Age-stratified risk of suicide in patients with schizophrenia.

OBJECTIVES: Schizophrenia is associated with an increased risk of suicide. Few studies have investigated the risk of suicide across different ages, likely due to limitations around sample size. METHODS: From the National Health Insurance Research Database in Taiwan, this study identified 195,787 patients with schizophrenia from January 1, 2000, to December 31, 2019. During the study period, 3848 patients died from suicide. We calculated the standardized mortality ratio (SMR) for suicide stratified by age. In this age-stratified, nested case-control study, risk set sampling was used to match each case with 4 living controls by age, sex, and the year of the first diagnosis with schizophrenia. Conditional logistic regression was used for estimating age-stratified risk profiles. RESULTS: The SMR was the highest in the <25 years age group (52.8) and inversely correlated with age. Unemployment was associated with an increased risk of suicide in the 25 to 34, 35 to 44, 45 to 54, and 55 to 64 years age groups. Depressive and sleep disorders before suicide were more common among suicide cases with schizophrenia than among controls across all age groups. Drug-induced and alcohol-induced mental disorders were significantly associated with suicide but were observed only in the age group younger than 54. Heart disease, pneumonia, and moderate or severe renal disease were risk factors for suicide in the age groups less than 65. CONCLUSIONS: The risk factors for suicide differ by age. This study's findings can be used to optimize health-care interventions for preventing suicide in patients with schizophrenia.

Risk factors for suicide among veterans living with and without HIV: a nested case-control study.

The rate of suicide among people with HIV (PWH) remains elevated compared to the general population. The aim of the study was to examine the association between a broad range of risk factors, HIV-specific risk factors, and suicide. We conducted a nested case-control study using data from the Veterans Aging Cohort Study (VACS) between 2006 and 2015. The risk of suicide was estimated using conditional logistic regression and models were stratified by HIV status. Most risk factors associated with suicide were similar between PWH and people without HIV; these included affective disorders, use of benzodiazepines, and mental health treatment. Among PWH, HIV-specific risk factors were not associated with suicide. A multiplicative interaction was observed between a diagnosis of HIV and a previous suicide attempt. Among PWH, a high prevalence of psychiatric, substance use disorders and multimorbidity contribute to the risk of suicide.

RESUMEN: La tasa de suicidio entre las personas con VIH (PWH) sigue siendo elevada en comparación con la población general. El objetivo del estudio fue examinar la asociación entre un amplio rango de factores de riesgo, los riesgos específicos del VIH y el suicidio. Realizamos un estudio anidado de casos y controles usando datos del Veterans Aging Cohort Study (VACS) entre 2006­2015. El riesgo de suicidio fue estimado mediante regresión logística condicional y los modelos se estratificaron por estado serológico. La mayoría de los factores de riesgo asociados con el suicidio fueron similares entre las PWH y las personas sin VIH; estos incluyeron trastornos afectivos, uso de benzodiazepinas y tratamiento de salud mental. Entre las PWH, los factores de riesgo específicos del VIH no se asociaron con el suicidio. Se observó una interacción multiplicativa entre un diagnóstico de VIH y un intento de suicidio previo. Entre las PWH, una alta prevalencia de trastornos psiquiátricos, por consumo de sustancias y multimorbilidad contribuyen al riesgo de suicidio.

Trends in suicide mortality among prostate cancer survivors in the United States, 1975-2019.

BACKGROUND: Suicide was an important cause of death in prostate cancer. This study intended to investigate trends in suicide mortality among prostate cancer (PCa) survivors from 1975 to 2019 in the United States. METHOD: We identified PCa survivors from the Surveillance, Epidemiology, and End Results (SEER) program from January 1975 to December 2019. Standardized mortality rate (SMR) was calculated d to assess the relative risk of suicide in PCa survivors compared with the general men population. Poisson regression model was performed to test for trend of SMRs. The cumulative mortality rate of suicide was calculated to assess the clinical burden of suicide mortality. RESULTS: 7108 (0.2%) cases were death from suicide cause, and 2,308,923(65.04%%) cases recorded as dying from non-suicidal causes. Overall, a slightly higher suicide mortality rate among PCa survivors was observed compared with general male population (SMR: 1.15, 95%CI: 1.09-1.2). The suicide mortality rate declined significantly relative to the general population by the calendar year of diagnosis, from an SMR of 1.74(95%CI: 1.17-2.51) in 1975-1979 to 0.99(0.89-1.1) in 2015-2019 (Ptrend < 0.001). PCa survivors with aged over 84 years, black and other races, registered in registrations (including Utah, New Mexico, and Hawaii) failed to observe a decrease in suicide mortality (Ptrend > 0.05). The cumulative suicide mortality during 1975-1994 was distinctly higher than in 1995-2019(P < 0.001). CONCLUSION: The trend in suicide mortality declined significantly from 1975 to 2019 among PCa survivors compared with the general male population in the United States. Notably, part of PCa survivors had no improvement in suicide mortality, and additional studies in the future were needed to explore it.

Impact of drought on mental and behavioral disorders, contributions of research in a climate change context. A narrative review.

Mental and behavioral disorders are an important public health problem and constitute a priority for the WHO, whose recommendations include the surveillance of their risk factors. On the other hand, drought episodes have been increasing in frequency and severity in Europe since 1980. Therefore, to review the present knowledge about the impact of drought on mental and behavioral disorders, in the present climate change context, and to underline potential research gaps, could be of major interest. Thus, we performed a narrative review using online academic databases with the aim of identifying relevant literature about the impact of drought on mental and behavioral disorders. To the best of our knowledge, no study in Europe quantifies the potential association between drought and mental disorders. A limited number of studies have found significant associations between droughts (with different temporal ranges) and various measures of mental health. However, according to our review, only three of them quantified the association between drought and objective mental health outcomes, such as number of emergencies due to clinically diagnosed mental disorders or suicides. Additionally, few studies used specific indices as a measure of drought; and finally, as far as authors are aware, none of them has analyzed this relationship adjusting for various other potential environmental confounders. Moreover, the eventual association could vary between different geographical areas within the same country. Therefore, national and regional studies would be especially necessary. Thus, there is a need for specific national and regional studies, in Europe and globally, that assess the impact of specific indices of drought (with different temporal ranges) on objective mental health outcomes controlling for potential environmental confounders. Moreover, the quantification of its cost would be necessary for health prioritization, evidence-based policies and strategic health planning.

Are We Undercounting the True Burden of Mortality Related to Suicide, Alcohol Use, or Drug Use? An Analysis Using Death Certificate Data From Colorado Veterans.

Knowledge regarding deaths due to suicide or alcohol- or drug-related causes may be limited by inconsistent and/or restrictive case definitions, resulting in concerns regarding validity of findings and underestimates of burden. In this proof-of-concept study, we assessed varying case definitions (suicide, alcohol-related, and drug-related mortality using underlying-cause-of-death (UCOD) versus multiple-cause-of-death (MCOD) International Classification of Diseases, Tenth Revision (ICD-10) codes) on the basis of counts and rates among Colorado veterans who died (2009-2020). Suicide, alcohol-related, or drug-related ICD-10 codes were identified, and 2 case definitions were compared: UCOD (qualifying ICD-10 code listed as the UCOD) and MCOD (qualifying ICD-10 code in any cause-of-death field). Of 109,314 decedents, the number of deaths and the age-adjusted mortality rate (per 100,000 persons) significantly increased when MCOD codes were included: n = 4,930 (110.3 deaths/100,000 persons) for UCOD versus n = 6,954 (138.4 deaths/100,000 persons) for MCOD. While rates of suicide mortality did not change, rates of alcohol-related mortality doubled with the more inclusive case definition: 1,752 (27.3 deaths/100,000 persons) for UCOD versus 3,847 (59.8 deaths/100,000 persons) for MCOD. Alcohol-use disorder codes accounted for 71% of additional alcohol-related deaths captured with the MCOD definition. Studies that rely on UCOD codes may be underestimating the burden of deaths, especially alcohol-related deaths. Increased effort is required to reevaluate current classifications of deaths associated with suicide, alcohol use, or drug use.

Healthcare utilization, psychiatric disorders, and physical illnesses shortly before suicide mortality in adolescents in Taiwan.

BACKGROUND: This study examined the pattern of medical utilization and the distribution of comorbidities shortly before death among adolescents who died from suicide and compared these data with those of living controls. METHODS: From Taiwan's National Health Insurance Research Database, this study identified adolescents aged 10-19 years who died from suicide (n = 935) between 1 January 2000, and 31 December 2016, by linking each patient with the national mortality database. The researchers conducted a nested case-control study through risk set sampling, and for each case, 20 age- and sex-matched controls (n = 18 700) were selected from the general population. The researchers applied conditional logistic regression to investigate differences in medical utilization and physical and psychiatric comorbidities between cases and controls. RESULTS: Cases had a higher proportion of contact with the psychiatric department but a similar proportion of contact with any non-psychiatric medical department within 1 year before suicide compared with controls. There were 18.6% of adolescent suicide victims who only had contacted with a psychiatric department 3 months before suicide. Moreover, cases had a higher proportion of contact with non-psychiatric services within 3 months before suicide, particularly with emergency, surgery, and internal medicine departments. Cases had higher risks of several psychiatric disorders and physical illnesses, including heart diseases, pneumonia, and ulcer disease, than did controls. CONCLUSIONS: The findings of increased medical utilization and higher risks of physical and psychiatric comorbidities in adolescent suicide victims are crucial for developing specific interventions to prevent suicide in this population.

Suicide Following the COVID-19 Pandemic Outbreak: Variation Across Place, Over Time, and Across Sociodemographic Groups. A Systematic Integrative Review.

PURPOSE OF REVIEW: To systematically examine changes in suicide trends following the initial COVID-19 outbreak, focusing on geographical and temporal heterogeneity and on differences across sociodemographic subgroups. RECENT FINDINGS: Of 46 studies, 26 had low risk of bias. In general, suicides remained stable or decreased following the initial outbreak - however, suicide increases were detected during spring 2020 in Mexico, Nepal, India, Spain, and Hungary; and after summer 2020 in Japan. Trends were heterogeneous across sociodemographic groups (i.e., there were increases among racially minoritized individuals in the US, young adults and females across ages in Japan, older males in Brazil and Germany, and older adults across sex in China and Taiwan). Variations may be explained by differences in risk of COVID-19 contagion and death and in socioeconomic vulnerability. Monitoring geographical, temporal, and sociodemographic differences in suicide trends during the COVID-19 pandemic is critical to guide suicide prevention efforts.

Urban green spaces and suicide mortality in Belgium (2001-2011): A census-based longitudinal study.

BACKGROUND: Exposure to green spaces is associated with improved mental health and may reduce risk of suicide. Here, we investigate the association between long-term exposure to residential surrounding greenness and suicide mortality. METHODS: We used data from the 2001 Belgian census linked to mortality register data (2001-2011). We included all registered individuals aged 18 years or older at baseline (2001) residing in the five largest urban areas in Belgium (n = 3,549,514). Suicide mortality was defined using the tenth revision of the World Health Organisation International Classification of Diseases (ICD-10) codes X60-X84, Y10-Y34, and Y870. Surrounding greenness was measured using the Normalized Difference Vegetation Index (NDVI) within a 300 m and 1,000 m buffer around the residential address at baseline. To assess the association between residential surrounding greenness and suicide mortality, we applied Cox proportional hazards models with age as the underlying time scale. Models were adjusted for age, sex, living arrangement, migrant background, educational attainment, neighbourhood socio-economic position. We additionally explored potential mediation by residential outdoor nitrogen dioxide (NO2) concentrations. Finally, we assessed potential effect modification by various socio-demographic characteristics of the population (sex, age, educational attainment, migrant background, and neighbourhood socio-economic position). Associations are expressed as hazard ratios and their 95% confidence intervals (CI) for an interquartile range (IQR) increase in residential surrounding greenness. RESULTS: We observed a 7% (95%CI 0.89-0.97) and 6% (95%CI 0.90-0.98) risk reduction of suicide mortality for an IQR increase in residential surrounding greenness for buffers of 300 m and 1,000 m, respectively. Furthermore, this association was independent of exposure to NO2. After stratification, the inverse association was only apparent among women, and residents of Belgian origin, and that it was stronger among residents aged 36 or older, those with high level of education, and residents of most deprived neighbourhoods. CONCLUSION: Our results suggest that urban green spaces may protect against suicide mortality, but this beneficial effect may not be equally distributed across all strata of the population.

Factors associated with suicide mortality among reproductive age women: a case-control study.

OBJECTIVE: Examine demographic, psychosocial, pregnancy-related, and healthcare utilisation factors associated with suicide mortality among reproductive age women. METHODS: Data from nine health care systems in the Mental Health Research Network were included. A case-control study design was used in which 290 reproductive age women who died by suicide (cases) from 2000 to 2015 were matched with 2,900 reproductive age women from the same healthcare system who did not die by suicide (controls). Conditional logistic regression was used to analyse associations between patient characteristics and suicide. RESULTS: Women of reproductive age who died by suicide were more likely to have mental health (aOR = 7.08, 95% CI: 5.17, 9.71) or substance use disorders (aOR = 3.16, 95% CI: 2.19, 4.56) and to have visited the emergency department in the year prior to index date (aOR = 3.47, 95% CI: 2.50, 4.80). Non-Hispanic White women (aOR = 0.70, 95% CI: 0.51, 0.97) and perinatal (pregnant or postpartum) women were less likely to have died by suicide (aOR = 0.27, 95% CI: 0.13, 0.58). CONCLUSIONS: Reproductive age women with mental health and/or substance use disorders, prior emergency department encounters, or who are of racial or ethnic minority status were at increased risk of suicide mortality and may benefit from routine screening and monitoring. Future research should further examine the relationship between pregnancy-related factors and suicide mortality.

[The suicides in the Russian Federation: review of national studies].

The epidemiological data of suicide rate, protective and risk factors is required to evaluate suicide losses, to develop appropriate interventions and to determine their effectiveness. Despite stable decreasing trend in suicide rates over the past three decades, the burden of suicides is determined by loss of young working-age population. In the post-Soviet Russia, fluctuations in suicide mortality indicators are associated with complicated periods of social economic transformations and radical changes of public policy. The risk factors also include economically depressive territories of residence, unemployment, psychoactive substance abuse, childhood and adolescence, family ill-being, incarceration, particular professional groups, physical illnesses, etc. The review established researchers' aspirations for topics improving understanding of suicide risk factors in population of Russia and needs of vulnerable groups. Such works are to result in better strategies of suicide prevention and development of new crisis care technologies. They identify problems in program implementation and provide important stimulus for determining global priorities in research and development areas.

High temperatures trigger suicide mortality in Brussels, Belgium: A case-crossover study (2002-2011).

BACKGROUND: Temperature may trigger the risk of suicide, however, the extent and shape of the associations show geographical variation. Here, we investigate the short-term effects of temperature on suicide deaths occurring in Brussels between January 1st, 2002 and December 31st, 2011. METHODS: We conducted a bidirectional time-stratified case-crossover study with cases being suicide deaths occurring among Brussels residents aged 5 years or older. Cases were matched by day of the week with control days from the same month and year. The exposure was the daily average temperature measured at the Uccle station (Brussels) and obtained from the Belgian Royal Meteorological Institute. We combined conditional logistic regression with distributed lag non-linear models (DLNM) to obtain one week (lag 0-6) cumulative risk ratios (RR) and their 95% confidence intervals (CI) for the effects of moderate and extreme cold (5th and 1st percentiles of temperature, respectively) and moderate and extreme heat (95th and 99th percentiles of temperature, respectively), relative to the median temperature. RESULTS: In total, 1891 suicide deaths were included. The median temperature was 11.6 °C, moderate and extreme cold temperatures were 0 and -3.1 °C, respectively, and moderate and extreme high temperatures were 20.9 and 24.4 °C, respectively. The cumulative risk of suicide mortality was almost twice higher among lags 0 to 6 for both moderate and extreme heat, relative to the period median temperature (e.g. moderate heat RR = 1.80 CI:1.27-2.54). No statistically significant associations were observed for cold temperatures. CONCLUSIONS: In Brussels, a western European city with temperate climate, high temperatures may trigger suicide deaths up to one week later. In the context of climate change, adaptation strategies must take into consideration the effects of temperature on mental health.

Suicide Mortality Rate as a Sustainable Development Goal (SDG): A Bibliometric Analysis.

Suicidal behaviors are a serious but potentially preventable cause of premature death. Increased awareness of the importance of mental health for global health has led to new initiatives, supported by the World Health Organization (WHO) and the United Nations (UN). The suicide mortality rate is one of the indicators covered in the UN's Sustainable Development Goal (SDG) 3. The aim of this study is to identify the scientific production and its temporal evolution related to the suicide mortality rate indicator in the context of mental disorders and as one of the SDG. A bibliometric analysis was performed in Scopus to assess the related research on suicide mortality rate, including on the context of the third SDG, from inception to September 2, 2020. The set of articles were analyzed for bibliometric measures. A total of 3126 documents about mental health and suicide mortality rate on the context of SDG were collected. Articles were the predominant type of literature on this area (78.3%), with significant expression on the last years, more evident around 2015, the year of adoption of SDGs. Despite a large volume of evidence, the debate about suicide mortality rate as an indicator of SDG is still very sparse suggesting a need for better consensus on its evaluation methods. This study presents useful characteristics for the formulation of new studies and provides specific targets for the construction or improvement of public policies on the context of the SDGs for further discussion on this strategy proposed by the UN.

Part-time work and other occupational risk factors for suicide among working women in the Swiss National Cohort.

OBJECTIVE: The aim of this study was to describe the factors associated with mortality by suicide among working women focusing on work-related factors. METHODS: The study population consisted in all Swiss residents recorded in the 1990 and/or the 2000 compulsory national censuses and were linked to emigration and mortality registers. We selected all women aged 18-65 and at work at the official census dates. Following work-related variables were available: socio-economic status, weekly hours of work, the sector of activity and the job title coded according to the International Standard Classification of Occupations (ISCO). The risk of suicide was modelled using negative binomial regression. RESULTS: The cohort comprised 1,771,940 women and 2526 deaths by suicide corresponding to 24.9 million person-years. The most significant non-occupational predictors of suicide were age, period, civil status, religion, nationality and geographical regions. Adjusted on these factors, part-time work was associated with increased suicide rates. According to job codes, health and social activities, in particular care-worker had the highest suicide risks. CONCLUSION: Suicide among working women depended on work-related factors even taking into account other socio-demographic factors.

Insurance status and risk of suicide mortality among patients with cancer: a retrospective study based on the SEER database.

OBJECTIVE: Given that the presence of insurance may affect the risk of suicide mortality in cancer patients, we aimed to examine the association in a population-based study using the Surveillance, Epidemiologic, and End Results (SEER) database. STUDY DESIGN: A retrospective analysis of data from the SEER database. METHODS: We conducted a retrospective study using the SEER database. Hazard ratios (HRs), adjusted HRs (aHRs), and 95% confidence intervals (95% CIs) of suicide death were calculated using Cox proportional hazard models to evaluate the risk of suicide mortality among the cohorts. RESULTS: Multivariable analysis revealed that cancer patients without insurance had an increased risk of suicide death compared with patients with private insurance (aHR, 1.37; 95% CI, 1.01-1.72), whereas no significant result was observed in patients with any Medicaid (aHR, 1.10; 95% CI, 0.93-1.30; P = 0.27). In addition, the stratified analysis indicated that the risk of suicide death in patients in the uninsured and Medicaid groups presented with localized stage of disease (aHR, 1.32; 95% CI, 1.02, 1.69), White (aHR, 1.34; 95% CI, 1.05, 1.71), and American Indian/Alaska Native and Asian/Pacific Islander (aHR, 1.89; 95% CI, 1.08, 3.30) were greater than insured patients. CONCLUSION: Overall, our results indicated that insurance status was a statistically significant predictor of suicide death in patients with cancer. Healthcare providers should identify those patients at high risk of suicide and provide appropriate mental health and psychosocial oncology services in time.

Rural-urban differences in suicide attempts and mortality among young people in northern Sweden, 1998-2017: A register-based study.

Aim: The aim of this study was to assess trends in suicide attempts and mortality between 1998 and 2017 by residential area and gender among northern Swedish youths. Methods: Events of suicide attempts and deaths for each municipality in the four counties of the northern Swedish region, stratified by gender, were retrieved for each year from 1998 to 2017. All cases identified within the registers with the diagnostic codes X60-X84 or Y10-Y34 (International Classification of Diseases, 10th revision) for individuals aged 15-24 years were included. Place of residence at municipal level was categorized into three groups: rural - municipalities with a population of <10,000 inhabitants; semi-rural - those between 10,000 and 50,000; and urban - those with >50,000 inhabitants. Results: The rates of attempted suicides in the northern region were higher in both men and women than in Sweden, while the rates of suicide deaths were slightly higher in young men but similar in young women compared to the national averages. Overall, the risk of suicide attempts was higher in semi-rural municipalities compared to urban ones, particularly among women. A significantly higher risk of mortality was also observed for men and women in semi-rural municipalities, but only in the period 2010-2013. Conclusions: The high rates of attempted and completed suicides among youth in northern Sweden and the higher risks in rural and semi-rural municipalities need close attention. The implementation of suicide prevention programs, especially in rural and semi-rural municipalities, should be intensified.

[Occupational factors associated with suicide among French employees from the special agricultural social security scheme (MSA) working between 2007 and 2013]. / Facteurs professionnels en lien avec le suicide au sein des salariés affiliés à la Mutualité sociale agricole (MSA) et en activité entre 2007 et 2013.

BACKGROUND: Work and related exposures may play a role in suicide and there has been evidence in the literature that some occupational factors may be associated with suicide. The identification of occupational risk factors of suicide mortality among employees affiliated to the French special agricultural social security scheme (MSA), an understudied population, appears important. The objective of this study was to identify the occupational factors associated with suicide mortality among French employees from the MSA working between 2007 and 2013. METHODS: The study population included all the employees affiliated to the MSA working between 1st January 2007 and 31st December 2013, i.e. 1,699,929 men and 1,201,017 women. The studied occupational factors included: economic activity, skill level, and work contract. Survival analyses (Cox models) stratified on gender were performed using age as time scale and region and year of contract as adjustment variables. RESULTS: Among men, the factors associated with an elevated suicide risk were: economic activities of forestry, agriculture and related activities, and manufacture of food products and beverages (e.g. meat, wine), low-skilled level and working in the regions of Brittany, Burgundy Franche-Comté, Pays de la Loire, Normandy, Grand Est and Centre-Val-de-Loire. No association was observed among women. CONCLUSION: These results suggest that economic activity and low-skilled level may be associated with suicide among men affiliated to the MSA and may contribute to the implementation of prevention interventions. Further studies are needed to confirm and better understand these associations.

The Association between Firearm Control Policies and Firearm Suicide among Men: A State-Level Age-Stratified Analysis.

This study examined the association between state-specific firearm control policies and firearm suicide rates among men after adjusting for state-level demographics. This cross-sectional study used state-level mortality data from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System and the Brady Campaign State Scorecard in 2017. An age-stratified (15-24 years, 25-44 years, 45-64 years, and ≥ 65 years) multivariable analysis was conducted to identify gun control policies that are associated with firearm suicide rates among men in each age group. Results indicate that the associations of specific firearm control policies and firearm suicide rates differ across the age span. In particular, more policies (for example, dealer regulations and waiting periods) are negatively associated with firearm suicide rate among men 15 to 24 years of age. The findings underscore the importance of designing gender- and age-specific policy advocacy programs directed at lowering the rate of firearm suicide. This study also suggests that California, known for its innovative gun safety legislation efforts, could serve as a model for other states starting preventive programs to reduce the firearm suicide rate. Implications of the findings for social work practice are discussed.

Factors associated with deaths from suicide in a French nationwide HIV-infected cohort.

OBJECTIVES: People living with HIV (PLHIV) are at a higher risk of dying by suicide than the general population. Epidemiological data regarding determinants of suicide in PLHIV are scarce. The aim of this study was thus to study demographic, socio-economic, psychiatric history and immunovirological characteristics associated with death from suicide in the French multicenter Dat'AIDS cohort, from January 2000 to July 2013. METHODS: This was a nested case-control study. All deceased PLHIV during the study period who died by suicide and whose medical files could be checked were included as cases. Controls were selected using incidence density sampling. For each case, up to four controls were selected among all actively followed PLHIV at the index date (date of death of cases). Controls were matched for time from HIV diagnosis (5-year periods) and clinical centre. RESULTS: Seventy cases and 279 controls were included in the study. By multivariable analysis, the factors significantly associated with death from suicide were: not having children, active or substituted drug consumption, alcohol intake > 20 g/day or history of alcohol abuse, history of depressive disorder and/or of attempted suicide, and psychotropic drug intake. Conversely, age, gender, country of birth, positive HCV serology and HIV-related factors, such as AIDS status, use of combination antiretroviral therapy (cART), nadir and current CD4 counts and HIV viral load, were not significantly associated with the risk of death from suicide. CONCLUSIONS: In the cART era, HIV-related factors are not associated with a higher risk of suicide mortality. Suicide prevention measures should target PLHIV with the psychological morbidities observed in our cohort.

Socio-demographic and economics factors associated with suicide mortality in Iran, 2001-2010: application of a decomposition model.

BACKGROUND: Suicide is a major global health problem, especially among youth. Suicide is known to be associated with a variety of social, economic, political and religious factors, vary across geographical and cultural regions. The current study aimed to investigate the effects of socioeconomic factors on suicide mortality rate across different regions in Iran. METHODS: The data on distribution of population and socio-economic factors (such as unemployment rate, divorce rate, urbanization rate, average household expenditure etc.) at province level were obtained from the Statistical Centre of Iran and the National Organization for Civil Registration. The data on the annual number of deaths caused by suicide in each province was extracted from the published reports of the Iranian Forensic Medicine Organization. We used a decomposition model to distinguish between spatial and temporal variation in suicide mortality. RESULTS: The average rate of suicide mortality was 5.5 per 100,000 population over the study period. Across the provinces (spatial variation), suicide mortality rate was positively associated with household expenditure and the proportion of people aged 15-24 and older than 65 years and was negatively associated with the proportion of literate people. Within the provinces (temporal variation), higher divorce rate was associated with higher suicide mortality. By excluding the outlier provinces, the results showed that in addition to the proportion of people aged 15-24 and older than 65, divorce and unemployment rates were also significant predictors of spatial variation in suicide mortality while divorce rate was associated with higher suicide mortality within provinces. CONCLUSION: The findings indicate that both spatial and temporal variations in suicide mortality rates across the provinces and over time are determined by a number of socio-economic factors. The study provides information that can be of importance in developing preventive strategies.

Airborne pollen and suicide mortality in Tokyo, 2001-2011.

Prior research has indicated that pollen might be linked to suicide mortality although the few studies that have been undertaken to date have produced conflicting findings and been limited to Western settings. This study examined the association between the level of airborne pollen and suicide mortality in Tokyo, Japan in the period from 2001 to 2011. The daily number of suicide deaths was obtained from the Japanese Ministry of Health, Labour and Welfare, with pollen data being obtained from the Tokyo Metropolitan Institute of Public Health. A time-stratified case-crossover study was performed to examine the association between different levels of pollen concentration and suicide mortality. During the study period there were 5185 male and 2332 female suicides in the pollen season (February to April). For men there was no association between airborne pollen and suicide mortality. For women, compared to when there was no airborne pollen, the same-day (lag 0) pollen level of 30 to <100 grains per cm2 was associated with an approximately 50% increase in the odds for suicide (e.g. 30 to <50 grains per cm2: odds ratio 1.574, 95% confidence interval 1.076-2.303, p=0.020). The estimates remained fairly stable after adjusting for air pollutants and after varying the cut-points that defined the pollen levels. Our results indicate that pollen is associated with female suicide mortality in Tokyo.