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      The WHO START Study : Suicidal Behaviors Across Different Areas of the World

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          Abstract

          Background: The World Health Organization (WHO) study entitled Suicide Trends in At-Risk Territories (START) is an international multisite initiative that aims to stimulate suicide research and prevention across different areas of the globe. A central component of the study is the development of registration systems for fatal and nonfatal suicidal behaviors. Aims: This paper provides an overview of the data collected on suicidal behaviors from the participating locations in the START study. Method: Descriptive statistics on the data are presented in terms of age, sex, and method. Results: A greater proportion of suicide deaths occurred among males. In all areas except the Philippines more females than males engaged in nonfatal suicidal behaviors. Compared to Australia, Italy, New Zealand, the Philippines, and Hong Kong SAR, in the Pacific Islands suicide most often occurs in younger age groups. Results indicate notable variations between countries in choice of method. A greater proportion of suicides occurred by hanging in Pacific Islands, while inhalation of carbon monoxide, use of firearms, ingestion of chemicals and poisons, and drug overdose were the most frequent methods of choice in other areas. Conclusion: The information drawn from this study demonstrates the enormous variation in suicidal behavior across the areas involved in the START Study. Further research is needed to assess the reliability of the established data-recording systems for suicidal behaviors. The baseline data established in START may allow the development of suicide prevention initiatives sensitive to variation in the profile of suicide across different locations.

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          Most cited references32

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          The gender paradox in suicidal behavior and its impact on the suicidal process.

          An important gender difference has been reported regarding suicidal behavior with an overrepresentation of females in nonfatal suicidal behavior and a preponderance of males in completed suicide, also known as the 'gender paradox of suicidal behavior'. The concept of a 'suicidal process' classifies suicidal behavior chronologically; this process starts with suicidal ideation and then implies a progression of suicidality ranging from suicidal ideation over plans to suicide attempts and finally fatal suicide. The current paper aims to deepen the knowledge on the gender paradox by collecting and discussing the recent literature on this topic: the most relevant, impacting gender-related factors will be discussed within the suicidal process concept. Several factors had a gender-dependent impact on suicidal behavior: psychosocial life stressors such as stressful life events but also sociodemographical or socio-economical factors, and sexual abuse. The gender differences in psychiatric (co)morbidity and in response to or attitude towards antidepressant treatment also appear to have an impact. Furthermore, not only suicide methods but also the gender-dependent variation in reporting suicide has an influence. Finally, the gender differences in help seeking behavior as well as region-dependent cultural beliefs and societal attitudes are discussed. Especially life-events seem to exert an important influence at the beginning of a suicidal process, whereas the other factors occur at a further stage in the process, however without a fixed chronology. Also, the duration of the suicidal process is much shorter in male than in females. Finally, some implications with regard to clinical practice and suicide prevention are suggested. Copyright © 2011 Elsevier B.V. All rights reserved.
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            Attempted suicide in Europe: rates, trends and sociodemographic characteristics of suicide attempters during the period 1989-1992. Results of the WHO/EURO Multicentre Study on Parasuicide.

            The World Health Organization/EURO Multicentre Project on Parasuicide is part of the action to implement target 12 of the WHO programme, "Health for All by the Year 2000', for the European region. Sixteen centres in 13 European countries are participating in the monitoring aspect of the project, in which trends in the epidemiology of suicide attempts are assessed. The highest average male age-standardized rate of suicide attempts was found for Helsinki, Finland (314/100,000), and the lowest rate (45/100,000) was for Guipuzcoa, Spain, representing a sevenfold difference. The highest average female age-standardized rate was found for Cergy-Pontoise, France (462/100,000), and the lowest (69/100,000) again for Guipuzcoa, Spain. With only one exception (Helsinki), the person-based suicide attempt rates were higher among women than among men. In the majority of centres, the highest person-based rates were found in the younger age groups. The rates among people aged 55 years or over were generally the lowest. For the majority of the centres, the rates for individuals aged 15 years or over decreased between 1989 and 1992. The methods used were primarily "soft' (poisoning) or cutting. More than 50% of the suicide attempters made more than one attempt, and nearly 20% of the second attempts were made within 12 months after the first attempt. Compared with the general population, suicide attempters more often belong to the social categories associated with social destabilization and poverty.
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              Suicide attempts, plans, and ideation in culturally diverse sites: the WHO SUPRE-MISS community survey.

              The objectives were to assess thoughts about suicide, plans to commit suicide and suicide attempts in the community, to investigate the use of health services following a suicide attempt, and to describe basic socio-cultural indices of the community. The community survey was one component of the larger WHO multisite intervention study on suicidal behaviours (SUPRE-MISS). In each site, it aimed at randomly selecting and interviewing at least 500 subjects of the general population living in the catchment area of the emergency department where the intervention component of the study was conducted. Communities of eight SUPRE-MISS sites (in Brazil, China, Estonia, India, Iran, South Africa, Sri Lanka, and Viet Nam) participated plus two additional sites from Australia and Sweden conducting similar surveys. Suicide attempts (0.4-4.2%), plans (1.1-15.6%), and ideation (2.6-25.4%) varied by a factor of 10-14 across sites, but remained mostly within the ranges of previously published data. Depending on the site, the ratios between attempts, plans, and thoughts of suicide differed substantially. Medical attention following a suicide attempt varied between 22% and 88% of the attempts. The idea of the suicidal process as a continuous and smooth evolution from thoughts to plans and attempts of suicide needs to be further investigated as it seems to be dependent on the cultural setting. There are indications, that the burden of undetected attempted suicide is high in different cultures; an improved response from the health sector on how to identify and support these individuals is needed.
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                Author and article information

                Journal
                cri
                Crisis
                The Journal of Crisis Intervention and Suicide Prevention
                Hogrefe Publishing
                0227-5910
                2151-2396
                May 2013
                : 34
                : 3
                : 156-163
                Affiliations
                [ 1 ] Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Australia
                [ 2 ] Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
                [ 3 ] Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, UNESP, Botucatu, Brazil
                [ 4 ] Social Psychiatry and Population Mental Health Research Unit, University of Otago, Wellington, New Zealand
                [ 5 ] Department de Psychiatrie Centre Hospitalier de Polynésie Française, Tahiti, French Polynesia
                [ 6 ] Department of Psychiatry, Chinese University of Hong Kong, China, Hong Kong, SAR
                [ 7 ] The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, China, Hong Kong, SAR
                [ 8 ] Institute of Mental Health, Peking University, People’s Republic of China
                [ 9 ] Vila Central Hospital, Port Vila, Vanuatu
                [ 10 ] Life Line and Suicide Hot Line, Tonga Life Line, Nuku’alofa, Tonga
                [ 11 ] Health Partners, L. L. C, Tamuning, Guam
                [ 12 ] Government Department of Mental Health and Substance Abuse (DMHSA), Hagatna, Guam
                [ 13 ] University of Philippines Open University (UPOU), Manila, The Philippines
                [ 14 ] II Medical School, Sapienza University of Rome, Italy
                [ 15 ] Western Pacific Regional Office, World Health Organization, Manila, The Philippines
                Author notes
                Prof. Diego De Leo, Griffith University, Mt Gravatt, 4122 QLD, Australia +61 7 3735-3379 +61 7 3735-3450 d.deleo@ 123456griffith.edu.au
                Article
                cri_34_3_156
                10.1027/0227-5910/a000193
                23628665
                5e879f96-4076-47cf-b7a0-1df67b8fd277
                Copyright @ 2013
                History
                : June 25, 2012
                : October 20, 2012
                : October 21, 2012
                Categories
                Research Trends

                Emergency medicine & Trauma,Psychology,Health & Social care,Clinical Psychology & Psychiatry,Public health
                suicide,START study,World Health Organization,Western Pacific,culture

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