Suicidal behaviour across the African continent:a review of the literature

Background: Suicide is a major cause of premature mortality worldwide, but data on its epidemiology in Africa, the world’s second most populous continent, are limited. Methods: We systematically reviewed published literature on suicidal behaviour in African countries. We searched PubMed, Web of Knowledge, PsycINFO, African Index Medicus, Eastern Mediterranean Index Medicus and African Journals OnLine and carried out citation searches of key articles. We crudely estimated the incidence of suicide and suicide attempts in Africa based on country-specific data and compared these with published estimates. We also describe common features of suicide and suicide attempts across the studies, including information related to age, sex, methods used and risk factors. Results: Regional or national suicide incidence data were available for less than one third (16/53) of African countries containing approximately 60% of Africa’s population; suicide attempt data were available for <20% of countries (7/53). Crude estimates suggest there are over 34,000 (inter-quartile range 13,141 to 63,757) suicides per year in Africa, with an overall incidence rate of 3.2 per 100,000 population. The recent Global Burden of Disease (GBD) estimate of 49,558 deaths is somewhat higher, but falls within the inter-quartile range of our estimate. Suicide rates in men are typically at least three times higher than in women. The most frequently used methods of suicide are hanging and pesticide poisoning. Reported risk factors are similar for suicide and suicide attempts and include interpersonal difficulties, mental and physical health problems, socioeconomic problems and drug and alcohol use/ abuse. Qualitative studies are needed to identify additional culturally relevant risk factors and to understand how risk factors may be connected to suicidal behaviour in different socio-cultural contexts. Conclusions: Our estimate is somewhat lower than GBD, but still clearly indicates suicidal behaviour is an important public health problem in Africa. More regional studies, in both urban and rural areas, are needed to more accurately estimate the burden of suicidal behaviour across the continent. Qualitative studies are required in addition to quantitative studies

Prevalence and patterns of antidepressant switching amongst Primary Care patients in the UK

Objective: Non-response to antidepressant treatment is a substantial problem in primary care, and many patients with depression require additional second-line treatments. This study aimed to examine the prevalence and patterns of antidepressant switching in the UK, and identify associated demographic and clinical factors. Method: Cohort analysis of antidepressant prescribing data from the Clinical Practice Research Datalink, a large, anonymised UK primary care database. The sample included 262,844 patients who initiated antidepressant therapy between 1 January 2005 and 31 June 2011. Results: 9.3% of patients switched to a different antidepressant product, with most switches (60%) occurring within 8 weeks of the index date. The proportion switching was similar for selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants and other antidepressants (9.3%, 9.8% and 9.2%, respectively). Most switches were to an SSRI (64.5%), and this was the preferred option regardless of initial antidepressant class. Factors predictive of switching included male gender, age, and history of self-harm and psychiatric illness. Conclusion: Over one in every 11 patients who initiates antidepressant therapy will switch medication, suggesting that initial antidepressant treatment has been unsatisfactory. Evidence to guide choice of second-line treatment for individual patients is currently limited. Additional research comparing different pharmacological and psychological second-line treatment strategies is required in order to inform guidelines and improve patient outcomes. </jats:sec

Searching for suicide methods:Accessibility of information about helium as a method of suicide on the Internet

Abstract. Background: Helium gas suicides have increased in England and Wales; easy-to-access descriptions of this method on the Internet may have contributed to this rise. Aims: To investigate the availability of information on using helium as a method of suicide and trends in searching about this method on the Internet. Method: We analyzed trends in (a) Google searching (2004–2014) and (b) hits on a Wikipedia article describing helium as a method of suicide (2013–2014). We also investigated the extent to which helium was described as a method of suicide on web pages and discussion forums identified via Google. Results: We found no evidence of rises in Internet searching about suicide using helium. News stories about helium suicides were associated with increased search activity. The Wikipedia article may have been temporarily altered to increase awareness of suicide using helium around the time of a celebrity suicide. Approximately one third of the links retrieved using Google searches for suicide methods mentioned helium. Conclusion: Information about helium as a suicide method is readily available on the Internet; the Wikipedia article describing its use was highly accessed following celebrity suicides. Availability of online information about this method may contribute to rises in helium suicides. </jats:p

Regional variation in suicide rates in Sri Lanka between 1955 and 2011:a spatial and temporal analysis

Abstract Background Between 1955 and 2011 there were marked fluctuations in suicide rates in Sri Lanka; incidence increased six-fold between 1955 and the 1980s, and halved in the early 21st century. Changes in access to highly toxic pesticides are thought to have influenced this pattern. This study investigates variation in suicide rates across Sri Lanka’s 25 districts between 1955 and 2011. We hypothesised that changes in the incidence of suicide would be most marked in rural areas due to the variation in availability of highly toxic pesticides in these locations during this time period. Methods We mapped district-level suicide rates in 1955, 1972, 1980 and 2011. These periods preceded, included and postdated the rapid rise in Sri Lanka’s suicide rates. We investigated the associations between district-level variations in suicide rates and census-derived measures of rurality (population density), unemployment, migration and ethnicity using Spearman’s rank correlation and negative binomial models. Results The rise and fall in suicide rates was concentrated in more rural areas. In 1980, when suicide rates were at their highest, population density was inversely associated with area variation in suicide rates (r = −0.65; p < 0.001), i.e. incidence was highest in rural areas. In contrast the association was weakest in 1950, prior to the rise in pesticide suicides (r = −0.10; p = 0.697). There was no strong evidence that levels of migration or ethnicity were associated with area variations in suicide rates. The relative rates of suicide in the most rural compared to the most urban districts before (1955), during (1980) and after (2011) the rise in highly toxic pesticide availability were 1.1 (95% CI 0.5 to 2.4), 3.7 (2.0 to 6.9) and 2.1 (1.6 to 2.7) respectively. Conclusions The findings provide some support for the hypothesis that changes in access to pesticides contributed to the marked fluctuations in Sri Lanka’s suicide rate, but the impact of other factors cannot be ruled out

Unemployment and initiation of psychotropic medication:a case-crossover study of 2,348,552 Norwegian employees

Objectives: The study investigated initiation of psychotropic medication in relation to unemployment in the months before, during and after job loss to detect the period of greatest risk.Methods: The Norwegian working population in 2004 (N=2 348 552) was observed from 2005 to 2010 through administrative registries linked to the Norwegian Prescription Database. A casecrossover design was used to analyse within-person relative risk of incident purchases of prescribed psychotropic drugs in relation to timing of unemployment. Control periods were defined 12, 24 and 36 months before the drug purchase. Supplementary analyses were performed on medication for cardiovascular disease, diabetes, obesity, thyroid disorder, pain and musculoskeletal conditions.Results: Purchases of all psychotropic drugs increased 1-3 months before job loss. Antidepressants had the highest estimate in the month before job loss (odds ratio (OR) 2.68, 95% confidence intervals (CI) 2.39 to 3.01), followed by hypnotics/sedatives (OR 2.21, 95% CI 1.97 to 2.48), anxiolytics (OR 2.18, 95% CI 1.91 to 2.48) and antipsychotics (OR 2.09, 95% CI 1.76 to 2.48). Rises were greatest in males. Risk of starting psychotropic medication remained raised during a spell of unemployment, but returned to close to baseline levels following re-employment. Drugs used to treat somatic and pain conditions showed similar trends but with weaker associations.Conclusions: Concerns about impending unemployment may influence mental health several months prior to job loss, especially around the time of notification. The clinical implications of this might be a strengthening of preventive health initiatives early in the unemployment proces

Identifying and Tracking Gas Suicides in the U.S. Using the National Violent Death Reporting System, 2005–2012

IntroductionIdentifying the source and specific type of gas used in suicides is difficult using most data systems owing to limitations in ICD-10 coding. The National Violent Death Reporting System (NVDRS), with its rich collection of both coded and free-text variables, has the potential to overcome these limitations. This study used a multipronged approach to identify gas-specific suicides in NVDRS and to track the incidence of these suicides over time.MethodsUsing suicide cases from the 16 NVDRS states that participated throughout 2005–2012, free-text and code searches were conducted for four types of variables—incident narratives, coroner/medical examiner cause-of-death statements, cause-of-death codes, and substance names—to identify suicides by carbon monoxide, helium, hydrogen sulfide, and four other gases. All analyses were conducted in 2015.ResultsApproximately 4% (3,242 of 80,715) of suicides recorded in NVDRS over the study period were the result of gas inhalation. Of these, the majority (73%) were carbon monoxide suicides (almost exclusively from motor vehicle exhaust and charcoal burning). Other types of gas (most notably helium), once rare, are now more common: At the start of the study period non–carbon monoxide gas suicides represented 15% of all gas suicides; at the end of the study period, they represented 40%.ConclusionsPublic health policies to reduce a suicidal person’s access to more lethal suicide methods require a reliable source of surveillance data on specific methods used in suicide. Small changes to NVDRS could make it an efficient and nimble surveillance system for tracking these deaths