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Objective: Past meta-analyses on suicide in eating disorders included few available studies., Method: PubMed/Medline search for papers including sample n ≥40 and follow-up ≥5 years: 40 studies on anorexia nervosa (AN), 16 studies on bulimia nervosa (BN), and three studies on binge eating disorder (BED) were included., Results: Of 16,342 patients with AN, 245 suicides occurred over a mean follow-up of 11.1 years (suicide rate=0.124 per 100 person-years). Standardized mortality ratio (SMR) was 31.0 (Poisson 95% CI=21.0-44.0); a clear decrease in suicide risk over time was observed in recent decades. Of 1768 patients with BN, four suicides occurred over a mean follow-up of 7.5 years (suicide rate=0.030 per 100 person-years): SMR was 7.5 (1.6-11.6). No suicide occurred among 246 patients with BED (mean follow-up=5.3 years)., Conclusion: AN and BN share many risk factors for suicide: the factors causing lower suicide rates per person-year in BN compared to AN should be investigated., (© 2010 John Wiley & Sons A/S.)

Background: Recent studies have reported changes in the time patterns of suicide, with conflicting findings regarding the direction of these changes: data from Italy were investigated to evaluate the influence of recent social and medicine-related changes on the seasonality of suicides in the country., Methods: A total of 71,227 male suicides and 26,466 female suicides occurring in Italy from 1974 to 2003 were investigated with harmonic spectral analysis to extract their monthly seasonal dispersion by five-year intervals., Results: The suicide rates of both males and females showed a rising trend, with an evident peak in the 1987-1994 period and a decrease thereafter. Seasonality of suicides, with a clear peak in spring as against the other seasons, accounted for a statistically significant proportion of total variance: around 40% among males and 39% among females. Seasonality did not change across time in a relevant way; however, an anticipation of the peak was observed in both males and females over time, with amplitude increasing or decreasing as a function of yearly suicide rates., Limitations: Data could not be analysed according to age or to the method of suicide, since this information was not available across the whole time interval., Conclusion: The seasonal effect on mortality by suicide is positively related to suicide rates, so much that changes in suicide rates over time correspond to changes in suicide seasonality.

Aims: This study set out to test the hypothesis that the suicides that can be attributed to a psychiatric illness show a higher seasonality than the suicides due to any other reason., Methods: All the suicides registered in Italy from 1984 to 2000 (57,796 deaths by suicide: males = 41,741, yearly rate = 11.3 per 100,000; females = 16,055, yearly rate = 4.0 per 100,000) were analyzed with circular statistic techniques, based on the maximization of mean vector length method and on the Rayleigh test., Results: The suicides clearly attributed to a psychiatric illness were 35.0% among males and 51.3% among females. An economic reason for suicide was more frequently found among males; somatic illness or sentimental reasons were equally distributed in both sexes. The suicides attributable to a psychiatric illness showed a significantly higher seasonal unevenness than the suicides attributable to somatic illness and to sentimental or economic reasons., Conclusions: The main drawback of this study is that psychiatric diagnoses were not formally assessed by a forensic specialist. However, it succeeded in showing that the dynamics of suicidal behaviour are not unilineal: suicides due to psychiatric or somatic illness mainly happen in spring/summer and those due to economic difficulties mainly in December. Patients with psychiatric and/or somatic illness should be more carefully followed in spring/summer., (2007 S. Karger AG, Basel)

Background: Recent studies have reported changes in the time patterns of suicide, with reduced seasonality in some European and Asian countries. Anyway conflicting data were reported on the fading of suicide seasonality, and in some countries a rising trend was reported., Methods: Harmonic spectral analysis was used to analyze all suicides in Slovenia in the years 1971 to 2002 (14,325 among males; 4350 among females). Analyses of overall changes are based on data aggregated by intervals of 8 years., Results: In both sexes, seasonal variance accounts for a statistically significant proportion of total variance (36.0% among males; 13.3% among females). Anyway in both sexes the season-attributable variance in the latest interval is considerably lower than in the preceding periods., Limitations: Data could not be analyzed according to age or to mental disorder diagnosis, since this information was not available., Conclusion: The seasonal effect on mortality by suicide is sensitive to change, but its causes seem not to be sex-dependant.

In order to assess whether substance-abusing people show a higher risk of dying from unintentional acute intoxication in specific periods of the year, and whether this unevenly distributed risk is subject to the same seasonal influences observed in suicide cases, we studied a total of 15,792 drug-related deaths (males=14,259; females=1533) and 20,332 deaths by suicide (males=15,571; females=4761), ascertained in Italy among 15-44-year-old people from 1984 to 2000. Distribution of deaths by month was studied with circular statistic techniques, based on the maximization of mean vector length method and the Rayleigh test. The monthly distribution of deaths over the study period followed an uneven trend that clearly differed, however, between the two time-series characterizing suicides and drug-related deaths. A clear seasonal variation was found for suicides in both genders, recurring on a significant circannual cycle. No circannual cycle was observed in the monthly distribution of drug-related deaths, which seem to be influenced by non-casual oscillations following a thrice-yearly cycle, linked to a significantly more evident 6-month recurrence. Some periods of the year, however, are clearly and consistently linked to an enhanced risk of dying by unintentional, acute intoxication by illicit drugs.

Aim: To assess whether substance-abusing people have a higher risk of dying from unintentional acute intoxication in specific periods of the year., Methods: A total of 15,792 deaths (males=14,259; females=1533) were ascertained to be due to unintentional acute intoxication by illicit drugs in Italy in the study period (1984-2000). Distribution of deaths by month was studied with circular statistics techniques, based on the maximization of mean vector length (MMVL) method. The Rayleigh test was used to verify the hypothesis of uniform distribution of the events across some relevant periods. Density estimates for significant periodicities were derived with the kernel method for circular variables., Results: Over the study period there was a steady increase in the number of deaths by overdose in Italy, affecting both genders, but more evident among males. The monthly distribution of deaths over the study period followed an uneven trend, with a slightly higher risk in the period between December and January, and in August, in both genders. The monthly distribution of deaths due to unintentional acute intoxication by illicit drugs appears influenced by non-casual oscillations following a thrice-yearly cycle, interlaced with a significantly more evident 6-monthly recurrence., Conclusions: There does seem to be a higher risk of dying from unintentional overdose in specific periods of the year. Better knowledge of the factors affecting the risk of mortality among substance-abusing people--due to changes in environmental or biological rhythms--could allow prediction of negative events, hence their prevention.

The problem of the time distribution of suicide has aroused the interest of many authors, but their findings often appear uncertain and contradictory. These inconsistencies can be partially explained by both the choice of the sample and the statistical method used for the analysis. In this study, in order to reveal expected and unexpected periodicities in the time distribution of suicides, we analyzed a small but complete and very homogeneous sample of suicides which occurred in the Mountain District of the Metauro River Valley in Italy in the period 1960-1994. A recent circular statistics technique, the "maximization of mean vector length" was used. We found no significant weekly and lunar patterns, but significant seasonal and intraseasonal cycles, with peaks in March and at the beginning of each season. The superposition of these two significant cyclic trends was also studied.