The Werther Effect of Two Celebrity Suicides: an Entertainer and a Politician

Purpose

Suicide is a major health problem in Korea. Extensive media exposure of celebrity suicide may induce imitative suicide, a phenomenon called the Werther effect. We examined the increased suicide risk following the suicides of an entertainer and a politician, and identified the relative suicide risks.

Methods

News articles about the celebrity suicides were obtained from three major newspapers and analysed for quantitative and qualitative features. Imitative suicide risk was investigated by applying a Poisson time series autoregression model with suicide mortality data from the National Statistics Office for 1.5 years before and 1.5 years after each celebrity’s suicide. The period with a significantly increased number of suicides immediately after the celebrity’s suicide determined the Werther effect band. The relative risk during this period was examined for different ages, genders, and suicide methods.

Results

News reports were more numerous and they contained more positive definitions about the entertainer’s suicide. The risk of suicide deaths rose markedly after both celebrity suicides. However, the Werther effect band was longer for the entertainer (6 weeks) than for the politician (4 weeks). The relative suicide risk was significant for almost all ages and both genders during that of both individuals. Use of the same suicide method was a prominent risk factor after both celebrity suicides.

Conclusions

Our results confirm the existence of imitative suicide behaviours, suggesting a facilitation effect of media reports. Guidelines for responsible media reporting need to be implemented to enhance public mental health in Korea.     

Are there Hebrews left?

The Samaritan sect in the Middle East traces its ancestry over a period of more than 2,000 years from the Biblical Samaritans. The Samaritans are the guardians of a unique and very ancient religious literature which together with other historical accounts makes their claim of such a length of existence probable. Comparison of blood group frequencies as well as other genetic markers (such as PTC sensitivity, color blindness and G6PD deficiency) indicate that the Samaritans are unlike any of the existing surrounding groups whom they might be expected to resemble. From comparison of anthropometric data the Samaritans appear to exhibit their own “typical” features which do not resemble those of any other Jewish or non-Jewish community in the Middle East. These differences support the contention that the Samaritans' separation and isolation from the communities is not a recent event. The possibility that the Samaritans today can be regarded as modern representatives of the ancient Hebrews and the living offspring of a particular branch of the Israelite kingdom is discussed.     

Efficacy of a Regional Poisoning Treatment Centre in Preventing Further Suicidal Behaviour

A survey of parasuicide (attempted suicide) in general practice in Edinburgh allowed comparison of the rates of further suicidal behaviour in patients treated for their initial episode in the Edinburgh Regional Poisoning Treatment Centre and in those referred to psychiatrists elsewhere or not referred at all. Further suicidal behaviour was only one-third as common among those treated in the treatment centre as among non-admitted patients; patients referred to other psychiatric services did no better than those who were not referred to a psychiatrist at all. The difference in repetition frequencies could not be accounted for in terms of selection of patients in the treatment centre who were less likely to repeat. The tentative conclusion is made that crisis intervention of the kind available at the Edinburgh centre is effective in secondary prevention. The findings add support to Government recommendations that special units like the one in Edinburgh should be set up in other regions.     

Suicide seasonality: complex demodulation as a novel approach in epidemiologic analysis

Background

Seasonality of suicides is well-known and nearly ubiquitous, but recent evidence showed inconsistent patterns of decreasing or increasing seasonality in different countries. Furthermore, strength of seasonality was hypothesized to be associated with suicide prevalence. This study aimed at pointing out methodological difficulties in examining changes in suicide seasonality.

Methododology/Principal Findings

The present study examines the hypothesis of decreasing seasonality with a superior method that allows continuous modeling of seasonality. Suicides in Austria (1970–2008, N = 67,741) were analyzed with complex demodulation, a local (point-in-time specific) version of harmonic analysis. This avoids the need to arbitrarily split the time series, as is common practice in the field of suicide seasonality research, and facilitates incorporating the association with suicide prevalence. Regression models were used to assess time trends and association of amplitude and absolute suicide numbers. Results showed that strength of seasonality was associated with absolute suicide numbers, and that strength of seasonality was stable during the study period when this association was taken into account.

Conclusion/Significance

Continuous modeling of suicide seasonality with complex demodulation avoids spurious findings that can result when time series are segmented and analyzed piecewise or when the association with suicide prevalence is disregarded.     

Description of the effect of polyclonal mitogens on a population of splenic lymphocytes in the presence of serum against isologous aggregated mouse immunoglobulins

Antiserum against isologous aggregated mouse immunoglobulins was shown to be mitogenic for spleen cells during the first 48 hours of culture. The mitogenic effect of the serum factor is mediated through T lymphocytes and may be macrophage-dependent. Whe incubated with spleen cells the serum was demonstrated to inhibit the DNA synthesis in B cells in response to sulfate dextran and lipopolysaccharide. Experiments with B cells and the thymidine "suicide" test suggest that the target cells for the serum factor may reside in the population of radiosensitive and highly proliferating B lymphocytes. The degree of suppressing by the antiserum factor depends on the differentiation stage and the presence of antigen-binding receptors on the membrane of B cells.     

Intratumoral activation of cyclophosphamide by retroviral transfer of the cytochrome P450 2B1 in a pancreatic tumor model. Combination with the HSVtk/GCV system

Background

Pancreatic cancer is one of the most aggressive human tumors and the development of new therapeutic approaches is particularly urgent since current therapies are not effective. The use of pro‐drug‐activating genes is a possible approach for cancer gene therapy.

Methods

The present study evaluated the efficiency of the cytochrome P4502B1 (CYP2B1) suicide gene that encodes the enzyme responsible for activating the pro‐drug cyclophosphamide (CPA), in pancreatic tumor cells invitro and in vivo. The effects on tumor growth of the combination of two suicide systems, CYP2B1/CPA and herpes simplex virus thymidine kinase gene/ganciclovir (HSVtk/GCV), were also studied.

Results

Retroviral CYP2B1 transfer followed by CPA treatment highly sensitized pancreatic tumor cells NP‐9, NP‐18, and NP‐31, and led to stabilization of tumor growth in a pancreatic tumor model. Differences in tumor volume at the end of the treatment were statistically significant when compared with animals injected with CPA alone. The combination of both suicide systems CYP2B1/CPA and HSVtk/GCV in vitro resulted in a potentiation of the killing effect. However, no potentiation was achieved in vivo, although retardation in tumor growth was evident.

Conclusions

The results show that in situ transduction of pancreatic tumor cells with the CYP2B1 gene by retroviral vectors clearly increases the sensitivity to CPA. Moreover, they suggest that in order to achieve a potentiation on cell killing when the two suicide systems HSVtk/GCV and CYP2B1/CPA are combined, co‐expression of both genes in the same tumor cell would be necessary. Copyright © 2002 John Wiley & Sons, Ltd.

     

Comparative study on gene tags of the neurotransmission system in schizophrenic and suicidal subjects

Schizophrenia and suicidal behaviour are sever and complex mental disorders, largely determined by factors of inheritance. Both disorders present pathological changes in the catecholamine neurotransmitter system. The study was conducted on three groups; a group of subjects suffering from schizophrenia, a second compounded by individuals who attempted suicide and a third group of phenotypically healthy examinees. The blood samples of schizophrenic patients as of those who attempted suicide were obtained at the Psychiatric Hospital "Sveti Ivan" in Zagreb in the year 2004. Tests were conducted on the statistic relation between a total of 18 SNPs within three candidate-genes of the dopamine and adrenergic system (DRD4, SLC6A3 and ADRA2B) and the manifestation of schzophrenia and suicidal behaviour. Cases were genotyped by use of SNPlex system. Statistically significant differences were determined in the allelic frequency between the mentioned groups. Findings show a significant connection between 4 SNPs (ADRA2B rs749457, SLC6A3 rs464094, DRD4 rs11246226 and rs4331145) and schizophrenia, and 2 SNPs with suicidal attempt (ADRA2B rs1018351 i SLC6A3 rs403636). In addition, this is the first study that highlights the potential role/effect of polymorphisms in ADRA2B on the manifestation of schizophrenia, as on suicidal behaviour.     

Sodium cromoglycate in chronic asthma.

A long-term double-blind trial of sodium cromoglycate (SCG) with and without isoprenaline, with a placebo control, was undertaken in Edinburgh to a similar design as a previously reported trial in London. The results from the two centres were compared and combined. In Edinburgh 41 patients were studied for 36 weeks and 40 for 52 weeks and in the combined series 121 were studied for 36 weeks and 114 for 52 weeks. In the second year 14 patients were followed-up in Edinburgh and 27 in London. The two SCG regimens were superior overall to placebo both in the Edinburgh and London patients. SCG was effective in similar proportions of patients with extrinsic and intrinsic asthma. In the second year the effectiveness of SCG was further tested by randomly allocating half the patients to a placebo. Some patients derived a continuing benefit from SCG, but its continued use did not appear to be necessary for others, whose progress on placebo was satisfactory.     

Risk Factors of Internet Addiction among Internet Users: An Online Questionnaire Survey

Backgrounds

Internet addiction (IA) has become a major public health issue worldwide and is closely linked to psychiatric disorders and suicide. The present study aimed to investigate the prevalence of IA and its associated psychosocial and psychopathological determinants among internet users across different age groups.

Methods

The study was a cross-sectional survey initiated by the Taiwan Suicide Prevention Center. The participants were recruited from the general public who responded to the online questionnaire. They completed a series of self-reported measures, including Chen Internet Addiction Scale-revised (CIAS-R), Five-item Brief Symptom Rating Scale (BSRS-5), Maudsley Personality Inventory (MPI), and questions about suicide and internet use habits.

Results

We enrolled 1100 respondents with a preponderance of female subjects (85.8%). Based on an optimal cutoff for CIAS-R (67/68), the prevalence rate of IA was 10.6%. People with higher scores of CIAS-R were characterized as: male, single, students, high neuroticism, life impairment due to internet use, time for internet use, online gaming, presence of psychiatric morbidity, recent suicide ideation and past suicide attempts. Multiple regression on IA showed that age, gender, neuroticism, life impairment, internet use time, and BSRS-5 score accounted for 31% of variance for CIAS-R score. Further, logistic regression showed that neuroticism, life impairment and internet use time were three main predictors for IA. Compared to those without IA, the internet addicts had higher rates of psychiatric morbidity (65.0%), suicide ideation in a week (47.0%), lifetime suicide attempts (23.1%), and suicide attempt in a year (5.1%).

Conclusion

Neurotic personality traits, psychopathology, time for internet use and its subsequent life impairment were important predictors for IA. Individuals with IA may have higher rates of psychiatric morbidity and suicide risks. The findings provide important information for further investigation and prevention of IA.     

Prevalence of HIV among childbearing women and women having termination of pregnancy: multidisciplinary steering group study.

OBJECTIVE--To determine the prevalence of HIV among pregnant women, in particular those whose behaviour or that of their partners put them at "low risk" of infection. DESIGN--Voluntary named or anonymous HIV testing of pregnant women during 21 months (November 1988 to July 1990). SUBJECTS AND SETTING--All women who planned to continue their pregnancy and attended clinics serving the antenatal populations of Edinburgh and Dundee. All women admitted for termination of pregnancy to gynaecology wards serving the pregnant populations of Dundee and outlying rural areas. MAIN OUTCOME MEASURES--Period prevalence of HIV antibody positivity. RESULTS--91% of antenatal clinic attenders and 97% of women having termination of pregnancy agreed to HIV testing on a named or anonymous basis. HIV period prevalences for antenatal clinic attenders and women having termination of pregnancy tested in Dundee were 0.13% and 0.85% respectively, and for antenatal clinic attenders tested in Edinburgh 0.26%. For those at "low risk" rates for antenatal clinic attenders and women having termination of pregnancy in Dundee were 0.11% and 0.13%, and for antenatal clinic attenders in Edinburgh 0.02%. In Dundee HIV prevalence among women having a termination of pregnancy (0.85%) was significantly greater than that among antenatal clinic attenders (0.13%). CONCLUSIONS--HIV infection is undoubtedly occurring among women at "low risk," and it is clear that a policy of selective testing of those at only "high risk" is inadequate for pregnant women living in areas of high prevalence such as Edinburgh and Dundee. Moreover, when studying pregnant populations in such areas there is the need to include those having a termination of pregnancy.     

TGFβ secreted by B16 melanoma antagonizes cancer gene immunotherapy bystander effect

Tumor-targeted delivery of immune stimulatory genes, such as pro-inflammatory cytokines and suicide genes, has shown to cure mouse models of cancer. Total tumor eradication was also found to occur despite subtotal tumor engineering; a phenomenon coined the "bystander effect". The bystander effect in immune competent animals arises mostly from recruitment of a cancer lytic cell-mediated immune response to local and distant tumor cells which escaped gene modification. We have previously described a Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF) and Interleukin 2 (IL2) fusokine (aka GIFT2) which serves as a potent anticancer cytokine and it here served as a means to understand the mechanistic underpinnings to the immune bystander effect in an immune competent model of B16 melanoma. As expected, we observed that GIFT2 secreted by genetically engineered B16 tumor cells induces a bystander effect on non modified B16 cells, when admixed in a 1:1 ratio. However, despite keeping the 1:1 ratio constant, the immune bystander effect was completely lost as the total B16 cell number was increased from 10(4) to 10(6) which correlated with a sharp reduction in the number of tumor-infiltrating NK cells. We found that B16 secrete biologically active TGFbeta which in turn inhibited GIFT2 dependent immune cell proliferation in vitro and downregulated IL-2R beta expression and IFN gamma secretion by NK cells. In vivo blockade of B16 originating TGFbeta significantly improved the immune bystander effect arising from GIFT2. We propose that cancer gene immunotherapy of pre-established tumors will be enhanced by blockade of tumor-derived TGFbeta.     

Genetic and physiological characterization of 23S rRNA and ftsJ mutants of Borrelia burgdorferi isolated by mariner transposition

Borrelia burgdorferi contains one 16S rRNA gene and two tandem sets of 23S and 5S rRNA genes located in a single chromosomal region. This unusual rRNA gene organization has been speculated to be involved in the slow growth of this organism. Because we were repeatedly unable to isolate a 23S ribosomal mutant in B. burgdorferi by allelic exchange, we developed a transposition mutagenesis system for this bacterium. To this end, Himar1 transposase is expressed in B. burgdorferi from a resident plasmid containing an erythromycin resistance marker, and this strain is then electroporated with suicide plasmids containing mariner transposons and kanamycin resistance genes expressible in B. burgdorferi. This system permitted us to generate hundreds of erythromycin/kanamycin-resistant B. burgdorferi clones with each of three suicide plasmids. DNA sequencing of several kanamycin-resistant clones generated with one of the suicide plasmids showed stable and random insertion of the transposon into the B. burgdorferi chromosomal and plasmid genome. One mutant was inactivated in rrlA (23S rRNA), another in ftsJ (rrmJ). rrlA disruption had no effect on growth rate under a wide range of culture conditions, but disruption of ftsJ interfered significantly with growth rate and bacterial morphology. These data show it is possible to isolate random and stable B. burgdorferi transposition mutants for physiological analysis of this pathogenic spirochete.     

Toward the development of metal-free synthetic nucleases: cleavage of a model substrates by 1,4-diazabicyclo[2.2.2]octane derivatives

Artificial ribonucleases of A(n)BCL series were synthesized by solid-phase method. They consist of a hydrophobic alkyl radical A (n = 3-12 carbon atoms), an "RNA-binding domain" B (bisquaternary salt of 1,4-diazabicyclo[2.2.2]octane), a "catalytic domain" C (histidine residue) and a "linker" L that joins the domains B and C. The effect of the alkyl radical on the catalytic properties of the chemical catalyst was studied using three activated phosphate ester substrates: p-nitrophenyl phosphate, bis-p-nitrophenyl phosphate, and thymidine-3'-p-nitrophenyl phosphate.     

Seasonal Variation of Suicide in Brazil

Most of what is known about the seasonal variation in suicide rate originates from studies conducted in the northern hemisphere; very few studies have been done in the southern hemisphere. The purpose of the present study was to explore the possibility that in Brazil, the seasonal variation of suicides is a function of photoperiod. This was accomplished by analyzing monthly suicide data for a 12 yr period (1979 to 1990), within latitudes ranging from 2°N to 33°S. Single cosinor analyses with periods of 12 or 6 months were applied to time series of monthly total and suicidal deaths, separated by gender and state. Significant spring or early summer peaks of suicide were found only in the south of Brazil for both men and women, except for the latter in one state. These peaks did not coincide with those found for total deaths, which occurred in the autumn or winter in all areas. No significant six‐month period was found. In the present study, the chance of a suicide was typically 10–17% higher during the peak period than during the other months of the year. Although this moderate seasonal effect might not be sufficient to justify planning large scale prophylactic interventions, those dealing with patients who have suicide ideation should be aware of this high risk time.     

Seasonal variation of suicide in Brazil

Most of what is known about the seasonal variation in suicide rate originates from studies conducted in the northern hemisphere; very few studies have been done in the southern hemisphere. The purpose of the present study was to explore the possibility that in Brazil, the seasonal variation of suicides is a function of photoperiod. This was accomplished by analyzing monthly suicide data for a 12 yr period (1979 to 1990), within latitudes ranging from 2°N to 33°S. Single cosinor analyses with periods of 12 or 6 months were applied to time series of monthly total and suicidal deaths, separated by gender and state. Significant spring or early summer peaks of suicide were found only in the south of Brazil for both men and women, except for the latter in one state. These peaks did not coincide with those found for total deaths, which occurred in the autumn or winter in all areas. No significant six-month period was found. In the present study, the chance of a suicide was typically 10-17% higher during the peak period than during the other months of the year. Although this moderate seasonal effect might not be sufficient to justify planning large scale prophylactic interventions, those dealing with patients who have suicide ideation should be aware of this high risk time.     

Social and psychological factors of the suicidal tendencies of Chinese medical students

Background

Over the past few decades, concern about suicide by college students has been on the rise worldwide, in general and in China particularly. The main objective of this study is to investigate the effects of social and psychological factors on the suicidal tendencies of Chinese medical students.

Findings

Of the 540 students surveyed, 48 had a suicidal tendency to some extent. The highest rate of suicide was observed for fourth-year students, followed by the fifth-year, first-year, third-year, and second-year students. Female students and students not satisfied with their major had a higher rate of suicidal tendency. However, mature coping strategies had a protective effect on suicide. The stepwise regression analysis shows that academic burden, grade, and introversion/extraversion are the most significant risk factors for the suicidal tendency of Chinese medical students.

Conclusion

Suicide is affected by demographic risk factors as well as psychological factors. Our results lend support to a multi-factorial approach to the understanding and prevention of suicide by college students.

     

Chronotype Differences in Suicidal Behavior and Impulsivity Among Suicide Attempters

Morning- and evening-type individuals differ on a number of psychological and biological variables. There has been increasing interest in the relationship between chronotype and personality traits. The aim of this study was to investigate the relationship between impulsivity and chronotype in suicide attempters. Eighty-nine suicide attempters were included in the study, and systematic information on suicide attempts was recorded. The Morningness-Eveningness Questionnaire was applied to determine chronotype, and attempter impulsivity was measured by the total score of the Barratt Impulsiveness Scale. Significant differences between chronotype and impulsivity scores were found. Evening-type subjects reported significantly higher impulsivity scores than both neither- and morning-types. A significant association between chronotype and type of suicide attempt was detected. The largest proportion of violent suicide attempters were evening-type subjects. Violent suicide attempters also reported significantly higher impulsivity scores than nonviolent attempters. Previous studies have pointed out possible relations between eveningness and impulsivity. Current findings suggest that eveningness may be a risk factor for violent suicide attempts by increasing impulsivity. (Author correspondence: dryavuzselvi@yahoo.com)     

Identifying Probable Suicide Clusters in Wales Using National Mortality Data

Background

Up to 2% of suicides in young people may occur in clusters i.e., close together in time and space. In early 2008 unprecedented attention was given by national and international news media to a suspected suicide cluster among young people living in Bridgend, Wales. This paper investigates the strength of statistical evidence for this apparent cluster, its size, and temporal and geographical limits.

Methods and findings

The analysis is based on official mortality statistics for Wales for 2000–2009 provided by the UK''s Office for National Statistics (ONS). Temporo-spatial analysis was performed using Space Time Permutation Scan Statistics with SaTScan v9.1 for suicide deaths aged 15 and over, with a sub-group analysis focussing on cases aged 15–34 years. These analyses were conducted for deaths coded by ONS as: (i) suicide or of undetermined intent (probable suicides) and (ii) for a combination of suicide, undetermined, and accidental poisoning and hanging (possible suicides). The temporo-spatial analysis did not identify any clusters of suicide or undetermined intent deaths (probable suicides). However, analysis of all deaths by suicide, undetermined intent, accidental poisoning and accidental hanging (possible suicides) identified a temporo-spatial cluster (p = 0.029) involving 10 deaths amongst 15–34 year olds centred on the County Borough of Bridgend for the period 27^th December 2007 to 19^th February 2008. Less than 1% of possible suicides in younger people in Wales in the ten year period were identified as being cluster-related.

Conclusions

There was a possible suicide cluster in young people in Bridgend between December 2007 and February 2008. This cluster was smaller, shorter in duration, and predominantly later than the phenomenon that was reported in national and international print media. Further investigation of factors leading to the onset and termination of this series of deaths, in particular the role of the media, is required.     

Association between the Density of Physicians and Suicide Rates in Japan: Nationwide Ecological Study Using a Spatial Bayesian Model

Background

Regional disparity in suicide rates is a serious problem worldwide. One possible cause is unequal distribution of the health workforce, especially psychiatrists. Research about the association between regional physician numbers and suicide rates is therefore important but studies are rare. The objective of this study was to evaluate the association between physician numbers and suicide rates in Japan, by municipality.

Methods

The study included all the municipalities in Japan (n = 1,896). We estimated smoothed standardized mortality ratios of suicide rates for each municipality and evaluated the association between health workforce and suicide rates using a hierarchical Bayesian model accounting for spatially correlated random effects, a conditional autoregressive model. We assumed a Poisson distribution for the observed number of suicides and set the expected number of suicides as the offset variable. The explanatory variables were numbers of physicians, a binary variable for the presence of psychiatrists, and social covariates.

Results

After adjustment for socioeconomic factors, suicide rates in municipalities that had at least one psychiatrist were lower than those in the other municipalities. There was, however, a positive and statistically significant association between the number of physicians and suicide rates.

Conclusions

Suicide rates in municipalities that had at least one psychiatrist were lower than those in other municipalities, but the number of physicians was positively and significantly related with suicide rates. To improve the regional disparity in suicide rates, the government should encourage psychiatrists to participate in community-based suicide prevention programs and to settle in municipalities that currently have no psychiatrists. The government and other stakeholders should also construct better networks between psychiatrists and non-psychiatrists to support sharing of information for suicide prevention.     

Association between parity and risk of suicide among parous women

Background

There are limited empirical data to support the theory of a protective effect of parenthood against suicide, as proposed by Durkheim in 1897. I conducted this study to examine whether there is an association between parity and risk of death from suicide among women.

Methods

The study cohort consisted of 1 292 462 women in Taiwan who had a first live birth between Jan. 1, 1978, and Dec. 31, 1987. The women were followed up from the date of their first birth to Dec. 31, 2007. Their vital status was ascertained by means of linking records with data from a computerized mortality database. Cox proportional hazard regression models were used to estimate hazard ratios of death from suicide associated with parity.

Results

There were 2252 deaths from suicide during 32 464 187 person-years of follow-up. Suicide-related mortality was 6.94 per 100 000 person-years. After adjustment for age at first birth, marital status, years of schooling and place of delivery, the adjusted hazard ratio was 0.61 (95% confidence interval [CI] 0.54–0.68) among women with two live births and 0.40 (95% CI 0.35–0.45) among those with three or more live births, compared with women who had one live birth. I observed a significantly decreasing trend in adjusted hazard ratios of suicide with increasing parity.

Interpretation

This study provides evidence to support Durkheim’s hypothesis that parenthood confers a protective effect against suicide.Childbearing is considered to have long-term effects on women’s health.¹ However, little is known about the relation between parity and mortality among women except for cancers of the reproductive organs.²In his book on suicide published in 1897, Durkheim concluded that the rate of death from suicide was lower among married women than among unmarried women because of the effect of parenthood and not marriage per se.³ Three studies since then have explored Durkheim’s hypothesis. In the first, published almost 100 years later, Hoyer and Lund conducted a prospective study in Norway involving 989 949 married women aged 25 years or older who were followed up for 15 years.⁴ They reported a negative association between suicide-related mortality and number of children. In a nested case–control study in Denmark involving 6500 women who committed suicide between Jan. 1, 1981, and Dec. 31, 1997, and 130 000 matched control subjects, Qin and Mortensen found a significantly decreased risk of suicide with increasing number of children.⁵ In the third study, 12 055 pregnant women in Finland were followed up from delivery in 1966 until 2001; the authors found a decreasing trend in suicide-related mortality with increasing parity.¹One reason for the limited empirical evidence exploring Durkheim’s hypothesis may have to do with sample size and study design.⁴ Only studies involving representative suicides from the general population could make it possible to achieve sufficient power to detect the effect of parity on rare events such as suicide.^1,4,5 Even in the prospective study involving 989 949 women followed for 15 years, only 11 deaths from suicide occurred among women with six or more children.⁴In Taiwan, suicide is the eighth leading cause of death among men and the ninth among women. The age-adjusted rate of death from suicide was 19.7 per 100 000 among men and 9.7 among women in 2007.⁶ Suicide rates in Western countries have been generally lower than those in Asian countries.⁷ A consistent increase in the suicide rate since 1999 has been found in Taiwan.⁶ However, most Western countries have had stable or slightly decreasing rates during the 1990s.^8,9 The male:female ratio of suicide is frequently greater than 3:1 in Western countries,⁷ whereas it is 2:1 in Taiwan.¹⁰ High suicide rates among Chinese women have been well documented.¹¹ One explanation is that Chinese women do not benefit from marriage as much as their male counterparts.¹² The sex difference in suicide rates is largely driven by a high rate of suicide among women in Chinese societies.¹¹ In many Western countries, the trend over the past several years has been in the opposite direction: rates among women have been stable or decreasing, whereas rates among men have been increasing.¹² Furthermore, in an epidemiologic study of suicides in Chinese communities, the prevalence of mental illness among people committing suicide was much lower in those communities than in Western societies.¹³Because the previous studies that related parity and suicide-related mortality were carried out in economically developed countries and because different cultural settings might influence suicide patterns,³ I undertook the present study in Taiwan, using a cohort of women who had a first and singleton live birth between Jan. 1, 1978, and Dec. 31, 1987, to explore further Durkheim’s hypothesis.