Article
Time trends in means of suicides in Germany from 1991 until 2002
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Published: | September 8, 2005 |
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Outline
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Background
Suicides are the main fatal outcome of psychological diseases. Over the last decade, significant downward time trends in suicide mortality were observed in most Western countries with a stronger decline in women. Little is known whether these favourable trends occurred for particular suicide means. Therefore, we aimed to assess the incidence of different suicide methods in Germany and their time trends over a recent 12-year observation period.
Material and Methods
Death by suicide was defined as “intentional self-harm” according to the ICD-9 (International Classification of Diseases, 9th revision; WHO, 1992) categories E950 to E959 in the time period from 1991 to 1997 and the ICD-10 (International Classification of Diseases, 10th revision; WHO, 1998) categories X70 to X89 and Y87 in the time period from 1998 to 2002. From 1991 until 2002, a total of 146,709 suicides for subjects aged ≥ 15 years were recorded by the Federal Statistical Office of Germany according to death certificates. We defined seven different suicide means by allocating similar death causes to one group: “Self poisoning” (E950, E951, E952 or X60 to X69), “HSS” (hanging, strangling or suffocation: E953 or X70), “Drowning/Submersion” (E954 or X71), “Firearm discharge” (E955 or X72 to X75), “Stab with sharp object” (E956 or X78), “Jumping from high places” (E957 or X80) and “Other means” (E958 or X76, X77, X79, X81 to X84). A number of 214 suicide cases seen as “a death following a suicide attempt” (E959 from ICD9 or Y87 from ICD10) without assessing the underlying suicide method were excluded from the present analysis. Therefore, the study population consisted of 145,865 suicide cases. To assess time trends for different suicide methods during the observation period, the age-adjusted annual percentage change (AAPC) of the number of suicides was estimated in each suicide method for men and women using Poisson regression and age-specific population numbers.
Results
The majority of suicides were conducted by men (71.7%, n = 104,536). The suicide methods most frequently used during the observation period in both sexes were hanging, strangling or suffociation (HSS) with 55.8% (in men) and 39.9% (in women), followed by self poisoning (men: 13.6%, women 24.8%). Significant declines of the number of suicides were observed, in descending order, for self poisoning, drowning and HSS in both sexes (AAPC between -6.2 and -1.1). In contrast, methods using firearm discharges or stab with sharp object remained in roughly constant level during the observation period in both sexes. The number of suicides by jumping from high places decreased significantly in women, but not in men.
Discussion
The present study demonstrates different time trends for suicide methods. It underlines the urgent need for amplified research efforts in particular fields of suicide methods. Further examinations are recommended in particular concerning possible reasons of different suicidal methods.