Time of Suicide and Risk for Death

The estimated annual rate of mortality by committing suicide is 14.5 death per 100,000 globally, which is equivalent to one death every 40 seconds. Even if it dose not result to death, suicide attempts still result in significant social and economic burden for communities due to the utilization of death services to treat the injury and other resulting factors.

Factors influencing suicidal attempt

The estimated annual rate of mortality by committing suicide is 14.5 death per 100,000 globally, which is equivalent to one death every 40 seconds.1. Even if it does not result to death, suicide attempts still result in a significant social and economic burden for communities due to the utilization of health services to treat the injury and other resulting factors.2 Suicide is a complex problem that is influenced by multiple factors.3 The naturally occurring alternation of light and dark is one of cause particularly influence suicidal behavior, leading to significant diurnal variation in deaths by suicide by time of a day.4,5 Photoperiod variations lead to subsequent changes of mood and impulsivity induced by the serotonergic pathway.6

Regarding diurnal variations, the attempts tends to be earlier in female.7,8,9 Morning were reported to be common in the elderly.10,11,12,13 However, some studies stated that the common period for them was in the late evening.14 The study in Italy found time of suicide was peak in the late morning (8:00-11:00 h) for both genders but varied by age. The incidence, trends and patterns of suicide differ considerably between Asian and Western countries.15 In general, seasons are less to affect suicide due to the narrow gradients with no extreme weather condition as well as problem regarding daylight is also not an issue in most of the tropical countries.16,17

Suicide attempt and death

The predictors of death by suicide were violent methods (such as hanging, drowning, firearms, and jumping)18,19,20 low income, severe illness 21 and switching methods of suicide attempts is a strong predictor of completed suicide in subjects who previously chose a low-lethal method in the index self-harm.22,23

Is the time of suicidal attempt related to the risk of death?

One study showed evening time was associated with a higher mortality rate.17 In 2017,a  retrospective cohort study using 20-year(1997 to 2016) to determine the time of suicide and risk of death. There were 6,022 patients with suicidal attempts during the study period and dead from suicidal attempts were 239 patients. The case-fatality rate of suicide was 4 per 10,000. Peak time of suicidal attempt was late evening (18:01 to 21:00), especially at 20:00 o’clock. The study shown, time of suicidal attempts was not found to be associated with death (adjusted odds ratio 1.5, 95% confidence interval 0.3 to 7.8).24
 

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Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.

References
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    3.     Lee CA, Choi SC, Jung KY, Cho SH, Lim KY, Pai KS, et al. Characteristics of patients who visit the emergency department with self-inflicted injury. J Korean Med Sci. 2012 Mar;27(3):307–12.

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    5.     Preti A, Miotto P. Diurnal variations in suicide by age and gender in Italy. J Affect Disord. 2001 Aug;65(3):253–61.

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    8.     van Houwelingen CA, Beersma DG. Seasonal changes in 24-h patterns of suicide rates: a study on train suicides in The Netherlands. J Affect Disord. 2001 Oct;66(2-3):215–23.

    9.     Schmidtke A. Suicidal behaviour on railways in the FRG. Soc Sci Med. 1994 Feb;38(3):419–26.

    10. Maldonado G, Kraus JF. Variation in suicide occurrence by time of day, day of the week, month, and lunar phase. Suicide Life Threat Behav. 1991 Summer;21(2):174–87.

    11. Altamura C, VanGastel A, Pioli R, Mannu P, Maes M. Seasonal and circadian rhythms in suicide in Cagliari, Italy. J Affect Disord. 1999 Apr;53(1):77–85.

    12. Chew KS, McCleary R. The spring peak in suicides: a cross-national analysis. Soc Sci Med. 1995 Jan;40(2):223–30.

    13. Yip PS, Chao A, Ho TP. A re-examination of seasonal variation in suicides in Australia and New Zealand. J Affect Disord. 1998 Jan;47(1-3):141–50.

    14. Jessen G, Andersen K, Arensman E, Bille-brahe U, Crepet P, Leo DD, et al. Temporal fluctuations and seasonality in attempted suicide in europe: Findings from the who/euro multicentre study on parasuicide. Arch Suicide Res. 1999;5(1):57–69.

    15. Cheng A, Lee CS. Suicide in Asia and the far East. The international handbook of suicide and [Internet]. 2000; Available from: https://books.google.com/books?hl=en&lr=&id=swbMhfC2D3AC&oi=fnd&pg=PA29&dq=Cheng+Andrew+TA+and+Chau-Shoun+Lee+%22Suicide+in+Asia+and+the+far+East+%22+The+international+handbook+of+suicide+and+attempted+suicide+(2000)+29-48&ots=o6yPe0JWuv&sig=Os-j6w3gMYXmYQPSQp_IXCpSavo

    16. Cantor CH, Hickey PA, De Leo D. Seasonal variation in suicide in a predominantly Caucasian tropical/subtropical region of Australia. Psychopathology. 2000 Nov;33(6):303–6.

    17. Carroll R, Metcalfe C, Gunnell D, Mohamed F, Eddleston M. Diurnal variation in probability of death following self-poisoning in Sri Lanka--evidence for chronotoxicity in humans. Int J Epidemiol. 2012 Dec;41(6):1821–8.

    18. Bostwick JM, Pabbati C, Geske JR, McKean AJ. Suicide Attempt as a Risk Factor for Completed Suicide: Even More Lethal Than We Knew. Am J Psychiatry. 2016 Nov 1;173(11):1094–100.

    19. Runeson B, Tidemalm D, Dahlin M, Lichtenstein P, Långström N. Method of attempted suicide as predictor of subsequent successful suicide: national long term cohort study. BMJ. 2010 Jul 13;341:c3222.

     

    20. Wang L-J, Huang Y-C, Lee S-Y, Wu Y-W, Chen C-K. Switching suicide methods as a predictor of completed suicide in individuals with repeated self-harm: a community cohort study in northern Taiwan. Aust N Z J Psychiatry. 2015 Jan;49(1):65–73.

    21. Chung C-H, Pai L, Kao S, Lee M-S, Yang T-T, Chien W-C. The interaction effect between low income and severe illness on the risk of death by suicide after self-harm. Crisis. 2013 Jan 1;34(6):398–405.

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    23. Issues in Clinical Psychology, Psychiatry, and Counseling: 2011 Edition. ScholarlyEditions; 2012. 2915 p.

    24.  Satthapisit S. Time of suicidal attempt and risk for death:20-year retrospective

           cohort study. The Clinical Academia; 2017 March;41(2):35-42

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