This study investigates the under-reporting of suicide with particular reference to differences between sex and age groups and the various modes of suicide. The study was performed retrospectively using the files of H M Coroner for South Yorkshire (West) over the years 1985 to 1991. There were 536 deaths judged on the balance of probability to be suicidal in nature. Only 60 per cent of these deaths received a suicide verdict and would therefore register in official suicide statistics. A significantly smaller proportion of females (51.7 per cent) received a suicide verdict than males (64.5 per cent). Of the young females (< 45) 61.7 per cent were given a suicide verdict compared to 46.6 per cent of older females (45+). These differences are explained by different preferences for mode of suicide, in particular for poisoning using solids or liquids. Only 40 per cent of cases within this category received a suicide verdict. Drowning showed an even smaller percentage (24 per cent). Self-immolation (42 per cent) and jumping from a height (51 per cent) were also under-represented. Of these, self-poisoning, drowning and jumping from a height were relatively popular among females. In contrast, common causes of death favoured predominantly by males--hanging and carbon monoxide poisoning--received a high percentage of suicide verdicts (81 per cent and 90 per cent). Thus official suicide statistics produce a distorted view of the suicide population with relative under-reporting of females, particularly older females, and marked under-reporting of some causes of death, notably poisoning using solids or liquids, drowning, self-immolation and jumping from a height.
The skin affords an excellent model of human carcinogenesis because a variety of lesions from benign tumours to invasive malignancy, with or without metastatic potential, are commonly found, and are accessible to biopsy. To date, few genetic alterations have been observed in skin neoplasia. In this study we have used a recently developed monoclonal antibody (DO7) to examine p53 protein expression in a wide variety of benign and malignant skin lesions. Benign skin lesions were negative, but a significant number of malignant epithelial lesions showed detectable p53; 56% of squamous carcinomas and 42% of basal cell carcinomas were positive. A smaller proportion of dysplastic epithelial lesions were positive (27%), and only 3.6% of malignant melanomas were positive. Thus, although detectable p53 protein is a common occurrence in malignant epithelial lesions, it does not correlate with the malignant phenotype or with metastatic potential. The finding of a lower proportion of positivity in dysplastic lesions, and absence of staining in benign tumours, suggests that p53 mutation may be involved in the progression towards invasive malignancy in human squamous skin lesions.
Differences in the characteristics of those individuals choosing violent methods of suicide in South Yorkshire were studied. With the exception of jumping from a height, these methods were more frequently used by males, with a particular male predominance in deaths due to self-immolation, railway collision, hanging, firearms, and electrocution. The most potentially painful/disfiguring methods of suicide, jumping from a height, self-immolation, and railway deaths, were favored by the young. Drowning, stabbing and cutting and electrocution were common among the elderly. Severe mental illness was common amongst those choosing some of the most painful or disfiguring modes of death (jumping from a height; self-immolation; cutting/stabbing and road traffic “accidents”) particularly when compared to the principal alternative of hanging. The same group of causes of death was associated with a high proportion of individuals who had previously attempted suicide. Severe mental illness was not so obviously a feature of the railway or firearm deaths. Hanging represented more than half the cases included in the study and showed a sex ratio of over 4 to 1 in favor of males. However, all seven individuals of non-European origin, six of whom were female, chose to hang themselves. Whereas half of the females aged under 40 jumped from a height, hanging was the method of choice in the age group 40 to 59. Among males, hanging was particularly favored by those with what might be considered an impulsive reason for suicide, namely, the end of a relationship with a member of the opposite sex. A high proportion of these were intoxicated with alcohol and a high proportion left a suicide note.
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