Urban-rural inequalities in suicide mortality: a comparison of urbanicity indicators.

BACKGROUND: Urban-rural disparities in suicide mortality have received considerable attention. Varying conceptualizations of urbanity may contribute to the conflicting findings. This ecological study on Germany assessed how and to what extent urban-rural suicide associations are affected by 14 different urban-rural indicators. METHODS: Indicators were based on continuous or k-means classified population data, land-use data, planning typologies, or represented population-based accessibility indicators. Agreements between indicators were tested with correlation analyses. Spatial Bayesian Poisson regressions were estimated to examine urban-rural suicide associations while adjusting for risk and protective factors. RESULTS: Urban-rural differences in suicide rates per 100,000 persons were found irrespective of the indicator. Strong and significant correlation was observed between different urban-rural indicators. Although the effect sign consistently referred to a reduced risk in urban areas, statistical significance was not universally confirmed by all regressions. Goodness-of-fit statistics suggested that the population potential score performs best, and that population density is the second best indicator of urbanicity. Numerical indicators are favored over classified ones. Regional planning typologies are not supported. CONCLUSIONS: The strength of suicide urban-rural associations varies with respect to the applied indicator of urbanicity. Future studies that put urban-rural inequalities central are recommended to apply either unclassified population potentials or population density indicators, but sensitivity analyses are advised.

The German version of the Interpersonal Needs Questionnaire (INQ)--Dimensionality, psychometric properties and population-based norms.

PURPOSE: The Interpersonal Needs Questionnaire (INQ) assesses the two interpersonal constructs perceived burdensomeness (PB) and thwarted belongingness (TB) that lead to suicidal ideation, according to the interpersonal theory of suicide (IPTS). The present study investigates dimensionality and psychometric properties of the German version of the INQ in a population-based representative sample and delivers norm values. METHODS: The German INQ as well as measures of depression and past suicidality were administered to a population-based representative sample of the German general population (n=2513) to analyze its dimensionality and construct validity by confirmatory factor analysis and correlational analysis. RESULTS: Results of the confirmatory factor analysis were in line with the assumption of two-dimensionality of the INQ. The two subscales showed very good internal consistencies (α ≥ 0.89) as well as correlations with depression and suicidality that indicate convergent validity. There were no gender effects but slight age effects in the scores of both subscales. Population-based norms are provided. LIMITATIONS: Convergent validity was solely examined with measures of depression and suicidal thoughts instead of further suitable constructs like loneliness and social support. Divergent validity was not investigated in the study. CONCLUSION: The German version of the INQ shows good psychometric properties making it a promising tool for assessing PB and TB. The provided norms enable researchers to compare INQ scores of their samples with reference values of a population-based representative sample.

Understanding weekly cycles in suicide: an analysis of Austrian and Swiss data over 40 years.

BACKGROUND: Seasonal as well as weekly cycles in suicide have been described, replicated and poorly understood for a long time. In Western countries, suicides are typically least frequent on weekends and most frequent on Mondays and Tuesdays. To improve understanding of this phenomenon a strategy is required which focuses on anomalous findings beyond the regular patterns. Here, we focused on instances where the weekly suicide patterns disappear or are interrupted. METHODS: We used data from Swiss and Austrian mortality statistics for the periods 1969-2010 and 1970-2010, respectively. First, the data were cross-tabulated by days of the week and the available socio-demographic information (sex, age, religious affiliation and region). Second, time series of cumulated daily frequencies of suicide were analysed by seasonal Autoregressive Integrated Moving Average (ARIMA) models which included intervention effects accounting for Easter and Pentecost (Whit) holidays. RESULTS: First, the cross tabulations showed that weekly cycles may be smoothed above all in young persons and smoothed in drowning, jumping and car gas exhaustion suicides. Second, the ARIMA analyses displayed occasional preventive effects for holidays Saturdays and Sundays, and more systematic effects for holiday Mondays. There were no after effects on Tuesdays following holiday Mondays. CONCLUSIONS: In general, the weekend dip and the Monday backlog effect in suicide show striking similarities to the Advent season effect and are interpretable within the same template. The turning points between low and high frequencies possibly provide promising frames for the timing of prevention activities.

Suicidal ideation and temperament: an investigation among college students.

BACKGROUND: Suicide is a major health problem accounting for up to 1.5 percent of all deaths worldwide and represents one of the most common causes of death in adolescents and young adults. A number of studies has been performed to establish risk factors for suicide in patients with psychiatric disorders including temperamental features. This study set out to assess the relationship between suicidal ideation and temperament in young adults. METHODS: A cross-sectional sample of healthy college students (n=1381) was examined using a self-rating questionnaire. Suicidal ideation, social background, educational status, substance abuse, and affective temperament according to TEMPS-M were assessed. Predictors of lifetime suicidal ideation were examined in multivariate logistic regression analyses. RESULTS: Suicidal ideation was reported by 12.5% of all subjects at some point in their life and was higher in nicotine dependents, youth with alcohol related problems and users of illicit substances as well as in youth with lower educational status. Lifetime suicidal ideation was associated with the anxious, depressive and cyclothymic temperament in both sexes and the irritable temperament in males. These results remained significant after adjustment for smoking status, frequency of alcohol consumption, drug experience and educational status in a multivariate logistic regression analysis. LIMITATIONS: The use of self-rating instruments always reduces objectivity and introduces the possibility of misreporting. CONCLUSIONS: Considering the fact that many subjects completing suicide have never been diagnosed with mental disorders it might be reasonable to include an investigation of temperament in screenings for risk of suicide. This might be especially useful for health care professionals without mental health care background.

Inpatient treatment of major depression in Austria between 1989 and 2009: impact of downsizing of psychiatric hospitals on admissions, suicide rates and outpatient psychiatric services.

BACKGROUND: During the last 20 years Austrian psychiatric services underwent fundamental changes, as a focus was set on downsizing psychiatric hospitals. Little is known about how restructuring of mental health services affected patients with major depression and suicide rates. METHODS: Monthly hospital discharges from all hospitals in Austria with the diagnosis of unipolar major depression as primary reason for inpatient treatment were obtained for the time period between 1989 and 2008. These data were correlated with relevant parameters from the general health system, such as number of hospital beds, suicide rate, density of psychotherapists and sales of antidepressants. RESULTS: While the number of psychiatric beds was reduced by almost 30%, the total annual numbers of inpatient treatment episodes for depression increased by 360%. This increase was stronger for men than for women. Further on this development was accompanied by a decrease in the suicide rate and an improvement in the availability of professional outpatient mental health service providers. LIMITATIONS: Only aggregated patient data and no single case histories were available for this study. The validity of the correct diagnosis of unipolar major depression must be doubted, as most likely not all patients were seen by a clinical expert. CONCLUSIONS: Our data show that although inpatient treatment for unipolar major depression dramatically increased, reduction of psychiatric beds did not lead to an increase of suicide rates.

Characteristics of police officer suicides in the Federal Austrian Police Corps.

BACKGROUND: Suicide rates among police officers may be high because of strong occupational stressors. AIMS: This study examined the suicide rate and suicide characteristics among police officers in the Federal Austrian Police Force. METHODS: All suicides among policemen during the period 1996-2006 were analyzed retrospectively on the basis of personalized police record files from all Austrian police departments. Information on sex, age, marital status, children, region, method and place of suicide, suicide notes, position, and length of service was extracted from these files. The general Austrian population, adjusted for sex and age composition, served as the comparison group. RESULTS: The suicide rate among male police officers was 30.2/100,000 (SD 11.0), which was comparable to the suicide rate in the adjusted general population (30.5/100,000; SD 2.9). The female police officer suicide rate was 1.8/100,000, while the corresponding suicide rate of the adjusted female general population was 12.5/100,000 (SD 1.7). Firearms were the most frequent suicide method (77.8%), and the incidence of suicide notes was 30.8%. CONCLUSIONS: Suicide rates among police officers seem comparable to those of the age-adjusted general population. Given the healthy-worker effect, these results still suggest an increased risk of suicide among police officers. These findings should stimulate further research on stressors and risk factors for suicide among officers and should also encourage departments to increase awareness regarding suicidal signs among officers.

Influence of psychotherapist density and antidepressant sales on suicide rates.

OBJECTIVE: Antidepressant sales and suicide rates have been shown to be correlated in industrialized countries. The aim was to study the possible effects of psychotherapy utilization on suicide rates. METHOD: We assessed the impact of antidepressant sales and psychotherapist density on suicide rates between 1991 and 2005. To adjust for serial correlation in time series, three first-order autoregressive models adjusted for per capita alcohol consumption and unemployment rates were employed. RESULTS: Antidepressant sales and the density of psychotherapists in the population were negatively associated with suicide rates. CONCLUSION: This study provides evidence that decreasing suicide rates were associated with both increasing antidepressant sales and an increasing density of psychotherapists. The decrease of suicide rates could reflect a general improvement in mental health care rather than being caused by antidepressant sales or psychotherapist density alone.