Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 143 No. 1920 (2013)

Suicide attempts in the county of Basel: results from the WHO/EURO Multicentre Study on Suicidal Behaviour

  • Flavio Muheim
  • Martin Eichhorn
  • Pascal Berger
  • Stephanie Czernin
  • Gabriela Stoppe
  • Merle Keck
  • Anita Riecher-Rössler
DOI
https://doi.org/10.4414/smw.2013.13759
Cite this as:
Swiss Med Wkly. 2013;143:w13759
Published
19.05.2013

Summary

BACKGROUND: This article presents epidemiological and clinical findings from the Basel research centre parti­cipating in the WHO/EURO Multicentre Study on Suicidal Behaviour.

METHODS: Between January 2003 and December 2006, 984 suicide attempts were documented for patients presenting at medical institutions with a suicide attempt.

RESULTS: The mean suicide attempt rate was 164/100,000 inhabitants. Women attempted suicide nearly twice as often as men. The highest suicide attempt rates were found for women aged 20–24 years, for men aged 30–34 years, and for people who were unmarried, of foreign nationality, and of low education or low employment status. ‘Soft methods’ were used significantly more often than ‘hard methods’. Of the suicide attempt methods employed, a relatively high proportion was accounted for by self-poisoning with drugs (X60-64), especially with non­steroidal anti-inflammatory drugs, benzodiazepines and antidepressants. Significant gender differences were found in the various methods and in the frequency of psychiatric diagnoses. A total of 98.7% of the attempters were diagnosed with a psychiatric disorder according to ICD-10; 35% suffered from an affective disorder. Men were significantly more frequently affected by substance abuse disorder or psychosis, whereas in women adjustment disorders and personality disorders were diagnosed significantly more often.

CONCLUSIONS: This study offers the first published representative data of an entire Swiss county. Established sociodemographic and clinical risk factors for suicide attempts were reproduced. The identification of risk factors contributes to developing local targeted prevention strategies, for example education of risk groups and caregivers, and pharmacolegal consequences for package sizes. Gender- and age-specific prevention and aftercare programmes are indicated.

References

  1. Platt S, Bille-Brahe U, Kerkhof A, Schmidtke A, Bjerke T, Crepet P, et al. Parasuicide in Europe: The WHO/EURO Multicentre Study on Parasuicide. I. Introduction and preliminary analysis for 1989. Acta Psychiatr Scand. 1992;85:97–104.
  2. Federal Office of Public Health. Suicide and suicide prevention in Switzerland – Report in fulfillment of the postulate Widmer (02.3251). [Bundesamt für Gesundheit. Suizid und Suizidprävention in der Schweiz – Bericht in Erfüllung des Postulates Widmer (02.3251). Bern. Redaktionsteam: Salome von Greyerz, Elvira Keller-Guglielmetti; Wissenschaftliche Mitarbeit: Vladeta Ajdacic-Gross (Psychiatrische Universitätsklinik PUK Zürich), Martin Eichhorn (Psychiatrische Universitätsklinik PUK Basel), Konrad Michel (Universitäre psychiatrische Dienste UPD Bern), Regula Ricka (Bundesamt für Gesundheit)] 15. April 2005 [cited: 20.07.2010]. Available from: http://www.bag.admin.ch/themen/medizin/00683/01915/.
  3. Shneidman ES. Suicide as psychache. J Nerv Ment Dis. 1993;181(3):145–7.
  4. WHO European Ministerial Conference on Mental Health. Facing the Challenges, Building Solutions. Facing the Suicide Prevention. Helsinki. 12–15 January 2005 (29.10.2004) [cited: 14.03.2010]. Available from: http://www.euro.who.int/document/MNH/ebrief07.pdf.
  5. Clayton D, Barcel A. The cost of suicide mortality in New Brunswick, 1996. Chronic Dis Can. 1999;20(2):89–95.
  6. World Health Organisation [cited: 30.11.2011]. Available from: http://www.who.int/mental_health/prevention/suicide/country_reports/en/index.html
  7. Frei A, Han A, Weiss MG, Dittmann V, Ajdacic-Gross V. Use of army weapons and private firearms for suicide and homicide in the region of Basel, Switzerland. Crisis. 2006;27(3):140–6.
  8. Ajdacic-Gross V, Killias M, Hepp U, Haymoz S, Bopp M, Gutzwiller F, et al. Firearm suicides and availability of firearms: the Swiss experience. Eur Psychiatry. 2010;25(7):432–4.
  9. Hepp U, Ring M, Frei A, Rössler W, Schnyder U, Ajdacic-Gross V. Suicide trends diverge by method: Swiss suicide rates 1969–2005. Eur Psychiatry. 2010;25(3):129–35.
  10. Hepp U, Stulz N, Unger-Köppel J, Ajdacic-Gross V. Methods of suicide used by children and adolescents. Eur Child Adolesc Psychiatry. 2012;21(2):67–73.
  11. Ajdacic-Gross V, Lauber C, Baumgartner M, Malti T, Rössler W. In-patient suicide – a 13-year assessment. Acta Psychiatr Scand. 2009;120(1):71–5.
  12. Schnyder U, Valach L. Suicide attempters in a psychiatric emergency room population. Gen Hosp Psychiatry. 1997;19(2):119–29.
  13. Hepp U, Moergeli H, Trier SN, Milos G, Schnyder U. Attempted suicide: factors leading to hospitalization. Can J Psychiatry. 2004;49(11):736–42.
  14. Hoffmann-Richter U, Känzig S, Frei A, Finzen A. Suicide after discharge from psychiatric hospital. Psychiatr Prax. 2002;29(1):22–4.
  15. Hepp U, Wittmann L, Schnyder U, Michel K. Psychological and psychosocial interventions after attempted suicide: an overview of treatment studies. Crisis. 2004;25(3):108–17.
  16. Frei A, Schenker TA, Finzen A, Kräuchi K, Dittmann V, Hoffmann-Richter U. Assisted suicide as conducted by a “Right-to-Die”-society in Switzerland: a descriptive analysis of 43 consecutive cases. Swiss Med Wkly. 2001;131(25-26):375–80.
  17. Bosshard G, Fischer S, Bär W. Open regulation and practice in assisted dying. Swiss Med Wkly. 2002;132(37-38):527–34.
  18. Bosshard G, Ulrich E, Bär W. 748 cases of suicide assisted by a Swiss right-to-die organisation. Swiss Med Wkly. 2003;133(21-22):310–7.
  19. Fischer S, Bosshard G, Faisst K, Tschopp A, Fischer J, Bär W et al. Swiss doctors’ attitudes towards end-of-life decisions and their determinants: a comparison of three language regions. Swiss Med Wkly. 2006;136(23-24):370–6.
  20. Wasserfallen JB, Chioléro R, Stiefel F. Assisted suicide in an acute care hospital: 18 months’ experience. Swiss Med Wkly. 2008;138(15-16):239–42.
  21. Fischer S, Huber CA, Furter M, Imhof L, Mahrer Imhof R, Schwarzenegger C, et al. Reasons why people in Switzerland seek assisted suicide: the view of patients and physicians. Swiss Med Wkly. 2009;139(23-24):333–8.
  22. WHO-World Health Organisation. Health-for-all targets. The health policy for Europe. Summary of the updated edition. Copenhagen. September 1991. World Health Organisation. EUR ICP HSC 013; 1992.
  23. Bille-Brahe U, Schmidtke A, Kerkhof A, De Leo D, Lönnqvist J, Platt S, et al. Background and introduction to the WHO/Euro Multicentre Study on Parasuicide. Crisis 1995;16(2):72–84.
  24. Kerkhof A, Schmidtke A, Bille-Brahe U, De Leo D, Lönnqvist J. Attempted suicide in Europe. Leiden: DSWO Press; 1994. p. 3–14.
  25. Schmidtke A, Bille-Brahe U, De Leo D, Kerkhof A, Bjerke T, Crepet P, et al. 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. Acta Psychiatr Scand. 1996;93:327–38.
  26. Bille-Brahe U, Andersen K, Wasserman D, Schmidtke A, Bjerke T, Crepet P, et al. The WHO/Euro Multicentre Study: risk of parasuicide and the comparability of the areas under study. Crisis. 1996;17(1):32–42.
  27. Bille-Brahe U. WHO/EURO Multicentre Study on Parasuicide. Facts and figures. 2nd ed. Copenhagen: World Health Organization; 1999.
  28. Neeleman J. A continuum of premature death: meta-analysis of competing mortality in the psychosocially vulnerable. Int J Epidemiol. 2001;30(1):154–62.
  29. Bertolote JM, Fleischmann A. Suicidal behavior prevention: WHO perspectives on research. Am J Med Genet C Semin Med Genet. 2005;133C(1):8–12.
  30. World Health Organisation. Suicide Prevention in Europe: The WHO European monitoring survey on national suicide prevention programmes and strategies. 2002 [cited: 14.03.2010]. Available from: http://www.euro.who.int/document/E77922.pdf.
  31. Schmidtke A, Weinacker B, Löhr C, Waeber V, Michel K. Chapter 17 Suicidal Behaviour in Switzerland. In: Schmidtke A, Bille-Brahe U, Kerkhof A, De Leo D, editors. Suicidal Behaviour in Europe: Results from the WHO/EURO Multicentre Study on Suicidal Behaviour; 1st ed. Göttingen: Hogrefe & Huber; 2004. p. 157–163.
  32. Michel K, Knecht C, Kohler I, Sturzenegger M. Suizidversuche in der Agglomeration Bern. Schweiz Med Wschr. 1991;121:1133–9.
  33. Reisch T, Maillart A, Michel K. Monitoring of suicidal behaviour in the agglomeration of Bern in the framework of the WHO/EURO Multicenter study on Suicidal Behaviour and the Bern alliance against depression. [Monitoring des suizidalen Verhaltens in der Agglomeration Bern im Rahmen der WHO/EURO Multicenter Study on Suicidal Behaviour und des Berner Bündnisses gegen Depressionen.] April 2007. Report: Available from: http://www.bag.admin.ch/themen/medizin/00683/03923/index.html.
  34. Steffen T, Maillart A, Michel K, Reisch T. Monitoring of suicidal behaviour in the agglomeration of Bern from 2004 to 2010 in the framework of the WHO/Monsue Multicenter study on Suicidal Behaviour and the Bern alliance against depression. [Monitoring des suizidalen Verhaltens in der Agglomeration Bern der Jahre 2004 bis 2010 im Rahmen der WHO/Monsue Multicenter Study on Suicidal Behaviour und des Berner Bündnisses gegen Depressionen.] May 2011. Report: Available from http://www.bag.admin.ch/themen/medizin/00683/03923/index.html.
  35. Kõlves K, Vecchiato T, Pivetti M, Barbero G, Cimitan A, Tosato F, et al. Non-fatal suicidal behaviour in Padua, Italy, in two different periods: 1992–1996 and 2002–2006. Soc Psychiatry Psychiatr Epidemiol. 2011;46(9):805–11.
  36. Bronisch T, Wolfersdorf M. Definition von Suizidalität – Wie grenzen wir suizidales von nicht-suizidalem Verhalten ab? Suizidprophylaxe. 2012;39(2):41–50.
  37. Statistical Office Basel-City. Binningerstrasse 6, Postfach, CH-4001 Basel, Switzerland. [cited: 14.03.2010]. Available from http://www.statistik-bs.ch/ on personal request (unpublished).
  38. ICD-10 Classification of Mental and Behavioural Disorders with Glossary and Diagnostic Criteria for Research ICD-10: DCR-10. WHO Geneva: Churchill Livingstone; 1991.
  39. Swiss Federal Statistical Office, health section, statistics on cause of death, Espace de l’Europe 10, CH-2010 Neuchâtel, Switzerland. [cited: 14.03.2010]. Available from: http://www.statistik.admin.ch on personal request (unpublished).
  40. Baer C. Incidence of suicide attempts in the canton of Basel-City: analysis of the completeness of patient data within the WHO/EURO-NF study. [Häufigkeit von Suizidversuchen im Kanton Basel-Stadt: Analyse der Vollständigkeit der Patientenerfassung im Rahmen der WHO/EURO-NF-Studie]. Unpublished Master-Thesis in Public Health. University of Basel. 2006.
  41. Lehfeld H, Althaus DA, Hegerl U, Ziervogel A, Niklewski G. Suicide attempts: results and experiences from the German Competency Network on Depression. Adv Psychosom Med. 2004; 26:137–43.
  42. Hultén A, Jiang G-X, Wasserman D, Hawton K, Hjelmeland H, De Leo D, et al. Repetition of attempted suicide among teenagers in Europe: frequency, timing and risk factors. Eur Child Adolesc Psychiatry. 2001;10(3):161-9.
  43. Bronisch T. Der Suizid: Ursachen – Warnsignale – Prävention. München: C.H. Beck; 2007.
  44. Bille-Brahe U, Kerkhof A, DeLeo D, Schmidtke A. Chapter 3 Definitions and Terminology Used in the WHO/EURO Multicentre Study. In: Schmidtke A, Bille-Brahe U, Kerkhof A, De Leo D, editors. Suicidal Behaviour in Europe: Results from the WHO/EURO Multicentre Study on Suicidal Behaviour; 1st ed. Göttingen: Hogrefe & Huber; 2004. P. 11–4.
  45. Schmidtke A, Weinacker B, Löhr C, Bille-Brahe U, DeLeo D, Kerkhof A, et al. Chapter 4 Suicide and Suicide Attempts in Europe: An Overview. In: Schmidtke A, Bille-Brahe U, Kerkhof A, De Leo D, editors. Suicidal Behaviour in Europe: Results from the WHO/EURO Multicentre Study on Suicidal Behaviour; 1st ed. Göttingen: Hogrefe & Huber; 2004. p. 15–28.
  46. Batt A, Eudier F, Philippe A, Pommereau X. Chapter 14 Suicidal Behaviour in France. In: Schmidtke A, Bille-Brahe U, Kerkhof A, De Leo D, editors. Suicidal Behaviour in Europe: Results from the WHO/EURO Multicentre Study on Suicidal Behaviour; 1st ed. Göttingen: Hogrefe & Huber; 2004. p. 133–140.
  47. Hawton K, Arensman E, Wasserman D, Hultén A, Bille-Brahe U, Bjerke T, et al. Relation between attempted suicide and suicide rates among young people in Europe. J Epidemiol Community Health. 1998;52(3):191–4.
  48. Murphy E, Kapur N, Webb R, Purandare N, Hawton K, Bergen H, et al. Risk factors for repetition and suicide following self-harm in older adults: multicentre cohort study. Br J Psychiatry. 2011;200(5):399–404.
  49. Schmidtke A, Bille-Brahe U, DeLeo D, Kerkhof A, Weinacker B, Löhr C, et al. Chapter 5 Sociodemographic Characteristics of Suicide Attempters in Europe. In: Schmidtke A, Bille-Brahe U, Kerkhof A, De Leo D, editors. Suicidal Behaviour in Europe: Results from the WHO/EURO Multicentre Study on Suicidal Behaviour; 1st ed. Göttingen: Hogrefe & Huber; 2004. p 29–43.
  50. Nock MK, Borges G, Bromet EJ, Alonso J, Angermeyer M, Beautrais A, et al. Cross-national prevalence and risk factors for suicidal ideation, plans, and attempts in the WHO World Mental Health Surveys. Br J Psychiatry. 2008;192:98–105.
  51. Weissman MM, Bland RC, Canino GJ, Greenwald S, Hwu HG, Joyce PR, et al. Prevalence of suicide ideation and suicide attempts in nine countries. Psychol Med. 1999;29:9–17.
  52. Bursztein Lipsicas C, Mäkinen IH, Apter A, De Leo D, Kerkhof A, Lönnqvist J, et al. Attempted suicide among immigrants in European countries: an international perspective. Soc Psychiatry Psychiatr Epidemiol. 2012;47(2):241–51.
  53. Brückner B, Muheim F, Berger, P, Riecher-Rössler A. Characteristics of suicide attempts among Turkish immigrants living in Basel City – results from the WHO/ EURO-Multicentre study. Nervenheilkunde. 2011;30: 517–22.
  54. Yilmaz TA, Riecher-Rössler A. Suicid attempts among first and second generation immigrants. Neuropsychiatr. 2008;22(4):261–7.
  55. Yilmaz T, Riecher-Rössler A. Attempted suicide in immigrants from Turkey. A comparison with Swiss suicide attempters. Psychopathology. In Press.
  56. Löhr C, Schmidtke A, Wohner J, Sell, R. Epidemiologie suizidalen Verhaltens von Migranten in Deuschland. Suizidprophylaxe. 2006;33(4), 171–6.
  57. Grube M. Suizidversuche von Migranten in der Akutpsychiatrie. Nervenarzt. 2004;75: 681–7.
  58. O’Donnell L, O’Donnell C, Wardlaw DM, Stueve A. Risk and resiliency factors influencing suicidality among urban African American and Latino youth. Am J Community Psychol. 2004;33:37–49.
  59. Hjelmeland H, Groholt B. A comparative study of young and adult deliberate self-harm patients. Crisis. 2005;26(2):64–72.
  60. Stravynski A, Boyer R. Loneliness in relation to suicide ideation and parasuicide: a population-wide study. Suicide Life Threat Behav. 2001;31(1):32–40.
  61. Nock MK, Borges G, Bromet EJ, Cha CB, Kessler RC, Lee S. Suicide and suicidal behavior. Epidemiol Rev. 2008;30:133–54.
  62. Qin P, Mortensen PB. The impact of parental status on the risk of completed suicide. Arch Gen Psychiatry. 2003;60:797–802.
  63. Garfinkel BD, Froese A, Hood, J. Suicide attempts in children and adolescents. Am J Psychiatry. 1982;139(10):1257–61.
  64. Kaslow NJ, Webb Price A, Wyckoff S, Bender Grall M, Sherry A, Young S, et al. Person factors associated with suicidal behavior among African American women and men. Cultur Divers Ethnic Minor Psychol. 2004;10(1):5–22.
  65. Garroutte EM, Goldberg J, Beals J, Herrell R, Manson SM; AI-SUPERPFP Team. Spirituality and attempted suicide among American Indians. Soc Sci Med. 2003;56:1571–9.
  66. Dervic K, Oquendo MA, Grunebaum MF, Ellis S, Burke AK, Mann JJ. Religious affiliation and suicide attempt. Am J Psychiatry. 2004;161:2303–8.
  67. Blum RW, Halcon L, Beuhring T, Pate E, Campell-Forrester S, Venema A. Adolescent health in the Caribbean: risk and protective factors. Am J Public Health. 2003;93:456–60.
  68. Kranitz L, Abrahams J, Spiegel D, Keith-Spiegel P. Religious beliefs of suicidal patients. Psychol Rep. 1968;22(3):936.
  69. Loewenthal KM, MacLeod AK, Cook S, Lee M, Goldblatt V. The suicide beliefs of Jews and Protestants in the UK: How do they differ? Isr J Psychiatry Relat Sci. 2003;40(3):174–81.
  70. Lester D, Beck AT. Attempted suicide and religion. Psychology: A Journal of Human Behavior. 1974;11(3):32–4.
  71. Morphew JA. Religion and attempted suicide. Int J Soc Psychiatry. 1968;14(3):188–92.
  72. Spoerri A, Zwahlen M, Bopp M, Gutzwiller F, Egger M. Religion and assisted and non-assisted suicide in Switzerland: National Cohort Study. Int J Epidemiol. 2010;39(6):1486–94.
  73. Rezaeian M. Suicide among young Middle Eastern Muslim females. Crisis. 2010;31(1):36–42.
  74. Oquendo MA, Dragatsi D, Harkavy-Friedman J, Dervic K, Currier D, Burke AK, et al. Protective factors against suicidal behaviour in Latinos. J Nerv Ment Dis. 2005;193:438–43.
  75. Meadows LA, Kaslow NJ, Thompson MP, Jurkovic GJ. Protective factors against suicide attempt risk among African American women experiencing intimate partner violence. Am J Community Psychol. 2005;36:109–21.
  76. Beautrais AL. Suicide and serious suicide attempts in youth: a multiple-group comparison study. Am J Psychiatry. 2003;160(6):1093–9.
  77. Taylor R, Page A, Morrell S, Carter G, Harrison J. Socio-economic differentials in mental disorders and suicide attempts in Australia. Br J Psychiatry. 2004;185:486–93.
  78. Bogdanovica I, Jiang GX, Löhr C, Schmidtke A, Mittendorfer-Rutz E. Changes in rates, methods and characteristics of suicide attempters over a 15-year period: comparison between Stockholm, Sweden, and Würzburg, Germany. Soc Psychiatry Psychiatr Epidemiol. 2011;46(11):1103–14.
  79. Michel K, Ballinari P, Bille-Brahe U, Bjerke T, Crepet P, De Leo D, et al. Methods used for parasuicide: results of the WHO/EURO Multicentre Study on Parasuicide. Soc Psychiatry Psychiatr Epidemiol. 2000;35(4):156–63.
  80. Canetto SS, Sakinofsky I. The gender paradox in suicide. Suicide Life Threat Behav. 1998;28(1):1–23.
  81. Fekete S, Voros V, Osvath P. Gender differences in suicide attempters in Hungary: retrospective epidemiological study. Croat Med J. 2005;46(2):288–93.
  82. Michel K, Arestegui G, Spuhler T. Suicide with psychotropic drugs in Switzerland. Pharmacopsychiatry. 1994;27(3):114-8.
  83. Bille-Brahe U, Kerkhof A, De Leo D, Schmidtke A, Crepet P, Lonnqvist J, et al. A repetition-prediction study of European parasuicide populations: a summary of the first report from part II of the WHO/EURO Multicentre Study on Parasuicide in co-operation with the EC concerted action on attempted suicide. Acta Psychiatr Scand. 1997;95(2):81–6.
  84. Gibb SJ, Beautrais AL, Fergusson DM. Mortality and further suicidal behaviour after an index suicide attempt: a 10-year study. Aust NZ J Psychiatry. 2005;39:95–100.
  85. Owens D, Horrocks J, House A. Fatal and non-fatal repetition of self-harm. Systematic review. Br J Psychiatry. 2002; 181:193–9.
  86. Schmidtke A, Weinacker B, Löhr C. Chapter 16 Suicidal Behaviour in Germany. In: Schmidtke A, Bille-Brahe U, Kerkhof A, De Leo D, editors. Suicidal Behaviour in Europe: Results from the WHO/EURO Multicentre Study on Suicidal Behaviour; 1st ed. Göttingen: Hogrefe & Huber; 2004. p. 147–56.
  87. Kessler RC, Borges G, Walters EE. Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Arch Gen Psychiatry. 1999;56:617–26.
  88. Mann JJ, Waternaux C, Haas GL, Malone KM. Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psychiatry. 1999;156:181–9.
  89. Maier R, Stieglitz RDS, Marsch SC, Riecher-Rössler A. Patients in intensive care after a suicide attempts with legal drugs – risk profile and course. Fortschr Neurol Psychiat. 2011;79(5):283–9.
  90. Eichhorn M. Suizidforschung – was nützen Zahlen in der Praxis? Psychiatrie (4). 2005:14–18.
  91. Mann JJ, Apter A, Bertolote J, Beautrais A, Currier D, Haas A, et al. Suicide prevention strategies: a systematic review. JAMA. 2005;294:2064–74.
  92. Kreitman N. The coal gas story. United Kingdom suicide rates, 1960–71. Br J Prev Soc Med. 1976;30:86–93.
  93. Carrington PJ. Gender, gun control, suicide and homicide in Canada. Arch Suicide Res. 1999;5:71–5.
  94. Bridges FS. Gun control law (Bill C-17), suicide, and homicide in Canada. Psychol Rep. 2004;94:819–26.
  95. Oliver RG, Hetzel BS. Rise and fall of suicide rates in Australia: relation to sedative availability. Med J Aust. 1972;2:919–23.
  96. Lester D. The effect of the detoxification of domestic gas in Switzerland on the suicide rate. Acta Psychiatr Scand. 1990;82:383–4.
  97. Reisch, T, Schuster U, Michel K. Suicide by jumping and accessibility of bridges: results from a national survey in Switzerland. Suicide Life Threat Behav. 2007;37(6):681–7.
  98. Reisch T, Schuster U, Michel K. Suicide by jumping from bridges and other heights: social and diagnostic factors. Psychiatric Res. 2008;161(1):97–104.
  99. Corcoran P, Reulbach U, Keeley HS, Perry IJ, Hawton K, Arensman E. Use of analgesics in intentional drug overdose presentations to hospital before and after the withdrawal of distalgesic from the Irish market. BMC Clin Pharmacol. 2010;10–6.
  100. Rutz W, von Knorring L, Walinder J. Frequency of suicide on Gotland after systematic postgraduate education of general practitioners. Acta Psychiatr Scand. 1989;80:151–4.
  101. Rihmer Z, Belso N, Kalmar S. Antidepressants and suicide prevention in Hungary. Acta Psychiatr Scand. 2001;103:238–9.
  102. Szanto K, Kalmar S, Hendin H. Rihmer Z, Mann JJ. A suicide prevention program in a region with a very high suicide rate. Arch Gen Psychiatry. 2007;64:914–20.
  103. Hegerl U, Althaus D, Schmidtke A, Niklewski G. The alliance against depression: 2-year evaluation of a community-based intervention to reduce suicidality. Psychol Med. 2006;36(9):1225–33.
  104. Neuner T, Hegerl U, Hajak G, Spiessl H. Reducing suicides through an alliance against depression? Gen Hosp Psychiatry. 2010;32(5):514–8.
  105. Kessler RC, Berglund P, Borges G, Nock M, Wang PS. Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990–1992 to 2001–2003. JAMA. 2005;293:2487–95.
  106. Demyttenaere K, Bruffaerts R, Posada-Villa J, Gasquet I, Kovess V, Lepine J.P, et al. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA. 2004;291:2581–90.
  107. Jenkins R. Addressing suicide as a public health problem. Lancet. 2002;359:813–4.
  108. United Nations. Prevention of suicide guidelines for the formulation and implementation of national strategies. New York, NY: United Nations; 1996.
  109. Jenkins, R., Singh, B. General population strategies of suicide prevention. In: Hawton, K.; van Heeringen, K., editors. International handbook of suicide and attempted suicide. 1st. Chichester, United Kingdom: John Wiley & Sons; 2000. p. 631–44.
  110. Swiss Federal Statistical Office, Espace de l’Europe 10, CH-2010 Neuchâtel, Switzerland. Comparator tool. [cited: 14.03.2010]. Available from: http://www.bfs.admin.ch/bfs/portal/en/index/regionen/regionalportraets/comparator.html.

Most read articles by the same author(s)