Suicide is a major worldwide public concern that causes almost half of all violent deaths of males and 71% in the female population, which translates to about 800,000 suicides per year (1). In Mexico, suicide rates have been increasing over the past 40 years, affecting more men than women (2). The suicide rate for men increased from 5.95 to 8.50 (per 100,000 inhabitants) from 2000 to 2015, and from 1.06 to 2.00 for women (3, 4). Mexico City, one of the largest urban areas in the world, has one of the lowest suicide rates in the country: the mean standardized suicide rate was 4.1/100,000 for 2015 and 4.8/100,000 for 2014, being 6.8 for males and 1.7 for females in 2015 and 7.9 for males and 2.1 for females in 2014 (4, 5). Nevertheless, a rise of 14.30% has been observed in the number of suicides between 2000 and 2014 in Mexico City (4). In this context of increasing suicide rates, the study of suicide related to demographic and clinical risk factors has special relevance.
Several demographic risk factors associated with suicide have been clearly documented, for example, male sex, younger age, single, low income, and job loss (6–8). Actually, several studies have reported gender and age differences associated with suicide (6, 7, 9–14). In Mexico, very few studies focus on this area (3, 15, 16). A forensic study in the south of Mexico reported that more men die by suicide than woman (78 vs. 22%). Women decedents were older on the average than men. Also, women had more years of schooling, but their main occupation was housewife (37.5%). Men were most likely to be retired and were more likely to consume alcohol at the time of suicide (52.1%) (17).
The official sources for suicide data in Mexico come from the National Population Council (CONAPO; Spanish acronym) the national vital statistics system of the National Institute of Statistics and Geography, and the General Department of Health Information (Dirección General de Información en Salud) (DGIS). These institutions sometimes have discrepancies in their suicide data, probably due to differences in the classification criteria for deaths, in registration, and in filing inconsistences (18). The statistics they provided are useful, but they are insufficient to produce a summary profile of suicide cases, because they do not report the demographic characteristics of the deceased or the circumstances surrounding the deaths. In many countries, assessment of coroner or medical records is frequently used to gain insights on basic demographic data for suicide (14, 19–21). In Mexico, and in accordance with National Code of Criminal Procedures(22), a coroner must identify the causes of all uncertain or violent deaths, including all potential cases of suicide. Therefore, each possible suicide is subject to an investigation conducted by forensic pathologists and police officers, providing data to enable the coroner’s office to generate a formal verdict regarding manner of death. The records from the coroner involving suicides generally include demographic information, circumstances of the death (as reported by witness reports), acute, and chronic stressful life situations, autopsy and toxicology reports, police investigation records, medical and psychiatric reports from hospitals, suicide notes, and insurance data. In Mexico City, the Forensic Science Institute (INCIFO) is the institution that garners all suicide cases for the inhabitants of the city. To the best of our knowledge, this information has not been used before to produce a profile of suicide victims in Mexico City.
Coroner’s records provide an accessible source of information on suicides. Given that suicide is an increasing problem in Mexico, we believe that a better understanding of the demographic and clinical profiles of suicide victims can not only advance the research literature, but also could have important implications for suicide prevention, with a gender perspective. For these reasons, the aim of this study is to analyze the demographic and clinical characteristics such as history of suicide, previous history of suicide attempts, individual’s use of drugs, and the presence or absence of a medical health problem of individuals who died by suicide in Mexico City, focusing on possible sex differences.
Por: Dra Ana Luisa Romero Pimentel, egresada UDLAP.
En colaboración con: Roberto C. Mendoza-Morales, Ana Fresan, Fernando Garcia-Dolores, Eli E. Gonzalez-Saenz, Mirna E. Morales-Marin, Humberto Nicolini and Guilherme Borges