Repetition of attempted suicide among immigrants in Europe

Objectives: To compare frequencies of suicide attempt repetition in immigrants and local European populations, and the timing of repetition in these groups. Method: Data from 7 European countries, comprising 10 574 local and 3032 immigrant subjects, were taken from the World Health Organization European Multicentre Study on Suicidal Behaviour and the ensuing Monitoring Suicidal Behaviour in Europe (commonly referred to as MONSUE) project. The relation between immigrant status and repetition of suicide attempt within 12-months following first registered attempt was analyzed with binary logistic regression, controlling for sex, age, and method of attempt. Timing of repetition was controlled for sex, age, and the recommended type of aftercare. Results: Lower odds of repeating a suicide attempt were found in Eastern European (OR 0.50; 95% CI 0.41 to 0.61, P < 0.001) and non-European immigrants (OR 0.68; 95% CI 0.51 to 0.90, P < 0.05), compared with the locals. Similar patterns were identified in the sex-specific analysis. Eastern European immigrants tended to repeat their attempt much later than locals (OR 0.58; 95% CI 0.35 to 0.93, P < 0.05). In general, 32% of all repetition occurred within 30 days. Repetition tended to decrease with age and was more likely in females using harder methods in their index attempt (OR 1.29; 95% CI 1.08 to 1.54, P < 0.01). Large variations in the general repetition frequency were identified between the collecting centres, thus influencing the results. Conclusions: The lower repetition frequencies in non-Western immigrants, compared with locals, in Europe stands in contrast to their markedly higher tendency to attempt suicide in general, possibly pointing to situational stress factors related to their suicidal crisis that are less persistent over time. Our findings also raise the possibility that suicide attempters and repeaters constitute only partially overlapping populations

Gender distribution of suicide attempts among immigrant groups in European countries—an international perspective

Background: Studies report high rates of suicide attempts for female immigrants. This study assesses variations in the distribution of suicide attempts across gender in immigrant and non-immigrant groups in Europe. Method: Data on 64 native and immigrant groups, including 17 662 local and 3755 immigrant person-cases collected, between 1989 and 2003, in 24 million person-years were derived from the WHO/EURO Multicentre Study on Suicidal Behaviour. Female-to-male ratios of suicide attempt rates (SARs) were calculated for all groups. Results: The cases were combined into four major categories: hosts; European and other Western immigrants; non-European immigrants; and Russian immigrants. The non-European immigrants included higher female SARs than the Europeans, both hosts and immigrants. Unlike the other groups, the majority of suicide attempters among the Russian immigrants in Estonia and Estonian hosts were male. This was also true for immigrants from Curaçao, Iran, Libya and Sri Lanka. When the single groups with a male majority were excluded, the correlation between female and male SARs was relatively high among the European immigrants (r = 0.74, P < 0.0005) and lower among the non-European immigrants (r = 0.55, P < 0.03). Generalized estimating equation analysis yielded a highly significant difference (P < 0.0005) in gender ratios of suicide attempts between hosts (ratio 1.52) and both non-European immigrants (ratio 2.32) and Russian immigrants (0.68), but not the European immigrants. Conclusions: The higher suicide attempt rates in non-European immigrant females compared with males may be indicative of difficulties in the acculturation processes in Europe. Further understanding of factors underlying suicidal behaviour in immigrant and minority groups is necessary for planning effective prevention strategie

Immigration and recommended care after a suicide attempt in Europe: equity or bias?

This report describes the investigation of care recommendations in the medical system across European countries to immigrants who attempted suicide. Data from seven European countries with 8865 local and 2921 immigrant person-cases were derived from the WHO/EURO Multicentre Study on Suicidal Behaviour and ensuing MONSUE (Monitoring Suicidal Behaviour in Europe) project. The relationship between immigrant status and type of aftercare recommended was analysed with binary logistic regression, adjusting for gender, age, method of attempt and the Centre collecting the data. Clear disparities were identified in the care recommendation practices toward immigrants, compared with hosts, over and above differing policies by the European Centre

A Genome-Wide Association Study of Diabetic Kidney Disease in Subjects With Type 2 Diabetes

dentification of sequence variants robustly associated with predisposition to diabetic kidney disease (DKD) has the potential to provide insights into the pathophysiological mechanisms responsible. We conducted a genome-wide association study (GWAS) of DKD in type 2 diabetes (T2D) using eight complementary dichotomous and quantitative DKD phenotypes: the principal dichotomous analysis involved 5,717 T2D subjects, 3,345 with DKD. Promising association signals were evaluated in up to 26,827 subjects with T2D (12,710 with DKD). A combined T1D+T2D GWAS was performed using complementary data available for subjects with T1D, which, with replication samples, involved up to 40,340 subjects with diabetes (18,582 with DKD). Analysis of specific DKD phenotypes identified a novel signal near GABRR1 (rs9942471, P = 4.5 x 10(-8)) associated with microalbuminuria in European T2D case subjects. However, no replication of this signal was observed in Asian subjects with T2D or in the equivalent T1D analysis. There was only limited support, in this substantially enlarged analysis, for association at previously reported DKD signals, except for those at UMOD and PRKAG2, both associated with estimated glomerular filtration rate. We conclude that, despite challenges in addressing phenotypic heterogeneity, access to increased sample sizes will continue to provide more robust inference regarding risk variant discovery for DKD.Peer reviewe

Självmordsdödligheten i den östeuropeiska omvandlingen

Suicide mortality in the Eastern European transition The current paper seeks to systematize the discussion on the causes of the changes in Eastern European countries' suicide mortality during the last 15 years by analyzing the changes in relation to some common causes: alcohol consumption, economic changes, "general pathogenic social stress", political changes and social disorganization. It is found that the development in suicide has varied between in different countries, and that the same causes cannot apply to all of them. However, the relation between suicide mortality and social processes is obvious. A model consisting of general stress, democratization, alcohol consumption and social disorganization (with a period-dependent effect) predicted fairly accurately the percentual changes in the suicide rates in 16 out of the 28 Eastern Bloc countries in 1984-89 and 1989-94, while it failed to do so for Albania, Poland, Romania, Slovakia and the Caucasian and Central Asian newly independent states. The data are subject to many potential sources of error: the small number of units and the large multicollinearity between the independent variables may bias results. Nevertheless, the results indicate that the changes in Eastern European suicide mortality, both its decreases and increases, may be explained with the same set of variables. However, more than one factor is needed, and the multicollinearity will continue to pose a problem.Sociologisk Forsknings digitala arkiv</p

The acceptance of suicide and its concomitants in Eastern and Western Europe in times of transition

Wstęp. Celem niniejszej pracy było zbadanie akceptacji samobójstwa i jej związku z umieralnością z powodu samobójstw oraz czynników, od których zależy ocena samobójstwa w Europie. Dane dotyczące postaw: 33 221 wywiadów przeprowadzonych w 25 krajach europejskich (Światowe Badania Wartości, World Values Study, 1990&#8211;1991). Dane dotyczące umieralności z powodu samobójstwa: statystyki WHO. Materiał i metody. Obliczono korelację rangową między wskaźnikami samobójstw wśród kobiet i mężczyzn z różnych grup wiekowych a postawami wobec samobójstwa. Czynniki determinujące postawę badano z użyciem analizy regresji zarówno logistycznej, jak i liniowej. Aby opisać różne struktury postaw, przeprowadzono analizę czynnikową. Wyniki. Ogólnie samobójstwo oceniano negatywnie, lecz poszczególne kraje różniły się ze względu na wysokość i rozkład ocen. Statystycznie istotne dodatnie korelacje między umieralnością samobójczą a postawami wobec samobójstwa stwierdzono wśród kobiet w wieku 15-64 lat. Ostateczny model czynników determinujących na poziomie indywidualnym akceptację samobójstwa obejmował: wysoką pozycję Boga (korelat ujemny), religii (ujemny) i rodziny (ujemny) w hierarchii ważności, wiek (ujemny), nietolerancję wobec niezrównoważenia psychicznego (ujemny), dobre zdrowie subiektywne, myśli o śmierci oraz liberalny styl wychowywania dzieci. Ten model wyjaśniał 12,6% wariancji w Europie Zachodniej, ale tylko 2,6% we Wschodniej. Analiza czynnikowa wykazała, że miejsce samobójstwa wśród innych aktów również odróżniało Europę Wschodnią do Zachodniej. Wnioski. Kraje europejskie różnią się pod względem akceptacji samobójstwa. Dodatnie związki między postawami wobec samobójstwa a umieralnością samobójczą istnieją wśród kobiet. Osobista religijność jest najlepszym predyktorem akceptacji samobójstwa w Europie Zachodniej, lecz czynnik ten nie ma znaczenia w Europie Wschodniej, co wskazuje na ogólniejszą różnicę dotyczącą sensu samobójstwa.Background. The aim of the article was to investigate the acceptance of suicide and its correlation with suicide mortality, as well as the determinants of suicide evaluation in Europe. Attitude data: 33 221 interviews from 25 European countries (World Values Study, 1990-1991). Suicide mortality data: WHO statistics. Material and methods. Suicide rates in different sex/age groups were rank-correlated with suicide attitudes. In the analysis of attitude determinants, both logistic and linear regression were used. Factor analysis was employed to describe different attitude structures. Results. Overall, suicide was negatively evaluated, but there were national differences in scores and rating distributions. Significant positive correlations between suicide mortality and suicide attitudes appeared in female groups aged between 15 and 64 years. The final model for individual-level determinants of suicide acceptance included the importance of God (negative correlate), religion (negative), and family (negative), age (negative), intolerance towards mental instability (negative), feeling healthy, thoughts of death, and liberal parenting. This model explained 12.6% of the variation in Western Europe, but only 2.6% in the East. Factor analyses revealed that the place of suicide among other acts also differed between Eastern and Western Europe. Conclusions. European countries differ in their acceptance of suicide. Positive associations between suicide attitudes and suicide mortality exist among women. Personal religiosity is the best predictor of suicide acceptance in Western Europe, but its lack of importance in Eastern Europe indicates a more general difference concerning the meaning of suicide

Pitirim Sorokins essä ’Självmordet som samhällsfenomen’ - en introduktion

Sorokin on suicide This introduction to the following, previously unknown essay on suicide by Pitirim Sorokin analyzes the piece itself and its ideological background. It is noted that the later world-famous author was only one of the hundreds who wrote on the topic in Russia in the 1910s, at the time of the ”second suicide epidemic”. The piece itself was intended to convey the results of science to the masses and the publication was accordingly cheaply priced. From the outset, Sorokin presents largely Durkheimian ideas, but tends to draw his own conclusions from Durkheim ’s data. The main differences between the Master and the Disciple are Sorokin’s denial of the existence of the so-called ”altruistic suicide” in primitive society, his support of imitation as a factor in suicide, his thematic stress on ”the isolation of the individual” in modern society as the main cause of suicide and, especially, his statement that ”need, hunger, and unemployment” are in fact responsible for most suicides.Sociologisk Forsknings digitala arkiv</p

Eastern European transition and suicide mortality

The current paper seeks to systematize the discussion on the causes of the changes in Eastern European countries' suicide mortality during the last 15 years by analyzing the changes in relation to some common causes: alcohol consumption, economic changes, "general pathogenic social stress", political changes, and social disorganization. It is found that the developments in suicide have been very different in different countries, and that the same causes cannot apply to all of them. However, the relation between suicide mortality and social processes is obvious. A model consisting of the hypothetical general stress (as indicated by mortality/life expectancy), democratization, alcohol consumption, and social disorganization (with a period-dependent effect) predicted the percentual changes in the suicide rates in 16 out of the 28 Eastern Bloc countries in 1984-89 and 1989-94 fairly accurately, while it failed to do this for Albania, Poland, Romania, Slovakia, and the Caucasian and Central Asian newly independent states. Most interesting were the strong roles played by changes in life expectancy, the causes of which are discussed, and the fact that economic change seemed to lack explanatory power in multiple analyses. The data are subject to many potential sources of error, the small number of units and the large multicollinearity between the independent variables may distort the results. Nevertheless, the results indicate that the changes in Eastern European suicide mortality, both decreases and increases, may be explained with the same set of variables. However, more than one factor is needed, and the multicollinearity will continue to pose problems.Alcohol Eastern Europe Homicide Mortality Russia Suicide

Suicide mortality of Eastern European regions before and after the Communist period

The aim of this study was to investigate the spatial distribution of Eastern European suicide mortality both before and at the end of the Communist period, as well as the changes that occurred during this period. Regional data on suicide mortality were collected from Czarist "European Russia" in 1910 and from the corresponding area in 1989. The distribution of suicide mortality was mapped at both points in time. Regional continuity over time was further studied with the help of geographical units specially constructed for this purpose. In 1910, suicide mortality was found to be high in the northern Baltic provinces, in the urban parts of north and central Russia, the more urbanized parts of northern and western Poland, in east Ukraine, and in the northern Caucasus, while suicide rates were generally low in south Russia, Dagestan, and in southern Poland. In 1989, suicide mortality was highest in the Urals, the east Russian "ethnic" areas, and in southeast Russia. The rates were low in Poland, Moldavia, and in most of the northern Caucasus. The across-time analysis using specially constructed comparison units showed that the spatial distributions of suicide mortality in 1910 and 1989 were not correlated with each other. Additional analyses pointed to a short-term consistency of regional patterns both in the 1900s-1920s and the 1980s-1990s. The lack of regional continuity in suicide mortality in the area may imply an absence of strong and continuous regional cultures, or a strong influence of other factors, such as societal modernization, on suicide mortality. Suicide as an act changed its social nature during the Communist period, becoming more normal, and more equally distributed among social classes and geographical locations.Suicide Eastern Europe Poland Russia Ukraine

The structure of health in Europe : The relationships between morbidity, functional limitation, and subjective health

The main objective of this study is to explore the relationships between the three commonly used proxies of health, morbidity, functional limitation, and subjective health, using the most recent data from 18 European countries. The existing studies on the topic are outdated, limited to the United States and to elderly population. Data on 32,679 respondents of the European Social Survey (2014) were analyzed using structural equation modeling. The results suggest that (a) morbidity and functional limitation lead to poorer self-rated health, and (b) morbidity increases the probability of reporting functional limitation(s). Moreover, functional limitation mediates the relationship between morbidity and self-rated health. The model as a whole holds across both genders and all age groups. However, specific tests (SEM multi-group analyses, t-tests) show differences in the health structure between all seven subsamples compared with each other. When both gender and age are taken into account the differences in the structure of health seem to diminish, apart from the elderly, suggesting that the health structure of the elderly differs from others. It is recommended for policy planners to acknowledge the group differences when shaping the policies and health services