Smoking and suicidality among adolescent psychiatric patients

Purpose: To investigate the relationship between smoking and suicidality among adolescent psychiatric patients in Finland. Methods: Data from 157 patients (aged 12-17 years) admitted to inpatient psychiatric hospitalization between April 2001 and July 2002 were collected. Logistic regression analyses were used to examine the association between regular daily smoking and suicidality. The data were adjusted for several sociodemographic and clinical characteristics. Results: The results showed over four-fold risk for definite and/or life-threatening suicide attempts among smoking adolescents in inpatient psychiatric facility compared with nonsmoking ones (OR 4.33, 95% CI 1.23-15.20). Also, the smoking adolescents had three times greater risk for occasional (OR 3.32, 95% CI 1.09-10.10) or frequent (OR 3.00, 95% CI 1.08-10.10) self-mutilation. Suicidality was more common among girls than boys and among those adolescents who suffered from depression. Conclusions: Among teens hospitalized for psychiatric illnesses, daily smoking was significantly related to suicide attempts and self-mutilation, even after controlling for several confounding factors, including psychiatric diagnosis. (C) Society for Adolescent Medicine, 2004.Peer reviewe

Suicide Seasonality: Complex Demodulation as a Novel Approach in Epidemiologic Analysis

Seasonality of suicides is well-known and nearly ubiquitous, but recent evidence showed inconsistent patterns of decreasing or increasing seasonality in different countries. Furthermore, strength of seasonality was hypothesized to be associated with suicide prevalence. This study aimed at pointing out methodological difficulties in examining changes in suicide seasonality. METHODODOLOGY/PRINCIPAL FINDINGS: The present study examines the hypothesis of decreasing seasonality with a superior method that allows continuous modeling of seasonality. Suicides in Austria (1970-2008, N = 67,741) were analyzed with complex demodulation, a local (point-in-time specific) version of harmonic analysis. This avoids the need to arbitrarily split the time series, as is common practice in the field of suicide seasonality research, and facilitates incorporating the association with suicide prevalence. Regression models were used to assess time trends and association of amplitude and absolute suicide numbers. Results showed that strength of seasonality was associated with absolute suicide numbers, and that strength of seasonality was stable during the study period when this association was taken into account.Continuous modeling of suicide seasonality with complex demodulation avoids spurious findings that can result when time series are segmented and analyzed piecewise or when the association with suicide prevalence is disregarded

Depressive symptoms and suicide in 56,000 older Chinese: a Hong Kong cohort study

Objective: To examine dose-response associations between depressive symptoms and suicide and modification effects of sex, age and health status in older Chinese. Methods: We used the Chinese version of the 15-item Geriatric Depression Scale (GDS) to measure depressive symptoms (GDS score ≥ 8) and Cox regression to examine association with suicide mortality in a population-based cohort of 55,946 individuals, aged 65 years or above, enrolled from July 1998 to December 2000 at one of 18 Elderly Health Centres of Hong Kong Department of Health. The cohort was followed up for suicide mortality till 31 March 2009 (mean follow-up 8.7 years). Results: Depressive symptoms were associated with suicide in men [hazard ratio (HR) 2.03, 95% confidence interval (CI) 0.96-4.29] and women (HR = 2.36, 95% CI 1.31-4.24) after adjusting for age, education, monthly expenditure, smoking, alcohol drinking, physical activity, body mass index, health status, and self-rated health. There was no threshold for GDS score and suicide in either sex. Age, sex and health status did not modify the association. Conclusions: Depressive symptoms predict higher suicide risk in older Chinese in a dose-response pattern. These associations were not attenuated by adjustment for health status, suggesting that depressive symptoms in older people are likely to be an independent causal factor for suicide. The GDS score showed no threshold in predicting suicide risk, suggesting that older people with low GDS scores deserve further attention and those with very high scores need urgent intervention. © 2011 The Author(s).published_or_final_versionSpringer Open Choice, 21 Feb 201

Association of temporal factors and suicides in the United States, 2000–2004

The purpose of the study was to examine the association of temporal factors, in particular days of the week and seasons of the year and death from suicide in the United States. Data were pooled from the Multiple Cause of Death Files. Hierarchical logistic regression models were fitted to all deaths occurring in 2000 through 2004 by suicide. The incidence of suicide was significantly higher on Wednesdays, compared to Sunday. Specifically, individuals were 99% more likely to kill themselves on Wednesday than on Sunday. Suicides were more prevalent in the summer months, and they were less likely to occur in winter. The state suicide rate significantly elevated individual suicide risk. The results held even after controlling for the potentially confounding effects of socio-economic and demographic variables at both the individual and state levels. It was concluded that the observed association between seasonality and suicide cannot be discounted as a mere coincidence. Future research ought to focus on integrating individual level data and contextual variables when testing for seasonality effects

Seasonal variation of suicides and homicides in Finland:with special attention to statistical techniques used in seasonality studies

Abstract Seasonal variations of events are apparently playing an important part in various psychiatric conditions. To study the seasonal variation of a condition appears to be one useful approach to clarify the aetiology of a mental disorder and phenomena to which mental disorders are associated. In the present study the seasonal variations of suicides during the period of 1980-95 (n=21279) and homicides during the years 1957-95 (n=4553) in Finland were analysed. In addition, the use of statistical techniques for seasonality and some important characteristics of study samples were evaluated from 44 original suicide seasonality studies published between 1970-97. Special attention was paid to statistical methods for seasonality and these were reviewed in the summary part of this dissertation. A statistically significant spring peak of suicides was found in both genders, in all age groups (aged 39 years or below, 40-64 years, and 65 years or more) and in violent (hanging, drowning, shooting, wrist-cutting, jumping from a height) and non-violent suicides (poisoning, gas, other methods). A secondary autumn peak of suicides was present in females and also associated with non-violent methods. The rate of violent suicides had increased significantly during 1980-90 and decreased thereafter, while the non-violent suicides had kept steadily increasing over the whole 16-year study period. The seasonal variation of violent suicides had remained stable and statistically significant over the whole study period, but the seasonality in non-violent suicides has diminished over time. The seasonal pattern of homicides showed a statistically significant peak in summer and a trough in winter. The observed rate of homicides was about 6% higher in summer and 6% lower in winter than expected under the null hypothesis of a uniform distribution. Both the crude numbers of homicide and the rate of homicides per 100 000 population increased significantly over the 39-year study period. The increasing rate of homicides in Finland was accompanied by decreasing homicide seasonality. The seasonal trends in homicides correlated significantly (positive correlation) with the seasonal trends in the violent suicides over the period of 1980-95. The use of particular statistical techniques was specified in the majority of the 44 reviewed suicide seasonality articles. This was considered as satisfactory, although in subgroup analyses and in comparisons of the seasonal pattern of suicides with phenomena other than suicides, researchers tended to interpret their study findings without a statistical significance test. In those 37 articles, which had actually examined the seasonal pattern of suicides with a statistical test, statistical methods varied from simple standard tests like the chi-square test (14 articles, 38%) to sophisticated time series analyses such as a spectral analysis (4 articles, 11%). The calendar effect (i.e. effect due to the unequal lengths of months and leap years) was reported to have been taken into account in only 10 out of 44 (22%) reviewed studies. The lack of reporting the size of a sample (12 articles, 27%) or monthly values of suicides (17 articles, 54%) was found to be a major deficit in the reviewed studies. On the basis of these findings it is recommended to carry out further surveys, which evaluate statistical content and use of statistical methods in published medical articles. These kinds of surveys remind researchers to consider more thoroughly methodological and statistical issues in their investigations

Synodic lunar phases and suicide:based on 2605 suicides over 23 years, a full moon peak is apparent in premenopausal women from northern Finland

Abstract Suicide data for this study were available for the period of March 1988 to June 2011, and involved 2111 male and 494 female victims from the Finnish province of Oulu. Data for lunar phases during that period were categorised into three groups: new moon (<25% visible), full moon (>75% visible) and other times with values in between. Seasonal effects were controlled with definitions for winter (Nov, Dec, Jan), spring (Feb, Mar, Apr), summer (May, June, July), and autumn (Aug, Sep, Oct). Suicide occurrences during different lunar phases were compared with their expected distribution using multinomial tests with all tests being two-tailed. Statistical significance was set at p < 0.05. No correlation between suicides and moon phase in any of the four seasons was apparent for male victims, but in winter for women it was (p = 0.001). Further analysis of the data revealed that the full moon association was statistically significant only for premenopausal women, defined as female victims younger than 45 years of age. To explain this unexpected finding a number of factors were considered, e.g., the darkness of a northern Finnish winter with increases of SAD and depression especially in premenopausal women, the influence of the lunar periodicity on the menstrual cycle, and cosmogeophysical effects on the humoral and autonomous nervous system