Associations between youth suicide rates and state school personnel suicide prevention training requirements.

Objective: As youth spend the majority of their time in school, school personnel suicide prevention training has gained support as an approach to mitigate rising youth suicide rates. This study examined associations between state school personnel suicide prevention training requirements (i.e., mandatory/non-mandatory and annual/not annual), year of legislation enactment (2013 or earlier/2014 or later), and changes in youth suicide rates by state from 2007-09 to 2016-18. Methods: School personnel suicide prevention training requirement data were collected through state-specific Department of Education websites while state-specific youth suicide rates were collected from the Center for Disease Control and Prevention's 2020 National Vital Statistics Report. Data were analyzed using a mixed effects linear regression model. Results: Training is mandated in 40/50 (80 %) states; 19/50 (38 %) require annual training. All states demonstrated increases in youth suicide rates from 2007-09 to 2016-18 (mean increase 3.9/100,000 [sd = 1.8]), but the change did not differ significantly by state requirements for mandatory (p = 0.44) or annual (p = 0.70) training, nor for year of enactment of legislation (p = 0.45). Conclusions: School personnel suicide prevention training requirements were not associated with changes in the youth suicide rate, though study results are limited in that data was not available on how successfully schools implemented the required trainings.

Impact of continuity of care on older adults diagnosed with mental and behavioural disorders at risk of death due to intentional self-harm: a retrospective Korean cohort study.

OBJECTIVES: The aim of this study was to evaluate the impact of continuity of care on older adults diagnosed with mental and behavioural disorders who are at risk of death due to intentional self-harm. STUDY DESIGN: This was a retrospective cohort study. METHODS: Data from the Korean National Health Insurance Service-Elderly Cohort Database (2002-2013) were used. A total of 53,980 patients who had visited the outpatient clinic three or more times within the year following the initial diagnosis of mental and behavioural disorders were included. A generalised estimating equation model was generated to examine the impact of continuity of care (CoC) on the risk of death due to intentional self-harm among older adults with mental illnesses. RESULTS: The risk of death due to intentional self-harm was significantly higher in those with poor CoC for mental and behavioural disorders than in those with good CoC. The risk ratio, adjusting for all covariates, was larger for the Usual Provider of Care index (adjusted risk ratio [aRR]: 1.63, 95% confidence interval [CI]: 1.25-2.12) than for the CoC index (aRR: 1.50, 95% CI: 1.18-1.90), indicating a stronger association with the concentration of contact with the most frequently visited provider. CONCLUSIONS: Poor CoC among Korean older adults diagnosed with mental and behavioural disorders was identified as a significant risk factor for death due to intentional self-harm. The results of this study highlight the need for interventions that can prevent suicidal behaviour in older adults, such as institutionalising the usual providers of mental health care for older adults.

Longitude-based time zone partitions and rates of suicide.

BACKGROUND: Increasing evidence suggests that conditions with decreased morning and increased evening light exposure, including shift work, daylight-saving time, and eveningness, are associated with elevated mortality and suicide risk. Given that the alignment between the astronomical, biological, and social time varies across a time zone, with later-shifted daylight exposure in the western partition, we hypothesized that western time zone partitions would have higher suicide rates than eastern partitions. METHODS: United States (U.S.) county-level suicide and demographic data, from 2010 to 2018, were obtained from a Centers for Disease Control database. Using longitude and latitude, counties were sorted into the western, middle, or eastern partition of their respective time zones, as well as the northern and southern halves of the U.S. Linear regressions were used to estimate the associations between suicide rates and time zone partitions, adjusting for gender, race, ethnicity, age group, and unemployment rates. RESULTS: Data were available for 2872 counties. Across the U.S., western partitions had statistically significantly higher rates of suicide compared to eastern partitions and averaged up to two additional yearly deaths per 100,000 people (p < .001). LIMITATIONS: Ecological design and limited adjustment for socioeconomic factors. CONCLUSIONS: To our knowledge, this is the first study of the relationship between longitude-based time zone partitions and suicide. The results were consistent with the hypothesized elevated suicide rates in the western partitions, and concordant with previous reports on cancer mortality and transportation fatalities. The next step is to retest the hypothesis with individual-level data, accounting for latitude, photoperiodic changes, daylight-saving time, geoclimatic variables, physical and mental health indicators, as well as socioeconomic adversity and protection.

Trends of completed suicide rates among Malaysian elderly between 1995 and 2020.

BACKGROUND: Suicide among the elderly has become a global public health concern. This study was carried out to determine the trend of completed suicide rates according to age, sex, and ethnicity and the suicidal methods among the elderly in Malaysia. METHODS: All suicide-related deaths in elderly aged 60 years and above from the Year 1995 to 2020 reported to the National Registration Department (NRD) were analyzed. Causes of death for suicide were coded based on the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). The completed suicide rate was calculated by dividing the completed suicide number by the total elderly population for the respective year. RESULTS: Overall, the analysis of 1,600 suicide-related deaths was investigated over 26 years. Male was seen to be correlated with higher suicidal risk, with a male-female relative risk (RR) = 1.89 (95%CI:1.46,2.45). The risk of suicide was also found to be significantly higher for those aged 60 to 74 years old and Chinese, with RR = 4.26 (95%CI:2.94, 6.18) and RR = 5.81 (95%CI: 3.70, 9.12), respectively. Hanging was found to be a statistically significant suicide method (IRR:4.76, 95%CI:2.34,9.65) as compared to pesticide poisoning. The completed suicide rate was fluctuating over the years. CONCLUSIONS: In conclusion, it is believed that Malaysia's elderly suicide rate has reached an alarmingly high incidence. By identifying the crucial criteria of sociodemographic factors, the government and responsible agencies have the essential and additional information to put together a more effective strategy and approach to overcome the issue in the future.

Trends in patient suicide rate after psychiatric discharge in Korea from 2010 to 2018: A nationwide population-based study.

BACKGROUND: There is limited quantitative evidence to investigate short-term suicide rates although the risk of suicide in psychiatric patients is exceptionally high in the early post-discharge period. This study aimed to explore the trends of the 30 days suicide rate after discharge using population-based data from Korea. METHODS: This study was conducted on psychiatric patients aged 15 years or older discharged between 2010 and 2018. Patients were extracted from the National Health Insurance Claim Database (NHICD) and information on suicide was obtained from the National Statistical Office. Age-standardized suicide rate (ASR) and Standardized Mortality Ratio (SMR) within 30 days after discharge was estimated and tested using joinpoint regression. RESULTS: Of the 1,576,028 patients discharged from hospitals from 2010 to 2018, 53.9 % were male and 47.9 % were aged between 40 and 59 years. The 30 days ASRs for psychiatric patients after discharge varied from 174.9 to 218.0 per 100,000 patients with no clear trend excluding patients with schizophrenia and anxiety disorder. The SMR for suicide within 30 days after discharge was 66.8 in 2016-2018, and patients aged 20 to 39, female, and patients with depression had high SMRs compared to other groups. LIMITATIONS: Factors that may impact the suicide were not considered in this study. Since the NHICD data is collected for payment of medical expenses, there may be scope for inaccuracies. CONCLUSIONS: The 30 days suicide rate after psychiatric discharge has failed to decrease between 2010 and 2018. This study recommends early interventions after discharge and intensive interventions for patient groups who may be vulnerable to suicide.

Changes in the Suicide Rate of Older Adults According to Gender, Age, and Region in South Korea from 2010 to 2017.

BACKGROUND: South Korea's suicide rates are the highest among Organization for Economic Co-operation and Development (OECD) countries, making it one of the most important societal issues in South Korea. METHODS: the statistics on causes of death and resident registration central population (RRCP) provided by the National Statistical Office were used to calculate the suicide rate among older adults in Korea. We examined gender (male, female), age (young-old, old-old), and region (urban, rural) by conducting latent growth modeling to estimate changes in the overall older adult suicide rate and verify its relationship. RESULTS: over a period of 8 years, the older adult suicide rate was 104.232 on average in 2010 and it decreased by approximately 10.317 every year, and the rate of decrease gradually slowed down. The initial value of the older adult suicide rate was found to be higher among males, the old-old group, and those living in rural regions. In the quadratic function change rate, only males and the old-old group were statistically significant. CONCLUSION: in this study, the direction of and the rate of change in the older adult suicide rates and the relationship between gender, age, and region were examined. It is expected that this study will provide basic data to assist in establishing older adult suicide prevention policies, considering the gender, age, and region of the aging population.

An Exploratory Analysis of Fifteen Years Suicide Trends Using Population-Level Data From Croatian Committed Suicides Registry.

Objectives: The provide a descriptive analysis of the available population-level aggregated data on committed suicides in the Republic of Croatia, in the 2004-2018 period, showing emerging trends in suicide incidence focusing on sex/age/geographical distribution of suicides and the primary and secondary causes of suicide mortality, as well as making comparisons with similar neighboring neighboring countries. Methods: The aggregated suicide data were obtained from the Croatian Committed Suicides Registry, a national registry maintained by the public health authority. The raw data extract was organized into tables according to several variables (age, sex, place of birth, place of residence, and cause of death). Simple descriptive statistics were performed on the structured data. Results: Despite being among the highest in the world and EU, the number of committed suicides in Croatia is in decline since 2004. A higher number of suicides by males was observed when compared to females. Most of the suicides occur during spring and summer. The wealthier, northern continental region of the country had the highest average rate of committed suicides per 1,00,000 population, contrary to some of the findings in the published literature associating economic instability with suicide. The most common way to commit suicide for both sexes in all age groups is self-harm by hanging, strangulation and suffocation. Suicide by firearm and explosive devices discharge remains higher than the global average. Conclusions: Despite its steadily declining incidence rates in the past 20 years, suicides remain a major public health challenge in Croatia. Results may bolster the Ugro-Finnish suicide hypothesis, linking higher suicide rates to regions with populations of Hungarian descent.

Suicide Prevention Interventions and Their Linkages in Multilayered Approaches for Older Adults: A Review and Comparison.

Multilayered approaches to suicide prevention combine universal, selective, and indicated prevention interventions. These approaches may be more successful in reducing suicide rates among older adults if they link these layers more systematically: that is, if the programs are designed so that interventions at a lower level facilitate involvement at a higher level when appropriate. This study aimed to examine the effect on suicide rates of the structure of multilayered approaches, and in particular the types of interventions and the connections or linkages between them. We also wished to consider any different effects by sex. A literature search used PubMed and PsycINFO to identify systematic reviews of interventions in this age group. From the reference lists of these articles, we identified controlled studies assessing the impact of a multilayered program on suicide incidence among older adults. We were particularly interested in initiatives linking different kinds of prevention interventions. We found three relevant systematic reviews, and from these, we identified nine eligible studies. These included seven non-randomized controlled studies from rural areas in Japan (average eligible population: 3,087, 59% women, average duration: 8 years). We also found two cohort studies. The first was from a semi-urban area in Padua, Italy (18,600 service users, 84% women, duration: 11 years). The second was from urban Hong Kong, with 351 participants (57% women) over a 2-year follow-up period. We used a narrative synthesis of these studies to identify five different multilayered programs with different forms of connections or linkages between layers. Two studies/programs (Italy and Hong Kong) involved selective and indicated prevention interventions. One study/program (Yuri, Japan) included universal and selective prevention interventions, and the final six studies (two programs in northern Japan) involved linkages between all three layers. We also found that these linkages could be either formal or informal. Formal linkages were professional referrals between levels. Informal linkages included advice from professionals and self-referrals. Several of the studies noted that during the program, the service users developed relationships with services or providers, which may have facilitated movements between levels. All five programs were associated with reduced suicide incidence among women in the target groups or communities. Two programs were also associated with a reduction among men. The study authors speculated that women were more likely to accept services than men, and that the care provided in some studies did less to address issues that are more likely to affect men, such as suicidal impulsivity. We therefore suggest that it is important to build relationships between levels, especially between selective and indicated prevention interventions, but that these can be both formal and informal. Additionally, to reach older men, it may be important to create systematic methods to involve mental health professionals in the indicated prevention intervention. Universal interventions, especially in conjunction with systematically linked indicated and selective interventions, can help to disseminate the benefits across the community.

Urban parks as a potential mitigator of suicide rates resulting from global pandemics: Empirical evidence from past experiences in Seoul, Korea.

Globally, the increased suicide rate of the general population has become a concern not only because of the COVID-19 pandemic, but also because of its associated socioeconomic insecurity, loss of jobs, and economic shocks. This study employed robust fixed-effects panel models to empirically identify the mitigating effects of infectious diseases, via urban parks, on the suicide rate, and to examine gender differences in this regard, based on previous experiences in Seoul, Korea. We found that the differentiating mitigating effect did not significantly affect suicide rates during the 2015 MERS epidemic. However, during the 2009 H1N1 pandemic, wherein the number of confirmed cases was very high and diffused nationwide, urban parks significantly reduced the suicide rates for both men and women. The role of parks as a mitigator was more enhanced in cities with a high number of confirmed cases if it was associated with economic shocks. However, this effect was significant only in the suicide rates of men, not women. During a pandemic, urban parks can help maintain social interaction and sustain physical activities (i.e., walking and exercise) while maintaining physical distance. National and local governments should develop urban parks to actively control the suicide rate influenced by movement restriction measures inevitably occurring during the spread of infectious diseases.

An analysis of age-standardized suicide rates in Muslim-majority countries in 2000-2019.

BACKGROUND: This study examines the 20-year trend of suicide in 46 Muslim-majority countries throughout the world and compares their suicide rates and trends with the global average. Ecological-level associations between the proportion of the Muslim population, the age-standardized suicide rates, male-to-female suicide rate ratio, and the Human Development Index (HDI) in 2019 were examined. METHODS: Age-standardized suicide rates were extracted from the WHO Global Health Estimates database for the period between 2000 and 2019. The rates in each country were compared with the age-standardized global average during the past 20 years. The countries were further grouped according to their regions/sub-regions to calculate the regional and sub-regional weighted age-standardized suicide rates involving Muslim-majority countries. Correlation analyses were conducted between the proportion of Muslims, age-standardized suicide rate, male: female suicide rate ratio, and the HDI in all countries. Joinpoint regression was used to analyze the age-standardized suicide rates in 2000-2019. RESULTS: The 46 countries retained for analysis included an estimated 1.39 billion Muslims from a total worldwide Muslim population of 1.57 billion. Of these countries, eleven (23.9%) had an age-standardized suicide rate above the global average in 2019. In terms of regional/sub-regional suicide rates, Muslim-majority countries in the Sub-Saharan region recorded the highest weighted average age-standardized suicide rate of 10.02/100,000 population, and Southeastern Asia recorded the lowest rate (2.58/100,000 population). There were significant correlations between the Muslim population proportion and male-to-female rate ratios (r=-0.324, p=0.028), HDI index and age-standardized suicide rates (r=-0.506, p<0.001), and HDI index and male-to-female rate ratios (r=0.503, p<0.001) in 2019. Joinpoint analysis revealed that seven Muslim-majority countries (15.2%) recorded an increase in the average annual percentage change regarding age-standardized suicide rates during 2000-2019. CONCLUSIONS: Most Muslim-majority countries had lower age-standardized suicide rates than the global average, which might reflect religious belief and practice or due to Muslim laws in their judicial and social structure which may lead to underreporting. This finding needs further in-depth country and region-specific study with regard to its implication for public policy.

Epidemiological changes, demographic drivers, and global years of life lost from suicide over the period 1990-2019.

OBJECTIVE: To quantify the contributions of epidemiological changes (age- and gender-specific suicide rates) and demographic forces (population growth and aging) to global changes in years of life lost (YLLs) from suicide over the last 30 years. METHOD: A decomposition analysis was used to assess the impacts of population growth, population aging, and suicide prevalence on global changes in YLLs from suicide between 1990 and 2019. RESULTS: From 1990 to 2019, global YLLs from suicide reduced by 2,073,714 years (5.9%), from 35,246,316 years to 33,172,602 years. This was mainly due to the decline in age-specific suicide rates, which reduced the overall YLLs from suicide by 20,185,691 years (973.4%). However, this decline was offset by the impacts of population growth and population aging, which increased global YLLs from suicide by 14,949,110 years (-720.9%) and 3,442,074 years (-166.0%), respectively. The combined effects of epidemiological and demographic drivers were also reflected in different trends in YLLs from suicide across genders and World Bank income level regions, with particularly notable increases in low- income and lower-middle income countries and the aging population. CONCLUSIONS: With the significant effects of epidemiological and demographic drivers, global and regional YLLs from suicide may be expected to change greatly in the future. Efforts to reduce the burden of suicide require appropriate allocation of resources for suicide-prevention strategies and further consideration of demographic factors.

Opposite nonlinear effects of unemployment and sentiment on male and female suicide rates: Evidence from Australia.

We investigate gender differences in the effects of unemployment and sentiment on suicide rates. Using monthly Australian data, we find a positive relationship between the unemployment rate and the suicide rate, and a negative relationship between consumer sentiment and the suicide rate. However, there is strong evidence of nonlinearity in the effects of both unemployment and sentiment on suicide rates, with substantial gender differences. For men, an increase in the unemployment rate increases the suicide rate, but an unemployment decrease has no effect; we find the opposite for women. For men, an increase in sentiment has stronger effects on the suicide rate than a decrease in sentiment. Again, we observe the opposite effect for women. Among sentiment components, forward-looking expectations are stronger predictors of suicide rates than present conditions. Sentiment has a much stronger effect on male suicide rates than on female suicide rates.

Occupation, work-related stress, and personal characteristics among suicide deaths with occupation-related compensation claims in Korea.

OBJECTIVES: This study compared differences in age-standardized suicide mortality rates, personal characteristics (demographics, employment conditions, and details of suicide), and work-related stress by gender and occupation among workers who had committed suicide in Korea. METHODS: Data comprised 413 suicide death claims lodged with the Industrial Accident Compensation Insurance (IACI) from 2010 to 2018, which were coded. We calculated age-standardized suicide mortality rates by gender and occupation. The chi-square test, Fisher's exact test, and t-test were conducted to examine gender differences. Frequency and percentage distribution by gender and occupation were calculated using descriptive statistics. RESULTS: Regardless of gender, age-standardized suicide mortality rate was highest among "Managers." Women who died by suicide were significantly younger and more likely to be unmarried, live alone, and have fewer years of continuous employment than men. "Managers," "Professionals and Related Workers," and "Clerks" experienced similar work-related stresses, including "Difficult work to achieve," "Fail to achieve allocation workload," and "Change of job contents or workload." "Skilled Agricultural, Forestry and Fishery Workers," "Craft and Related Trades Workers," and "Equipment, Machine Operating and Assembling Workers" had higher work-related stress related to "Severe disease/injury" or "Causing a serious accident" compared with other workers. CONCLUSIONS: Work-related stress related to suicide deaths differed by gender and occupation. The gender gap of labor market participation in Korea may affect gender differences in terms of demographics and employment conditions among workers who died by suicide. Our study suggests that gender- and occupation-specific strategies and policies to reduce work-related stress can prevent suicide among workers.

Looking Into Recent Suicide Rates and Trends in Malaysia: A Comparative Analysis.

Background: Suicide is a preventable cause of death. Examining suicide rates and trends are important in shaping national suicide prevention strategies. Therefore, the objectives of this study were to analyze age-standardized suicide trends of Malaysia between 2000 and 2019 using the WHO Global Health Estimates data, and to compare the 2019 rate with countries from the Association of South-East Asian Nations (ASEAN), Muslim majority countries, and the Group of Seven (G7). Methods: The age-standardized suicide rates data were extracted from the WHO Global Health Estimates. We calculated the average age-standardized suicide rates of the last 3 years from 2017 to 2019. Joinpoint regression analysis was conducted to calculate the average annual percentage change (APC) of the age-standardized suicide rates in Malaysia from 2000 to 2019. Results: Between 2000 and 2019, the minimum and maximum suicide rates for both sexes in Malaysia were 4.9 and 6.1 per 100,000 population respectively, whilst the past 3-year (2017-2019) average rates were 5.6, 8.8, and 2.4 for both sexes, males, and females, respectively. The suicide rates decreased significantly for both sexes between 2000 and 2013. Between 2014 and 2019, the suicide rates increased significantly for males. In 2019, Malaysia recorded the rate of 5.8 per 100,000 population, with an estimated 1,841 suicide deaths, i.e., ~5 deaths per day. The Malaysian suicide rate was the second highest amongst selected Muslim majority countries, in the middle range amongst ASEAN countries, and lower than all G7 countries except Italy. Conclusions: There is a need to further explore factors contributing to the higher suicide rates among Malaysian males. In light of the rising suicide rates in Malaysia, national mental health and suicide prevention initiatives are discussed and the importance of high-quality suicide surveillance data is emphasized.

Suicide in frontotemporal dementia and Huntington disease: analysis of family-reported pedigree data and implications for genetic healthcare for asymptomatic relatives.

OBJECTIVE: Genomic testing for early-onset dementia is becoming more accessible, along with predictive testing for at-risk relatives; however, complex counselling issues are important to address. The topic of suicide often has stigma associated, and thoughts or experiences may not be volunteered without prompting. Little has been published with consideration to suicide rates in the context of family experiences and their significance in genetic counselling for relatives of people with Huntington disease and frontotemporal dementia. DESIGN: This study included pedigree information for 267 symptomatic individuals with frontotemporal dementia or Huntington disease, provided via genetic counselling clinics. MAIN OUTCOME MEASURES: Descriptive statistics and suicide rate calculations based on family reported pedigree data. RESULTS: The suicide rate was 2996 per 100,000 compared with the population rate of 10 per 100,000. Approximately one in 15 families reported suicide of an affected family member, and file notes indicated that one in five families had experienced suicide, suicidal thoughts or suicide attempts in one or more affected, unaffected or pre-symptomatic relative. CONCLUSION: Health professional awareness of family experiences, including suicide of a relative, is vital in facilitating client decisions about genetic testing, and in providing adequate psychosocial support during the process of genetic testing and adaption to results.

Regional Variation of Suicide Mortality in South Korea.

South Korea's suicide rate is the highest among the members of the Organization for Economic Cooperation and Development. This study seeks to verify regional variation in suicide rates in South Korea and to identify correlating factors. We used age-adjusted suicide rates for 252 administrative districts, and a Community Health Survey, national representative data, and other national representative data such as censuses were used to obtain information on socioeconomic, health related and social integration variables according to each administrative district. Regional variation in suicide rates was analyzed by using Extremal Quotient (EQ), and multiple linear regression analyses were used to investigate associations between variation in suicide rates and regional socioeconomic, public service factors and health related factors. The average suicide rate from 252 regions was 142.7 per 100,000 people. The highest region was Hongchun-gun (217.8) and the lowest was Gwachen-si (75.5). The EQ was 2.89, meaning that there is significant regional variation in suicide rates. Financial independence (ß = -0.662, p < 0.001), social welfare budget (ß = -0.754, p < 0.001) and divorce rates (ß = 17.743, p < 0.001) were significant, along with other adjusted variables. This study suggests considering these factors in order to reduce suicide rates in South Korea.

Association between lithium in tap water and suicide mortality rates in Miyazaki Prefecture.

BACKGROUND: Most studies have reported that suicide mortality rates are negatively associated with lithium levels in tap water; however, a few studies showed either no association or a positive association. Thus, the association between suicide mortality and lithium levels in tap water remains controversial. To clarify the association, our study evaluated the association between lithium levels in tap water and suicide mortality rates in Miyazaki Prefecture of Japan, after adjusting for confounding factors. METHODS: We measured lithium levels in tap water across the 26 municipalities of Miyazaki Prefecture in Japan. We examined the standardized mortality ratio (SMR) for suicide in each municipality and used the data as the average suicide SMRs over 5 years (2009-2013). Weighted least-squares regression analysis, adjusted for the size of each municipality's population, was used to investigate the association between lithium levels in tap water and suicide SMRs. In addition to a crude model, in an adjusted model, potential confounding factors (proportion of elderly people, proportion of one-person households, annual marriage rate, annual mean income, unemployment rate, the density of medical doctors per 100,000 people, annual total rainfall, and proportion of people with a college education or higher) were added as covariates. RESULTS: We showed that male and female suicide SMRs were not associated with lithium levels in tap water in Miyazaki Prefecture. After adjusting for confounders, male suicide SMRs were significantly and positively associated with the proportion of elderly people in the population and annual total rainfall, and female suicide SMRs were associated with the proportion of elderly people in the population. CONCLUSIONS: No association between lithium levels in tap water and suicide mortality rates was found in Miyazaki Prefecture.

Can we expect an increased suicide rate due to Covid-19?

Human disasters come in all shapes and sizes including wars, terrorist violence, natural events, economic recessions and depressions as well as infection. As a species more fragile than we often allow, humans would be expected to adversely react to these types of disasters in terms of mental ill health and possibly suicidal behaviour leading to increased demands on the Mental Health services. This narrative historical paper examines relevant studies into how previous disasters affected mental health and suicidal behaviour. The characteristics of what is known of the current Covid-19 disease are analysed and compared to other types of disasters with a view to gaining some insight into what we might expect. Of all the types of disasters, economic recession appears most toxic. Mitigating the worst effects of recession appears to be protective. Particularly vulnerable groups are identified in whom we might expect an increase in suicidal behaviour.

Revisiting the Relationship Between Suicide and Unemployment in Mexico: Evidence From Linear and Non-linear Co-integration.

This study attempts to investigate if suicide is interlinked with unemployment in Mexico by making use of a recently developed Bootstrap ARDL bound test over the years of 1981-2016. To avoid omitting variable bias, we use economic growth rate as a control variable. The empirical results indicate that no co-integration among these three variables and there is a positively bidirectional causality between suicide rate and the unemployment rate. This study will showcase that the economic growth rate negatively affects unemployment rate and unidirectional Granger causality running from economic growth rate to the unemployment rate in Mexico. The findings presented in this study could provide with valuable information for society and health policy makers to formulate the policies on suicide prevention in Mexico.

Association between lithium in tap water and suicide mortality rates in Miyazaki Prefecture

BACKGROUND@#Most studies have reported that suicide mortality rates are negatively associated with lithium levels in tap water; however, a few studies showed either no association or a positive association. Thus, the association between suicide mortality and lithium levels in tap water remains controversial. To clarify the association, our study evaluated the association between lithium levels in tap water and suicide mortality rates in Miyazaki Prefecture of Japan, after adjusting for confounding factors.@*METHODS@#We measured lithium levels in tap water across the 26 municipalities of Miyazaki Prefecture in Japan. We examined the standardized mortality ratio (SMR) for suicide in each municipality and used the data as the average suicide SMRs over 5 years (2009-2013). Weighted least-squares regression analysis, adjusted for the size of each municipality's population, was used to investigate the association between lithium levels in tap water and suicide SMRs. In addition to a crude model, in an adjusted model, potential confounding factors (proportion of elderly people, proportion of one-person households, annual marriage rate, annual mean income, unemployment rate, the density of medical doctors per 100,000 people, annual total rainfall, and proportion of people with a college education or higher) were added as covariates.@*RESULTS@#We showed that male and female suicide SMRs were not associated with lithium levels in tap water in Miyazaki Prefecture. After adjusting for confounders, male suicide SMRs were significantly and positively associated with the proportion of elderly people in the population and annual total rainfall, and female suicide SMRs were associated with the proportion of elderly people in the population.@*CONCLUSIONS@#No association between lithium levels in tap water and suicide mortality rates was found in Miyazaki Prefecture.