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Suicide Prevention: A Public Health Imperative

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Mental Health".

Deadline for manuscript submissions: closed (30 April 2022) | Viewed by 34120

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Special Issue Editor

Dr. Kyoung-Sae Na

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Guest Editor

Department of Psychiatry, Gachon University College of Medicine, Incheon 21565, Korea
Interests: suicide; public health; mood disorder; dialectical behavioral therapy; acceptance commitment therapy; forensic psychiatry

Special Issue Information

Dear Colleagues,

Suicide is defined as death caused by harming oneself with the intent to die. According to the World Health Organization, nearly 800,000 people complete suicide every year. Suicide is the third leading cause of death in 15 to 19 years old. Whereas suicide contributes a substantial socioeconomic burden, it is also significantly associated with psychological trauma and physical distress among bereaved people. Given the harmful influences of suicide at the population and individual level, every effort is needed to identify and decrease the possible risk factors and increase protective factors for suicide at the national and state level.

However, it is not easy to solve this matter. For example, while it is undeniable that depression is a strong potential factor for suicide from a medical perspective, recent findings suggest that the role of psychiatric disorders, including depression, is not as substantial as we thought. Suicide does not solely arise from a single factor such as low economic status, psychiatric disorder, or interpersonal problem and possible prejudice and stigma prevent suicidal people from seeking help. Hence, a multidisciplinary and public approach is mandatory to deal with this highly complicated social problem.

In this Special Issue, we look forward to compiling and presenting various aspects of national suicide prevention strategies as well as novel methodological approaches with publicly available data.

Dr. Kyoung-Sae Na
Guest Editor

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Keywords

suicide
mental health
public health
psychiatry
self-injurious behavior
social medicine
population health
global health

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Published Papers (10 papers)

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Research

14 pages, 994 KiB

Open AccessArticle

Predicting Suicide in Counties: Creating a Quantitative Measure of Suicide Risk

by Kate Mobley and Gita Taasoobshirazi

Int. J. Environ. Res. Public Health 2022, 19(13), 8173; https://doi.org/10.3390/ijerph19138173 - 4 Jul 2022

Cited by 5 | Viewed by 2371

Abstract

Rising rates of suicide over the past two decades have increased the need for wide-ranging suicide prevention efforts. One approach is to target high-risk groups, which requires the identification of the characteristics of these population sub-groups. This suicidology study was conducted using large-scale, secondary data to answer the question: using the research on suicide, are there variables studied at the community level that are linked to suicide and are measurable using quantitative, demographic data that are already collected and updated? Data on deaths from suicide in U.S. counties for the years 2000, 2005, 2010 and 2015 were analyzed using multiple regression, longitudinal regression, and cluster analysis. Results indicated that the suicide rate in a county can be predicted by measuring the financial stability of the residents, the quality of mental health in the county, and the economic opportunity in the county. The results are further analyzed using two sociological theories, Social Strain Theory and the Theory of Anomie, and two psychological theories, the Shame Model and the Interpersonal Theory of Suicide. Full article

(This article belongs to the Special Issue Suicide Prevention: A Public Health Imperative)

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13 pages, 344 KiB

Open AccessArticle

Psychiatric and Psychosocial Factors of Suicide Decedents and Survivor of Suicide Loss: Psychological Autopsy Study of Incheon City in South Korea

by Mi-Nam Bae, Seo-Eun Cho, Ju-Hyeon Ryu, Mi-Hwa Kim, Hye-Jin Jeon, Eun-Ji Shin, Seon-A Lee, Tae-Yeon Hwang and Seung-Gul Kang

Int. J. Environ. Res. Public Health 2022, 19(13), 7895; https://doi.org/10.3390/ijerph19137895 - 27 Jun 2022

Cited by 4 | Viewed by 2663

Abstract

In South Korea, the suicide rate is more than double the OECD average, and precise identification of the cause is required for suicide prevention. Psychological autopsy is used to reveal factors related to suicidal behavior; however, such studies are lacking in Korea. This study investigated the factors related to suicide using psychological autopsies in Incheon, a major city in Korea. In total, 46 cases were investigated using the Korea-Psychological Autopsy Checklist (K-PAC), and data on mental health conditions and psychosocial factors of suicide decedents and their families were analyzed. It was estimated that 87% of individuals of suicides had a mental health condition before death, but only 15.2% continued treatment or counseling. Most individuals who died of suicide showed warning signs before death, but only 19.6% of survivors of suicide loss noticed them. Mental health concerns before and after the death of the individual were also identified in more than half of their families. To prevent suicide, intensive and continuous treatment for psychiatric conditions and prompt recognition of active response to suicide warning signs are required. Care for the mental health of family members is also important. Full article

(This article belongs to the Special Issue Suicide Prevention: A Public Health Imperative)

10 pages, 353 KiB

Open AccessArticle

Suicide among Older People in Different European Welfare Regimes: Does Economic (in)Security Have Implications for Suicide Prevention?

by Jing Wu, Ying Li and Margda Waern

Int. J. Environ. Res. Public Health 2022, 19(12), 7003; https://doi.org/10.3390/ijerph19127003 - 8 Jun 2022

Cited by 3 | Viewed by 2658

Abstract

Older adult suicide rates vary widely within Europe, and differential welfare policies might contribute to this. We studied variations in economic indicators and suicide rates of people 65+ across 28 European countries and examined the effects of these indicators on suicide rates, grouping countries according to their socio-political systems and welfare regimes. Suicide data was obtained from the WHO European Mortality Database. The European Union Statistics on Income and Living Conditions and the European Union Labour Force Survey provided data on economic indicators. Linear mixed models were applied. Suicide rates ranged from 4.22/100,000 (Cyprus) to 36.37/100,000 (Hungary). Material deprivation was related to elevated suicide rates in both genders in the pooled data set and in men but not women in the Continental and Island countries. Higher ratio of median income (65+/under 65) was associated with lower likelihood of suicide in women in the South-Eastern European countries. In the Nordic region, the 65+ employment rate was associated with a decreased likelihood of suicide in men. These factors to some extent show economic insecurity against older people, which influences the likelihood of suicide. Active labor market policies and inclusive social environment may contribute to suicide prevention in this age group. Full article

(This article belongs to the Special Issue Suicide Prevention: A Public Health Imperative)

10 pages, 349 KiB

Open AccessArticle

Analysis of Motives and Factors Connected to Suicidal Behavior in Patients Hospitalized in a Psychiatric Department

by Aneta Bednarova, Natasa Hlavacova and Jan Pecenak

Int. J. Environ. Res. Public Health 2022, 19(10), 6283; https://doi.org/10.3390/ijerph19106283 - 22 May 2022

Cited by 2 | Viewed by 1707

Abstract

(1) Background: This study aimed to investigate the motives and factors connected to suicidal behavior in 121 hospitalized patients with intentional self-harm (diagnosis X 60-81 according to the ICD-10); (2) Methods: Suicidal behavior of the patient was assessed from data obtained by psychiatric examinations and by the Columbia Suicide Severity Rating Scale. Analysis of data to identify the patients’ reason and motives behind suicidal behavior in a group of patients with a suicide attempt (SA, n = 80) and patients with Non-Suicidal Self-Injurious Behavior (NSSIB, n = 41) was carried out; (3) Results: Results showed that patients with affective disorder have a 19-times higher rate of SA against other diagnoses. Patients with personality disorders have a 32-times higher rate of NSSIB than patients with other diagnoses. Living alone and the absence of social support increased the likelihood of SA. Qualitative data analysis of patients’ statements showed different themes in the justification of motives for suicidal behavior between SA and NSSIB cases. Significant differences were shown for non-communicated reasons, loneliness, social problems, extortion, and distress; (4) Conclusions: The evaluation of patients’ verbal statements by qualitative analysis during the psychiatric examination should be considered in clinical practice. It should be considered to include self-poisoning in the criteria of the Non-suicidal Self-Injury diagnostic categories. Full article

(This article belongs to the Special Issue Suicide Prevention: A Public Health Imperative)

13 pages, 325 KiB

Open AccessArticle

Experiences of Bereaved Families by Suicide in South Korea: A Phenomenological Study

by Eunjoo Lee

Int. J. Environ. Res. Public Health 2022, 19(5), 2969; https://doi.org/10.3390/ijerph19052969 - 3 Mar 2022

Cited by 9 | Viewed by 3059

Abstract

When an individual commits suicide, family members frequently experience feeling of hurt, denial, shock and anger, resentment, shame, and guilt. These negative emotions experienced by family survivors make their life suffer and impede the grieving process. If left untreated, they become physically and psychologically vulnerable and the risk of suicidal ideation is high, so professional intervention is needed. This study aimed to explore the experiences of suicidally bereaved families in South Korea. This research was designed to a qualitative phenomenological study conducted by using Colaizzi’s methods. Participants were seven individuals who had lost a family member to suicide in Changwon City, South Korea. The Data were collected through in-depth and individual interviews with participants from June to December 2018, and the interviews took place 1 to 15 months after their loss. A total of 25 meaning units, 12 themes, and 5 theme clusters emerged from the analysis. The 5 themes of south Korean bereaved families’ experience were: (1) an absurd breakup that came without notice, (2) a life trapped in pain, (3) family isolation by themselves, (4) uncontrolled mind in daily life, and (5) liberating from the bondage of pain. The findings of this study provide insight regarding how suicide loss affects bereaved families and could inform the development of evidence-based programs to prevention suicide thought experienced by bereaved families. Full article

(This article belongs to the Special Issue Suicide Prevention: A Public Health Imperative)

10 pages, 1036 KiB

Open AccessArticle

Development of a Suicide Prediction Model for the Elderly Using Health Screening Data

by Seo-Eun Cho, Zong Woo Geem and Kyoung-Sae Na

Int. J. Environ. Res. Public Health 2021, 18(19), 10150; https://doi.org/10.3390/ijerph181910150 - 27 Sep 2021

Cited by 20 | Viewed by 2704

Abstract

Suicide poses a serious problem globally, especially among the elderly population. To tackle the issue, this study aimed to develop a model for predicting suicide by using machine learning based on the elderly population. To obtain a large sample, the study used the big data health screening cohort provided by the National Health Insurance Sharing Service. By applying a machine learning technique, a predictive model that comprehensively utilized various factors was developed to select the elderly aged > 65 years at risk of suicide. A total of 48,047 subjects were included in the analysis. Individuals who died by suicide were older, and the number of men was significantly greater. The suicide group had a more prominent history of depression, with the use of medicaments significantly higher. Specifically, the prescription of benzodiazepines alone was associated with a high suicide risk. Furthermore, body mass index, waist circumference, total cholesterol, and low-density lipoprotein level were lower in the suicide group. We developed a model for predicting suicide by using machine learning based on the elderly population. This suicide prediction model can satisfy the performance to some extent by employing only the medical service usage behavior without subjective reports. Full article

(This article belongs to the Special Issue Suicide Prevention: A Public Health Imperative)

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10 pages, 857 KiB

Open AccessArticle

Relationship between Willingness and Psychological Characteristics of Suicide Prevention Telephone Counselors: A Retrospective Observational Study

by Osamu Murakami, Kanae Kanda, Nlandu Roger Ngatu and Tomohiro Hirao

Int. J. Environ. Res. Public Health 2021, 18(18), 9800; https://doi.org/10.3390/ijerph18189800 - 17 Sep 2021

Viewed by 2063

Abstract

Suicide is a major public health issue worldwide, and telephone counseling is an important preventive measure. As the number of telephone counselors is insufficient in Japan, public needs cannot be fully met. Willingness is important for securing telephone counselors, but few studies have examined the willingness to engage in telephone counseling activities. Therefore, we investigated the relationship between telephone counselors’ willingness to perform their activities and their psychological characteristics, health status, and received social support. In this study, a questionnaire survey was conducted by mail among telephone counselors belonging to the Federation of Inochi No Denwa in Japan. The total number of valid responses was 709 (recovery rate: 50.4%). Following an exploratory factor analysis, three factors were extracted: (1) willingness to engage in telephone counseling activities, (2) sense of being burdened by telephone counseling activities, and (3) sense of difficulty in coping. Structural equation modeling, using all the factors, showed that social support and grit were directly related to the willingness to engage in telephone counseling activities, while physical health, mental health, and general self-efficacy were indirectly related to it. The findings obtained may be useful in devising concrete measures for telephone counselors to continue their activities. Full article

(This article belongs to the Special Issue Suicide Prevention: A Public Health Imperative)

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16 pages, 3752 KiB

Open AccessArticle

Effects of Financial Expenditure of Prefectures/Municipalities on Regional Suicide Mortality in Japan

by Takashi Shiroyama, Kouji Fukuyama and Motohiro Okada

Int. J. Environ. Res. Public Health 2021, 18(16), 8639; https://doi.org/10.3390/ijerph18168639 - 16 Aug 2021

Cited by 14 | Viewed by 2825

Abstract

In Japan, suicide mortality has been improving from 2009; however, suicide remains one of the leading causes of death. Although previous studies identified solid relationships between governmental financial support for social welfare systems and suicide mortality, little attention is paid to how specific regional policies, designed according to regional cultural, economic, and social welfare situations, affect suicide mortality. Therefore, the present study analyses the relationships between the regional governmental expenditure of six major divisions and suicide mortality across the 47 prefectures in Japan from 2009 to 2018 using fixed-effect analysis of hierarchal linear regression with robust standard error. The expenditure in “public health”, “police”, “ambulance/fire services”, “welfare” and “education” is associated with reduction in suicide mortality, at least in some statistical indicators, whereas expenditure of “public works” indicated the influence of increasing suicide mortality or had no effect. Welfare expenditure was the most predominantly effective among the six major divisions of regional governmental expenditure. In the welfare subdivisions, expenditure of “child welfare” and “social welfare” was effective in a reduction in suicide mortality, but expenditure of “elderly welfare” surprisingly contributed to increasing suicide mortality. Child welfare expenditure negatively impacted suicide mortality in wide-ranging generations of both males and females; the positive effects of elderly welfare expenditure reached were limited as working-age populations increased, but unexpectedly did not affect the suicide mortality of elderly populations. The relatively increasing expenditure of elderly welfare with the relatively decreasing child welfare are unavoidable due to the Japanese social issues associated with a declining birth rate and ageing population. Furthermore, the budget of that regional government that can modify its expenditure structure by making its own policies is limited since most regional governmental expenditure is composed of essential expenditure for maintaining and operating regional social welfare systems. Although severe social situations in Japan are still unoptimised, the present results suggest that scientific-evidence-based redistributions of welfare expenditure in regional governments can at least partially improve Japanese society and welfare systems. Full article

(This article belongs to the Special Issue Suicide Prevention: A Public Health Imperative)

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15 pages, 298 KiB

Open AccessArticle

The Male Experience of Suicide Attempts and Recovery: An Interpretative Phenomenological Analysis

by Cara Richardson, Adele Dickson, Kathryn A. Robb and Rory C. O’Connor

Int. J. Environ. Res. Public Health 2021, 18(10), 5209; https://doi.org/10.3390/ijerph18105209 - 14 May 2021

Cited by 14 | Viewed by 6063

Abstract

Suicidal behaviour is a complex phenomenon—its aetiology spans biological, psychological, environmental, social and cultural facets. Men’s deaths by suicide outnumber women in every country in the world. This study explored the male experience of suicide attempts and recovery as well as factors which may be protective for men. Men (n = 12) participated in semi-structured face-to-face interviews which were subjected to Interpretative Phenomenological Analysis (IPA). Four master themes were identified: (1) “characteristics of attempt/volitional factors”, (2) “dealing with suicidal thoughts and negative emotions”, (3) “aftermath” and (4) “protective factors”. The theoretical and clinical implications of this study are discussed, including help seeking, emotional expression, the long-term impact of suicide attempt as well as the applied contribution to established theories. Full article

(This article belongs to the Special Issue Suicide Prevention: A Public Health Imperative)

10 pages, 538 KiB

Open AccessArticle

Which PHQ-9 Items Can Effectively Screen for Suicide? Machine Learning Approaches

by Sunhae Kim, Hye-Kyung Lee and Kounseok Lee

Int. J. Environ. Res. Public Health 2021, 18(7), 3339; https://doi.org/10.3390/ijerph18073339 - 24 Mar 2021

Cited by 56 | Viewed by 6678

Abstract

(1) Background: The Patient Health Questionnaire-9 (PHQ-9) is a tool that screens patients for depression in primary care settings. In this study, we evaluated the efficacy of PHQ-9 in evaluating suicidal ideation (2) Methods: A total of 8760 completed questionnaires collected from college students were analyzed. The PHQ-9 was scored in combination with and evaluated against four categories (PHQ-2, PHQ-8, PHQ-9, and PHQ-10). Suicidal ideations were evaluated using the Mini-International Neuropsychiatric Interview suicidality module. Analyses used suicide ideation as the dependent variable, and machine learning (ML) algorithms, k-nearest neighbors, linear discriminant analysis (LDA), and random forest. (3) Results: Random forest application using the nine items of the PHQ-9 revealed an excellent area under the curve with a value of 0.841, with 94.3% accuracy. The positive and negative predictive values were 84.95% (95% CI = 76.03–91.52) and 95.54% (95% CI = 94.42–96.48), respectively. (4) Conclusion: This study confirmed that ML algorithms using PHQ-9 in the primary care field are reliably accurate in screening individuals with suicidal ideation. Full article

(This article belongs to the Special Issue Suicide Prevention: A Public Health Imperative)

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