Elsevier

Psychiatry Research

Volume 260, February 2018, Pages 67-74
Psychiatry Research

Choice of a suicide method: Trends and characteristics

https://doi.org/10.1016/j.psychres.2017.11.035Get rights and content

Highlights

  • Different suicide methods have distinguishable profiles by individual characteristics.

  • The biggest future challenge of suicide prevention will be the increase in hanging.

  • Changes in the prevalence have altered the order of different suicide methods used between 2000 and 2015.

Abstract

The aim of this study was to examine (1) suicide trends by most prevalent methods in Queensland, Australia, during 2000–2015, and (2) characteristics of people by choice of suicide method in 2000–2013. Data were obtained from the Queensland Suicide Register, which includes police and toxicology reports, post-mortem autopsy and Coroner's findings. Poisson and Joinpoint regression were used to study the first aim, and uni-variate and multi-variate logistic regression analyses were applied to investigate the second aim. Suicide method trends showed a significant increase in hanging for both sexes and poisoning with drugs for females, while there was a decline for poisoning by other means for both sexes, and ‘other methods’ decreased for males. Changes in the trends have altered the order of suicide methods, especially in males. Analyses of 8140 suicides were composed by the choice of method, distinguishable profiles by their demographic, clinical and social characteristics, such as having mental or physical illness or different recent life stressors were identified. This suggests that socio-cultural acceptability, and availability are the key drivers in the choice of suicide methods. Continuing increases in hanging is a big challenge in suicide prevention due to its lethality, easy realisation and its increasing acceptability.

Introduction

The prevalence of suicide methods differs between countries. Globally, hanging is the predominant method for both sexes, particularly in high-income countries (World Health Organization, 2014), with the exception of the USA, where firearms are used most frequently as a method of suicide (Ajdacic-Gross et al., 2008). Poisoning by solid/liquid substances, mainly pesticides, is the most common suicide method in Asia (Wu et al., 2012), but also in some South and Central American countries (Ajdacic-Gross et al., 2008), where pesticides are easily accessible in agricultural rural regions. Poisoning by pesticides is estimated to account for 30% of global suicides, with this method being especially dominant in lower and middle-income countries (World Health Organization, 2014). Jumping from height as a mean of suicide is frequent in highly urbanised areas such as Singapore and Hong Kong (Chia et al., 2011, Wong et al., 2014). Despite differences across the world, the main drivers in the choice and prevalence of suicide methods seem to be physical and cognitive availability, lethality and socio-cultural acceptability (Barber and Miller, 2014, Florentine and Crane, 2010, Kolves and de Leo, 2017, Yip et al., 2012).

To date, the majority of research about suicide methods has focused on gender and age differences. Only limited research has examined other characteristics of people who died by suicide by their choice of method (de Leo et al., 2002, Pirkola et al., 2003). A few studies have focussed on comparing suicides by hanging and firearms by males (de Leo et al., 2002, Lester et al., 2012, Pirkola et al., 2003, Tewksbury et al., 2010). An Australian analysis from Tasmania found that men who used firearms were reacting impulsively to an interpersonal conflict under influences of alcohol; while those choosing hanging seemed to be more likely to have chronic problems, depression and sadness (Lester et al., 2012). A Finnish study examining a number of different suicide methods found the choice of method distinguishable by socio-demographic and clinical characteristics (Pirkola et al., 2003).

Australian suicide rates have been rising steadily from 10.2 per 100,000 in 2006 to 12.5 in 2015 (Australian Bureau of Statistics, 2016). Comprehensive analysis of suicide methods would enable better prediction of the future ‘at risk’ groups and plan suicide prevention activities. The aim of this study was to examine (1) suicide trends by most prevalent methods in Queensland, Australia in 2000–2015 and (2) characteristics of people who died by their choice of suicide method in 2000–2013.

Section snippets

The Queensland Suicide Register

The analyses used data from the Queensland Suicide Register (QSR), a comprehensive suicide database including a wide range of high-quality data on all suicides by Queensland residents. QSR information sources include police reports of death (Form 1), post-mortem autopsy report, toxicology report and Coroner's findings, including narrative of circumstances of death. Documents are crosschecked with records from the National Coronial Information System (NCIS). Data entered into the QSR include

Trends by suicide methods

In 2000–2015, there was a significant decline in suicide trend (RR = 0.994; 95%CI: 0.990–0.999); more specifically, there was a decline for males (RR = 0.991; 95%CI: 0.986–0.996). Fig. 1 However, there was a notable jump up in 2015. Suicide method trends showed a significant increase in hanging for both sexes (for males RR = 1.013; 95%CI: 1.006–1.020; for females RR = 1.029; 95%CI: 1.014–1.044). There was a significant decline for poisoning by other means (mainly CO) for both sexes (for males

Discussion

There are numerous studies about suicide trends by methods; however, only a few studies have examined characteristics of people by choice of suicide method (de Leo et al., 2002, Pirkola et al., 2003). In addition to recent suicide trends in Queensland Australia, our study investigated individual characteristics by methods for over 8000 persons who died by suicide. Our results indicate that socio-cultural acceptability, physical and cognitive availability are the key drivers in the choice of

Conclusion

Characteristics of persons who died by suicide were found to be distinguishable between suicide methods chosen. In coming years, the biggest challenge of suicide prevention will be the increase in hanging, which seems to have become more socially acceptable, and a physically and cognitively available method, particularly in young and middle-aged males. This method – particularly difficult to control – has become popular also in females, and is likely to be used in situational crisis in

Acknowledgement

We would like to acknowledge funding of the Queensland Suicide Register by Queensland Mental Health Commission and Queensland Health.

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