Analysis of suicides in one of the administrative regions of Bulgaria for 10-year period (2009-2018)

Abstract Background Suicide is an important medical and social problem responsible for nearly one million deaths per year globally. However, distal and proximal risk factors for suicide, expect being mentally diagnosed, are not enough studied. The aim of the study was to analyze the dynamics, structure, socio-demographic and clinical characteristics of all suicides committed by persons with mental disorder for 10-year period (2009-2018) in Pleven district. Methods Retrospective analysis of medical records of all mentally ill persons who committed suicide was done. Data were extracted from the databases of all in- and outpatient mental health centers in the region. Data processing was performed by IBM SPSS Statistics v.25. Statistical associations between a number of socio-demographic and clinical characteristics and the age of suicide victims was studied by dispersion analysis and Mann-Whitney test. Statistical significance was set at p ≤ 0.05. Results Among all 281 registered suicide cases during the studied period, 77 (28%) were with mental disorders. The most common were mood disorders (44%), followed by schizophrenia, anxiety disorders, substance abuse disorders and organic mental conditions. The mean age of all suicides was 55.62 years; significantly lower in males than in females (p = 0.042); lower in divorced or never married/single living persons compared to married or who had lived with a partner (F (2.74) =17.682, p < 0.001]; the lowest in patients with schizophrenia (44.62 years), and the highest in organic disorders (66.83 years). Higher educational degree was associated with lower age of suicide (U = 3.713, p < 0.01) and the earlier age of onset of the psychiatric disorder (r = 0.754, p < 0.001). Most of the suicide cases had occurred in March and September. Tuesdays and Fridays were most suicidal. Conclusions Severe mental disorders are major risk factors for suicide with the additional contribution of certain socio-demographic and disease related characteristics. Key messages • Suicide monitoring should be constant in all patients with chronic and severe mental disorders. • Suicide registration in Bulgaria needs to be improved in terms of collecting sufficient and reliable information about the mental health of suicide victims.


Background:
Reporting a case of suicide on a newspaper could lead to an emulation effect (Werther effect). It is important to report suicide cases by following specific recommendations implemented by World Health Organization (WHO). This study aimed to analyze articles published on Italian newspapers to quantify the adherence to the WHO recommendations in suicide report. Methods: All the articles published in the three most important Italian newspapers from June 2019 to May 2020 that described one or more cases of suicide were included. Two researchers analyzed all the articles through an ad-hoc checklist, constructed on the basis of the WHO recommendations, that included 18 ''negative'' items (e.g. ''presence of suicide-related words in the title'') and nine ''positive'' items (e.g. ''the article reports the contacts of a suicide-prevention hotline''). For each negative item a ''-1'' point, and for each positive item a + 1 point, was assigned. Multivariable linear regressions were performed to identify factors related with a lower adherence to the WHO recommendations and with higher social engagement of the articles.

Results:
A total of 110 articles were analyzed. In the 73% of the cases, the individual was male. The 14.5% of the suicide cases were homicide-suicide, while 9% were femicide-suicide. The median score of the checklist was -6 (IQR 3). Only 5% of the articles had at least one positive item. The word ''suicide'' (or related words) were present in 90% of the titles. Multivariable analyses showed that female suicides were associated with a higher score of the checklist (coeff 0.816, p = 0.039). No correlation was retrieved between the score of the checklist and the social media engagement of the articles included.

Conclusions:
Italian newspapers do not follow WHO recommendations on how to report suicide cases, leading to a potential emulation effect. Public health professionals should raise decision makers' and journalists' awareness about the importance of these recommendations. Key messages: Since Italian newspapers are not compliant with the recommendations of the World Health Organization on how to report a suicide case, there is the risk of a potential emulation effect. Specific training for journalists and other professionals in the field of communication should be implemented, to raise the awareness on the importance of the ''reporting on suicide'' recommendation.

Background:
Suicide is an important medical and social problem responsible for nearly one million deaths per year globally. However, distal and proximal risk factors for suicide, expect being mentally diagnosed, are not enough studied. The aim of the study was to analyze the dynamics, structure, socio-demographic and clinical characteristics of all suicides committed by persons with mental disorder for 10-year period (2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018) in Pleven district.

Methods:
Retrospective analysis of medical records of all mentally ill persons who committed suicide was done. Data were extracted from the databases of all in-and outpatient mental health centers in the region. Data processing was performed by IBM SPSS Statistics v.25. Statistical associations between a number of socio-demographic and clinical characteristics and the age of suicide victims was studied by dispersion analysis and Mann-Whitney test. Statistical significance was set at p 0.05.

Results:
Among all 281 registered suicide cases during the studied period, 77 (28%) were with mental disorders. The most common were mood disorders (44%), followed by schizophrenia, anxiety disorders, substance abuse disorders and organic mental conditions. The mean age of all suicides was 55.62 years; significantly lower in males than in females (p = 0.042); lower in divorced or never married/single living persons compared to married or who had lived with a partner (F (2.74) = 17.682, p < 0.001]; the lowest in patients with schizophrenia (44.62 years), and the highest in organic disorders (66.83 years). Higher educational degree was associated with lower age of suicide (U = 3.713, p < 0.01) and the earlier age of onset of the psychiatric disorder (r = 0.754, p < 0.001). Most of the suicide cases had occurred in March and September. Tuesdays and Fridays were most suicidal.

Conclusions:
Severe mental disorders are major risk factors for suicide with the additional contribution of certain socio-demographic and disease related characteristics.
Key messages: Suicide monitoring should be constant in all patients with chronic and severe mental disorders. Suicide registration in Bulgaria needs to be improved in terms of collecting sufficient and reliable information about the mental health of suicide victims.