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Trott M, Suetani S, Arnautovska U, Kisely S, Kar Ray M, Theodoros T, Le V, Leske S, Lu M, Soole R, Warren N, Siskind D. Suicide methods and severe mental illness: A systematic review and meta-analysis. Acta Psychiatr Scand 2025; 151:467-484. [PMID: 39350700 PMCID: PMC11884913 DOI: 10.1111/acps.13759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 09/05/2024] [Accepted: 09/07/2024] [Indexed: 03/08/2025]
Abstract
INTRODUCTION People with severe mental illness (SMI) have a higher risk of suicide compared with the general population. However, variations in suicide methods between people with different SMIs have not been examined. The aim of this pre-registered (PROSPERO CRD42022351748) systematic review was to pool the odds of people with SMI who die by suicide versus those with no SMI, stratified by suicide method. METHODS Searches were conducted on December 11, 2023 across PubMed, PsycInfo, CINAHL, and Embase. Eligible studies were those that reported suicide deaths stratified by SMI and suicide methods. Studies were pooled in a random-effects meta-analysis, and risk of bias was measured by the Joanna Briggs Institute checklist. RESULTS After screening, 12 studies were eligible (n = 380,523). Compared with those with no SMI, people with schizophrenia had 3.38× higher odds of jumping from heights (95% CI: 2.08-5.50), 1.93× higher odds of drowning (95% CI: 1.50-2.48). People with bipolar disorder also had 3.2× higher odds of jumping from heights (95% CI: 2.70-3.78). Finally, people with major depression had 3.11× higher odds of drug overdose (95% CI: 1.53-6.31), 2.11× higher odds of jumping from heights (95% CI: 1.93-2.31), and 2.33× lower odds of dying by firearms (OR = 0.43, 95% CI: 0.33-0.56). No studies were classified as high risk of bias, and no outcomes had high levels of imprecision or indirectness. CONCLUSION These findings could inform lethal means counselling practices in this population. Additionally individual, clinical, community and public health interventions for people with SMI should prioritise, where feasible, means restriction including access to heights or drugs to overdose.
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Affiliation(s)
- M. Trott
- UQ Medical School, Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
- Physical and Mental Health Research StreamQueensland Centre for Mental Health ResearchBrisbaneQueenslandAustralia
- Metro South Addiction and Mental Health ServiceMetro South HealthBrisbaneQueenslandAustralia
| | - S. Suetani
- Physical and Mental Health Research StreamQueensland Centre for Mental Health ResearchBrisbaneQueenslandAustralia
- Institute for Urban Indigenous HealthBrisbaneQueenslandAustralia
- Queensland Brain InstituteThe University of QueenslandSt LuciaQueenslandAustralia
- School of Medicine and DentistryGriffith UniversityNathanQueenslandAustralia
| | - U. Arnautovska
- UQ Medical School, Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
- Physical and Mental Health Research StreamQueensland Centre for Mental Health ResearchBrisbaneQueenslandAustralia
- Metro South Addiction and Mental Health ServiceMetro South HealthBrisbaneQueenslandAustralia
| | - S. Kisely
- UQ Medical School, Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
- Metro South Addiction and Mental Health ServiceMetro South HealthBrisbaneQueenslandAustralia
- Department of Psychiatry, Community Health and EpidemiologyDalhousie UniversityTruroNova ScotiaCanada
| | - M. Kar Ray
- UQ Medical School, Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
- Metro South Addiction and Mental Health ServiceMetro South HealthBrisbaneQueenslandAustralia
| | - T. Theodoros
- Metro South Addiction and Mental Health ServiceMetro South HealthBrisbaneQueenslandAustralia
- School of Health and Medical SciencesUniversity of Southern QueenslandToowoombaQueenslandAustralia
| | - V. Le
- UQ Medical School, Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - S. Leske
- UQ Medical School, Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
- UQ Poche Centre for Indigenous HealthThe University of QueenslandBrisbaneQueenslandAustralia
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied PsychologyGriffith UniversityBrisbaneQueenslandAustralia
| | - M. Lu
- UQ Medical School, Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
- Metro South Addiction and Mental Health ServiceMetro South HealthBrisbaneQueenslandAustralia
| | - R. Soole
- UQ Medical School, Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
- Physical and Mental Health Research StreamQueensland Centre for Mental Health ResearchBrisbaneQueenslandAustralia
| | - N. Warren
- UQ Medical School, Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
- Metro South Addiction and Mental Health ServiceMetro South HealthBrisbaneQueenslandAustralia
| | - D. Siskind
- UQ Medical School, Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
- Physical and Mental Health Research StreamQueensland Centre for Mental Health ResearchBrisbaneQueenslandAustralia
- Metro South Addiction and Mental Health ServiceMetro South HealthBrisbaneQueenslandAustralia
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Rivart P, Bojanić L, Turnbull P, Appleby L, Kapur N, Hunt IM. Suicide in mental health patients in the UK between 2005 and 2021: study of methods and clinical characteristics to inform prevention. BJPsych Open 2024; 10:e228. [PMID: 39635771 PMCID: PMC11698139 DOI: 10.1192/bjo.2024.822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 10/07/2024] [Accepted: 10/17/2024] [Indexed: 12/07/2024] Open
Abstract
BACKGROUND Tackling methods of suicide and limiting access to lethal means remain priority areas of suicide prevention strategies. Although mental health services are a key setting for suicide prevention, no recent studies have explored methods used by mental health patients. AIMS To investigate associations between main suicide methods and social, behavioural and clinical characteristics in patients with mental illness to inform prevention and improve patient safety. METHOD Data were collected as part of the National Confidential Inquiry into Suicide and Safety in Mental Health. We examined the main suicide methods of 26 766 patients in the UK who died within 12 months of contact with mental health services during 2005-2021. Associations between suicide methods and patient characteristics were investigated using chi-square tests and univariate and multivariate logistic regression. RESULTS Suicide methods were associated with particular patient characteristics: hanging was associated with a short illness history, recent self-harm and depression; self-poisoning with substance misuse, personality disorder and previous self-harm; and both jumping and drowning with ethnic minority groups, schizophrenia and in-patient status. CONCLUSIONS A method-specific focus may contribute to suicide prevention in clinical settings. Hanging deaths outside of wards may be difficult to prevent but our study suggests patients with recent self-harm or in the early stages of their illness may be more at risk. Patients with complex clinical histories at risk of suicide by self-poisoning may benefit from integrated treatment with substance use services. Environmental control initiatives are likely to be most effective for those at risk of jumping or drowning.
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Affiliation(s)
- Pauline Rivart
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Lana Bojanić
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Pauline Turnbull
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Nav Kapur
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK
- Mersey Care NHS Foundation Trust, Prescot, UK
| | - Isabelle M. Hunt
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Oden C, Weinschreider E, Linzie H. Self-inflicted Stabbings as Nonfatal Suicide Attempts: A Systematic Review and Case Series. J Acad Consult Liaison Psychiatry 2023; 64:294-304. [PMID: 36646320 DOI: 10.1016/j.jaclp.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 12/28/2022] [Accepted: 01/04/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Suicide by cutting or piercing is a rare and often nonlethal method. Self-stabbings are a subset of these cases, which can lead to significant injuries. Current literature does not adequately summarize the psychiatric characteristics of this population. OBJECTIVE To examine the psychiatric presentations of adults with nonfatal self-inflicted stabbing suicide attempts to better inform the evidence-based care provided by the psychiatric consult service. METHODS We searched Embase, Ovid MEDLINE, APA Psych INFO, and CINAHL for studies published within the last 15 years. All full-article case reports, case series, cohort studies, and systematic literature reviews in English were included. Studies not specific to adult (>18 years old) patients with self-inflicted stabbing wounds were excluded. Included studies were separated into 2 groups: case reports and cohort studies. Simple summative statistical analyses were performed. The quality of evidence was assessed using a modified version of the Joanna Briggs Institute Critical Appraisal Tools. RESULTS Thirty-four case reports, 3 cohort studies, and zero systematic literature reviews met the inclusion and quality assessment criteria. A total of 184 cases of self-stabbing were identified, 66% of which included male patients. The mean age of cohort patients was 44 years. The mean age of case report patients was 47 years. The most common tool for stabbing was a knife. Common stabbing locations included the neck, chest, and abdomen. Commonly reported psychiatric diagnoses included mood disorders and schizophrenia spectrum disorders. Self-stabbing characteristics important to psychiatry were inconsistently reported across studies. CONCLUSIONS This literature review found that self-stabbing appears to be a male-preferred method and may be associated with mood disorders. Inconsistent reporting of relevant psychiatric data such as psychiatric diagnosis, previous psychiatric history, suicidal intent, and intoxication is present in our review and is potentially due to a lack of reports from the psychiatric perspective. This limits our understanding of psychiatric issues in adults who made nonfatal self-inflicted stabbing suicide attempts. A further study into the presentations of this population is needed to better understand this distinct group of patients.
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Affiliation(s)
- Crystal Oden
- Department of Psychiatry and Behavioral Health, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV; University Medical Center of Southern Nevada, Las Vegas, NV.
| | - Emily Weinschreider
- Department of Psychiatry and Behavioral Health, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV
| | - Hilary Linzie
- Department of Psychiatry and Behavioral Health, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV; University Medical Center of Southern Nevada, Las Vegas, NV
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Suicide attempts by jumping and length of stay in general hospital: A retrospective study of 225 patients. J Psychosom Res 2019; 119:34-41. [PMID: 30947815 DOI: 10.1016/j.jpsychores.2019.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Violent suicide attempts, such as jumping from a height, frequently lead to hospitalization in general hospital with high length of stay (LOS). We investigated features associated with LOS in this context. METHODS We retrospectively included all patients admitted after suicide attempts by jumping in non-psychiatric wards of a university hospital between 2008 and 2016. Several socio-demographic and clinical data were collected, including psychiatric diagnoses, coded with the International Classification of Diseases-10th Revision. We used general linear models to identify factors associated with LOS. RESULTS Among 225 patients (125 men; mean age ± sd: 37.5 ± 15.4 years), several clinical factors were independently associated with a longer LOS: number of injuries (β = 8.2 p < .001), external fixator (β = 18.1 p = .01), psychotic disorder (β = 14.6 p = .02) and delirium (β = 16.6 p = .005). Admission in psychiatric ward at discharge tended to be associated with lower LOS (β = -15.3 p = .07). CONCLUSION In patients admitted in non-psychiatric wards after suicide attempt by jumping, the presence of a psychotic disorder may increase LOS by several days, and indirectly costs of hospitalization, to a similar extent of non-psychiatric factors. The association of transfer in psychiatric ward with lower LOS suggests that the psychiatric disorder might interfere with medical care.
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Omi T, Ito H, Riku K, Kanai K, Takada H, Fujimi S, Matsunaga H, Ohi K. Possible factors influencing the duration of hospital stay in patients with psychiatric disorders attempting suicide by jumping. BMC Psychiatry 2017; 17:99. [PMID: 28320371 PMCID: PMC5359942 DOI: 10.1186/s12888-017-1267-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 03/11/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Patients with psychiatric disorders have a high rate of suicide. The present study investigated factors influencing hospital stays for Japanese patients with psychiatric disorders attempting suicide by jumping. METHODS We diagnosed all suicide attempts (n = 113) by jumping based on the International Classification of Diseases 10th Revision (ICD-10) and investigated the mean hospital stays of patients with each diagnosis based on the ICD-10 code. We then analyzed differences in the demographic and clinical characteristics between the diagnostic groups to identify factors influencing the duration of hospital stay. RESULTS Patients diagnosed with schizophrenia (F2 code) were the most frequent (32.7%) of all diagnoses; therefore, we divided the diagnostic groups into schizophrenia group (n = 37) and other psychiatric diagnoses group (n = 76). The patients with schizophrenia showed a significantly longer hospital stay (125.7 ± 63.9 days) compared with the patients with other psychiatric diagnoses (83.6 ± 63.2) (β ± SE = 42.1 ± 12.7, p = 0.0013), whereas there was no difference in the jump height between the two groups (the average was the 3rd to 4th floor; p > 0.05). The number of injured parts, particularly lower-limb fractures, was significantly higher (p = 0.017) in patients with schizophrenia than in patients with other psychiatric diagnoses. The duration of psychiatric treatment in patients with schizophrenia were significantly longer (z = 3.4, p = 0.001) than in patients with other psychiatric diagnoses. CONCLUSION Our findings indicate that the number of injuries and the body parts injured in patients with schizophrenia are associated with a longer duration of hospital stay following a suicide attempt by jumping. The current use of antipsychotics and a longer duration of taking antipsychotics might contribute to the risk of bone fracture via hyperprolactinemia. Further cognitive impairment in patients with schizophrenia might prevent rehabilitation for the management of lower-limb fractures. From these results, we suggest that clinicians should monitor the level of prolactin and cognitive function in patients with schizophrenia in future studies on managing of lower-limb fractures.
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Affiliation(s)
- Tsubasa Omi
- Department of Psychiatry, Osaka General Medical Center, Osaka, Japan.
| | - Hiroshi Ito
- Department of Emergency Medicine, Osaka General Medical Center, Osaka, Japan
| | - Keisen Riku
- Department of Psychiatry, Osaka General Medical Center, Osaka, Japan
| | - Koji Kanai
- Department of Psychiatry, Osaka General Medical Center, Osaka, Japan
| | - Hiromune Takada
- Department of Psychiatry, Osaka General Medical Center, Osaka, Japan
| | - Satoshi Fujimi
- Department of Emergency Medicine, Osaka General Medical Center, Osaka, Japan
| | | | - Kazutaka Ohi
- Department of Neuropsychiatry, Kanazawa Medical University, Ishikawa, Japan.
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Pentone A, Innamorato L, Introna F. Her life ended jumping from the fifth floor: the importance of scene investigation and the need for restrictive means to prevent jumping suicide. Am J Forensic Med Pathol 2015; 36:75-78. [PMID: 25955975 DOI: 10.1097/paf.0000000000000149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In January 2014, a dead woman was found lying near the back entrance of a building belonging to Bari University Hospital compound. After the external examination and identification of the corpse, through history, circumstances, and postmortem findings, it was supposed that the woman probably committed suicide, by jumping from the nearby building. But only after additional investigation of the scene was it possible to locate the window through which the victim had jumped, by assessing the height from which she leapt. We underline the importance of the examination of the scene. It has to be done with circumspection, even in cases that could be considered routine, paying attention to details, not excluding things that, at first glance, seem to be unnecessary. Inspection needs time, patience and accuracy, knowledge, competence, and intuition and must be the result of an efficient team action. Furthermore the occurrence of suicides, particularly jumping from a height, among immediate postdischarge psychiatric patients, stresses the importance of immediate follow-up treatment and alternative preventive strategies, considering, of course, the feasibility of structural means.
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Gender differences in socio-demographic, clinical characteristics and psychiatric diagnosis in/of suicide attempters in a Mexican population. Acta Neuropsychiatr 2015; 27:182-8. [PMID: 25686910 DOI: 10.1017/neu.2015.6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim of the present study was to analyse demographic and clinical characteristics, as well as psychiatric diagnoses to identify gender differences in patients with attempted suicide in a Mexican population. METHODS Between September 2010 and September 2012, 140 suicide attempts were documented in the Department of Psychiatry at the General Hospital of Comalcalco (Hospital General de Comalcalco in Spanish) in Tabasco, Mexico. Diagnoses were established using the DSM-IV questionnaire in which Axis I and II were considered. The Suicide Intent Scale was also applied. RESULTS In our sample, 63.6% were females and 36.4% males. With regard to socio-demographic characteristics, the predominant marital status in males was single, and in females married (χ2=5.93, df=2, p=0.05). In occupation the male group was mainly unemployed and housewife in females (χ2=55.51, df=4, p<0.001). Male subjects were more likely to consume alcohol (χ2=20.40, df=1, p≤0.001), cannabis (χ2=16.62, df=1, p≤0.001) or tobacco. The prevalence of psychiatric diagnosis was significantly different because, the male group was mainly diagnosed with substance-related disorders, whereas female participants showed a prevalence of stress-related disorders (χ2=34.17, gl=4, p=0.0001). CONCLUSION Our results provide evidence that the characteristics of suicide attempt are different by gender in the Mexican population. Interventions are necessary for the development of prevention strategies that may lead to a reduction in suicidal behaviour. These preventive activities should consider the occupation for the female group and consumption of alcohol, cannabis or tobacco in the male group.
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Pierre JM. Culturally sanctioned suicide: Euthanasia, seppuku, and terrorist martyrdom. World J Psychiatry 2015; 5:4-14. [PMID: 25815251 PMCID: PMC4369548 DOI: 10.5498/wjp.v5.i1.4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 12/21/2014] [Accepted: 01/19/2015] [Indexed: 02/05/2023] Open
Abstract
Suicide is one of the greatest concerns in psychiatric practice, with considerable efforts devoted to prevention. The psychiatric view of suicide tends to equate it with depression or other forms of mental illness. However, some forms of suicide occur independently of mental illness and within a framework of cultural sanctioning such that they aren’t regarded as suicide at all. Despite persistent taboos against suicide, euthanasia and physician-assisted suicide in the context of terminal illness is increasingly accepted as a way to preserve autonomy and dignity in the West. Seppuku, the ancient samurai ritual of suicide by self-stabbing, was long considered an honorable act of self-resolve such that despite the removal of cultural sanctioning, the rate of suicide in Japan remains high with suicide masquerading as seppuku still carried out both there and abroad. Suicide as an act of murder and terrorism is a practice currently popular with Islamic militants who regard it as martyrdom in the context of war. The absence of mental illness and the presence of cultural sanctioning do not mean that suicide should not be prevented. Culturally sanctioned suicide must be understood in terms of the specific motivations that underlie the choice of death over life. Efforts to prevent culturally sanctioned suicide must focus on alternatives to achieve similar ends and must ultimately be implemented within cultures to remove the sanctioning of self-destructive acts.
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