This is an interesting study on suicide death. There are some issues I have that the authors do mention: it is from Minnesota, which is cold, full of Americans, and where handguns are easily found. They had a death rate from suicide attempts of 5.2% including previous and following attempts, this is ten times higher than the published meta analyses.
But note this: hanging, poisons and medications are far less lethal.
The associations of demographic characteristics and clinical factors with any death, index death, and subsequent completed suicide were first explored using univariate analysis. Older age was marginally associated with higher probability of death (odds ratio=1.6, p=0.091) and significantly associated with index death (odds ratio=1.02, p=0.009). Male sex bestowed a 6.04 odds ratio for death on an index suicide attempt, a risk that was highly significant (p<0.0001). Lethality on an index suicide attempt was significantly associated with method of attempt, as nearly three-fourths (72.9%) of those who died on index suicide attempt had shot themselves (p<0.0001). Of index suicide attempt survivors, only 1.5% had shot themselves, whereas nearly 60% had overdosed. To underscore the comparative lethality of the gunshot method compared with other methods on index attempt, only 8.9% of hangings, 5.2% of non-medication poisonings, and 0.6% of medication overdoses culminated in death.
Importantly, in a multivariate model, neither older age nor sex retained significance after adjustment for gunshot as the method. Regardless of sex, those using firearms had 140 times the risk of dying on index suicide attempt than those using other methods.
This causes me difficulties. It is fairly easy to get a long gun in New Zealand, but handguns are restricted to (a) Officers in the armed services (b) police and (c) olympic level shooting hobbyists, who have a special licence for such guns. THe firearms we have are for hunting varmints, taking deer, and putting stock down. We have less suicide attempts by firearms as a consequence.
And this means that I worry about gender and age and previous attempts and access, with little data as to what makes a difference. Most papers have a much lower death rate from suicide. But most papers come from Scandinavia or England, and the rules are different there.
Somewhat off topic – are you seeing ‘antidepressant’ suicides (out of the blue) by violent means – characteristically hanging from the kneeling position – in NZ?
http://davidhealy.org/left-hanging-suicide-in-bridgend/
No. we had a bunch of bizarre methamphetamine ones a few yrs back. The kneeling suicide is a new thing. We have had clusters here, nut not that.
I am seeing a lot of agitation with fluoxetine and I always warn that any antidepressant can increase risk.
If you are talking with David, his opinion on personality dysfunction — I have heard the new ICD 11 draft authors a few time and their removal of typology (borderline, narcissistic etc) makes sense — increases risk. My reading says it does and these people seem to have higher risks.
They also get depressed frequently, and get higher (at times inappropriate cocktials as well) doses of medication. This is where a therapeutic relationship matters.
However, sympathy for the familis, and it sounds litker there are real problems in Wales.