Risk factors for suicide in rural Italy: a case-control study.

PURPOSE: Increased frequency of suicide in rural areas of Tuscany has been described since the 1970s. A case-control study was conducted in 2014 and 2015. The objective of this study was to identify major individual risk factors related to suicides in six rural districts of Tuscany. METHODS: Cases were identified as all 128 suicides occurred in six rural districts between 2009 and 2013. Controls (three for each case) were matched for age, sex, and general practice. Information was collected from GPs using a structured questionnaire. Univariate and multivariate analyses were carried out to investigate the association between individual risk factors and suicide. RESULTS: Informants for 91 cases of the 128 identified cases were successfully interviewed (response rate 71.1%). About 40.5-65.9% suicide cases and 11.4-20.0% of controls had some psychiatric pathology, accordingly to different definitions. Univariate conditional regression analysis showed that living in isolated houses (OR 2.48), living alone (OR 2.97), not being married (OR 2.63), low income (OR 2.73), psychiatric pathology (OR 9.70), psychotropic medication (OR 5.58), problems with relatives (OR 14.78), psychiatric family history (OR 5.67), and suicidal ideation (OR 15.61) were all risk factors. Practising religion (OR 0.27) was the only protective factor identified. Multivariate regression identified two independently and significantly associated variables namely, psychiatric pathology (OR 8.87) and living alone (OR 2.30). CONCLUSIONS: Results of this study showed, similarly to recent research, that not all suicide events are the results of psychiatric pathology. Prevention strategies should, therefore, target both socio-economic and clinical risk factors.

Ecological study of isolation and suicide in Tuscany (Italy).

The purpose of the study was to investigate the association between suicide and demographic and socio-economic measures in Tuscany. Data on standardized rates of suicide from 1997 to 2005 in addition to census-derived variables, income and abstention were derived from the Mortality register, the 2001 Census, the Tax Agency and the Regional Electoral Office databases. Pearson's correlation and stepwise multiple regression analyses (unweighted and weighted by population) were used to analyze the association between suicide rates and demographic and socio-economic measures for the 34 health districts for both males and females. The correlation analyses showed that suicide was significantly associated with many variables in men, but only with old age in women. The multiple regression analyses showed that the best predictors in men were education, single person households and isolated houses (only education and single person households in the weighted model). For women, the best predictors were the proportion of elderly people and income (this was also true for the weighted model, but in the opposite order). An ecological correlation between suicide and measures of economic deprivation and social fragmentation was found in both men and women. Among the best predictors, isolated houses may act as a marker for remoteness and isolation on a small scale.

High temperatures and health outcomes: a review of the literature.

AIMS: To analyse the relationship between high temperatures and population health impacts, in terms of mortality and morbidity. METHODS: A literature search was conducted using Medline to collect data from studies on heat waves, temperature-health impacts curve, risk factors, and preventive measures. All the data collected was published in English and available up to December 2009. RESULTS: Numerous studies carried out in Europe following the 2003 heat wave, as well as those conducted prior to this date in Europe and North America, showed an increase in heat wave-related excess mortality. Recent studies have demonstrated that a forward shift of deaths may only explain a very limited quantity of the excess mortality observed (up to 15%) during major heat waves. Moreover, the results seem to exclude that ozone acts as a confounding variable, whilst it remains a potential effect modifier. CONCLUSIONS: Future research needs to explore the consistency of results in new settings, to quantify the burden of heat-related morbidity and in particular to evaluate the effectiveness of the implemented preventive measures.

[Health effects of heat waves]. / Effetti sulla salute delle ondate di calore.

Climate change, characterized by increased mean temperatures and more frequent occurrence of extreme temperatures, may lead to adverse health effects through different and complex mechanisms due to substantial changes in the physical and social environment. The most easily measurable health effects of climate change in high-risk groups are the direct effects of excessively high temperatures. A literature review was performed to identify studies regarding heat waves, risk factors and prevention programmes. A large number of studies performed in Europe during the August 2003 heat wave, and previously in both Europe and North America, showed excess mortality during periods of extreme heat. The role of pollution as a confounding factor remains dubious. Groups at risk include the elderly, the urban population, individuals with impaired health and those with low income. Aging of the population (especially in industrialised nations) and increased urbanization (especially in developing countries) may further increase ill health effects of high temperatures.

[The descriptive epidemiology of suicide in Tuscany, 1988-2002]. / Epidemiologia descrittiva del suicidio in Toscana, 1988-2002.

AIMS: To describe the epidemiology of Suicide in Tuscany according to the triad of time, place and person. METHODS: The 4,764 cases of suicide, defined according to categories E950-E959 of ICD-9 in Tuscany over the period 1988-2002, were obtained from the Tuscan Mortality Register. Mortality indicators were calculated and analyzed. The spatial analysis was carried out by deriving Empirical Bayes Estimates for the 287 municipalities. RESULTS: The crude mortality rate in the 2000-2002 is 7.8 per 100000 population (male: 12.4; female: 3.5). The age-standardized rate in the 2000-2002 is 5.8 per 100,000 population (male: 9.6; female: 2.6). The highest risk for suicide, especially in the case of males, are concentrated in the southern hinterland Tuscany, in a cluster of rural municipalities that represent the old mining district of Tuscany. The SMRs according to residential municipality (population per square kilometre), confirm a greater risk of suicide for males residing in rural communities. CONCLUSIONS: The cluster of excessive mortality from suicide in Southern Tuscany could be the consequence of social determinants, related to the urban and social crisis following agriculture decline and mine closure.