Forensic medical analysis of the dynamics of death rates in suicides

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justification.The increase in the number of completed suicides associated with a variety of risk factors - medical, social, economic, legal, etc., causes concern in many countries of the world [1, 3, 14]. According to the World Health Organization (WHO), about a million people commit suicide every year [2019]. If we take into account that official statistics reflect only explicit and confirmed cases of suicide, then the death rates from completed suicide actually exceed this number - more than 4 million people annually commit suicide [4, 5].Cases of completed suicide in groups of both sexes according to different researchers differ significantly [9, 11, 12, 13].These distinctive features are clearly seen in mortality rates, when choosing a method of committing suicide, in the context of different age groups [10].In Uzbekistan, completed suicides are also recognized as a socio-medical problem that negatively affects demographic indicators. This is confirmed by a significant number of examinations of corpses of cases of completed suicides.The purpose of the study: to investigate the gender characteristics of deaths of completed suicide according to the materials of the forensic medical examination of corpses for the period 1992-2019.MATERIALS AND METHOD In the course of the study, absolute and relative mortality rates in the context of the sex of suicides were studied. The analysis of mortality rates was carried out by the method of retrospective statistical analysis of information from official reports on the activities of forensic medical institutions of the country for the period 1992-2019. Relative suicide mortality rates were calculated per 100,000 population. These indicators are calculated separately for both sexes.For the study, demographic indicators of the population by total number, by gender were requested from the State Statistics Committee of the Republic of Uzbekistan for the corresponding period of time.A database was formed from the received data, their statistical processing was performed using the Microsoft Office Excel program.RESULTS:1.1 Absolute number of completed suicides (absolute mortality rate).During the study period, completed suicides accounted for 14.0% of the total number of examinations of the corpse, and 21.4% of all violent deaths.The change in the absolute mortality rate in the dynamics (annually) of the studied time period was undulating in the form of waves. Each wave rises and falls again, followed by another, which also rises and falls. At the same time, there was a cyclical change of states – rise, decline, stagnation. The duration of the cycle, the pace of movement (rise and fall) were not uniform. The cyclical change in the state of the absolute number of deaths from suicide is especially noticeable against the background of uniform population growth over this period.In 1992, 1,253 cases of completed suicide were detected, taken as the zero point. After a slight increase in 1993 – 6.4% (n=1335), in 1994 there was a decline of (-)7.7%. In the subsequent period from 1995 (n=1373) to 2000 (n=2080), there was a progressive increase in the absolute indicator (the rise of the first wave). In 2000, there was a peak in the rise of the first wave of the indicator by 66.7% compared to 1992. From 2001 (n=1988) to 2008 (n=1397), there was a steady decline in the indicator by 11% compared to 1992. Since 2009 (n=1604) the rise of the second wave was noted, which lasted until 2016 (n=2576). In 2016, the peak of the rise of the second wave was observed - 105% compared to 1992 (P≤0.001). In subsequent years, there was a decline in the mortality rate, so in 2019 it decreased by 10.3% compared to 2016 (Fig.1).Fig.1. Comparative analysis of the dynamics of absolute suicide mortality rates and population growth Fig.1. Comparative analysis of the dynamics of absolute suicide mortality rates and population Growth did not have a direct impact on the dynamics of the total population indicator. So, in 1992, the population indicator was equal to 21,106,213 people, and in 2019 - 33,255,538 people, the annual increase was 2.0-2.3%, the total increase over these years was 57%.1.2. Analysis of the absolute number of deaths from suicide by gender revealed a clear predominance of suicides in the group of men 33888 thousand. against 16036 suicides in the group of women, which amounted to 67.9% and 32.1%, respectively.1.2.1. The ratio of the absolute number of cases of completed suicide in the group of men and women was approximately ≈2:1. This ratio in the context of years did not differ significantly. It changed only in some years. Thus, in 2005, the number of suicides among men increased by a ratio of 3.0:1.0, and in 2011 and 2019, this gap slightly decreased to a ratio of 1.5:1.0. In other years, the sex ratio among suicides remained close to the established average (P≤0.001) (Fig.2).Fig.2. Dynamics of the absolute mortality rate by sex of suicidentsfig.2. Dynamics of the absolute mortality rate by gender of suicides1.2.2. A separate analysis of the absolute mortality rate in the group of men by year was carried out. In 1992, this indicator was the lowest - n=799, it was accepted as the zero point. In the period from 1993 to 2001, an increase in the indicator was revealed (in 2001, n= 1435), an increase of 79.5% compared to 1992. Since 2002, there has been an intensive decline in the indicator, which lasted until 2008 (n=945), a decrease of 35% compared to 1992. In 2009, the rise of the second wave began, it lasted until 2016, when the peak of its increase was noted - by 114% compared to 1992. In 2017, the decline in the indicator began again, which lasted until 2019. So, in 2017, the indicator decreased by 16% compared to 1992 (P≤0.001).As mentioned earlier, the considered suicide mortality rates did not have a direct impact on the dynamics of the total population. Thus, in the studied time period, the increase in the share of the male population exceeded 60% (in 1992 -10,443,848 people, in 2019 - 16,710,577 people) (Fig.3).Fig.3. Dynamics of the absolute mortality rate in the group of menfig.3. Dynamics of the absolute mortality rate in the group of men 1.2.3. In the group of women in 1992, there were 454 cases of completed suicide, the indicator was taken as the zero point. In 1993, an increase of 15% was revealed (compared with 1992). In 1994, the peak of the decline was revealed (n=327), a decrease of 28% (compared with 1992). In the period from 1995 to 2000, there was an increase in the indicator. So in 2000 (n=645), there was an increase of 40% (compared with 1992). From 2001 to 2005, there was a decline in the indicator, a decrease in the indicator in 2005 by 22.5% (compared with 1992). In the period from 2006 to 2016, there was a rise in the second wave, the indicator peaked in 2016 (n=871), an increase of 147% (compared with 1992). In 2017-2019, there was an uneven dynamics of its change in the form of an abrupt rise, then a decline (P≤0.001).The group of women made up 50.06% of the total population. Over the specified period of time, the increase in the female population was 55%. So, in 1992 there were 10662365 female persons, in 2019 – 16544961 (Fig.4).Rasm 4. Dynamics of the absolute mortality rate in the group of women.Fig.4. Dynamics of the absolute mortality rate in the group of women Relative mortality rates. 2.1. Relative mortality rates (frequencies) are calculated per 100,000 population.The average relative suicide mortality rate for the specified period was 6.6. However, the annual figures differed significantly.In particular, in 1994 this indicator was the lowest – 5.0. Since 1995, there has been an increase in the indicator during the period up to 2000, the peak of the rise in 2000 was 8.4. Since 2001, the decline of the first wave began, which lasted until 2008 (5.1). From 2009 to 2016, the rise of the second wave was noted, the peak of the rise (8,0) in 2016. From 2017 to 2019, the indicator again declined (P≤0.001) (Fig.5).Fig.5. Dynamics of the relative mortality indexfig.5. Dynamics of the relative mortality rate2.2. Analysis of the relative mortality rate from suicide by gender.The average relative mortality rate in the group of men is 9.0. In the context of years, it has features. In particular, in the studied period in 1992 and 2008 there were minimum values of indicators, respectively 7.5 and 6.9. The maximum indicators occurred in 2000 and 2016, respectively 11.5 and 10.7.2.3. In the group of women, the average relative mortality rate was 4.2. It varied considerably by years. Thus, in 1994 and 2005, the minimum values of the indicators were recorded, respectively 2.9 and 2.7, the maximum in 2000 and 2015, respectively 5.1 and 5.7 (Fig.6).Fig.6. Dynamics of the relative mortality rate by sex of suicidentsfig.6. Dynamics of the relative mortality rate in the context of the sex of suicides DISCUSSION Suicide rates depend on the country, region and gender. Thus, men are twice ahead of women in terms of suicide (12.6 per 100 thousand men and 5.4 per 100 thousand women). At the same time, men, as a rule, resort to suicide more in high-income countries (16.5 per 100 thousand). At the same time, women have the highest suicide rates characteristic of low-income countries - below average (7.1 per 100 thousand) (WHO review, 2019).According to researchers, the reasons for this are the low tolerance of men to suicide, the inability to seek help from others compared to women [6, 14, 15]. In particular, the sex ratio (men and women) was: in Uganda – 3.4:1 [7]; similar ratios were obtained in Australia [6], Russia [4, 5], Belarus [1, 2]. Suicide, as a rule, is a conscious, purposeful act of autoaggression, i.e. taking one's own life.

About the authors

Zaynitdin A. Giyasov

Tashkent Medical Academy

Author for correspondence.
Email: giyasov491@mail.ru
ORCID iD: 0000-0003-4637-3526

MD, Dr. Sci. (Med.), Professor

Узбекистан, 2, Faribi str., Tashkent, 100109

Kulfiddinkhon A. Makhsumkhonov

Center for the Development of Professional Qualifications of Medical Workers

Email: kmakhsum73@mail.ru
ORCID iD: 0000-0002-2582-9013

MD, Cand. Sci. (Med.)

Узбекистан, Tashkent

Ibrokhim I. Bakhriev

Tashkent Medical Academy

Email: ibragim.bakhriev@mail.ru
ORCID iD: 0000-0002-3022-3489

MD, Cand. Sci. (Med.), Associate Professor

Узбекистан, 2, Faribi str., Tashkent, 100109

Shavkat E. Islamov

Samarkand Medical Universitete

Email: shavkat.islamov.1972@mail.ru
ORCID iD: 0000-0003-1758-2513

MD, Dr. Sci. (Med.), Associate Professor

Узбекистан, Samarkand

References

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