Drug suicide: a sex-equal cause of death in 16 European countries

BMC Public Health, Jan 2011

Background There is a lack of international research on suicide by drug overdose as a preventable suicide method. Sex- and age-specific rates of suicide by drug self-poisoning (ICD-10, X60-64) and the distribution of drug types used in 16 European countries were studied, and compared with other self-poisoning methods (X65-69) and intentional self-injury (X70-84). Methods Data for 2000-04/05 were collected from national statistical offices. Age-adjusted suicide rates, and age and sex distributions, were calculated. Results No pronounced sex differences in drug self-poisoning rates were found, either in the aggregate data (males 1.6 and females 1.5 per 100,000) or within individual countries. Among the 16 countries, the range (from some 0.3 in Portugal to 5.0 in Finland) was wide. 'Other and unspecified drugs' (X64) were recorded most frequently, with a range of 0.2-1.9, and accounted for more than 70% of deaths by drug overdose in France, Luxembourg, Portugal and Spain. Psychotropic drugs (X61) ranked second. The X63 category ('other drugs acting on the autonomic nervous system') was least frequently used. Finland showed low X64 and high X61 figures, Scotland had high levels of X62 ('narcotics and hallucinogens, not elsewhere classified') for both sexes, while England exceeded other countries in category X60. Risk was highest among the middle-aged everywhere except in Switzerland, where the elderly were most at risk. Conclusions Suicide by drug overdose is preventable. Intentional self-poisoning with drugs kills as many males as females. The considerable differences in patterns of self-poisoning found in the various European countries are relevant to national efforts to improve diagnostics of suicide and appropriate specific prevention. The fact that vast majority of drug-overdose suicides came under the category X64 refers to the need of more detailed ICD coding system for overdose suicides is needed to permit better design of suicide-prevention strategies at national level.

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Drug suicide: a sex-equal cause of death in 16 European countries

BMC Public Health Drug suicide: a sex-equal cause of death in 16 European countries Airi Vrnik 0 1 Merike Sisask 0 1 Peeter Vrnik 0 1 Jing Wu 0 1 Kairi Klves 0 1 Ella Arensman 1 Margareth Maxwell 1 Thomas Reisch 1 Ricardo Gusmo 1 Chantal van Audenhove 1 Gert Scheerder 1 Christina M van der Feltz-Cornelis 1 Claire Coffey 1 Maria Kopp 1 Andras Szekely 1 Saska Roskar 1 Ulrich Hegerl 1 2 0 Estonian-Swedish Mental Health and Suicidology Institute; Estonian Centre of Behavioural and Health Sciences , Oie 39, Tallinn, 11615 , Estonia 1 zdravja RS Insititute of Public Health of the Republic of Slovenia , Trubarjeva, 1000 Ljubljana , Slovenia 2 Department of Psychiatry, University of Leipzig , Semmelweisstr.10, 04103 Leipzig , Germany Background: There is a lack of international research on suicide by drug overdose as a preventable suicide method. Sex- and age-specific rates of suicide by drug self-poisoning (ICD-10, X60-64) and the distribution of drug types used in 16 European countries were studied, and compared with other self-poisoning methods (X65-69) and intentional self-injury (X70-84). Methods: Data for 2000-04/05 were collected from national statistical offices. Age-adjusted suicide rates, and age and sex distributions, were calculated. Results: No pronounced sex differences in drug self-poisoning rates were found, either in the aggregate data (males 1.6 and females 1.5 per 100,000) or within individual countries. Among the 16 countries, the range (from some 0.3 in Portugal to 5.0 in Finland) was wide. 'Other and unspecified drugs' (X64) were recorded most frequently, with a range of 0.2-1.9, and accounted for more than 70% of deaths by drug overdose in France, Luxembourg, Portugal and Spain. Psychotropic drugs (X61) ranked second. The X63 category ('other drugs acting on the autonomic nervous system') was least frequently used. Finland showed low X64 and high X61 figures, Scotland had high levels of X62 ('narcotics and hallucinogens, not elsewhere classified') for both sexes, while England exceeded other countries in category X60. Risk was highest among the middle-aged everywhere except in Switzerland, where the elderly were most at risk. Conclusions: Suicide by drug overdose is preventable. Intentional self-poisoning with drugs kills as many males as females. The considerable differences in patterns of self-poisoning found in the various European countries are relevant to national efforts to improve diagnostics of suicide and appropriate specific prevention. The fact that vast majority of drug-overdose suicides came under the category X64 refers to the need of more detailed ICD coding system for overdose suicides is needed to permit better design of suicide-prevention strategies at national level. - Background Choice of suicide method is influenced by such factors as availability of means, cultural acceptance, suicidal intent and individual preference [1-3]. The methods chosen have a major bearing on differential outcomes of suicidal acts. Lethal methods (firearms, drowning and hanging) predominantly characterise suicide while less lethal ones (cutting and poisoning) are often used for suicide attempts [1,4-6]. Females preferred method is drug overdose, which is not usually lethal, whereas males tend to prefer more lethal methods [2,5]. Methods thus partially explain the sex paradox: although females are more commonly diagnosed as depressed and their suicide attempts are registered more frequently [6,7], males suicide rates are considerably higher in most countries [8]. Research into suicide methods has mostly explored drug self-poisoning as one of several method categories [1,9,10]. Use of specific drugs has prompted proposals to restrict their availability [11-18]. Some studies have observed an association between rates of suicide and/or attempted suicide and sale of specific medicines or classes of drugs [14-16,19-21]. Studies exploring other forms of self-poisoning, such as charcoal-burning [22] and pesticide ingestion [23,24] focusing mainly on Asian countries, have helped somewhat in formulation of medical management guidelines. Comparative European research on suicidal self-poisoning acts using drugs is lacking. Previous studies based on data from member countries in the European Alliance Against Depression (EAAD) [25,26] have shown that self-poisoning is the second or third most frequent suicide method for females and males alike. It accounts for a quarter of all female suicides overall and almost half of all female suicides in some countries studied, including Finland, Iceland, England and Scotland [10]. Our study examined rates of sex- and age-specific selfpoisoning suicide (ICD-10, X60-64) and determined the category composition of drugs used in 16 European countries. Comparisons were made with other means of selfpoisoning (X65-69) and intentional self-harm (X70-84). Methods Data collection Data for 2000-04/2005 were collected from 16 member countries in the EAAD project funded by the (...truncated)


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Airi Värnik, Merike Sisask, Peeter Värnik, Jing Wu, Kairi Kõlves, Ella Arensman, Margareth Maxwell, Thomas Reisch, Ricardo Gusmão, Chantal van Audenhove, Gert Scheerder, Christina M van der Feltz-Cornelis, Claire Coffey, Maria Kopp, Andras Szekely, Saska Roskar, Ulrich Hegerl. Drug suicide: a sex-equal cause of death in 16 European countries, BMC Public Health, 2011, pp. 61, 11, DOI: 10.1186/1471-2458-11-61