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Roberts SE, John A, Carter T, G Williams J. Suicide rates in the UK Armed Forces, compared with the general workforce and merchant shipping during peacetime years since 1900. BMJ Mil Health 2024; 170:e128-e133. [PMID: 37028908 PMCID: PMC11671895 DOI: 10.1136/military-2022-002309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/02/2023] [Indexed: 04/09/2023]
Abstract
INTRODUCTION The main objective was to compare suicide rates and their trends across the three UK Armed forces (Royal Navy, Army and Royal Air Force) from 1900 to 2020. Further objectives were to compare suicide rates with those in the corresponding general population and in UK merchant shipping and to discuss preventative measures. METHODS Examination of annual mortality reports and returns, death inquiry files and official statistics. The main outcome measure was the suicide rate per 100 000 population employed. RESULTS Since 1990, there have been significant reductions in suicide rates in each of the Armed Forces, although a non-significant increase in the Army since 2010. Compared with the corresponding general population, during the most recent decade from 2010 up to 2020, suicide rates were 73% lower in the Royal Air Force, 56% lower in the Royal Navy and 43% lower in the Army. Suicide rates have been significantly decreased in the Royal Air Force since the 1950s, in the Royal Navy since the 1970s and in the Army since the 1980s (comparisons for the Royal Navy and the Army were not available from the late 1940s to the 1960s).During the earliest decades from 1900 to the 1930s, suicide rates in the Armed Forces were mostly quite similar or moderately increased compared with the general population, but far lower than in merchant shipping. Following legislative changes in the last 30 years, suicide rates through poisoning by gases and through firearms or explosives have fallen sharply. CONCLUSIONS The study shows that suicide rates in the Armed Forces have been lower than in the general population over many decades. The sharp reductions in suicide rates over the last 30 years suggest the effectiveness of recent preventative measures, including reductions in access to a method of suicide and well-being initiatives.
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Affiliation(s)
| | - A John
- Medical School, Swansea University, Swansea, UK
| | - T Carter
- Norwegian Centre for Maritime and Diving Medicine, Haukeland Universitetssjukehus, Bergen, Norway
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Wu H, Li K, Wang Y, Huang R, Jin X, Li X, Wang H, Li B. Suicide and suicidality in people exposed to pesticides: A systematic review and meta-analysis. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 327:121542. [PMID: 37011781 DOI: 10.1016/j.envpol.2023.121542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 06/19/2023]
Abstract
Exposure to pesticides has been proposed to be a positive association in suicide and suicidality. Many studies have explored this topic, but have reported inconsistent findings. We carried out a systematic review and meta-analysis of the now existing evidence on the association between pesticide exposure and the risk of suicide and suicidality. We searched PubMed, EMBASE and Web of Science databases for studies published up to February 1, 2023. For studies that provided detailed data, we applied quantitative meta-analysis to calculate Odds ratio (OR) with 95% Confidence Intervals (CIs) to evaluate the results. Heterogeneity among the included studies was assessed using Cochran's Q test, I2 statistic and tau-squared (τ2). Publication bias was evaluated by funnel plots, Egger's test, and Begg's test. In addition, subgroup analyses according to pesticides category and geographical area were performed. 2906 studies were initially identified, and 20 studies were eventually included. Fifteen of the studies were on suicide deaths and suicide attempts, and five were on suicidal ideation. Pesticide exposure was positively related to suicide deaths and suicide attempts (pooled OR = 1.31; 95%CI: 1.04-1.64, p < 0.001) and suicidal ideation (pooled OR = 2.43; 95%CI: 1.51-3.91, p = 0.015). In the subgroup analysis, mixed pesticide type (pooled OR = 1.55; 95%CI: 1.39-1.74) increased the risk of suicide deaths and suicide attempts. The results of the analysis by geographic area showed that the risk of suicide deaths and suicide attempts with pesticide exposure was 2.27 (95%CI = 1.36-3.78), and 1.33 (95%CI = 1.14-1.56) in Asia and Europe, respectively. The risk of suicidal ideation caused by pesticide exposure in Asia and America were 2.19 (95%CI = 1.08-4.42) and 2.99 (95%CI = 1.76-5.06). In conclusion, pesticide exposure may increase the risk of suicide and suicidality based on the current evidence.
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Affiliation(s)
- Hong Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Provincial Laboratory of Inflammatory and Immune Diseases, Hefei, Anhui, China
| | - Kaidi Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Provincial Laboratory of Inflammatory and Immune Diseases, Hefei, Anhui, China
| | - Yiyu Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Provincial Laboratory of Inflammatory and Immune Diseases, Hefei, Anhui, China
| | - Ronggui Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Provincial Laboratory of Inflammatory and Immune Diseases, Hefei, Anhui, China
| | - Xue Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Provincial Laboratory of Inflammatory and Immune Diseases, Hefei, Anhui, China
| | - Xianbao Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Provincial Laboratory of Inflammatory and Immune Diseases, Hefei, Anhui, China
| | - Hua Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Provincial Laboratory of Inflammatory and Immune Diseases, Hefei, Anhui, China
| | - Baozhu Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Provincial Laboratory of Inflammatory and Immune Diseases, Hefei, Anhui, China.
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Roca-Barceló A, Crabbe H, Close R, Fahie H, Leonardi GS, Piel FB. Spatial and temporal trends and risk factors for intentional carbon monoxide poisoning hospitalizations in England between 2002 and 2016. J Affect Disord 2023; 329:168-175. [PMID: 36841308 DOI: 10.1016/j.jad.2023.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/27/2023]
Abstract
INTRODUCTION Suicide and mental health disorders are a recognized increasing public concern. Most suicide prevention rely on evidence from mortality data, although suicide attempts are a better predictor for completed suicides. Understanding spatio-temporal patterns and demographic profiles of people at risk can improve suicide prevention schemes, including for carbon monoxide (CO) poisoning, a common method for gas-related suicides. OBJECTIVE Describe spatio-temporal patterns of intentional CO poisoning hospitalization rates in England between 2002 and 2016, and identify population sub-groups at risk. METHODS We used NHS Digital's Hospital Episode Statistics (HES) routinely collected data on hospital admissions for intentional CO poisoning. We estimated age-standardised rates (ASR) by year, gender and residential small-area characteristics, including rural/urban, deprivation and ethnic composition. Temporal trends were assessed through linear regression and joinpoint regression analysis. Regional differences were explored. RESULTS On average, we identified 178 hospital admissions for intentional CO poisoning per year. The ASR decreased substantially over the study period, particularly among males (average annual percent change of -7.8 % (95 % CI: -11.0; -4.6)), in comparison to 3.9 % (95%CI, -6.4; -1.4) among females. Most admissions (81 %) occurred in males. White men aged 35-44 years were particularly at risk. The ASR in London (0.08/100,000) was almost six times lower than in the South-West (0.47/100,000). CONCLUSIONS This study provides novel insights into attempted suicides by intentional CO poisoning. Further prevention interventions, targeting sub-groups at risk (i.e. white men in their 30s/40s), need to be developed and implemented to reduce the burden of suicides and of CO poisoning.
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Affiliation(s)
- Aina Roca-Barceló
- Small Area Health Statistics Unit, Medical Research Council (MRC) Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Helen Crabbe
- Environmental Epidemiology Group, UK Health Security Agency, Radiation, Chemical and Environmental Hazards Directorate, Chilton, Oxon, United Kingdom; National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Environmental Exposures & Health, Imperial College London, London, United Kingdom
| | - Rebecca Close
- Environmental Epidemiology Group, UK Health Security Agency, Radiation, Chemical and Environmental Hazards Directorate, Chilton, Oxon, United Kingdom; National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Environmental Exposures & Health, Imperial College London, London, United Kingdom
| | - Helena Fahie
- Specialty Registrar in Public Health, Oxford School of Public Health, Health Education England, United Kingdom
| | - Giovanni S Leonardi
- Environmental Epidemiology Group, UK Health Security Agency, Radiation, Chemical and Environmental Hazards Directorate, Chilton, Oxon, United Kingdom; National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Environmental Exposures & Health, Imperial College London, London, United Kingdom
| | - Frédéric B Piel
- Small Area Health Statistics Unit, Medical Research Council (MRC) Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom; National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Environmental Exposures & Health, Imperial College London, London, United Kingdom; National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Chemical & Radiation Threats & Hazards, Imperial College London, London, United Kingdom.
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Roberts JP, Satherley RM, Iles J. It’s time to talk fathers: The impact of paternal depression on parenting style and child development during the COVID-19 pandemic. Front Psychol 2022; 13:1044664. [DOI: 10.3389/fpsyg.2022.1044664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/28/2022] [Indexed: 11/22/2022] Open
Abstract
This study aimed to understand the relationship between paternal depression, parenting behavior and child developmental outcomes during the SARS-CoV-2 (COVID) pandemic. In addition, the paternal experience of the pandemic, such as the impact of lockdowns, was explored. Fathers of children aged 6–11 years old (n = 87) were recruited for an online cross-sectional survey. Data was collected through questionnaires and open-ended comments. Regression analysis indicated a higher level of self-reported depressive symptomology in fathers more severely impacted by the pandemic across financial, familial and health domains. Further, COVID-19 impact, but not paternal depression, was linked to fewer authoritative parenting behaviors, characterized as lower warmth and responsiveness. Paternal pandemic impact and depression symptoms were independently predictive of child cognitive scores, and both were associated with emotional and behavioral outcomes. A content analysis of open-ended responses from fathers noted that concerns for their children, work and mental health were most prevalent during the pandemic. However, several responders also reported no change or positive facets of lockdowns related to the pandemic. These finds are discussed in the context of a possible behavioural mechanism of action accounting for the effect of these factors on child development. Clinical implications include targeted interventions for at risk groups as well as psychoeducation for fathers that acknowledge difference in paternal coping and support seeking.
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Ilic M, Ilic I. Worldwide suicide mortality trends (2000-2019): A joinpoint regression analysis. World J Psychiatry 2022; 12:1044-1060. [PMID: 36158305 PMCID: PMC9476842 DOI: 10.5498/wjp.v12.i8.1044] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 11/16/2021] [Accepted: 07/11/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Studies exploring suicide mortality on a global scale are sparse, and most evaluations were limited to certain populations.
AIM To assess global, regional and national trends of suicide mortality.
METHODS Suicide mortality data for the period 2000-2019 were obtained from the mortality database of the World Health Organization and the Global Burden of Disease Study. Age-standardized rates (ASRs; expressed per 100000) were presented. To assess trends of suicide mortality, joinpoint regression analysis was used: The average annual percent change (AAPC) with the corresponding 95% confidence interval (95%CI) was calculated.
RESULTS A total of 759028 (523883 male and 235145 female) suicide deaths were reported worldwide in 2019. The global ASR of mortality of suicide was 9.0/100000 population in both sexes (12.6 in males vs 5.4 in females). In both sexes, the highest rates were found in the region of Africa (ASR = 11.2), while the lowest rates were reported in Eastern Mediterranean (ASR = 6.4). Globally, from 2000 to 2019, ASRs of mortality of suicide had a decreasing tendency in both sexes together [AAPC = -2.4% per year; 95%CI: (-2.6)-(-2.3)]. The region of the Americas experienced a significant increase in suicide mortality over 2000-2019 unlike other regions that had a declining trend. Out of all 133 countries with a decline in suicide mortality, Barbados (AAPC = -10.0%), Grenada (AAPC = -8.5%), Serbia (AAPC = -7.6%), and Venezuela (AAPC = -6.2%) showed the most marked reduction in mortality rates. Out of all 26 countries with a rise in suicide mortality, Lesotho (AAPC = +6.0%), Cyprus (AAPC = +5.1%), Paraguay (AAPC = +3.0%), Saudi Arabia (AAPC = +2.8%), Brunei (AAPC = +2.6%), Greece (AAPC = +2.6%), Georgia (AAPC = +2.1%), and Mexico (AAPC = +2.0%), are among those with the highest increase in mortality.
CONCLUSION Decreasing trends in suicide mortality were observed in most countries across the world. Unfortunately, the mortality of suicide showed an increasing trend in a number of populations. Further research should explore the reasons for these unfavorable trends, in order to consider and recommend more efforts for suicide prevention in these countries.
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Affiliation(s)
- Milena Ilic
- Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac 34000, Serbia
| | - Irena Ilic
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
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Kim TH, Song KJ, Shin SD, Hong KJ, Lee JK. National Implementation of Emergency Department-Based Follow-up Program for Suicidal Attempts. J Korean Med Sci 2022; 37:e245. [PMID: 35942558 PMCID: PMC9359922 DOI: 10.3346/jkms.2022.37.e245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Death by suicide is a major public health problem. To provide multidisciplinary support to patients who attempted suicide, emergency department (ED)-based psychiatric screening and intervention programs were offered. We traced the long-term survival outcome of patients visiting the ED after suicide attempts using the national death certificate registration database. METHODS A retrospective observational study was conducted using a database of patients from "Psychiatric Crisis Response Centers" (PCRC) of 27 EDs between January 2013 and August 2015. Patients who visited the ED after attempting suicide were screened and interviewed by social workers from the PCRC. The database was merged with the national death certificate database to trace the death and cause of death of the patients until December 2018. The characteristics and outcomes were compared based on the patient's compliance with the follow-up case management program. RESULTS Of the 12,544 interviewed patients, the data of 9,587 patients were successfully matched with data from the death certificate database. Death by suicide was higher in the noncompliance group (4.5% vs. 12.4%, P < 0.001); however, death caused by factors other than suicide did not differ between groups (4.8% vs. 4.9%, P = 0.906). CONCLUSION Suicide resulted in a lower long-term mortality rate among patients who complied with the follow-up case management session in the ED-based brief psychiatric intervention and follow-up program.
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Affiliation(s)
- Tae Han Kim
- Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Ki Jeong Hong
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea
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Collados-Ros A, Torres-Sánchez C, Pérez-Cárceles MD, Luna A, Legaz I. Suicidal Behavior and Its Relationship with Postmortem Forensic Toxicological Findings. TOXICS 2022; 10:319. [PMID: 35736927 PMCID: PMC9229491 DOI: 10.3390/toxics10060319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/04/2022] [Accepted: 06/08/2022] [Indexed: 02/04/2023]
Abstract
Suicide affects all sociodemographic levels, age groups, and populations worldwide. The factors that can increase the risk of suicidal tendencies are widely studied. The aim of this study was to analyze the types and combinations of toxics found in fatal suicide victims with different suicide mechanisms. A total of 355 autopsies were retrospectively studied, and 26 toxics were determined and related to mechanisms of suicide. Hanging (55%), drug overdose (22.7%), and jumping from a height (17.8%) were most represented suicide mechanisms with positive toxicology. Hanging was the most represented in men (50.3%; p = 0.019), while jumping from a height was more represented in women (29.7%, p = 0.028). Drugs of abuse were the most frequent toxics found in men (55.5%; p < 0.001), while medicines were the most frequent type found in women (70.3%, p < 0.001). Alcohol, nordiazepam, cocaine, and venlafaxine were the most consumed toxics. Benzodiazepines and venlafaxine were found in suicides involving drug overdose, hanging, and jumping from a height. In conclusion, most suicides were associated with drug abuse in men. Hanging was more represented in men and jumping from a height in women. Alcohol was present in combination with other toxics and medicines. The toxicological analysis is fundamental to understanding consumption patterns and establishing strategies and protocols for detecting and preventing suicide.
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Affiliation(s)
- Aurelia Collados-Ros
- Department of Legal and Forensic Medicine, Biomedical Research Institute (IMIB), Regional Campus of International Excellence “Campus Mare Nostrum”, Faculty of Medicine, University of Murcia, 30100 Murcia, Spain; (A.C.-R.); (C.T.-S.); (M.D.P.-C.); (A.L.)
| | - Carmen Torres-Sánchez
- Department of Legal and Forensic Medicine, Biomedical Research Institute (IMIB), Regional Campus of International Excellence “Campus Mare Nostrum”, Faculty of Medicine, University of Murcia, 30100 Murcia, Spain; (A.C.-R.); (C.T.-S.); (M.D.P.-C.); (A.L.)
- Pathology Service, Institute of Legal Medicine and Forensic Sciences, 30100 Murcia, Spain
| | - María Dolores Pérez-Cárceles
- Department of Legal and Forensic Medicine, Biomedical Research Institute (IMIB), Regional Campus of International Excellence “Campus Mare Nostrum”, Faculty of Medicine, University of Murcia, 30100 Murcia, Spain; (A.C.-R.); (C.T.-S.); (M.D.P.-C.); (A.L.)
| | - Aurelio Luna
- Department of Legal and Forensic Medicine, Biomedical Research Institute (IMIB), Regional Campus of International Excellence “Campus Mare Nostrum”, Faculty of Medicine, University of Murcia, 30100 Murcia, Spain; (A.C.-R.); (C.T.-S.); (M.D.P.-C.); (A.L.)
| | - Isabel Legaz
- Department of Legal and Forensic Medicine, Biomedical Research Institute (IMIB), Regional Campus of International Excellence “Campus Mare Nostrum”, Faculty of Medicine, University of Murcia, 30100 Murcia, Spain; (A.C.-R.); (C.T.-S.); (M.D.P.-C.); (A.L.)
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Effects of Financial Expenditure of Prefectures/Municipalities on Regional Suicide Mortality in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168639. [PMID: 34444387 PMCID: PMC8394344 DOI: 10.3390/ijerph18168639] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/08/2021] [Accepted: 08/13/2021] [Indexed: 12/16/2022]
Abstract
In Japan, suicide mortality has been improving from 2009; however, suicide remains one of the leading causes of death. Although previous studies identified solid relationships between governmental financial support for social welfare systems and suicide mortality, little attention is paid to how specific regional policies, designed according to regional cultural, economic, and social welfare situations, affect suicide mortality. Therefore, the present study analyses the relationships between the regional governmental expenditure of six major divisions and suicide mortality across the 47 prefectures in Japan from 2009 to 2018 using fixed-effect analysis of hierarchal linear regression with robust standard error. The expenditure in “public health”, “police”, “ambulance/fire services”, “welfare” and “education” is associated with reduction in suicide mortality, at least in some statistical indicators, whereas expenditure of “public works” indicated the influence of increasing suicide mortality or had no effect. Welfare expenditure was the most predominantly effective among the six major divisions of regional governmental expenditure. In the welfare subdivisions, expenditure of “child welfare” and “social welfare” was effective in a reduction in suicide mortality, but expenditure of “elderly welfare” surprisingly contributed to increasing suicide mortality. Child welfare expenditure negatively impacted suicide mortality in wide-ranging generations of both males and females; the positive effects of elderly welfare expenditure reached were limited as working-age populations increased, but unexpectedly did not affect the suicide mortality of elderly populations. The relatively increasing expenditure of elderly welfare with the relatively decreasing child welfare are unavoidable due to the Japanese social issues associated with a declining birth rate and ageing population. Furthermore, the budget of that regional government that can modify its expenditure structure by making its own policies is limited since most regional governmental expenditure is composed of essential expenditure for maintaining and operating regional social welfare systems. Although severe social situations in Japan are still unoptimised, the present results suggest that scientific-evidence-based redistributions of welfare expenditure in regional governments can at least partially improve Japanese society and welfare systems.
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Höglund P, Hakelind C, Nordin S. Severity and prevalence of various types of mental ill-health in a general adult population: age and sex differences. BMC Psychiatry 2020; 20:209. [PMID: 32393209 PMCID: PMC7212684 DOI: 10.1186/s12888-020-02557-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 03/19/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Taking a broad approach, the aim of this study was to better understand severity and prevalence of various types of mental ill-health across age and sex groups in the general adult population. A first objective was to determine symptom severity of anxiety, depression, insomnia, burnout and somatization in combinations of different age groups and sex. A second objective was to determine prevalence of caseness of these types of mental ill-health in both absolute and relative terms in the combinations of age groups and sex. METHODS Cross-sectional data based on validated questionnaire instruments were used from the Västerbotten Environmental Health Study in Sweden. In total, 3406 participants, aged 18 to 79 years, constituted a random sample stratified for age and sex. RESULTS Severity and prevalence of anxiety, insomnia and burnout were high in women, in particular young women, and lower in older age groups. The prevalence rates for insomnia, burnout and somatization were particularly high based on the used cut-off scores. Men aged 30-49 years had the highest prevalence of mental ill-health compared to other age groups among men. Men and women aged 60-69 years had generally the lowest symptom severity and caseness. The prevalence of depression was similar in men and women in all age groups, whereas sex-related differences in extent in general were largest in the youngest age group, and gradually decreased with age. CONCLUSION The results suggest that focus in primary healthcare regarding mental ill-health should to be directed more towards insomnia, burnout and somatization, in particular in young women.
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Affiliation(s)
- Per Höglund
- Department of Psychology, Umeå University, 90187, Umeå, Sweden.
| | - Camilla Hakelind
- grid.12650.300000 0001 1034 3451Department of Psychology, Umeå University, 90187 Umeå, Sweden
| | - Steven Nordin
- grid.12650.300000 0001 1034 3451Department of Psychology, Umeå University, 90187 Umeå, Sweden
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Studart-Bottó P, Martins-Junior DF, Sarmento S, Argolo L, Galvão-de-Almeida A, Miranda-Scippa Â. Self-injurious behavior and related mortality in children under 10 years of age: a retrospective health record study in Brazil. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2020; 42:40-45. [PMID: 31389497 PMCID: PMC6986482 DOI: 10.1590/1516-4446-2018-0355] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 04/23/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe and analyze data on self-injurious behavior (SIB) and related mortality in children under 10 years old in Brazil. METHODS A descriptive study was performed using secondary public health care data extracted from the Hospital Information System (Sistema de Informações Hospitalares, SIH) and Mortality Information System (Sistema de Informações sobre Mortalidade, SIM) in Brazil. The databases are available for online access at http://datasus.saude.gov.br/. RESULTS In Brazil, according to SIH data, 11,312 hospitalizations of patients under 10 years of age were recorded from 1998 to 2018 as resulting from SIB (ICD-10 X60-X84 codes). Of these, 65 resulted in death. According to the SIM, from 1996 to 2016, 91 deaths related to SIB were recorded, 81 (89%) in children aged 5 to 9 years, nine (9.9%) in children aged 1 to 4 years, and one (1.1%) in a child below 1 year of age. CONCLUSION These results highlight the relevance of creating measures to better understand SIB and related mortality in this age group. They also reveal the vulnerability of children in Brazil and warrant further studies to address these issues.
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Affiliation(s)
- Paula Studart-Bottó
- Ambulatório de Transtorno do Humor e Ansiedade (CETHA), Complexo Hospitalar Universitário Professor Edgard Santos (HUPES), Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, BA, Brazil
| | - Davi F. Martins-Junior
- Ambulatório de Transtorno do Humor e Ansiedade (CETHA), Complexo Hospitalar Universitário Professor Edgard Santos (HUPES), Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, BA, Brazil
- Departamento de Saúde, Universidade Estadual de Feira de Santana (UEFS), Feira de Santana, BA, Brazil
| | - Stella Sarmento
- Ambulatório de Transtorno do Humor e Ansiedade (CETHA), Complexo Hospitalar Universitário Professor Edgard Santos (HUPES), Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | - Lucas Argolo
- Ambulatório de Transtorno do Humor e Ansiedade (CETHA), Complexo Hospitalar Universitário Professor Edgard Santos (HUPES), Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, BA, Brazil
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, BA, Brazil
| | - Amanda Galvão-de-Almeida
- Ambulatório de Transtorno do Humor e Ansiedade (CETHA), Complexo Hospitalar Universitário Professor Edgard Santos (HUPES), Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
- Departamento de Neurociência e Saúde Mental, Faculdade de Medicina, UFBA, Salvador, BA, Brazil
| | - Ângela Miranda-Scippa
- Ambulatório de Transtorno do Humor e Ansiedade (CETHA), Complexo Hospitalar Universitário Professor Edgard Santos (HUPES), Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, BA, Brazil
- Departamento de Neurociência e Saúde Mental, Faculdade de Medicina, UFBA, Salvador, BA, Brazil
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Saunders NR, Chiu M, Lebenbaum M, Chen S, Kurdyak P, Guttmann A, Vigod S. Suicide and Self-Harm in Recent Immigrants in Ontario, Canada: A Population-Based Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:777-788. [PMID: 31234643 PMCID: PMC6882076 DOI: 10.1177/0706743719856851] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To estimate the rates of suicide and self-harm among recent immigrants and to determine which immigrant-specific risk factors are associated with these outcomes. METHODS Population-based cohort study using linked health administrative data sets (2003 to 2017) in Ontario, Canada which included adults ≥18 years, living in Ontario (N = 9,055,079). The main exposure was immigrant status (long-term resident vs. recent immigrant). Immigrant-specific exposures included visa class and country of origin. Outcome measures were death by suicide or emergency department visit for self-harm. Cox proportional hazards estimated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). RESULTS We included 590,289 recent immigrants and 8,464,790 long-term residents. Suicide rates were lower among immigrants (n = 130 suicides, 3.3/100,000) than long-term residents (n = 6,354 suicides, 11.8/100,000) with aHR 0.3, 95% CI, 0.2 to 0.3. Male-female ratios in suicide rates were attenuated in immigrants. Refugees had 2.1 (95% CI, 1.3 to 3.6; rate 6.1/100,000) and 2.8 (95% CI, 2.5 to 3.2) times the likelihood of suicide and self-harm, respectively, compared with nonrefugee immigrants. Self-harm rate was lower among immigrants (n = 2,256 events, 4.4/10,000) than long-term residents (n = 68,039 events, 9.7/10,000 person-years; aHR 0.3; 95% CI, 0.3 to 0.3). Unlike long-term residents, where low income was associated with high suicide rates, income was not associated with suicide among immigrants and there was an attenuated income gradient for self-harm. Country of origin-specific analyses showed wide ranges in suicide rates (1.4 to 9.9/100,000) and self-harm (1.8 to 14.9/10,000). CONCLUSION Recent immigrants have lower rates of suicide and self-harm and different sociodemographic predictors compared with long-term residents. Analysis of contextual factors including immigrant class, origin, and destination should be considered for all immigrant suicide risk assessment.
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Affiliation(s)
- Natasha Ruth Saunders
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada.,These authors contributed equally, acting as co-first authors
| | - Maria Chiu
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada.,These authors contributed equally, acting as co-first authors
| | - Michael Lebenbaum
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
| | | | - Paul Kurdyak
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Astrid Guttmann
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
| | - Simone Vigod
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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12
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Renaud J, Lesage A, Gagné M, MacNeil S, Légaré G, Geoffroy MC, Skinner R, McFaull S. Regional Variations in Suicide and Undetermined Death Rates among Adolescents across Canada. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2018; 27:112-121. [PMID: 29662522 PMCID: PMC5896524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 10/17/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Trends in rates of adolescent suicide and undetermined deaths in Canada from 1981 to 2012 were examined, focusing specifically on variations between Canadian regions. Exploratory hypotheses were formulated for regional variability in adolescent suicide rates over time in Canada. METHODS A descriptive time trend analysis using public domain vital statistics data was performed. All deaths from 1981 to 2012 among 15 to 19 year olds coded as suicides or undetermined intent according to the International Classification of Diseases, 9th and 10th Revisions were included. RESULTS While there was an overall stability in adolescent suicide and undetermined death rates across Canada, regional analyses showed that Quebec experienced a 7.6% annual reduction between 2001 and 2012 while the Prairies and Atlantic provinces experienced significant annual increases since 2001. Ontario and British Columbia have had non-significant fluctuations since 2001. The trends remained similar overall when excluding undetermined deaths from the analyses. CONCLUSIONS Variations in adolescent suicide trends across provinces were found. Factors such as provincial suicide action and prevention legislation contributing to these variations remain to be studied, but these regional differences point towards the need for better consistency of suicide prevention strategies across the country.
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Affiliation(s)
- Johanne Renaud
- Manulife Centre for Breakthroughs in Teen Depression and Suicide Prevention, Montreal, Québec
- Douglas Mental Health University Institute, Montreal, Québec
- McGill Group for Suicide Studies, McGill University. Montreal, Québec
- Department of Psychiatry, McGill University, Montreal, Québec
| | - Alain Lesage
- Institut universitaire en santé mentale de Montréal, Montreal, Québec
| | - Mathieu Gagné
- Institut national de santé publique du Québec, Québec, Québec
- CRISE, Université du Québec à Montréal, Montreal, Québec
| | - Sasha MacNeil
- Douglas Mental Health University Institute, Montreal, Québec
| | - Gilles Légaré
- Institut national de santé publique du Québec, Québec, Québec
- CRISE, Université du Québec à Montréal, Montreal, Québec
- Université du Québec à Rimouski, Rimouski, Québec
| | - Marie-Claude Geoffroy
- Douglas Mental Health University Institute, Montreal, Québec
- McGill Group for Suicide Studies, McGill University. Montreal, Québec
- Department of Psychiatry, McGill University, Montreal, Québec
| | - Robin Skinner
- Health Surveillance and Epidemiology Division, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Ontario
| | - Steven McFaull
- Health Surveillance and Epidemiology Division, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Ontario
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13
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Saunders NR, Lebenbaum M, Stukel TA, Lu H, Urquia ML, Kurdyak P, Guttmann A. Suicide and self-harm trends in recent immigrant youth in Ontario, 1996-2012: a population-based longitudinal cohort study. BMJ Open 2017; 7:e014863. [PMID: 28864687 PMCID: PMC5589002 DOI: 10.1136/bmjopen-2016-014863] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To describe the trends in suicide and emergency department (ED) visits for self-harm in youth by immigration status and immigrant characteristics. DESIGN Population-based longitudinal cohort study from 1996 to 2012 using linked health and administrative datasets. SETTING Ontario, Canada. PARTICIPANTS Youth 10 to 24 years, living in Ontario, Canada. EXPOSURE The main exposure was immigrant status (recent immigrant (RI) versus long-term residents (LTR)). Secondary exposures included region of birth, duration or residence, and refugee status. MAIN OUTCOME MEASURE Trends over time in suicide and ED self-harm were modelled within consecutive 3-year time periods. Rate ratios were estimated using Poisson regression models. RESULTS 2.5 to 2.9 million individuals were included per cohort period. LTR suicide rates ranged from 7.4 to 9.4/100 000 male person-years versus 2.2-3.4/100 000 females. RI's suicide rates were 2.7-7.2/100,000 male versus 1.9-2.7/100 000 female person-years. Suicide rates were lower among RI compared with LTR (adjusted relative rate (aRR)=0.70, 95% CI=0.57 to 0.85) with different mechanisms of suicide. No significant time trend in suicide rates was observed (p=0.40). ED self-harm rates for LTR and RI were highest in females (2.6-3.4/1000 LTR females versus 1.1-1.5/1000 males, 1.2-1.8/1000 RI females versus 0.4-0.6/1000 males). RI had lower rates of self-harm compared with LTR (aRR=0.60, 95% CI=0.56 to 0.65). Stratum-specific rates showed a steeper decline per period in RI compared with LTR (RI: aRR=0.85, 95% CI=0.81 to 0.89; LTR: aRR=0.91, 95% CI=0.90 to 0.93). Observed trends were not universal across region of origin and by refugee status. INTERPRETATION Suicide rates have been stable and ED self-harm rates are declining over time among RI youth. These trends by important subgroups should continue to be monitored to allow for early identification of subpopulations of immigrant youth in need of targeted and culturally appropriate public health interventions.
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Affiliation(s)
- Natasha Ruth Saunders
- Division of Pediatric Medicine, Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Child Health Evaluative Sciences, Sickkids Research Institute, Toronto, Canada
| | | | - Therese A Stukel
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Hong Lu
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Marcelo L Urquia
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Manitoba Centre for Health Policy, Department of Community Health Services, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Kurdyak
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Astrid Guttmann
- Division of Pediatric Medicine, Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Child Health Evaluative Sciences, Sickkids Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Gontijo Guerra S, Vasiliadis HM. Gender Differences in Youth Suicide and Healthcare Service Use. CRISIS 2016; 37:290-298. [PMID: 27245811 DOI: 10.1027/0227-5910/a000387] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Healthcare service use among suicide decedents must be well characterized and understood since a key strategy for preventing suicide is to improve healthcare providers' ability to effectively detect and treat those in need. AIMS To determine gender differences in healthcare service use 12 months prior to suicide. METHOD Data for 1,231 young Quebec residents (≤ 25 years) who died by suicide between 2000 and 2007 were collected from public health insurance agency databases and coroner registers. Healthcare visits were categorized according to the setting (emergency department [ED], outpatient, and hospital) and their nature (mental health vs. non-mental health). RESULTS Girls were more likely than boys (82.5% vs. 74.9%, p = .011) to have used healthcare services in the year prior to death. A higher proportion of girls had used outpatient services (79.0% vs. 69.5%, p = .003), had been hospitalized (25.7% vs. 15.6%, p < .001) and had received a mental health-related diagnosis (46.7% vs. 33.1%, p < .001). However, no gender differences were observed in ED visits (59.5% vs. 54.5%, p = .150). CONCLUSION There is an important proportion of suicide decedents who did not receive a mental health diagnosis and healthcare services in the year prior to death. Future studies should focus on examining gender-specific individual and health system barriers among suicide decedents as well as the quality of care offered regarding detection and treatment.
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Affiliation(s)
- Samantha Gontijo Guerra
- 1 Department of Community Health Sciences, Faculty of Medicine and Health Sciences of the University of Sherbrooke, Charles Le Moyne Hospital Research Center, Longueuil, QC, Canada
| | - Helen-Maria Vasiliadis
- 1 Department of Community Health Sciences, Faculty of Medicine and Health Sciences of the University of Sherbrooke, Charles Le Moyne Hospital Research Center, Longueuil, QC, Canada
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Linsley KR, Schapira MA, Schapira K, Lister C. Changes in risk factors for young male suicide in Newcastle upon Tyne, 1961-2009. BJPsych Bull 2016; 40:136-41. [PMID: 27280034 PMCID: PMC4887731 DOI: 10.1192/pb.bp.114.048884] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims and method To ascertain differences in patterns of suicide in young men over three decades (1960s, 1990s and 2000s) and discuss implications for suicide prevention. Data on suicides and open verdicts in men aged 15-34 were obtained from coroner's records in Newcastle upon Tyne and analysed using SPSS software. Results An increase in suicide rates from the first to the second decade was followed by a fall in the third decade. This was associated with an increasing proportion of single men, those living alone, unemployment, consumption of alcohol, use of hanging, previous suicide attempt and history of treatment for mental illness. Clinical implications This study highlights the need for more interventions and focus to be given to young males in the suicide prevention area and is of high importance in the field of public health. Areas that could be tackled include reducing access to means of suicide, reducing alcohol use, support for relationship difficulties, engagement with mental health services and management of chronic illness.
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Age-period-cohort analysis of the suicide rate in Korea. J Affect Disord 2016; 194:16-20. [PMID: 26802502 DOI: 10.1016/j.jad.2016.01.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/02/2015] [Accepted: 01/10/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND The suicide rate has been increasing in Korea, and the country now has the highest rank in the world. This study aimed to present the long-term trends in Korea's suicide rate using Joinpoint analysis and age-period-cohort (APC) modeling. METHODS The population and the number of suicides for each five-year age group were obtained from the National Statistical Office for the period 1984-2013 for Koreans aged 10 years and older. We determined the changes in the trends in age-standardized mortality rates using Joinpoint. APC modeling was performed to describe the trends in the suicide rate using the intrinsic estimator method. RESULTS The age-standardized suicide rate in men rapidly increased from 1989 to 2004, and slightly increased thereafter, whereas the suicide rate in women increased from 1989 to 2009 and then decreased thereafter. Within the same period, the suicide rate was higher among the older age groups than in the younger groups. Within the same birth cohort, the suicide rate of the older groups was also higher than that in the younger groups. Within the same age group, the suicide rate of the younger cohorts was higher than it was in the older cohorts. In the APC modeling, old age, recent period, and having been born before 1924 were associated with higher suicide rates. LIMITATIONS The accuracy and completeness of the suicide rate data may lead to bias. CONCLUSIONS This study showed an increasing trend in the suicide rates for men and women after 1989. These trends may be mainly attributed to cohort effects.
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17
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de Cates AN, Broome MR. Can We Use Neurocognition to Predict Repetition of Self-Harm, and Why Might This Be Clinically Useful? A Perspective. Front Psychiatry 2016; 7:7. [PMID: 26858659 PMCID: PMC4728206 DOI: 10.3389/fpsyt.2016.00007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 01/11/2016] [Indexed: 12/13/2022] Open
Abstract
Over 800,000 people die by suicide each year globally, with non-fatal self-harm 20 times more common. With each episode of self-harm, the risks of future self-harm and suicide increase, as well as personal and healthcare costs. Therefore, early delineation of those at high risk of future self-harm is important. Historically, research has focused on clinical and demographic factors, but risk assessments based on these have low sensitivity to predict repetition. Various neurocognitive factors have been associated with self-harming behavior, but it is less certain if we can use these factors clinically (i) as risk markers to predict future self-harm and (ii) to become therapeutic targets for interventions. Recent systematic reviews and meta-analyses of behavioral tasks and fMRI studies point to an emerging hypothesis for neurocognition in self-harm: an underactive pre-frontal cortex is unable to respond appropriately to non-emotional stimuli, or inhibit a hyperactive emotionally-/threat-driven limbic system. However, there is almost no imaging data examining repetition of self-harm. Extrapolating from the non-repetition data, there may be several potential neurocognitive targets for interventions to prevent repeat self-harm: cognitive training; pharmacological regimes to promote non-emotional neurocognition; or other techniques, such as repetitive transcranial magnetic stimulation. Hence, there is an urgent need for imaging studies examining repetition and to test specific hypotheses. Until we investigate the functional neurocognitive basis underlying repetition of self-harm in a systematic manner using second-generational imaging techniques, we will be unable to inform third-generational imaging and potential future clinical applications.
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Affiliation(s)
- Angharad N. de Cates
- Unit of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Matthew R. Broome
- Unit of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
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Factors affecting survival following self-inflicted head and neck gunshot wounds: a single-centre retrospective review. Int J Oral Maxillofac Surg 2015; 45:513-6. [PMID: 26673835 DOI: 10.1016/j.ijom.2015.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 08/23/2015] [Accepted: 10/02/2015] [Indexed: 11/20/2022]
Abstract
Self-inflicted head and neck gunshot wounds are a common modality of suicide in the USA. This study reviewed all self-inflicted head and neck gunshot wound patients with complete records (n=157) treated at a tertiary centre between 2002 and 2012 inclusive. The associations between mortality and patient/clinical variables were evaluated with the χ(2) test or Fisher's exact test for statistical difference testing. Outcomes recorded were death (n=92, 59%), discharge to long-term care/rehabilitation (n=58, 37%), and discharge home (n=7, 4%). The majority of patients were male (86.6%) and single/separated/divorced (55.5%). The mortality rate by site, in descending order, was temporal 82%, frontal scalp 69%, submental/intraoral 30%, and neck 25%. Involvement of the central nervous system (n=127) resulted in a 70% mortality, but a lower mortality was observed among patients with an avulsion injury (P=0.025). A tracheostomy within 24h of admission was statistically associated with improved survival (P<0.001), but confounding factors were found. Multivariate analysis revealed increasing age, temporal entry site, and the severity of central nervous system involvement to be positively associated with an increased mortality.
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Barr B, Kinderman P, Whitehead M. Trends in mental health inequalities in England during a period of recession, austerity and welfare reform 2004 to 2013. Soc Sci Med 2015; 147:324-31. [DOI: 10.1016/j.socscimed.2015.11.009] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 11/05/2015] [Accepted: 11/06/2015] [Indexed: 10/22/2022]
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Lachal J, Orri M, Sibeoni J, Moro MR, Revah-Levy A. Metasynthesis of youth suicidal behaviours: perspectives of youth, parents, and health care professionals. PLoS One 2015; 10:e0127359. [PMID: 26001066 PMCID: PMC4441448 DOI: 10.1371/journal.pone.0127359] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 04/13/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Youth suicide is a major public health issue throughout the world. Numerous theoretical models have been proposed to improve our understanding of suicidal behaviours, but medical science has struggled to integrate all the complex aspects of this question. The aim of this review is to synthesise the views of suicidal adolescents and young adults, their parents, and their healthcare professionals on the topics of suicidal behaviour and management of those who have attempted suicide, in order to propose new pathways of care, closer to the issues and expectations of each group. METHODS AND FINDINGS This systematic review of qualitative studies--Medline, PsycInfo, Embase, CINAHL, and SSCI from 1990 to 2014--concerning suicide attempts by young people used thematic synthesis to develop categories inductively from the themes identified in the studies. The synthesis included 44 studies from 16 countries: 31 interviewed the youth, 7 their parents, and 6 the healthcare professionals. The results are organised around three superordinate themes: the individual experience, that is, the individual burden and suffering related to suicide attempts in all three groups; the relational experience, which describes the importance of relationships with others at all stages of the process of suicidal behaviour; and the social and cultural experience, or how the group and society accept or reject young people in distress and their families and how that affects the suicidal process and its management. CONCLUSION The violence of the message of a suicidal act and the fears associated with death lead to incomprehension and interfere with the capacity for empathy of both family members and professionals. The issue in treatment is to be able to witness this violence so that the patient feels understood and heard, and thus to limit recurrences.
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Affiliation(s)
- Jonathan Lachal
- AP-HP, Hôpital Cochin, Maison de Solenn, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- INSERM, U1178, Paris, France
| | - Massimiliano Orri
- INSERM, U1178, Paris, France
- Université Paris Sud-Paris 11, Paris, France
| | - Jordan Sibeoni
- AP-HP, Hôpital Cochin, Maison de Solenn, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- INSERM, U1178, Paris, France
| | - Marie Rose Moro
- AP-HP, Hôpital Cochin, Maison de Solenn, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- INSERM, U1178, Paris, France
| | - Anne Revah-Levy
- INSERM, U1178, Paris, France
- Argenteuil Hospital Centre, Centre de Soins Psychothérapeutiques de Transition pour Adolescents, Argenteuil, France
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Sánchez-Teruel D, Muela-Martínez JA, García-León A. An Analysis of Suicide Attempts in Jaén Province (Andalusia-Spain). PSYCHOLOGY, COMMUNITY & HEALTH 2015. [DOI: 10.5964/pch.v4i1.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Aim Suicide is the leading cause of non-accidental death in Spain across both sexes and all age groups; however, data on suicide attempts by region are heterogeneous and little reported. This study aimed to examine the socio-demographic and epidemiological variables most strongly related to suicide attempts in Jaén province. Method Data on people who had attempted suicide over a 26-month period (2009–2011) were collected from the emergency departments of two hospitals via their electronic medical record systems specific to the Autonomous Community of Andalusia (Spain). Descriptive and frequency statistics were obtained and the relationship among variables was examined. Results Suicide attempters were aged 24 to 53 years, being primarily women (65.25%). The most frequent suicide method was medication ingestion (85.55%); thus, ingestion of toxic substances has become the preferred method among women (LR(3) = 14.731; p = .02). The hospitals discharged the patients (46.44%) or referred them to mental health services in the area (20.08%) following a suicide attempt. There were more hospital discharges when the attempt involved ingestion of toxic substances or self-harm (LR(12) = 20.603; p = .05), and in winter and spring (LR(12) = 69.772; p < .001). Conclusion The need for emergency departments to have prevention and intervention procedures in place, specifically designed for suicide attempts and at-risk individuals, is discussed.
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Ghosh RE, Close R, McCann LJ, Crabbe H, Garwood K, Hansell AL, Leonardi G. Analysis of hospital admissions due to accidental non-fire-related carbon monoxide poisoning in England, between 2001 and 2010. J Public Health (Oxf) 2015; 38:76-83. [PMID: 25755248 PMCID: PMC4750524 DOI: 10.1093/pubmed/fdv026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Accidental non-fire-related (ANFR) carbon monoxide (CO) poisoning is a cause of fatalities and hospital admissions. This is the first study that describes the characteristics of ANFR CO hospital admissions in England. Methods Hospital Episode Statistics (HES) inpatient data for England between 2001 and 2010 were used. ANFR CO poisoning admissions were defined as any mention of ICD-10 code T58: toxic effect of CO and X47: accidental poisoning by gases or vapours, excluding ICD-10 codes potentially related to fires (X00-X09, T20-T32 and Y26). Results There were 2463 ANFR CO admissions over the 10-year period (annual rate: 0.49/100 000); these comprised just under half (48.7%) of all non-fire-related (accidental and non-accidental) CO admissions. There was seasonal variability, with more admissions in colder winter months. Higher admission rates were observed in the north of England. Just over half (53%) of ANFR admissions were male, and the highest rates of ANFR admissions were in those aged >80 years. Conclusion The burden of ANFR CO poisoning is preventable. The results of this study suggest an appreciable burden of CO and highlight differences that may aid targeting of public health interventions.
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Affiliation(s)
- Rebecca E Ghosh
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Rebecca Close
- Department of Epidemiology, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot, Oxon OX11 0RQ, UK
| | - Lucy J McCann
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot, Oxon OX11 0RQ, UK
| | - Helen Crabbe
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot, Oxon OX11 0RQ, UK
| | - Kevin Garwood
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Anna L Hansell
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Giovanni Leonardi
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot, Oxon OX11 0RQ, UK London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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Abstract
Patients often become distressed in health settings, and provision of emotional support is a routine part of clinical care. However, in some situations, patient distress can become disturbing to both clinicians and patients, and can affect ordinary therapeutic engagement. We argue that health systems that support people presenting with suicidal acts and self-harm are particularly at risk of providing maladaptive responses, which we have termed dysregulation. If health systems become dysregulated, staff and patients might find it difficult to think clearly and respond adaptively. We describe some common characteristics of dysregulation, including negative feelings about patients, an inappropriately narrow focus on diagnosis and risk assessment, and ad-hoc, abrupt, and inconsistent decision making. These dysregulated responses might impair more adaptive responses such as containment of distress, safety planning, and negotiated responsibility with patients and carers. We discuss the main drivers of dysregulation and the implications for clinical practice in the management of self-harm and suicide risk.
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Peñas-Lledó E, Guillaume S, Delgado A, Naranjo MEG, Jaussent I, LLerena A, Courtet P. ABCB1 gene polymorphisms and violent suicide attempt among survivors. J Psychiatr Res 2015; 61:52-6. [PMID: 25543520 DOI: 10.1016/j.jpsychires.2014.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/09/2014] [Accepted: 12/05/2014] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Those suicide attempters that choose violent methods dramatically diminish the possibility of survival. Completed suicide using violent means, which is common among first-time suicide attempters, was recently found to be more likely among T allele carriers in the three most common ABCB1 SNPs, encoding for P-gp. Thus, this study examined, for the first time, whether these ABCB1 SNPs were associated with the use of violent means among survivors of a suicide attempt. MATERIAL AND METHODS Suicide attempters (n = 578, 87.4% women; of whom 16.6% committed a violent intent) were genotyped for exonic SNPs in the ABCB1 (C1236T, G2677T/A, C3435T). The relations of the three genotypes and of the TTT haplotype with the use of a violent suicide method were evaluated separately. The impact of confounds on these variables was controlled. RESULTS A higher frequency (p = 0.02) of suicide attempters using violent methods was found among those carrying the ABCB1 haplotype (1236TT-2677TT-3435TT). Since gender and number of previous suicide attempts were identified as confounds, the relation was tested in the subset of women who were first-time attempters or second- and more-time attempters. The ABCB1 haplotype increased the risk more than three times in those women attempting a violent suicide for the first time (OR = 3.6; CI95%: 1.08-12.09; p = 0.04). DISCUSSION The ABCB1 haplotype (1236TT-2677TT-3435TT) was related to the use of a violent suicide attempt method. Genotyping for these three ABCB1 SNPs may be helpful to detect people at risk of first suicide intents using violent methods.
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Affiliation(s)
- E Peñas-Lledó
- CICAB Clinical Research Center, Extremadura University Hospital & Medical School, Badajoz, Spain.
| | - S Guillaume
- CHU Montpellier, Hôpital Lapeyronie, Psychiatric Emergency and Post Acute Care Department, Pole Urgence, Montpellier, France; Inserm, U1061 Montpellier, Université Montpellier I, Montpellier, F-34000, France; FondaMental Foundation, France
| | - A Delgado
- CICAB Clinical Research Center, Extremadura University Hospital & Medical School, Badajoz, Spain
| | - M E G Naranjo
- CICAB Clinical Research Center, Extremadura University Hospital & Medical School, Badajoz, Spain
| | - I Jaussent
- Inserm, U1061 Montpellier, Université Montpellier I, Montpellier, F-34000, France; FondaMental Foundation, France
| | - A LLerena
- CICAB Clinical Research Center, Extremadura University Hospital & Medical School, Badajoz, Spain; CIBERSAM, Instituto de Salud Carlos III, Spain
| | - P Courtet
- CHU Montpellier, Hôpital Lapeyronie, Psychiatric Emergency and Post Acute Care Department, Pole Urgence, Montpellier, France; Inserm, U1061 Montpellier, Université Montpellier I, Montpellier, F-34000, France; FondaMental Foundation, France
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Singh GK, Lokhande A, Azuine RE. Global Inequalities in Youth Mortality, 2007-2012. Int J MCH AIDS 2015; 3:53-62. [PMID: 27621986 PMCID: PMC4948171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES There is limited cross-national research on youth mortality. We examined age-and gender-variations in all-cause mortality among youth aged 15-34 years across 52 countries. METHODS Using the 2014 WHO mortality database, mortality rates for all countries were computed for the latest available year between 2007 and 2012. Rates, rate ratios, and ordinary least squares (OLS) and Poisson regression were used to analyze international variation in mortality. RESULTS Mortality rates among youth aged 15-34 years varied from a low of 28.4 deaths per 100,000 population for Hong Kong to a high of 250.6 for Russia and 619.1 for South Africa. For men aged 15-34, Singapore and Hong Kong had the lowest mortality rates (≈40 per 100,000), compared with South Africa and Russia with rates of 589.7 and 383.3, respectively. Global patterns in mortality among women were similar. Youth aged 15-24 in South Africa had 14 times higher mortality and those in the Philippines, Mexico, Russia, Colombia, and Brazil had 5-7 times higher mortality than those in Hong Kong. Youth aged 25-34 in Russia and South Africa had, respectively, 10 and 29 times higher mortality than their counterparts in Hong Kong. United States (US) had the 12th highest mortality rate among youth aged 15-24 and the 13th highest rate among youth aged 25-34. Overall, the US youth had 2-3 times higher rates of mortality than their counterparts in many industrialized countries including Hong Kong, Singapore, Netherlands, Switzerland, Germany, Norway, and Sweden. Income inequality, unemployment rate, and human development explained 50-66% of the global variance in youth mortality. Compared to the countries with low unemployment and income inequality and high human development levels, countries with high unemployment and income inequality and low human development had, respectively, 343%, 213%, and 205% higher risks of youth mortality. CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS Marked international disparities in youth all-cause mortality largely reflect differences in violence and injury deaths and in such risk factors as unemployment, income inequality, human development, and alcohol consumption. The US ranks in the upper quartile of all-cause mortality, with youth in Canada and many western industrialized countries showing signifi cantly lower mortality risks than the US youth.
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Affiliation(s)
- Gopal K Singh
- The Center for Global Health and Health Policy, Global Health and Education Projects, Riverdale, Maryland 20738, USA
| | - Anagha Lokhande
- Richard Montgomery High School, 250 Richard Montgomery Drive, Rockville, Maryland 20852, USA
| | - Romuladus E Azuine
- The Center for Global Health and Health Policy, Global Health and Education Projects, Riverdale, Maryland 20738, USA
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Spiers N, Bebbington PE, Dennis MS, Brugha TS, McManus S, Jenkins R, Meltzer H. Trends in suicidal ideation in England: the national psychiatric morbidity surveys of 2000 and 2007. Psychol Med 2014; 44:175-183. [PMID: 23537549 DOI: 10.1017/s0033291713000317] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Recent falls in suicide rates should be accompanied by a decline in the prevalence of suicidal ideation. METHOD We used a pseudo-cohort analytic strategy to examine trends in suicidal ideation measured identically in 2000 and 2007, in nationally representative English probability samples of adults aged ≥ 16 years. Suicidal ideation included tiredness of life, death wishes and thoughts of suicide. Logistic regression models were fitted to estimate trends in age-specific prevalence of suicidal ideation in the past year and past week between 2000 and 2007. RESULTS There were 6799 participants aged 16-71 years in 2000, and 6815 participants aged 16-78 years in 2007. There was little evidence of trends in prevalence of suicidal ideation, with the exception of women aged 44-50 years in 2007, whose prevalence was unusually high. Prevalence of suicidal ideation in the past year followed a W-shaped profile with age, with peaks at the transition to adulthood, in the forties, and in the oldest participants. CONCLUSIONS Despite falling suicide rates, suicidal ideation did not decline overall between 2000 and 2007. This may indicate the success of the National Suicide Prevention Strategy. Women aged 44-50 years in 2007 were, however, particularly prone to suicidal ideation. As they also have the highest age-adjusted prevalence of common mental disorders and the highest female suicide rate, there are clear implications for treatment access, availability and delivery in primary care.
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Affiliation(s)
- N Spiers
- Department of Health Sciences, University of Leicester, UK
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Windfuhr K, While D, Hunt IM, Shaw J, Appleby L, Kapur N. Suicide and accidental deaths in children and adolescents in England and Wales, 2001-2010. Arch Dis Child 2013; 98:945-50. [PMID: 24013808 DOI: 10.1136/archdischild-2012-302539] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the impact of narrative verdicts on suicide statistics among 10-19-year-olds; to identify the number and rate of suicide and accidental deaths, particularly in 10-14-year-olds. DESIGN National cohort study. SETTING England and Wales. METHODS Mid-year population estimates from the Office for National Statistics (ONS) were used to calculate rates per 100,000 population for suicide (undetermined and suicide verdicts) and accidental deaths (poisoning, hanging) for those aged 10-14 and 15-19. Trends in rates over time (2001-2010) were investigated using Poisson regression. Interaction tests were carried out to determine differences in trends between the two time periods (2001-2005 and 2006-2010). RESULTS There were 1523 suicides (2.25/100,000). Suicide rates were highest in those aged 15-19 years (4.04/100,000) and in males (3.14/100,000). Between 2001 and 2010, rates significantly decreased among those aged 15-19 years (incidence rate-ratio (IRR): 0.95; 95% CI 0.93 to 0.97), with no change in rates of accidental deaths (IRR: 1.01, 95% CI 0.95 to 1.07). However, there was a significant interaction between the two time periods for accidental poisonings (2001-2005: IRR: 0.79 (95% CI 0.69 to 0.91); 2006-2010: IRR: 1.01 (95% CI 0.89 to 1.15), interaction p=0.012) and accidental hangings (2001-2005: IRR: 0.93 (95% CI 0.76 to 1.14); 2006-2010: IRR: 1.25 (95% CI 1.04 to 1.49), interaction=0.01) Undetermined deaths significantly decreased among females aged 15-19 yeras (IRR: 0.93; 95% CI 0.88 to 0.98). There were no significant trends among 10-14-year-olds. CONCLUSIONS Rates of suicide are higher among older adolescents and males. There was a significant fall in suicide rates in males aged 15-19 years that was not accounted for by changes in rates of accidental death. The absence of a significant trend in suicide or accidental deaths in those aged 10-14 years may have been the result of small numbers. However, monitoring should continue to identify longitudinal trends in all young people.
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Affiliation(s)
- Kirsten Windfuhr
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Centre for Mental Health and Risk, Institute of Brain, Behaviour and Mental Health, University of Manchester, , Manchester, UK
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Rhodes AE, Skinner R, McFaull S, Katz LY. Canada-wide effect of regulatory warnings on antidepressant prescribing and suicide rates in boys and girls. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:640-5. [PMID: 24246435 DOI: 10.1177/070674371305801110] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the impact of the Health Canada regulatory warnings regarding antidepressant (AD) prescribing on suicide rates in boys and girls under the age of 18 and aged 18 to 19 years in Canada between 2004 and 2009. We hypothesized that an increase in suicide rates would be specific to girls, reflecting higher AD prescribing rates in girls than boys. METHOD We graphed and tested the difference between Canada-wide suicide rates before and after the regulatory warning periods (either from 1995 to 2006 or from 1995 to 2009) in boys and girls under the age of 18 or aged 18 to 19 years. For comparison with prior studies, we estimated rate ratios and 95% confidence intervals using either Poisson regression or negative binomial regression. RESULTS There was no statistically significant increase in suicide rates in girls under the age of 18, or aged 18 to 19 years in response to the AD regulatory warnings. In boys under the age of 18 or aged 18 to 19 years, suicide rates declined after 2003. CONCLUSIONS We did not find increased rates of suicide after the AD regulatory warnings in boys or girls under the age of 18 or aged 18 to 19 years in Canada-wide rates. However, this does not rule out the possibility that such an effect occurred in some jurisdictions in girls and (or) the regulatory warnings prevented the trend toward declining suicide rates. Factors influencing the downward trend in boys merit further attention.
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Affiliation(s)
- Anne E Rhodes
- Research Scientist, The Suicide Studies Research Unit and the Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario; Associate Professor, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario; Associate Professor, Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, Toronto, Ontario; Adjunct Scientist, The Institute for Clinical Evaluative Sciences, Toronto, Ontario
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Ougrin D, Boege I, Stahl D, Banarsee R, Taylor E. Randomised controlled trial of therapeutic assessment versus usual assessment in adolescents with self-harm: 2-year follow-up. Arch Dis Child 2013; 98:772-6. [PMID: 23709314 DOI: 10.1136/archdischild-2012-303200] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND An earlier randomised controlled trial demonstrated improved treatment engagement in adolescents who received Therapeutic Assessment (TA) versus Assessment As Usual (AAU), following an emergency presentation with self-harm. OBJECTIVES To determine 2-year outcomes for the same adolescents focusing on frequency of Accident and Emergency (A&E) self-harm presentations and treatment engagement. METHOD Patients in the TA groups (n=35) and the AAU group (n=34) were followed up 2 years after the initial assessment. Their primary and secondary care electronic records were analysed. RESULTS There was no significant difference in the frequency of self-harm resulting in A&E presentations between the two groups (OR 0.69, 95% CI 0.23 to 2.13, p=0.53). Treatment engagement remained higher in the TA group than the AAU group. CONCLUSIONS TA is not associated with a lower frequency of A&E self-harm presentations. The effect of TA on engagement is maintained 2 years after the initial assessment. Interventions to reduce self-harm in adolescents are needed. TRIAL REGISTRATION ISRCTN 81605131, http://www.controlled-trials.com/ISRCTN81605131/
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Affiliation(s)
- Dennis Ougrin
- Department of Child , and Adolescent Psychiatry, King's College London, Institute of Psychiatry, , London, UK
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Singh GK, Azuine RE, Siahpush M, Kogan MD. All-cause and cause-specific mortality among US youth: socioeconomic and rural-urban disparities and international patterns. J Urban Health 2013; 90:388-405. [PMID: 22772771 PMCID: PMC3665977 DOI: 10.1007/s11524-012-9744-0] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We analyzed international patterns and socioeconomic and rural-urban disparities in all-cause mortality and mortality from homicide, suicide, unintentional injuries, and HIV/AIDS among US youth aged 15-24 years. A county-level socioeconomic deprivation index and rural-urban continuum measure were linked to the 1999-2007 US mortality data. Mortality rates were calculated for each socioeconomic and rural-urban group. Poisson regression was used to derive adjusted relative risks of youth mortality by deprivation level and rural-urban residence. The USA has the highest youth homicide rate and 6th highest overall youth mortality rate in the industrialized world. Substantial socioeconomic and rural-urban gradients in youth mortality were observed within the USA. Compared to their most affluent counterparts, youth in the most deprived group had 1.9 times higher all-cause mortality, 8.0 times higher homicide mortality, 1.5 times higher unintentional-injury mortality, and 8.8 times higher HIV/AIDS mortality. Youth in rural areas had significantly higher mortality rates than their urban counterparts regardless of deprivation levels, with suicide and unintentional-injury mortality risks being 1.8 and 2.3 times larger in rural than in urban areas. However, youth in the most urbanized areas had at least 5.6 times higher risks of homicide and HIV/AIDS mortality than their rural counterparts. Disparities in mortality differed by race and sex. Socioeconomic deprivation and rural-urban continuum were independently related to disparities in youth mortality among all sex and racial/ethnic groups, although the impact of deprivation was considerably greater. The USA ranks poorly in all-cause mortality, youth homicide, and unintentional-injury mortality rates when compared with other industrialized countries.
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Affiliation(s)
- Gopal K Singh
- Health Resources and Services Administration, Maternal and Child Health Bureau, US Department of Health and Human Services, Rockville, MD, USA.
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Cutcliffe JR, McKenna H, Keeney S, Stevenson C, Jordan J. 'Straight from the horse's mouth': rethinking and reconfiguring services in Northern Ireland in response to suicidal young men. J Psychiatr Ment Health Nurs 2013; 20:466-72. [PMID: 23145993 DOI: 10.1111/jpm.12012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ougrin D, Zundel T, Ng AV, Habel B, Latif S. Teaching therapeutic assessment for self-harm in adolescents: training outcomes. Psychol Psychother 2013; 86:70-85. [PMID: 23386556 DOI: 10.1111/j.2044-8341.2011.02047.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe the teaching programme of Therapeutic Assessment (TA), a brief intervention at the point of initial assessment for adolescents with self-harm; to describe trainees' preferences and choices regarding their use of specific aspects of TA. DESIGN This is a comparative study investigating the differences in the TA skills before and after training. This design was chosen to establish whether or not TA training is efficacious. METHODS Twenty-four clinicians volunteered to participate in five half-day TA training sessions. Their scores on the Therapeutic Assessment Quality Assurance Tool (TAQAT, primary outcome measure) were compared before and after training. Satisfaction with training and therapeutic strategy choices as well as ability to perform TA in an RCT were investigated. RESULTS Clinicians who participated in TA training had significantly increased scores on TAQAT after training. The clinicians who achieved the required quality of TA post assessments were likely to be able to carry out TA in an RCT with high fidelity. In addition, prior to training, significant differences in the quality of assessments as measured by TAQAT were identified depending on the experience of the clinician. This discrepancy was no longer present post training. Therapeutic strategy based on solution-focused brief therapy (SFBT) was the option of choice post training. CONCLUSIONS TA training is feasible and associated with improved quality of self-harm assessment. PRACTITIONER POINTS TA is a brief intervention associated with improved treatment engagement. TA training is feasible and is associated with improved quality of self-harm assessment. SFBT-based exit is the most commonly used strategy in TA.
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Affiliation(s)
- Dennis Ougrin
- Institute of Psychiatry, Child and Adolescent Psychiatry, King's College London, UK
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Mendez-Bustos P, Lopez-Castroman J, Baca-García E, Ceverino A. Life cycle and suicidal behavior among women. ScientificWorldJournal 2013; 2013:485851. [PMID: 23533350 PMCID: PMC3603326 DOI: 10.1155/2013/485851] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 01/23/2013] [Indexed: 11/17/2022] Open
Abstract
It is nowadays accepted that, independently of methodological issues, women commit fewer suicides than men but make more frequent attempts. Yet, female suicidal risk varies greatly along the lifetime and is linked to the most significant moments in it. A wide analysis of the existing literature was performed to provide a narrative description on the evolution of female suicidal rates from childhood to old age, considering the milestones in their life history. A detailed analysis of gender differences in suicidal behavior is key to establish preventive measures and priorities. More specific studies are needed to adapt future interventions on female suicide.
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Affiliation(s)
- Pablo Mendez-Bustos
- Department of Psychology, Catholic University of Maule, Avenida San Miguel 3605, Talca, Chile
| | - Jorge Lopez-Castroman
- Department of Psychiatry, Fundacion Jimenez Diaz Hospital, Autonoma University, CIBERSAM Avenida Reyes Catolicos 2, 28040 Madrid, Spain
| | - Enrique Baca-García
- Department of Psychiatry, Fundacion Jimenez Diaz Hospital, Autonoma University, CIBERSAM Avenida Reyes Catolicos 2, 28040 Madrid, Spain
- Department of Psychiatry, New York State Psychiatric Institute Columbia University, 1051 Riverside Drive, New York, NY 10032, USA
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Légaré G, Hamel D. An age-period-cohort approach to analyzing trends in suicide in Quebec between 1950 and 2009. Canadian Journal of Public Health 2013. [PMID: 23618203 DOI: 10.1007/bf03405674] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Suicide rates in Quebec over the second half of the 20th century show a wide range of variation depending on age and time period. However, few studies have verified the presence of a cohort effect affecting trends in Quebec suicide rates. This study is designed to evaluate the potential effects of age, period and cohort (APC) on trends in suicide between 1950 and 2009 in Quebec. METHOD For these APC analyses, we used a multiphase approach combining a graphical inspection followed by an analysis that isolates the cohort effect from age and period effects (linear regression of the residuals from a median polish of the rates). RESULTS The graphical inspection of trends in rates points to combined effects of age, period and cohort among both men and women. However, the median polish analysis attributes primary importance to period effects, followed by age effects, but also shows weak cohort effects that are significant only among men born between 1950 and 1979. CONCLUSION The variation in Quebec suicide rates appears to be primarily a reflection of period, age and, to a lesser degree, birth cohort. Thus, in addition to sex, selection of risk groups should be based more on age and time period than on birth cohort.
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Affiliation(s)
- Gilles Légaré
- Institut national de santé publique du Québec and Université du Québec à Rimouski, Rimouski, QC.
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Légaré G, Hamel D. An age-period-cohort approach to analyzing trends in suicide in Quebec between 1950 and 2009. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2013; 104:e118-23. [PMID: 23618203 PMCID: PMC6974023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 02/05/2013] [Accepted: 02/15/2013] [Indexed: 11/14/2023]
Abstract
OBJECTIVE Suicide rates in Quebec over the second half of the 20th century show a wide range of variation depending on age and time period. However, few studies have verified the presence of a cohort effect affecting trends in Quebec suicide rates. This study is designed to evaluate the potential effects of age, period and cohort (APC) on trends in suicide between 1950 and 2009 in Quebec. METHOD For these APC analyses, we used a multiphase approach combining a graphical inspection followed by an analysis that isolates the cohort effect from age and period effects (linear regression of the residuals from a median polish of the rates). RESULTS The graphical inspection of trends in rates points to combined effects of age, period and cohort among both men and women. However, the median polish analysis attributes primary importance to period effects, followed by age effects, but also shows weak cohort effects that are significant only among men born between 1950 and 1979. CONCLUSION The variation in Quebec suicide rates appears to be primarily a reflection of period, age and, to a lesser degree, birth cohort. Thus, in addition to sex, selection of risk groups should be based more on age and time period than on birth cohort.
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Affiliation(s)
- Gilles Légaré
- Institut national de santé publique du Québec and Université du Québec à Rimouski, Rimouski, QC.
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36
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Jordan J, McKenna H, Keeney S, Cutcliffe J, Stevenson C, Slater P, McGowan I. Providing meaningful care: learning from the experiences of suicidal young men. QUALITATIVE HEALTH RESEARCH 2012; 22:1207-1219. [PMID: 22785623 DOI: 10.1177/1049732312450367] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Little is known about young suicidal men's preferences for care. Using a broad interpretive approach, we interviewed 36 formerly suicidal young men in a study addressing the development and provision of mental health services. Our analysis yielded three core categories: widening access and bolstering proactive outreach, on becoming a man, and equipping young men for future challenges. Collectively, these categories suggest key features and processes of appropriate service configuration and clinical care: (a) services that reach out proactively serve to encourage young men's initial and ongoing engagement; (b) care delivered over the long term ensures a necessary focus on a meaningful future life; (c) mental health professionals (MHPs) are centrally involved alongside significant others, including those with personal experience of suicide; and (d) the development of a vital interpersonal connection is based on MHPs actively communicating their empathy, open-mindedness, and interest in a young man's unique biography.
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Barr B, Taylor-Robinson D, Scott-Samuel A, McKee M, Stuckler D. Suicides associated with the 2008-10 economic recession in England: time trend analysis. BMJ 2012; 345:e5142. [PMID: 22893569 PMCID: PMC3419273 DOI: 10.1136/bmj.e5142] [Citation(s) in RCA: 256] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2012] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To determine whether English regions worst affected by the economic recession in the United Kingdom in 2008-10 have had the greatest increases in suicides. DESIGN Time trend analysis comparing the actual number of suicides with those that would be expected if pre-recession trends had continued. Multivariate regression models quantified the association between changes in unemployment (based on claimant data) and suicides (based on data from the National Clinical Health Outcomes Database). SETTING 93 English regions, based on the Nomenclature of Territorial Units Statistics level 3 groupings of local authorities at county level and groups of unitary local authorities. PARTICIPANTS Men and women with a record of death from suicide or injury of undetermined cause in 2000-10. MAIN OUTCOME MEASURE Number of excess suicides during the economic recession (2008-10). RESULTS Between 2008 and 2010, we found 846 (95% confidence interval 818 to 877) more suicides among men than would have been expected based on historical trends, and 155 (121 to 189) more suicides among women. Historically, short term yearly fluctuations in unemployment have been associated with annual changes in suicides among men but not among women. We estimated that each 10% increase in the number of unemployed men was significantly associated with a 1.4% (0.5% to 2.3%) increase in male suicides. These findings suggest that about two fifths of the recent increase in suicides among men (increase of 329 suicides, 126 to 532) during the 2008-10 recession can be attributed to rising unemployment. CONCLUSION The study provides evidence linking the recent increase in suicides in England with the financial crisis that began in 2008. English regions with the largest rises in unemployment have had the largest increases in suicides, particularly among men.
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Affiliation(s)
- Ben Barr
- Department of Public Health and Policy, University of Liverpool, Liverpool L69 3GB UK.
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Abstract
Suicide is second to only accidental death as the leading cause of mortality in young men across the world. Although suicide rates for young men have fallen in some high-income and middle-income countries since the 1990s, wider mortality measures indicate that rates remain high in specific regions, ethnic groups, and socioeconomic groups within those nations where rates have fallen, and that young men account for a substantial proportion of the economic cost of suicide. High-lethality methods of suicide are preferred by young men: hanging and firearms in high-income countries, pesticide poisoning in the Indian subcontinent, and charcoal-burning in east Asia. Risk factors for young men include psychiatric illness, substance misuse, lower socioeconomic status, rural residence, and single marital status. Population-level factors include unemployment, social deprivation, and media reporting of suicide. Few interventions to reduce suicides in young men have been assessed. Efforts to change help-seeking behaviour and to restrict access to frequently used methods hold the most promise.
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Affiliation(s)
- Alexandra Pitman
- University College London Mental Health Sciences Unit, London, UK.
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Zerbini T, Ponce JDC, Mayumi Sinagawa D, Barbosa Cintra R, Muñoz DR, Leyton V. Blood alcohol levels in suicide by hanging cases in the state of Sao Paulo, Brazil. J Forensic Leg Med 2012; 19:294-6. [PMID: 22687772 DOI: 10.1016/j.jflm.2012.02.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 02/08/2012] [Accepted: 02/14/2012] [Indexed: 12/31/2022]
Abstract
Suicide is one of the main causes of violent death worldwide, and has become a public health issue. Since alcohol consumption is associated with the increase in the number of suicides and hanging is one of the main methods used worldwide, the present study consists of an epidemiological analysis of BACs in victims of suicide by hanging autopsied in the State of Sao Paulo, Brazil. The objective of the present work was to establish an epidemiological profile and evaluate blood alcohol concentrations in victims of suicide by hanging in the State of São Paulo, Brazil, in the year of 2007. A cross-sectional retrospective study was conducted by collection of secondary data from autopsy reports of victims of hanging. According to the present study, positive results for alcohol were higher in male victims, but the mean BAC was higher in women.
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Mok PLH, Kapur N, Windfuhr K, Leyland AH, Appleby L, Platt S, Webb RT. Trends in national suicide rates for Scotland and for England & Wales, 1960-2008. Br J Psychiatry 2012; 200:245-51. [PMID: 22322460 DOI: 10.1192/bjp.bp.111.092908] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Suicide rates in Scotland have increased markedly relative to those in England in recent decades. AIMS To compare changing patterns of suicide risk in Scotland with those in England & Wales, 1960-2008. METHOD For Scotland and for England & Wales separately, we obtained national data on suicide counts and population estimates. Gender-specific, directly age-standardised rates were calculated. RESULTS We identified three distinct temporal phases: 1960-1967, when suicide rates in England & Wales were initially higher than in Scotland, but then converged; 1968-1991, when male suicide rates in Scotland rose slightly faster than in England & Wales; and 1992-2008, when there was a marked divergence in national trends. Much of the recent divergence in rates is attributable to the rise in suicide among young men and deaths by hanging in Scotland. Introduction of the 'undetermined intent' category in 1968 had a significant impact on suicide statistics across Great Britain, but especially so in Scotland. CONCLUSIONS Differences in temporal patterns in suicide risk between the countries are complex. Reversal of the divergent trends may require a change in the perception of hanging as a 'painless' method of suicide.
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Affiliation(s)
- Pearl L H Mok
- Centre for Suicide Prevention, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Canetto SS, Cleary A. Men, masculinities and suicidal behaviour. Soc Sci Med 2012; 74:461-5. [DOI: 10.1016/j.socscimed.2011.11.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 11/03/2011] [Indexed: 01/25/2023]
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Hawton K, Bergen H, Mahadevan S, Casey D, Simkin S. Suicide and deliberate self-harm in Oxford University students over a 30-year period. Soc Psychiatry Psychiatr Epidemiol 2012; 47:43-51. [PMID: 21076914 DOI: 10.1007/s00127-010-0310-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 10/18/2010] [Indexed: 11/27/2022]
Abstract
PURPOSE To determine whether rates of suicide and self-harm in university students differ from those in other young people. METHODS We obtained information on Oxford University students who died by suicide or presented to hospital following deliberate self-harm (DSH) between 1976 and 2006 from official records and a General Hospital monitoring system in Oxford. Rates of suicide and self-harm in the students and in other young people in the general population were calculated from university, local and national population figures. RESULTS Forty-eight Oxford University students (32 males and 16 females) died by suicide. Most (N = 42) were aged 18-25 years. The suicide rate did not differ from that of other people in this age group in England and Wales (SMR 105.4; 95% CI 75.2, 143.4). There was evidence of clustering of methods of suicide over time. During the same period, 602 students (383 females and 219 males) presented to the General Hospital following DSH. Most (90.7%) were aged 15-24 years, in which age group rates of DSH (per 100,000) during term-time were lower than in other young people in Oxford City (females: 206.5 vs. 285.6, z = -5.03, p < 0.001; males: 75.9 vs. 111.2, z = -4.35; p < 0.001). There was an excess of student DSH episodes in the main exam term. CONCLUSIONS Contrary to earlier findings and popular belief, suicide rates in Oxford University students do not differ from those in other young people. Rates of DSH are significantly lower than in other young people. Risk of DSH may increase around the time of examinations.
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Affiliation(s)
- Keith Hawton
- Department of Psychiatry, Warneford Hospital, University of Oxford Centre for Suicide Research, Headington, Oxford OX3 7JX, UK.
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Abstract
Suicide has reached epidemic proportions in the elderly, particularly in non-Hispanic white men. Unfortunately, the risk is underappreciated in this population. Known risk correlates for suicide in this population fall into three interrelated categories. Sociologic factors include such considerations as living alone and having few social interactions. Physical health factors include having more medical comorbidity and being a current smoker. The mental health risk factors include the presence of mood and anxiety disorders with a focus on the greater severity of symptoms, especially hypersomnia, hopelessness, and a history of suicide attempts. Suicide is a spectrum comprising ideation, intent, and plan. Clinical depression is never a normal part of aging and warrants aggressive treatment. Recent warnings linking antidepressants and suicide may have special relevance in the elderly. Based on preliminary studies with antipsychotic drugs, a subgroup of patients who experience akathisia may be particularly vulnerable to suicide. Upon initiation of antidepressants, it is recommended that adults be seen in follow-up three times within the first 12 weeks of treatment; if medically indicated, the first contact should be during the first week.
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Affiliation(s)
- David W Crumpacker
- Department of Psychiatry, Baylor University Medical Center, Dallas, Texas, USA.
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Humber N, Piper M, Appleby L, Shaw J. Characteristics of and trends in subgroups of prisoner suicides in England and Wales. Psychol Med 2011; 41:2275-2285. [PMID: 21557891 DOI: 10.1017/s0033291711000705] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The suicide rate is higher in prisoners compared with the general population. The aim was to describe the characteristics of and longitudinal trends in prisoner suicides in England and Wales. METHOD A case series was ascertained from the Safer Custody and Offender Policy Group at the Ministry of Justice and included a 9-year (1999-2007) national census of prisoner suicides. Questionnaires were completed by prison staff on sociodemographic, custodial, clinical and service-level characteristics of the suicides. RESULTS There was a fall in the number of prison suicides and a decline in the proportion of young prisoner (18-20 years) suicides over time. Females were over-represented. Upward trends were found in prisoners with a history of violence and with previous mental health service contact. A downward trend was found in those with a primary psychiatric diagnosis of drug dependence. Drug dependence was found to be significant in explaining suicides within the first week of custody. CONCLUSIONS The findings provide an important insight to aid a target set in the National Suicide Prevention Strategy in England to reduce suicides in the prisoner population by 20% and highlight an important area for policy development in mental health services. Examining trends identified subgroups that may require improved mental healthcare and recognized those that appeared to be having their treatment needs more adequately met. Evidence suggests that targeted suicide prevention strategies for subgroups of prisoners are required.
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Affiliation(s)
- N Humber
- Centre for Suicide Prevention, School of Community-Based Medicine, University of Manchester, Manchester, UK.
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Owens C, Owen G, Belam J, Lloyd K, Rapport F, Donovan J, Lambert H. Recognising and responding to suicidal crisis within family and social networks: qualitative study. BMJ 2011; 343:d5801. [PMID: 22010126 PMCID: PMC3273734 DOI: 10.1136/bmj.d5801] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2011] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To shed light on the difficulties faced by relatives, friends, and colleagues in interpreting signs of suicidality and deciding whether and how to intervene. DESIGN Qualitative study of completed suicides, based on in-depth interviews with multiple informants. SETTING London, southwest England, and south Wales. PARTICIPANTS 31 lay informants (one to five for each case), including parents, partners, siblings, friends, and colleagues of 14 cases of suicide in which the deceased was aged 18-34 and was not in contact with secondary mental health services. RESULTS Informants described both intellectual and emotional barriers to awareness and intervention within the family and social network. They reported that signs and communications of distress were often oblique and difficult to interpret, that they may have disregarded warning signals and focused instead on positive signs, and that, even when they were aware that something was seriously wrong, taking any action at all involved considerable personal risks. CONCLUSIONS As the suicidal process unfolds, significant others are faced with a highly complex task. Their proximity to the suicidal person and their emotional investment in the relationship make it difficult for them to see what is happening, to say anything to the person or to other members of the network, or to seek help outside the network. Efforts to strengthen the capacity of lay people to play a role in preventing suicide are urgently needed and should be informed by a thorough understanding of these difficulties. They should highlight the ambiguous nature of warning signs and should focus on helping people to acknowledge and overcome their fears about intervening.
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Affiliation(s)
- Christabel Owens
- Devon Partnership NHS Trust, Salmon Pool Lane, Exeter EX2 4SG, UK.
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Ceccherini-Nelli A, Priebe S. Economic factors and suicide rates: associations over time in four countries. Soc Psychiatry Psychiatr Epidemiol 2011; 46:975-82. [PMID: 20652218 DOI: 10.1007/s00127-010-0275-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Accepted: 07/08/2010] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Suicides account for more than 30,000 deaths per year in the US alone. Suicide rates change over time, and the factors influencing them remain poorly understood. Economic factors, in particular unemployment, have been suggested as a major influence. However, the evidence for this has been inconsistent, which may be partly explained by shortcomings of the statistical methods used. METHODS Time series analytical techniques (unit root and co-integration tests) were applied to test the associations over time between economic factors, i.e. unemployment, real gross domestic product per capita (RGDP) and the consumer price index (CPI) and death rates by suicide as collected by national agencies in the UK (1901-2006), US (1900-1997), France (1970-2004) and Italy (1970-2001). Traditional correlation analyses were used when appropriate. RESULTS Co-integration and correlation tests showed a long-run association between economic factors and suicide rates. Increase/decrease of unemployment predicted an increase/decrease of suicide rates over long historical periods and in different nations. RGDP and the CPI were also linked with suicide rates, but this was not consistently so and the direction of the association varied. CONCLUSIONS Unemployment is a major factor influencing suicide rates over long periods of time and in different national contexts. It needs to be considered as a confounding factor in evaluations of suicide prevention strategies.
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Hoang U, Stewart R, Goldacre MJ. Mortality after hospital discharge for people with schizophrenia or bipolar disorder: retrospective study of linked English hospital episode statistics, 1999-2006. BMJ 2011; 343:d5422. [PMID: 21914766 PMCID: PMC3172324 DOI: 10.1136/bmj.d5422] [Citation(s) in RCA: 147] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2011] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate whether the mortality gap has reduced in recent years between people with schizophrenia or bipolar disorder and the general population. DESIGN Record linkage study. SETTING English hospital episode statistics and death registration data for patients discharged 1999-2006. PARTICIPANTS People discharged from inpatient care with a diagnosis of schizophrenia or bipolar disorder, followed for a year after discharge. MAIN OUTCOME MEASURES Age standardised mortality ratios at each time, comparing the mortality in people with schizophrenia or bipolar disorder with mortality in the general population. Poisson test of trend was used to investigate trend in ratios over time. RESULTS By 2006 standardised mortality ratios in the psychiatric cohorts were about double the population average. The mortality gap widened over time. For people discharged with schizophrenia, the ratio was 1.6 (95% confidence interval 1.5 to 1.8) in 1999 and 2.2 (2.0 to 2.4) in 2006 (P < 0.001 for trend). For bipolar disorder, the ratios were 1.3 (1.1 to 1.6) in 1999 and 1.9 (1.6 to 2.2) in 2006 (P = 0.06 for trend). Ratios were higher for unnatural than for natural causes. About three quarters of all deaths, however, were certified as natural, and increases in ratios for natural causes, especially circulatory disease and respiratory diseases, were the main components of the increase in all cause mortality. CONCLUSIONS The total burden of premature deaths from natural causes in people with schizophrenia or bipolar disorder is substantial. There is a need for better understanding of the reasons for the persistent and increasing gap in mortality between discharged psychiatric patients and the general population, and for continued action to target risk factors for both natural and unnatural causes of death in people with serious mental illness.
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Affiliation(s)
- Uy Hoang
- Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford, Oxford OX3 7LF, UK.
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MacFarlane E, Simpson P, Benke G, Sim MR. Suicide in Australian pesticide-exposed workers. Occup Med (Lond) 2011; 61:259-64. [DOI: 10.1093/occmed/kqr031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Windfuhr K, Kapur N. Suicide and mental illness: a clinical review of 15 years findings from the UK National Confidential Inquiry into Suicide. Br Med Bull 2011; 100:101-21. [PMID: 21948337 DOI: 10.1093/bmb/ldr042] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Suicide risk is most commonly associated with mental illness. In particular, suicide in people under mental health care presents distinct patterns of risk and opportunities for prevention due to their close proximity to specialist care. SOURCES OF DATA The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (Inquiry) is a unique UK-wide national database of all suicide cases in contact with mental health services in the 12 months preceding suicide. This review presents Inquiry findings from the beginning of the Inquiry in 1996 up to the present (2011) (15 years). AREAS OF AGREEMENT Suicide varies substantially by socio-demographic (age, gender) and clinical features (e.g. diagnosis; care variables). Effective suicide prevention initiatives should incorporate research findings to inform clinical practice and policy. AREAS OF CONTROVERSY Risk assessment remains one of the most difficult areas of clinical practice and management although all areas of clinical practice, research and policy development would benefit from continued high-quality studies. GROWING POINTS The Inquiry work has positively influenced mental health practice and policy in the UK. These changes include: falling suicide rates in mental health patients, informing suicide prevention strategies and developing safety checklists for mental health services. AREAS TIMELY FOR DEVELOPING RESEARCH Investigating suicide in non-mental health settings, investigating suicide following different treatment services and investigating models of service delivery could usefully inform future directions for improving patient safety.
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Affiliation(s)
- Kirsten Windfuhr
- Centre for Mental Health and Risk, 2nd Floor, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK.
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Pompili M, Innamorati M, Vichi M, Masocco M, Vanacore N, Lester D, Serafini G, Tatarelli R, De Leo D, Girardi P. Inequalities and impact of socioeconomic-cultural factors in suicide rates across Italy. CRISIS 2011; 32:178-185. [PMID: 21940252 DOI: 10.1027/0227-5910/a000084] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2025]
Abstract
BACKGROUND Suicide is a major cause of premature death in Italy and occurs at different rates in the various regions. AIMS The aim of the present study was to provide a comprehensive overview of suicide in the Italian population aged 15 years and older for the years 1980-2006. METHODS Mortality data were extracted from the Italian Mortality Database. RESULTS Mortality rates for suicide in Italy reached a peak in 1985 and declined thereafter. The different patterns observed by age and sex indicated that the decrease in the suicide rate in Italy was initially the result of declining rates in those aged 45+ while, from 1997 on, the decrease was attributable principally to a reduction in suicide rates among the younger age groups. It was found that socioeconomic factors underlined major differences in the suicide rate across regions. CONCLUSIONS The present study confirmed that suicide is a multifaceted phenomenon that may be determined by an array of factors. Suicide prevention should, therefore, be targeted to identifiable high-risk sociocultural groups in each country.
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Affiliation(s)
- Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Functions, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Italy.
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