Elderly suicide with and without a history of suicidal behavior: implications for suicide prevention and management.

This study examined the impact of a history of suicidal behavior on suicide among elderly people in Singapore. In this coroner register-based study, characteristics of 409 elderly people who died of suicide in Singapore between 2000 and 2004 were examined. Sixty-five people were classified with a history of previous suicidal behavior and 344 people without a history of suicidal behavior. Elderly people who died of suicide and had a past history of suicidal behavior were more likely to suffer from major psychiatric disorders (26.2% vs 10.2%, p = 0.001), encounter social problems in life (33.9% vs 21.5%, p = 0.038), have alcohol detected in the blood toxicology report at autopsy (23.1% vs. 12.8%, p = 0.036), receive psychiatric treatment in the past (60% vs. 37.5%, p < 0.001), have antidepressant detected in the blood toxicology report at autopsy (16.9% vs. 8.1%, p = 0.037), and be admitted to a mental hospital under the mental health legislation (36.9% vs. 11.6%, p < 0.001). Conversely, those without a past history of suicidal behavior were more likely to have a pre-suicidal plan for the fatal suicide act (11.1% vs. 1.5%, p = 0.011) and have received medical or surgical treatment in the past (22.1% vs. 9.2%, p = 0.018). For suicide prevention in Asians, psychiatrists should aggressively treat major psychiatric disorders, engage social services to resolve social problems in elderly people with a history of suicidal behavior, and reduce access to alcohol. Clinicians working in medical or surgical departments should routinely screen for suicide plans in elderly patients without a past history of suicidal behavior.

Suicide in young Singaporeans aged 10-24 years between 2000 to 2004.

The objective of this study was to understand the features of young suicide in order to contribute to suicide prevention efforts. In this article, the demographic, clinical, and suicide-related features of all cases of young suicide (aged 10-24 years) in Singapore for the years 2000-2004 are described. We also compared those who sought mental health services to those who did not. Overall, the suicide rate was 5.7 per 100, 000, with gender ratio of 1:1 and higher rates among ethnic Indians. Psychosocial stressors and suicide by jumping from height were common. Mental health service use was associated with unemployment, previous suicide attempts, family history of suicide, more use of lethal methods, lack of identifiable stressor, and less suicide notes. Suicide prevention efforts should promote awareness of suicide risks and access to mental health services.

Suicide methods in singapore (2000-2004): types and associations.

The choice of suicide methods varies between countries. Common methods used in Singapore between 2000 and 2004 were jumping (72.4%), hanging (16.6%), and poisoning (5.9%). Those who jumped were more likely to be young, single, female, and to have had a major mental illness. By comparison, those who hung themselves were more likely to be older (OR 2.68), Indian (OR 2.32), and to leave a suicide note (OR 1.53). Those who used poison were more likely to be married (OR 2.33), to be on antidepressants (OR 2.40), to have previously attempted suicide (OR 2.13), and to leave a letter (OR 2.30). The choice was determined by accessibility, acceptability, generational, gender, and racial factors.

Suicide trends in Singapore: 1955-2004.

The objective of this study was to investigate suicide trends in Singapore between 1955 and 2004. Suicide cases were identified from the Registry of Birth and Death, Singapore, and analyzed using Poisson regression. Overall, suicide rates in Singapore remained stable between 9.8-13.0/100,000 over the last 5 decades. Rates remain highest in elderly males, despite declines among the elderly and middle-aged males in recent years. Rates in ethnic Chinese and Indians were consistently higher than in Malays. While the rates among female Indians and Chinese have declined significantly between 1995 and 2004, some increase was noted in female Malays. Although there was no increase in overall suicide rates, risk within certain population segments has changed over time.

Suicide in psychiatric patients: case-control study in Singapore.

OBJECTIVE: Persons with psychiatric illness, especially depression and schizophrenia, are at relatively high risk of suicide, but there are few studies that look at the Asian population. The aim of the present study was to identify the risk period and risk factors for suicide in psychiatric patients in Singapore. The nature of psychiatric care that was provided, both inpatient and outpatient, was also explored. METHOD: This is a case-control study of 123 patients who committed suicide from 2003 to 2004. Controls were 123 surviving patients who were individually matched for age, gender, principal diagnosis and calendar time. RESULTS: The most common principal diagnoses among the suicide subjects were schizophrenia (46.3%) and depression (26.8%). Numerous factors were associated with significantly increased suicide risk. Stepwise conditional logistic regression showed that the following three independent factors best predicted suicide: history of attempted suicide using highly lethal means; coexisting significant physical illness; and delusions. Suicides occur mainly soon after discharge and after an outpatient consult. Subgroup analyses were done to distinguish between subjects who suicided early and late following discharge. CONCLUSIONS: Suicidal risk remains high in Singaporean psychiatric patients soon after discharge. They share some common risk factors for suicide identified in Western studies but the lower prevalence of substance abuse and comorbidity in Singaporean suicide subjects was one notable difference. The phenomena of suicides soon after discharge and outpatient review suggest the need for proper identification and more intensive follow up during this period.

Suicide letters in Singapore.

The contents of suicide letters provide insight into the reasons for suicide and the mental states of victims. Coroner court records of 1,721 Singaporean suicides occurring between 2000 and 2004 were reviewed, 398 (23%) of whom left suicide letters. Letter writers tended to be younger, single, and less likely to have mental or physical illness. A reason for suicide was evident in 58%. Major reasons included school and relationship problems in the young, financial and marital problems in adults and physical illnesses in the elderly. Positive sentiment (care/concern) was expressed in 59%. Negative emotions in 45% of which despondency/agony (60%) was the most common, followed by emptiness (25%), guilt/shame (15%), hopelessness (10%), and anger (3%). The study of these letters suggests that there are combinations of social, psychological and physical factors that influence a person to suicide, all of which are important in the prevention, assessment, and management of suicide.