effects of digital games on individuals' mental and physical health. The research findings were presented based on true events that occurred in and around India. The results of the current study specified that gaming disorders were pushing individuals toward mental disorders and suicide. It is crucial to implement preventive measures to address this issue. CONCLUSION: According to the study, people who suffer from excessive gaming disorders may experience anxiety, depression, and even suicidal thoughts, which can have negative effects on society. To address this issue, it is helpful to monitor and control individuals' digital game usage and provide informative sessions on how to use digital games properly. While it may not be possible to completely ban the use of digital games, certain restrictions can be put in place. Educating individuals on both the benefits and drawbacks of digital gaming and the rapid technological advancements is essential. Through proper education, it is possible to reduce the number of suicides among gamers and individuals.

Identifying Witnessed Suicides in National Violent Death Reporting System Narratives.

There is increasing attention to suicides that occur in view of others, as these deaths can cause significant psychological impact on witnesses. This study illuminates characteristics of witnessed suicides and compares characteristics of these deaths to non-witnessed suicides. We develop a codable definition of what constitutes witnessed (vs. non-witnessed) suicide. Our data include a sample of 1200 suicide descriptions from the 2003-2017 National Violent Death Reporting System (NVDRS). We first developed criteria to identify probable cases of witnessed suicide. The coding scheme achieved 94.5% agreement and identified approximately 10% (n = 125) of suicides as witnessed. Next, we examined differences between witnessed and non-witnessed suicides in demographics, manner of death, and social/environmental factors using bivariate Chi-squared tests, multivariate logistic regression, and ANOVA. Witnessed suicide decedents were significantly more likely than non-witnessed suicide decedents to be male, younger, and members of a sexual minority, and to have died in living spaces by means of a firearm. Two thirds of witnesses were strangers to the decedents, while 23.2% were romantic partners or ex-partners of the decedents. Our coding method offers a reliable approach to identify witnessed suicides. While witnessed suicides are relatively infrequent, these deaths have profound impact on witnesses. Articulating the features of witnessed suicides may contribute to identifying potential risk mitigation strategies.

25-Year fatal workplace suicide trends in North Carolina: 1992-2017.

BACKGROUND: Suicide is a serious public health problem in the United States, but limited evidence is available investigating fatal suicides at work. There is a substantial need to characterize workplace suicides to inform suicide prevention interventions and target high-risk settings. This study aims to examine workplace suicide rates in North Carolina (NC) by worker characteristics, means of suicide used, and industry between 1992 and 2017. METHODS: Fatal workplace suicides were identified from records of the NC Office of the Chief Medical Examiner system and the NC death certificate. Sex, age, race, ethnicity, class of worker, manner of death, and industry were abstracted. Crude and age-standardized homicide rates were calculated as the number of suicides that occurred at work divided by an estimate of worker-years (w-y). Rate ratios and 95% confidence intervals (CIs) were calculated, and trends over calendar time for fatal workplace suicides were examined overall and by industry. RESULTS: 81 suicides over 109,464,430 w-y were observed. Increased rates were observed in workers who were male, self-employed, and 65+ years old. Firearms were the most common means of death (63%) followed by hanging (16%). Gas service station workers experienced the highest fatal occupational suicide rate, 11.5 times (95% CI: 3.62-36.33) the overall fatal workplace suicide rate, followed by Justice, Public Order, and Safety workers at 3.23 times the overall rate (95% CI: 1.31-7.97). CONCLUSION: Our findings identify industries and worker demographics that were vulnerable to workplace suicides. Targeted and tailored mitigation strategies for vulnerable industries and workers are recommended.

Little Strokes Fell Big Oaks: How Repeated Recommendations for Suicide Reporting Drive the Quality of Suicide News in South Korea.

This study investigates how far repeated releases of recommendations for responsible reporting on suicide (RRS) are associated with changes in the quality of suicide reporting. A content analysis was conducted on suicide news articles (N = 606) by the Korean newspapers Hankyoreh Sinmun and Chosun Ilbo in four six-month periods from 2004 to 2019, which covered the periods before and after the releases of three versions of suicide reporting guidelines. Elements for RRS served as a proxy for the reporting quality, which includes both avoiding negative elements and providing positive ones. Not only the number of suicide news stories reduced by half in the last two observation periods, overall RRS scores and most individual RRS elements increased in the third period, compared to the first or second period. The avoidance RRS for headline, however, was not significantly improved. Korean news media also tended to be sensationalistic in using photos.

A classification of combined homicide-suicide: An update-Part III: Extrafamilial homicide-suicide.

The subclassification of homicide-suicide into psychopathology and intrafamilial homicide-suicides having been presented in the foregoing Parts I and II, this Part III concerns extrafamilial homicide-suicides. Extrafamilial homicide-suicides are divided into adversarial, autogenic mass, cult, and terrorist homicide-suicides. Adversarial homicide-suicides involve a "formal" relationship between actor and homicide victims, further divided according to the role of the actor in their relationship as employee, current or former pupil/student as in school shootings, patient, and litigant. For comparison, school shootings were divided into those resulting in 10 or more homicide victims and those with fewer. The autogenic mass homicide-suicide, wherein victims are strangers to the actor, was heuristically bifurcated here depending on the number of homicide victims, 10 or more or fewer. As expected, the homicide-suicides with larger numbers of victims were more homogenous.

National Trends in Suicides and Male Twin Live Births in the US, 2003 to 2019: An Updated Test of Collective Optimism and Selection in Utero.

Prior research based on Swedish data suggests that collective optimism, as measured by monthly incidence of suicides, correlates inversely with selection in utero against male twins in a population. We test this finding in the US, which reports the highest suicide rate of all high-income countries, and examine whether monthly changes in overall suicides precede changes in the ratio of male twin to male singleton live births. Consistent with prior work, we also examine as a key independent variable, suicides among women aged 15-49 years. We retrieved monthly data on suicides and the ratio of male twin to singleton live births from CDC WONDER, 2003 to 2019, and applied Box-Jenkins iterative time-series routines to detect and remove autocorrelation from both series. Results indicate that a 1% increase in monthly change in overall suicides precedes a 0.005 unit decline in male twin live births ratio 6 months later (coefficient = -.005, p value = .004). Results remain robust to use of suicides among reproductive-aged women as the independent variable (coefficient = -.0012, p value = .014). Our study lends external validity to prior research and supports the notion that a decline in collective optimism corresponds with greater selection in utero.

Extracellular vesicles from cerebrospinal fluid revealed changes in miR-19a-3p and miR-4516 expression in Slovene male suicides.

Suicide is an important public-health concern, with more than 700,000 people dying by suicide yearly. It is a multifactorial phenomenon, shaped by the effects of sociodemographic, environmental and biological factors. The latter two factors can be linked through epigenetic studies, which examine differences in gene expression that are not due to changes in the DNA sequence itself. Epigenetic mechanisms include micro RNAs (miRNAs), which have a direct effect on already translated mRNA, leading to either decay or translational repression of the target mRNA. MiRNA molecules have been identified as cargo of extracellular vesicles (EVs) used by cells for long-distance communication, and pathophysiological changes in miRNA in brain cells may be reflected in cerebrospinal fluid (CSF) vesicles. In this study we investigated the presence and differential expression of selected miRNAs in EVs from the CSF of male suicide completers and controls. Western blot and nanoparticle tracking analyses confirmed the presence of small and medium sized EVs. Of the miRNA analyzed (miR-16-5p, miR-19a-3p, miR-34c-5p, miR-17-5p, miR-4286, miR-26b-5p, miR-381-3p, and miR-4516) miR-19a-3p and miR-4516 reached statistical significance with p-values of 0.0408 and 0.0168, respectively. Mir-4516 and miRNA-19a-3p have been previously studied in suicide, and target SLC6A4 and TNF-α expression, correspondingly. Approximately 70% of known miRNAs are expressed in the central nervous system, and therefore represent an important biomarker potential. Investigating the cargo of CFS and blood EVs would further support the identification of miRNAs with clinical use potential.

Do media coverage of suicides and search frequency on suicides predict the number of tweets seeking others for a suicide pact?

We examined whether media coverage of suicides and frequencies of searching for suicide methods or suicide pacts predicted the number of users posting tweets seeking others for a suicide pact. Analyses of 6,119 tweets containing "suicide pact" posted on Twitter during a 6-month period revealed that the number of users posting tweets seeking others for a suicide pact had a positive association with media coverage of celebrity suicides, but not with that of suicide pact victims, and a greater positive association with the search frequency for suicide methods than for suicide pacts. We found that the search frequency on suicide methods was positively associated with media coverage of celebrity suicides, while that on suicide pacts was more strongly related to media coverage of suicide pacts.

The specifics of homicide-suicide in France.

BACKGROUND: Homicide and suicide are two causes of violent death. This study focuses on situations in which these two types of violent death occur at the same time, known as homicide-suicide. AIM: The aim of this study is to review the circumstances surrounding homicide-suicides as well as the features of the victims and perpetrators in France at a recent period. The article characterizes homicide-suicides by comparing them with simple homicides in order to determine whether they exhibit distinctive characteristics and significant links. METHODOLOGY: The data analyzed are based on detailed police operational information collected about 1622 homicides that occurred in France in 2019 and 2020. After presenting the characteristics of all homicide-suicides, this article specifically compares those that take place within the family, whether they result in the suicide of the perpetrator or not, using bivariate tests (chi-square). The tests are based on a distinction between domestic homicide-suicides within a couple and between other family members. RESULTS: Analysis shows that 7 % of them were followed by the suicide of the perpetrator (203 cases). Almost all of them take place within family (91 %), and most often within the couple (60 %). Apart from couple configurations, familial homicide-suicides target the children (21 %) or parents (5 %) of the perpetrators. The perpetrators are mainly men, while most of the victims are women. Analysis revealed significant links between certain variables and suicide (or attempted suicide by the alleged perpetrator) in the context of couple homicide: the modus operandi, the spatio-temporal setting, the gender and average age of the victim and history of domestic violence suffered by the victim, as well as all the variables relating to the alleged perpetrator (age, gender, police and psychiatric history, alcohol consumption, etc.). Among other family members, these variables do not have a significant influence on whether the perpetrator commits suicide following the homicide. Perpetrators of domestic homicide-suicides are less likely to be under the influence of alcohol (8 %), to be known to the police (19 %), and to have a psychiatric history (11 %) than those who do not commit suicide following the homicide (respectively 41 %, 54 %, 22 %). There is also less record of domestic violence when the perpetrator commits suicide (20 %) than when they do not (48 %). CONCLUSIONS: Homicide-suicides are to some extent similar to simple couple homicides. Women are therefore overrepresented among domestic homicide victims; likewise, they are also overrepresented among the victims of homicide-suicides, which are mostly committed in family circumstances. The most significant risk factors are the presence of firearms in the household and history of domestic violence within the couple. RECOMMENDATIONS: The results suggest two areas for action: the screening (interpersonal conflicts, alcohol, depression, domestic violence, presence of a firearm) and the prevention of intra-family homicides. Prevention should focus on screening specific elements: the presence of a firearm, domestic violence, interpersonal conflicts, depression, and alcohol. Prevention could also take place with elderly people at the end of their lives.

Five healthcare trajectories in the year before suicide and what they tell us about opportunities for prevention: a population-level case series study.

Background: Suicide prevention requires a shift from relying on an at-risk individual to engage with the healthcare system. Understanding patterns of healthcare engagement by people who have died by suicide may provide alternative directions for suicide prevention. Methods: This is a population-based case-series study of all suicide decedents (n = 3895) in New South Wales (NSW), Australia (2013-2019), with linked coronial, health services and medicine dispensing data. Healthcare trajectories were identified using a k-means longitudinal 3d analysis, based on the number and type of healthcare contacts in the year before death. Characteristics of each trajectory were described. Findings: Five trajectories of healthcare utilisation were identified: (A) none or low (n = 2598, 66.7%), (B) moderate, predominantly for physical health (n = 601, 15.4%), (C) moderate, with high mental health medicine use (n = 397, 10.2%), (D) high, predominantly for physical health (n = 206, 5.3%) and E) high, predominantly for mental health (n = 93, 2.4%). Given that most decedents belonged to Trajectory A this suggests a great need for suicide preventive interventions delivered in the community, workplace, schools or online. Trajectories B and D might benefit from opioid dispensing limits and access to psychological pain management. Trajectory C had high mental health medicine use, indicating that the time that medicines are prescribed or dispensed are important touchpoints. Trajectory E had high mental health service predominantly delivered by psychiatrists and community mental health, but limited psychologist use. Interpretation: Although most suicide decedents made at least one healthcare contact in the year before death, contact frequency was overall very low. Given the characteristics of this group, useful access points for such intervention could be delivered through schools and workplaces, with a focus on alcohol and drug intervention alongide suicide awareness. Funding: Australia's National Health and Medical Research Council.

Nordic region suicide trends 2000-2018; sex and age groups.

BACKGROUND AND AIM: Overall, suicide rates in the Nordic region, Denmark, Finland, Iceland, Norway and Sweden, have declined in the past 40 years. The aim of this study was to determine trends in suicide mortality from 2000 to 2018. METHODS: Data were obtained from official suicide statistics for men and women, 15 years and older. Gender and age groups in four calendar periods were analyzed using Joinpoint Estimated Regression Coefficient. RESULTS: The crude regional suicide rate was 17.1, 2000-2004, decreased to 14.1 per 100,000 inhabitants in 2015-2018. Age-standardized rates are 13.6-11.3. The crude rate decreased by 19.5% (16.3% age-standardized), 19.3% for males and 20.5% for females. The largest decrease was found in Finland (34.9%), the smallest in Norway (1.4%). In males, the exception was an increased suicide rate among all Icelandic except 15-24-year olds, and in 45-64 year-old Norwegians. Among females, an increase was seen among 15-24-year olds in all countries except Iceland, in all age groups in Norway, and in 25-44-year olds in Sweden. In males, a decline of the suicide rated lower than 10% was noted in 25-44 olds in Norway and in 15-64 year-olds in Sweden. DISCUSSION: A robust decrease was observed in the overall regional suicide rate in recent years. Exceptions are rising rates in Icelandic males, in Norwegian females, and the youngest female groups in all except Iceland. The small decline among middle-aged males in Norway and Sweden is of concern.

Icy Intrigue: A Case Report of an Unusual Encounter With an Ice Pick Injury.

An ice pick is rarely observed as a weapon of offense in homicide or suicide. The severity of injuries produced by an ice pick ranges from circular contused abrasions to punctured wounds with clean-cut margins. We present a case of a self-inflicted ice pick injury to the chest autopsied at the AIIMS Rishikesh morgue. During this study, we noticed and analyzed the unusual presentation of injury by an ice pick, contrary to the injuries generally observed in ice pick cases. We highlight a peculiar case of a homicidal ice pick injury observed during the autopsy. The presentation deviated from typical patterns, with the weapon penetrating the victim's body in an unconventional manner. The findings challenge traditional assumptions regarding ice pick injuries and underscore the importance of comprehensive forensic analysis. Understanding and documenting atypical presentations of such injuries can aid forensic experts in accurately determining the cause and manner of death, facilitating the pursuit of justice in criminal investigations.

Child and adolescent mortality associated with pesticide toxicity in Cape Town, South Africa, 2010-2019: a retrospective case review.

BACKGROUND: Poisoning of children after exposure to pesticides is a major public health concern, particularly in countries with poorer urban populations, such as South Africa. This may stem from the illegal distribution and domestic use of street pesticides, which are highly hazardous agricultural pesticides. The aim of this study was to profile paediatric deaths due to acute pesticide poisoning in the west-metropole of Cape Town, South Africa; to identify whether the active ingredients were highly hazardous pesticides according to the FAO and WHO; and to inform policy and public health interventions to prevent future exposures and mortality. METHODS: A retrospective and descriptive analysis of forensic post-mortem records (2010 to 2019) was conducted to identify cases of paediatric deaths (< 18 years old) in the west metropole of Cape Town, involving pesticide poisoning admitted to the Salt River mortuary (one out of 16 mortuaries in the Western Cape province). Demographic, circumstantial, autopsy, and toxicological information was captured. Descriptive statistics, together with chi-square tests, Fisher's probability tests, and Mann-Whitney U tests were used to analyse the data. RESULTS: In total, 54 paediatric pesticide deaths were identified, including 22 (40.7%) males and 32 (59.3%) females, out of 5,181 paediatric unnatural deaths admitted over the 10-year period. The median age of the decedents was 8.3 years (range: 1 day to 17.9 years), with the majority under five years (42.6%) or between 15 and 18 years old (40.7%). All incidents occurred in peri-urban areas of Cape Town, with most individuals being admitted to hospital (88.9%) for a median survival time of 4.8 h. Toxicological analysis was requested in 50 cases (92.6%) with the organophosphate pesticides terbufos (n = 29), methamidophos (n = 2) and diazinon (n = 2) detected most frequently. Adolescent (15-18 years) suicides (29.6%) and accidental child deaths (< 4 years) (18.5%) were common. CONCLUSIONS: Terbufos and methamidophos are highly hazardous pesticide (HHP) active ingredients registered in South Africa for agricultural uses, yet commonly sold as street pesticides for domestic use in lower socioeconomic areas. Reducing access and availability of toxic pesticides, especially through the illegal selling of street pesticides, and providing low toxic alternatives to poorer communities, may support mortality reduction initiatives. Mortality and toxicology data provide important, often overlooked, surveillance tools for informing policy and public health interventions to reduce toxic pesticide harm in local communities.

A systematic review on suicide because of social isolation/and loneliness: does COVID-19 make a difference?

BACKGROUND: Suicide is a significant cause of death worldwide. Various purposes can explain why people choose to attempt or commit suicide such as mental-health disorders, income-related-factors, quality of life or issues related to social context. This study aims to identify an updated association between 'isolation' and suicides. METHODS: In this regard, we had made a systematic review of the most recent papers, published from January 2016 to March 2022, thought the most acknowledged databases. This review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews. To the best of our knowledge, this issue is very important due to the indirect relationship between COVID-19 and suicides. RESULTS: Our analysis demonstrates that suicide and -social isolation and loneliness- have a positive and direct relationship although these findings varied slightly by areas. Moreover, most of the attention is focused on the youth during the most recent period and this is a real problem because economies cannot afford losing (young) population. CONCLUSIONS: In order to prevent suicides, public policies should prevent suicidal thoughts that it could induce to terminate the lives of individuals in their most productive years and harmful outcomes to their families and friends.

Suicide and non-fatal self-injury-related emergency department visits among individuals with autism spectrum disorder.

LAY ABSTRACT: This study used data for 14.4 million individuals with 43.5 million emergency department visits from all hospitals in the state of New York to explore the association between suicide and non-fatal self-injury-related (self-injury) emergency department visits and autism spectrum disorder. Overall, we found that individuals with autism spectrum disorder had more emergency department visits and admissions through the emergency department, more years of emergency department utilization, and higher prevalence of mental health-related comorbidities. Individuals with autism spectrum disorder were also significantly more likely to have at least one self-injury-related emergency department visit compared to those without autism spectrum disorder. These results emphasize the need to raise awareness across both family caregivers and healthcare providers on the increased suicide and self-injury risks that individuals with autism spectrum disorder face and to improve care delivery practices. In addition, effort to promote and increase timely access to mental health care is an urgent priority for individuals with autism spectrum disorder.

Seasonal and Temporal Patterns of Homicides and Suicides in Cali and Manizales, Colombia: A Times-Series Analysis 2008-2015.

OBJECTIVE: To identify seasonal and temporal variations in daily incidence of homicides and suicides in Cali and Manizales, Colombia during 2008-2015. MATERIALS AND METHODS: An ecological time series study was performed using negative binomial regression models for daily incidence of homicides and suicides; analyses were controlled for yearly trends and temporal autocorrelations. RESULTS: Saturdays, Sundays, December holidays as well as New Year and New Year's Eve were associated with an increased risk of homicides in both cities. Suicide risk increased during December holidays and New Year in both cities. In addition, the suicide risk increased on paydays, Saturdays, Sundays, and Mondays in Cali, and it decreased during the Holy Week holidays in Manizales. December patterns of suicides and homicides are the opposite in each city, and between cities. CONCLUSIONS: The incidences of homicides and suicides are not homogeneous over time. These patterns can be explained partially by alcohol consumption and changes in people's routine activities which may modify exposure to violent circumstances.

Media Coverage of Senior and Celebrity Suicides and Its Effects on Copycat Suicides among Seniors.

This study examined whether suicide rates in the elderly population are associated with media coverage of senior or celebrity suicides. Analyzing data from 2012 to 2015, we found that seniors were likely to be more influenced by media coverage of senior suicides than by celebrity suicides. Furthermore, the effects of media coverage of senior suicides were more significant when the reported reason was either health (mental or physical problems) or financial issues, such as poverty than other reasons.

USA Suicides Compared to Other Western Countries in the 21st Century: Is there a Relationship with Gun Ownership?

OBJECTIVES: Causes of suicide are complex indicating a nation's psycho-socio-economic well-being hence this population-based study explores whether USA suicides worsened compared to nineteen Other Western Countries (OWC) being possibly related to gun ownership in the 21st Century. METHODS: Total suicide data are drawn from the latest WHO Age-Standardised-Death-Rates per million (pm) controlled for age, sex, and population, along with suicides in the five age- bands 15-34 years to 75 + years. National gun ownership data from the international Small Arms Survey. Chi-square tests any significant difference between American and OWC suicides during the century. Spearman Rank Order correlations are used to determine comparability of suicides and gun ownership per thousand person rates over the period 2000-15. RESULTS: USA had the highest gun ownership, treble the rate of the next highest country. American Total suicides rose 27%, significantly more than eight other countries (p < 0.05). The USA had significantly worse suicide outcomes for Older (75+) people than three OWC; eleven for Mature Adults 55-74; eight for Adults 34-54 and for ten countries for Young Adults 15-34. Young Adult suicides numbered 12,438, 6,702 gun-related in 2015, exceeding recent USA military losses. Only Young Adult suicides positively correlated with gun ownership (<0.025). CONCLUSIONS: The key finding is whilst most countries reduced suicides American rates rose substantially this century, raising questions about US society. Importantly the easy access to firearms in the USA makes Young Adult suicide more likely when facing psycho-social stress. This study exposes the vulnerability of distressed young American adults in a permissive gun culture, with its sequel, life-long grieving parents.HighlightsDuring 21st Century USA suicides rose substantially more than other Western nations.Only USA suicides rose >20% amongst Total suicides and in those aged 15-to-74years.USA Young Adult suicides 150,099 in 21st century, 12,438 in 2015, 6,702 were gun-related.