Analysis of pre-suicide signs: implications for suicide prevention.

The number of suicides in Japan has increased from about 22 000 per year between 1988 to 1997 to over 30 000 per year since then. Mie Prefecture, in central Japan, has also seen an increase in suicide. We believe suicide victims express suicidal signs before they act. According to a report by Yoshio-ka for the Ministry of Education, Culture, Sports, Science and Technology of Japan, which presented a statistical analysis of suicides in Mie Prefecture between 1989 to 1995, the prefecture showed intermediate levels of suicide and patterns of suicide similar to those of Japan as a whole (1). Therefore, the Mie Prefecture suicide data were analyzed as a reflection of the national problem. In the present report, the authors investigated the incidence and the circumstances surrounding all suicide cases from 1996 to 2002 in cooperation with the first department of criminal investigation of the Mie Prefectura police headquarters. Pre-suicide signs were also examined in detail. All data in the records were completely anonymous after encoding. Pre-suicide signs were determined by psychiatric specialists and divided into four stages: direct linguistic signs, indirect linguistic signs, direct action signs and indirect action signs. Direct linguistic signs are direct expressions of suicidal thoughts, such as " I want to die ". Indirect linguistic signs are indirect expressions, such as " I want to disappear ". Direct action signs are actions that directly indicate a preparation for suicide such as the purchase of knife or drugs. Indirect action signs are actions that indirectly indicate preparation for suicide such as a person who settles all his/her personal affairs (2, 3). During the test period, there were 2948 suicides (1979 males and 969 females). Pre-suicide signs were noted in 40.4% of the cases. Among them, direct linguistic signs, indirect linguistic signs, direct action signs, and indirect action signs accounted for 32.5%, 27.8%, 6.5% and 33.2% of cases respectively. The rate of pre-suicide signs is quite high. Since they are expressions and actions leading to suicide attempts, they must be given due attention. To prevent suicide, all these pre-suicide signs must be reported in due time for early intervention (4). Foreign body aspirations (FBAs) in childhood is frequent. Grass inflorescence aspiration is rare and may cause some serious complications (1–3). We present a case of grass inflorescence aspiration which caused a chest wall abscess (CWA) by migration into the chest wall.