Dataset Information

Association Between Means Restriction of Poison and Method-Specific Suicide Rates : A Systematic Review

ABSTRACT: This systematic review reports the preintervention and postintervention changes in suicide rates using restricted methods, such as pesticides, domestic gas, motor vehicle exhaust, and pharmaceuticals, among individuals in 26 countries. Key Points

Question

What is the association between means restriction of poison and population-level suicide rates?

Findings

In this systematic review of 62 studies from 26 countries, means restriction of poison was associated with reductions in method-specific suicide rates without an equivalent shift toward other methods. Means restriction was most promising when the poison was lethal and common, and decreases in suicides by the restricted poison were not associated with increases in suicide by other available methods.

Meaning

The findings suggest that restricting access to poisons was associated with decreases in suicide by poisoning. Changes in other methods of suicide were associated with historical trends rather than reduced availability of the poison.

Importance

Suicide is a major and preventable cause of death worldwide. Means restriction aims to reduce the rate of completed suicides by limiting public access to lethal suicide methods. Means restriction of agents used in poisoning is more controversial because there is potential to switch to other lethal methods.

Objective

To identify the changes in suicide rate by the targeted poison and the corresponding changes in suicide by other methods.

Evidence Review

Five databases (MEDLINE, Embase, Scopus, PsycInfo, and Web of Science) were searched for studies on national means restriction of poison that were published in the English language from inception until December 31, 2019. Of the 7657 articles that were screened by title and abstract, 62 studies were included in the analysis.

Findings

Sixty-two studies from 26 countries in Europe, the US, Australia, Asia, and the United Kingdom were included in the review. The studies included restrictions on pesticides (15 countries), domestic gas (14 countries), motor vehicle exhaust (9 countries), and pharmaceuticals (8 countries). The median (IQR) change in method-specific suicide rates was −1.18 (−2.03 to −0.46) per 100 000 people after restrictions, whereas the median (IQR) change in other methods of suicide (not the restricted poison) was −0.09 (−2.22 to 1.65) per 100 000 people. Decreases in suicide by the restricted poison were not associated with increases in suicide by other methods. An estimated 57 355 poison-specific suicides annually (before the interventions were implemented) may have benefited the most from means restriction.

Conclusions and Relevance

This systematic review found that means restriction of poison was associated with decreased method-specific suicide rates without an equivalent shift toward the use of other methods. Suicide prevention strategies need to address both individuals who are at risk and population-level policies.

SUBMITTER: Lim J

PROVIDER: S-EPMC8727039 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ObjectiveTo estimate the association between homicide and suicide rates in Brazilian municipalities over a period of 7 years.DesignWe conducted a longitudinal ecological study using annual mortality data from 5507 Brazilian municipalities between 2008 and 2014. Multivariable negative binomial regression models were used to examine the relationship between homicide and suicide rates. Robustness of results was explored using sensitivity analyses to examine the influence of data quality, population size, age and sex on the relationship between homicide and suicide rates.SettingA nationwide study of municipality-level data.ParticipantsMortality data and corresponding population estimates for municipal populations aged 10 years and older.Primary and secondary outcome measuresAge-standardised suicide rates per 100 000.ResultsMunicipal suicide rates were positively associated with municipal homicide rates; after adjusting for socioeconomic and demographic factors, a doubling of the homicide rate was associated with 22% increase in suicide rate (rate ratio=1.22, 95% CI: 1.13 to 1.33). A dose-response effect was observed with 4% increase in suicide rates at the third quintile, 9% at the fourth quintile and 12% at the highest quintile of homicide rates compared with the lowest quintile. The observed effect estimates were robust to sensitivity analyses.ConclusionsMunicipalities with higher homicide rates have higher suicide rates and the relationship between homicide and suicide rates in Brazil exists independently of many sociodemographic and socioeconomic factors. Our results are in line with the hypothesis that changes in homicide rates lead to changes in suicide rates, although a causal association cannot be established from this study. Suicide and homicide rates have increased in Brazil despite increased community mental health support and incarceration, respectively; therefore, new avenues for intervention are needed. The identification of a positive relationship between homicide and suicide rates suggests that population-based interventions to reduce homicide rates may also reduce suicide rates in Brazil.

Project description:IMPORTANCE:Previous studies have linked suicide risk with religious participation, but the majority have used ecologic, cross-sectional, or case-control data. OBJECTIVE:To examine the longitudinal association between religious service attendance and suicide and the joint associations of suicide with service attendance and religious affiliation. DESIGN, SETTING, AND PARTICIPANTS:We evaluated associations between religious service attendance and suicide from 1996 through June 2010 in a large, long-term prospective cohort, the Nurses' Health Study, in an analysis that included 89?708 women. Religious service attendance was self-reported in 1992 and 1996. Data analysis was conducted from 1996 through 2010. MAIN OUTCOMES AND MEASURES:Cox proportional hazards regression models were used to examine the association between religious service attendance and suicide, adjusting for demographic covariates, lifestyle factors, medical history, depressive symptoms, and social integration measures. We performed sensitivity analyses to examine the influence of unmeasured confounding. RESULTS:Among 89?708 women aged 30 to 55 years who participated in the Nurses' Health Study, attendance at religious services once per week or more was associated with an approximately 5-fold lower rate of suicide compared with never attending religious services (hazard ratio, 0.16; 95% CI, 0.06-0.46). Service attendance once or more per week vs less frequent attendance was associated with a hazard ratio of 0.05 (95% CI, 0.006-0.48) for Catholics but only 0.34 (95% CI, 0.10-1.10) for Protestants (P?=?.05 for heterogeneity). Results were robust in sensitivity analysis and to exclusions of persons who were previously depressed or had a history of cancer or cardiovascular disease. There was evidence that social integration, depressive symptoms, and alcohol consumption partially mediated the association among those occasionally attending services, but not for those attending frequently. CONCLUSIONS AND RELEVANCE:In this cohort of US women, frequent religious service attendance was associated with a significantly lower rate of suicide.

Project description:OBJECTIVE:To examine the association between reporting on suicides, especially deaths of celebrities by suicide, and subsequent suicides in the general population. DESIGN:Systematic review and meta-analysis. DATA SOURCES:PubMed/Medline, PsychInfo, Scopus, Web of Science, Embase, and Google Scholar, searched up to September 2019. REVIEW METHODS:Studies were included if they compared at least one time point before and one time point after media reports on suicide; follow-up was two months or less; the outcome was death by suicide; and the media reports were about non-fictional suicides. Data from studies adopting an interrupted time series design, or single or multiple arm before and after comparisons, were reviewed. RESULTS:31 studies were identified and analysed, and 20 studies at moderate risk of bias were included in the main analyses. The risk of suicide increased by 13% in the period after the media reported a death of a celebrity by suicide (rate ratio 1.13, 95% confidence interval 1.08 to 1.18; 14 studies; median follow-up 28 days, range 7-60 days). When the suicide method used by the celebrity was reported, there was an associated 30% increase in deaths by the same method (rate ratio 1.30, 95% confidence interval 1.18 to 1.44; 11 studies; median follow-up 28 days, range 14-60 days). For general reporting of suicide, the rate ratio was 1.002 (0.997 to 1.008; five studies; median follow-up 1 day, range 1-8 days) for a one article increase in the number of reports on suicide. Heterogeneity was large and partially explained by celebrity and methodological factors. Enhanced funnel plots suggested some publication bias in the literature. CONCLUSIONS:Reporting of deaths of celebrities by suicide appears to have made a meaningful impact on total suicides in the general population. The effect was larger for increases by the same method as used by the celebrity. General reporting of suicide did not appear to be associated with suicide although associations for certain types of reporting cannot be excluded. The best available intervention at the population level to deal with the harmful effects of media reports is guidelines for responsible reporting. These guidelines should be more widely implemented and promoted, especially when reporting on deaths of celebrities by suicide. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42019086559.

Dataset Information

Association Between Means Restriction of Poison and Method-Specific Suicide Rates : A Systematic Review

Question

Findings

Meaning

Importance

Objective

Evidence Review

Findings

Conclusions and Relevance

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