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      Suicide trends in Denmark—An ecological study exploring suicide methods from 1995 to 2019

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          Abstract

          Suicide is a major public health problem and complex phenomenon, affecting many people around the world. However, the incidence of suicide varies by sex and age, which includes differences in the means used. Therefore, to implement effective preventative interventions, it is important to study these differences to design effective, preventative interventions. This study investigates the trends in suicide rates in Denmark from 1995 to 2019 by analysing changes based on sex, age, and the means used for suicide. Data on all suicide deaths in the study period were extracted from the Danish Register of Causes of Death, and data on the background population were obtained from Statistics Denmark. We used negative binomial regression models to analyse the data, and the obtained estimates as a logarithm of the rate ratios allowed us to compare the results across groups and years. An overall decline in Danish suicide rates was observed during the study period, with the exception of young females aged 15–29 years. The demographic composition did not change significantly, and suicide rates are still highest for males and the elderly aged 60+. Hanging, self-poisoning and firearms remain the most prevalent means of suicide. Suicide prevention initiatives are required, especially interventions targeting males and the elderly. Restricting access to the means of suicide for these groups with high fatality rates may help reduce the overall suicide rate. Moreover, more research is needed to understand the factors that lead to suicide and affect the choice of means, which should also include studying the effects of different suicide prevention strategies on males and females from different age groups.

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          Most cited references32

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          Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research.

          Suicidal thoughts and behaviors (STBs) are major public health problems that have not declined appreciably in several decades. One of the first steps to improving the prevention and treatment of STBs is to establish risk factors (i.e., longitudinal predictors). To provide a summary of current knowledge about risk factors, we conducted a meta-analysis of studies that have attempted to longitudinally predict a specific STB-related outcome. This included 365 studies (3,428 total risk factor effect sizes) from the past 50 years. The present random-effects meta-analysis produced several unexpected findings: across odds ratio, hazard ratio, and diagnostic accuracy analyses, prediction was only slightly better than chance for all outcomes; no broad category or subcategory accurately predicted far above chance levels; predictive ability has not improved across 50 years of research; studies rarely examined the combined effect of multiple risk factors; risk factors have been homogenous over time, with 5 broad categories accounting for nearly 80% of all risk factor tests; and the average study was nearly 10 years long, but longer studies did not produce better prediction. The homogeneity of existing research means that the present meta-analysis could only speak to STB risk factor associations within very narrow methodological limits-limits that have not allowed for tests that approximate most STB theories. The present meta-analysis accordingly highlights several fundamental changes needed in future studies. In particular, these findings suggest the need for a shift in focus from risk factors to machine learning-based risk algorithms. (PsycINFO Database Record
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            The Danish Register of Causes of Death.

            Cause-specific mortality statistics is a valuable source for the identification of risk factors for poor public health. Since 1875, the National Board of Health has maintained the register covering all deaths among citizens dying in Denmark, and since 1970 has computerised individual records. Classification of cause(s) of deaths is done in accordance to WHO's rules, since 1994 by ICD-10 codes. A change in coding practices and a low autopsy rate might influence the continuity and validity in cause-specific mortality. The longstanding national registration of causes of death is essential for much research. The quality of the register on causes of death relies mainly upon the correctness of the physicians' notification and the coding in the National Board of Health.
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              Suicide in Asia: opportunities and challenges.

              Asian countries account for approximately 60% of the world's suicides, but there is a great mismatch in the region between the scale of the problem and the resources available to tackle it. Despite certain commonalities, the continent itself is culturally, economically, and socially diverse. This paper reviews current epidemiologic patterns of suicide, including suicide trends, sociodemographic factors, urban/rural living, suicide methods, sociocultural religious influences, and risk and protective factors in Asia, as well as their implications. The observed epidemiologic distributions of suicides reflect complex interplays among the traditional value/culture system, rapid economic transitions under market globalization, availability/desirability of suicide methods, and sociocultural permission/prohibitions regarding suicides. In general, compared with Western countries, Asian countries still have a higher average suicide rate, lower male-to-female suicide gender ratio, and higher elderly-to-general-population suicide ratios. The role of mental illness in suicide is not as important as that in Western countries. In contrast, aggravated by access to lethal means in Asia (e.g., pesticide poisoning and jumping), acute life stress (e.g., family conflicts, job and financial security issues) plays a more important role than it does in Western countries. Some promising suicide prevention programs in Asia are illustrated. Considering the specific socioeconomic and cultural aspects of the region, community-based suicide intervention programs integrating multiple layers of intervention targets may be the most feasible and cost-effective strategy in Asia, with its populous areas and limited resources.
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                Author and article information

                Contributors
                Role: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SoftwareRole: VisualizationRole: Writing – original draft
                Role: Project administrationRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLOS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                29 December 2023
                2023
                : 18
                : 12
                : e0296324
                Affiliations
                [1 ] Centre for Suicide Research, Odense, Denmark
                [2 ] Research Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Odense, Denmark
                [3 ] Research Unit Mental Health, Children and Adult, Aabenraa, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
                [4 ] Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
                [5 ] Faculty of Humanities and Director of Institute for Social Ethics, Nanzan University, Nagoya, Japan
                [6 ] Faculty of Law and Institute for Social Ethics, Nanzan University, Nagoya, Japan
                Universidade Federal do Rio Grande do Norte, BRAZIL
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0002-5433-7181
                Article
                PONE-D-22-32298
                10.1371/journal.pone.0296324
                10756527
                38157350
                f410561f-43a1-4dc7-8bd4-c017e3d2a581
                © 2023 Konieczna et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 23 November 2022
                : 11 December 2023
                Page count
                Figures: 1, Tables: 3, Pages: 13
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Research Article
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Suicide
                People and Places
                Population Groupings
                Age Groups
                Engineering and Technology
                Equipment
                Weapons
                Firearms
                People and places
                Geographical locations
                Europe
                European Union
                Denmark
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Mental Health Therapies
                People and Places
                Population Groupings
                Age Groups
                Adults
                Elderly
                Medicine and Health Sciences
                Clinical Medicine
                Signs and Symptoms
                Poisoning
                Medicine and Health Sciences
                Epidemiology
                Medical Risk Factors
                Custom metadata
                The data are owned by a third party and authors do not have permission to share the data. Others can apply for the data through the The Danish Health Data Authority. Data in this project is extracted from The Cause of Death Register. Data is owned by The Danish Health Data Authority. Access can be granted by applying for data at the Danish Health Data Authority’s Research Services ( forskerservice@ 123456sundhedsdata.dk ). In order to access data on an individual/personal level one needs to receive permission from The Danish Health Data Authority’s Research Service. Center for Suicide Research received this permission January 18th 2018. The data were anonymized before analysis. According to Danish law, studies based entirely on registry data do not require approval from an ethics review board.(1) For legal reasons, individual-level raw data from Danish administrative and health registries cannot be shared by the authors. 1. Thygesen LC, Daasnes C, Thaulow I, Bronnum-Hansen H. Introduction to Danish (nationwide) registers on health and social issues: Structure, access, legislation, and archiving. Scand J Public Health. 2011 Jul 1;39(7 Suppl):12–6.

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