The lethality of suicide methods: A systematic review and meta-analysis

Marti

2022

Front. Public Health

Background and aimsThe U.S. suicide data show that use of lethal methods, specifically firearms and hanging/suffocation, has been increasing among young and middle-aged adults of both sexes over the past decades. In this study, we examined demographic and clinical correlates of use of firearms, hanging/suffocation, and poisoning as suicide methods among suicide decedents age 18+.MethodsData came from the 2017-2019 National Violent Death Reporting System (NVDRS; N = 94,454, age ≥ 18 at the time of suicide; 74,042 men and 20,412 women). We fit generalized linear models (GLMs) for a Poisson distribution with a log link to examine (1) changes in four suicide methods (firearms, hanging/suffocation, poisoning, and other) during the study period, controlling for sex and age group; and (2) correlates of firearms, hanging/suffocation, and poisoning use.ResultsIn all age groups, 55% of men and 30% of women used firearms; 28% of men and 29% of women hanging/suffocation; 9% of men and 32% of women poisoning, and 8% of men and 9% of women “other” methods. Men age < 45 had higher likelihood of firearm and/or hanging/suffocation use than those age 45–64. Women age<45 also had higher likelihood of hanging/suffocation than those age 45–64. Prior suicide attempt history was associated with higher likelihood of poisoning in both sexes and hanging/suffocation in men; mental disorders/SUD were associated with higher likelihood of hanging/suffocation and poisoning in both sexes; physical health problems were associated with higher likelihood poisoning in both sexes and firearm use in men; relationship problems were associated with higher likelihood of firearm use; legal problems and job/financial/housing problems were associated with higher likelihood of hanging/suffocation in both sexes; and more crises were associated with higher likelihood of firearm use in both sexes.ImplicationsThe findings call for the following suicide prevention strategies: (1) restricted access to firearms; (2) improved access to mental health/substance use treatment; (3) improved long-term and palliative care services for those (mostly older adults) with physical health problems; (4) financial/housing support policies to mitigate economic hardship; and (5) more research to identify effective strategies to curtail the increasing use of firearm and hanging/suffocation among young and middle-aged adults.

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Three leading suicide methods in the United States, 2017–2019: Associations with decedents' demographic and clinical characteristics

Marti

2022

Front. Public Health

“…High lethality methods included firearm (CFR 89.7%), hanging (CFR 84.5%), drowning (CFR 80.4%), gas poisoning (CFR 56.6%), and jumping (CFR 46.7%). Low lethality methods included drug/liquid poisoning (CFR 8%), cutting (CFR 4%) [ 19 ]. So, in this study, high lethality methods referred to firearm, hanging, drowning, jumping, gas poisoning, and car crash while low lethality methods referred to drug/chemical liquid poisoning, pesticide, herbicide, alcohol/organic solvent toxicity, cutting/ blunt injury, and other/unspecified means.…”

Section: Methodsmentioning

confidence: 99%

Time-series analysis of trends in the incidence rates of successful and attempted suicides in Thailand in 2013–2019 and their predictors

et al. 2022

Background Suicide rates are of increasing concern worldwide. There are approximately 4000–5000 deaths by suicide each year in Thailand. This study examined trends in annual incidence rates and predictors of successful and attempted suicides in Thailand (2013–2019). Methods Secondary data analysis was conducted on data from two national-level databases: The National Health Security Office and the National Death Certification Registry System. Time-related trends and predictors of successful and attempted suicides were calculated using joinpoint regression and multivariable logistic regression analyses, respectively. Results Of all successful suicide cases from 2013 to 2019, about 80% involved men, with an average age of 45.37 (± 16.43) years. Predictors of successful suicide included male sex, older age, using highly lethal methods, and no prior psychiatric treatment. Among individuals admitted to hospitals following a suicide attempt from 2013– to 2019, the average age at first admission was 38.83 ± 22.47 years, with women more heavily represented than men. Only 2.3% of these patients received psychiatric treatment in the hospital. Predictors of attempted suicide included female sex; adolescent or adult; and mental, alcohol, or substance-related disorder(s). Age-standardized annual rates per 100,000 people showed that, through 2019, suicide incidence increased slightly, and attempts decreased. Conclusions There was a significantly increasing trend in successful suicide during the 7 years; the increase was more notable among men. The study highlights sex-related gaps in public health owing to an identified higher incidence of suicide among men, and a higher incidence of suicide attempts in women adolescents, emphasizing the need to consider sex-sensitive issues in individual as well as societal contexts.

“…Regarding suicide method lethality, a meta-analysis of 34 studies assessing the case fatality rate (CFR %) of various suicide methods has provided evidence about the lethality of the method based on the act used, where firearms was classified as the fastest, most lethal and most often an irreversible act (~89.7%), followed by suffocation/hanging (~84.5%), drowning (~80.4%), gas poisoning (~56.6%), jumping (~46.7%), liquid or drug poisoning (~8.0%) and cutting (~4.0%). Changes in lethality might vary overtime according to population of study and age groups [ 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Biological Factors Underpinning Suicidal Behaviour: An Update

et al. 2023

Suicide, a global health burden, represents the 17th leading cause of death worldwide (1.3%), but the 4th among young people aged between 15 and 29 years of age, according to World Health Organization (WHO), 2019. Suicidal behaviour is a complex, multi-factorial, polygenic and independent mental health problem caused by a combination of alterations and dysfunctions of several biological pathways and disruption of normal mechanisms in brain regions that remain poorly understood and need further investigation to be deciphered. Suicide complexity and unpredictability gained international interest as a field of research. Several studies have been conducted at the neuropathological, inflammatory, genetic, and molecular levels to uncover the triggers behind suicidal behaviour and develop convenient and effective therapeutic or at least preventive procedures. This review aims to summarise and focus on current knowledge of diverse biological pathways involved in the neurobiology of suicidal behaviour, and briefly highlights future potential therapeutic pathways to prevent or even treat this significant public health problem.