To identify the most frequent gender-specific suicide methods in Europe. Proportions of seven predominant suicide methods utilised in 16 countries participating in the European Alliance Against Depression EAAD were reported in total and cross-nationally. Relative risk RR relating to suicide methods and gender was calculated.
Suicide methods in europe: a gender-specific analysis of countries participating in the “european alliance against depression”
To group countries by pattern of suicide methods, hierarchical clustering was applied. Hanging was the most prevalent suicide method among both males For males, hanging was followed by firearms 9. Only in Switzerland did hanging rank as second for males after firearms. Hanging ranked first among females in eight countries, poisoning by drugs in five and jumping from a high place in three.
In all countries, males had a higher risk than females of using firearms and hanging and a lower risk of poisoning by drugs, drowning and jumping. Grouping showed that countries might be divided into five main groups among males; for females, grouping did not yield clear.
Research on suicide methods could lead to the development of gender-specific intervention strategies. Nevertheless, other approaches, such as better identification and treatment of mental disorders and the improvement of toxicological aid should be put in place. An important task for researchers and public health officials is to seek effective intervention strategies for suicide prevention.
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Studies about the methods of suicide in relation to different cultural, ethnic, gender and age groups can provide useful information for developing effective prevention and intervention programmes. Methods that individuals choose in suicide vary widely in their probability of resulting death.
At least two general factors determine lethality by a particular method. Firstly, the time span between the initiation of a suicidal act and expected death is crucial for outcome. Highly lethal suicide methods are fairly quick, reducing the possibility of detection and intervention. Also critical for outcome is the availability of medical aid and its quality related to the method used.
Several studies have suggested that a primary reason for gender differences in completed suicides is the result of differences in methods used by the two groups. Hendin 8 attributes choice of method to a form of final communication of both personal and social needs: a last message.
Different methods yield mixed in terms of lethality.
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Therefore, there is no single answer to the question whether method choice can be used as a measure of suicidal intent. Similarly, a review of the literature reveals disparate conclusions. Some have found no ificant gender differences between the level of suicidal intent, 4 9 10 others have argued that women tend to use less lethal methods because they have less desire to kill themselves. Gender differences in the utilisation of suicide methods may depend on beliefs about culturally acceptable gender-specific self-destructive behaviours.
The EAAD European Alliance Against Depressionan international partnership of 16 European countries, established inaims to reduce suicide rates in participating countries by implementing evidence-based actions and creating recommendations for effective interventions.
The present study reports the gender-specific suicide methods in 16 countries participating in the EAAD, compares the between countries and makes efforts to group countries with similar patterns of suicide methods.
The United Kingdom is represented in the study by two countries: England and Scotland.
In the following countries, suicide acts were identified by ICD-9 World Health Organization, codes EE for some or all of the study period: England inPortugal in —1 and Ireland for the entire study period.
As data on method-specific suicide are not available through the WHO databank, the data were obtained from the appropriate statistics institutions of the EAAD countries.
All suicide methods were re-categorised into eight groups using all ICD X-codes table 1. Statistical analysis was performed with SPSS For grouping countries by their distribution of suicide methods, standardised for Z-scores the Z-score reveals how many units of the standard deviation a case is above or below the mean separately by gender hierarchical clustering using Ward method was applied.
This procedure attempts to identify relatively homogeneous groups of cases countries based on selected characteristics suicide methodsusing an algorithm that starts with each case in a separate cluster and combines clusters until only one is left SPSS The most frequent suicide method for all studied EAAD countries for both genders was hanging For males, hanging was followed distantly and in almost equal place by firearms 9.
For females, poisoning by drugs Hanging was the most frequent suicide method among males in all countries except in Switzerland, where firearms ranked first. Firearms were the second most common suicide method among males in Belgium, Estonia, Finland, Germany and Slovenia.
Use of firearms ranked lowest in Scotland table 2. Poisoning by drugs was the most frequent method for females in five countries: England, Finland, Iceland, Scotland and Switzerland. Among females, jumping from a high place ranked first in Italy South TyrolLuxembourg and Spain table 2. A comparison of male and female suicide methods showed that males have a statistically ificantly higher risk than females of using firearms, hanging and poisoning by other means, and lower risk in poisoning by drugs, drowning and jumping table 3.
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In all EAAD countries, males had a higher risk of hanging than females. The situation was similar for firearms; only in Italy did the male-female difference not reach statistical ificance. Females male often used poisoning by drugs than males in all countries.
It was only in Italy that the higher risk of female poisoning by drugs was not statistically ificant. Similarly, drowning was more common in females than in males in all countries except in Luxembourg. Females looking had a higher risk of jumping than males, except in Iceland.
Other suicide methods varied by country table 3. Grouping with hierarchical clustering using the Ward method showed that countries might be divided into five main groups by suicide methods among males. The first group Estonia, Slovenia, Hungary had a very high proportion of hanging and low proportions of drowning and hanging a moving object as a mean.
The second group Finland and Switzerland had the highest proportion of using firearms and the lowest of hanging in comparison with other countries; also poisoning by drugs was above average. The third group Germany, Belgium and The Netherlands had average proportions of hanging and poisoning by drugs. In countries in the fourth group England, Scotland and Icelandthe proportion of poisoning by drugs was higher than in other countries and poisoning with other means was above average.
The fifth group Italy, Spain, Luxembourg and Portugal had a high proportion of jumping along with a low proportion of using a moving object. Italy, Portugal and Spain also had low percentages of poisoning by drugs. Ireland could not be grouped with Luxembourg other countries owing to its high proportion of drowning.
For females, grouping with hierarchical clustering divided countries into three triplets and three pairs.
The first cluster consisted of England, Scotland and Hungary which all had high proportions of poisoning by drugs, low percentages of jumping and below average proportions of drowning. The second cluster, Germany, Slovenia and The Netherlands, was similar to the overall average.
Estonia had a very high proportion of hanging and very low proportions of drowning and use of a moving object, consequently Estonia could not be grouped with any other countries. Finland and Switzerland each had high percentages of poisoning by drugs and low proportions of hanging.
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Belgium and Ireland had high proportions of drowning and low proportions of jumping. Italy, Luxembourg and Spain had very high proportions of jumping and low proportions of hanging. The last pair, Iceland and Portugal, ranked above average in drowning and low in Luxembourg use of a moving object. Hanging was ranked below average. The data reported is based on the average of five to six recent years. This reporting scheme eliminates temporary fluctuations essential to small s characteristic of suicide mortality, particularly when divided by gender and suicide methods.
One of the limitations of the study was that two different classifications of causes of death were covered: in England, Ireland and Portugal the 9th revision of the ICD was used, which was replaced by X-coded death using ICD in the other countries. To verify that the EAAD sample could represent the looking of Europe in terms of suicide mortality, the average annual age-adjusted suicide rates between the years —5 were compared.
For EAAD countries combined suicide rates The respective age-adjusted rates for 15 European Union member states until 1 May — With respect to individual countries, there were several countries that were limited by non-representative samples: Belgium was represented only by the Flemish region and Italy was represented only by South Tyrol County.
Also, two regions were reported separately in the United Kingdom. As England and Scotland are two separate sites in the EAAD study, they are reported here with caution as two separate countries. For cites where a region, rather than the whole country was studied Belgium, Italy, England and Scotlanddata were not comparable with WHO data. Several studies have addressed the issue of different patterns of methods used in male and female suicide populations as the primary reason for gender differences in suicide mortality.
Traditionally, women hang selected suicide methods that are male lethal and men have chosen techniques that are more violent and whose consequences are irreversible.
Card qualified the use of fire as a less lethal suicide method. The present study found hanging to be the most predominant method of suicide in all EAAD countries combined. In fact, As hanging is universally available, it makes sense that it is the most common suicide method in many countries worldwide 22 ; however, there is considerable variability internationally.
A study of suicide methods in a large of cases in Japan and the United States revealed that Japan had a very high proportion of hanging Self-poisoning X60—X69 ranked as the second highest suicide method for both males In the EAAD this usually meant poisoning by drugs—that is, medication X60—X64in contrast to worldwide trends, which show that self-poisoning by pesticides is the frequently used method among other poisonings X65—X69 in many Asian, African and Latin American countries, ing in rural areas for about a third of all suicides worldwide.
Firearms, a highly lethal method, ranked the third among males 9.
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In the United States, respective proportions were much higher— In Japan 23 and China 27 the use of firearms as a means of suicide was rare. The literature on this topic shows that limiting access to firearms has been found to be an effective mean of reducing suicide mortality.
Notwithstanding the similar rank order of suicide methods among males and females combined, males had a 7.