51
|
Denney JT, Wadsworth T, Rogers RG, Pampel FC. Suicide in the City: Do Characteristics of Place Really Influence Risk? SOCIAL SCIENCE QUARTERLY 2015; 96:313-329. [PMID: 26236047 PMCID: PMC4519975 DOI: 10.1111/ssqu.12165] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE This article investigates the role of social context on individual suicide mortality with attention paid to the possibility that contextual effects are simply the sum of individual characteristics associated with suicide. METHODS We use restricted data from the 1986-2006 National Health Interview Survey-Linked Mortality Files, which include nearly one million records and 1,300 suicides, to examine the role of familial and socioeconomic context on adult suicide. RESULTS Results show that adults living in cities with more socioeconomic disadvantage and fewer families living together have higher odds of suicidal death than adults living in less disadvantaged cities and cities with more families living together, respectively, after controlling for individual-level socioeconomic status, marital status, and family size. CONCLUSION The findings support classic sociological arguments that the risk of suicide is indeed influenced by the social milieu and cannot simply be explained by the aggregation of individual characteristics.
Collapse
|
52
|
Sgobin SMT, Traballi ALM, Botega NJ, Coelho OR. Direct and indirect cost of attempted suicide in a general hospital: cost-of-illness study. SAO PAULO MED J 2015; 133:218-26. [PMID: 26176926 PMCID: PMC10876379 DOI: 10.1590/1516-3180.2014.8491808] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 03/03/2014] [Accepted: 08/15/2014] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Knowledge of socioeconomic impact of attempted suicide may sensitize managers regarding prevention strategies. There are no published data on this in Brazil. The aim here was to describe the direct and indirect costs of care of hospitalized cases of attempted suicide and compare these with the costs of acute coronary syndrome cases. DESIGN AND SETTING Cost-of-illness study at a public university hospital in Brazil. METHOD The costs of care of 17 patients hospitalized due to attempted suicide were compared with those of 17 acute coronary syndrome cases at the same hospital, over the same period. The direct costs were the summation of the hospital and out-of-hospital costs resulting from the event, determined from the medical records. The indirect costs were estimated through the human capital lost. The Mann-Whitney test and analysis of covariance (ANCOVA) with transformation adjusted for age were used for comparisons. RESULTS The average costs per episode of attempted suicide were: direct cost, US$ 6168.65; indirect cost, US$ 688.08; and total cost, US$ 7163.75. Comparative analysis showed a difference between the indirect costs to family members, with significantly higher costs in the attempted suicide group (P = 0.0022). CONCLUSION The cost of care relating to attempted suicide is high and the indirect cost to family members reinforces the idea that suicidal behavior not only affects the individual but also his social environment.
Collapse
Affiliation(s)
- Sara Maria Teixeira Sgobin
- MSc. Collaborating Physician, Department of Medical Psychology and Psychiatry Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil.
| | - Ana Luisa Marques Traballi
- MD. Collaborating Physician, Department of Medical Psychology and Psychiatry Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil.
| | - Neury José Botega
- PhD. Titular Professor, Department of Medical Psychology and Psychiatry, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil.
| | - Otávio Rizi Coelho
- PhD. Titular Professor, Department of Cardiology, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil.
| |
Collapse
|
53
|
Kattimani S, Sarkar S, Rajkumar RP, Menon V. Stressful life events, hopelessness, and coping strategies among impulsive suicide attempters. J Neurosci Rural Pract 2015; 6:171-6. [PMID: 25883475 PMCID: PMC4387806 DOI: 10.4103/0976-3147.153222] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Suicides are among the most important causes of death in the economically productive population. Characteristics of impulsive and nonimpulsive suicide attempters may differ which would have a bearing on planning preventive measures. Aims: This study aimed to characterize the clinical and psychological profile of impulsive and nonimpulsive suicide attempters. Settings and Design: This retrospective comprehensive chart-based study was conducted at a tertiary care hospital in South India. Methods: The study utilized records of patients over a period of 3 years. An attempt was considered impulsive if the time between suicidal idea and the attempt was <30 min. Stressful life events were assessed using presumptive stressful life events scale; hopelessness was evaluated using Beck Hopelessness Scale (BHS) and coping was measured using Coping Strategies Inventory Short Form. Statistical Analysis Used: Impulsive and nonimpulsive suicide attempters were compared using appropriate inferential statistical tests. Results: Of 316 patients, 151 were classified as having an impulsive suicidal attempt (47.8% of the sample). The impulsive and nonimpulsive suicide attempters did not differ on demographic characteristics. Use of natural plant products was more common in impulsive attempters (27.2% vs. 12.7%), while physical methods like hanging was less common (0.7% vs. 7.3%). Those with an impulsive attempt were more likely to have a recent contact with a health professional (24.5% vs. 4.5%). Impulsive suicide attempters had higher scores on BHS (Mann–Whitney U = 7680.5, P < 0.001), and had recollected greater number of stressors. Conclusion: Impulsive suicide attempters differ from nonimpulsive suicide attempters in clinical features like methods of attempt, presence of hopelessness, and stressors.
Collapse
Affiliation(s)
| | | | | | - Vikas Menon
- Department of Psychiatry, JIPMER, Puducherry, India
| |
Collapse
|
54
|
Abstract
AIMS There is substantial diversity in national suicide rates, which has mainly been related to socio-economic factors, as well as cultural factors. Stigma is a cultural phenomenon, determining the level of social acceptance or rejection of persons with mental illness in a society. In this study, we explore whether national suicide rates are related to the degree of mental illness stigma in that country. METHODS We combine the data on country-level social acceptance (Eurobarometer) with the data on suicide rates and socio-economic indicators (Eurostat) for 25 European countries. RESULTS In a linear regression model controlling for socio-economic indicators, the social acceptance of someone with a significant mental health problem in 2010 was negatively correlated with age standardised national suicide rates in the same year (β -0.46, p = 0.014). This association also held true when combining national suicide rates with death rates due to events of undetermined intent. CONCLUSIONS Stigma towards persons with mental health problems may contribute to differences in suicide rates in a country. We hypothesise possible mechanisms explaining this link, including stigma as a stressor and social isolation as a consequence of stigma.
Collapse
|
55
|
Modernisation de l’agriculture et santé mentale : les contradictions au travail. PERSPECTIVES INTERDISCIPLINAIRES SUR LE TRAVAIL ET LA SANTÉ 2015. [DOI: 10.4000/pistes.4430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
56
|
Morales L. Taking Facts Seriously: Judicial Intervention in Public Health Controversies. Public Health Ethics 2015. [DOI: 10.1093/phe/phu041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
57
|
Rubanzana W, Hedt-Gauthier BL, Ntaganira J, Freeman MD. Exposure to genocide and risk of suicide in Rwanda: a population-based case-control study. J Epidemiol Community Health 2014; 69:117-22. [PMID: 25488977 PMCID: PMC4316837 DOI: 10.1136/jech-2014-204307] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background In Rwanda, an estimated one million people were killed during the 1994 genocide, leaving the country shattered and social fabric destroyed. Large-scale traumatic events such as wars and genocides have been linked to endemic post-traumatic stress disorder, depression and suicidality. The study objective was to investigate whether the 1994 genocide exposure is associated with suicide in Rwanda. Methods We conducted a population-based case–control study. Suicide victims were matched to three living controls for sex, age and residential location. Exposure was defined as being a genocide survivor, having suffered physical/sexual abuse in the genocide, losing a first-degree relative in the genocide, having been convicted for genocide crimes or having a first-degree relative convicted for genocide. From May 2011 to May 2013, 162 cases and 486 controls were enrolled countrywide. Information was collected from the police, local village administrators and family members. Results After adjusting for potential confounders, having been convicted for genocide crimes was a significant predictor for suicide (OR=17.3, 95% CI 3.4 to 88.1). Being a survivor, having been physically or sexually abused during the genocide, and having lost a first-degree family member to genocide were not significantly associated with suicide. Conclusions These findings demonstrate that individuals convicted for genocide crimes are experiencing continued psychological disturbances that affect their social reintegration into the community even 20 years after the event. Given the large number of genocide perpetrators reintegrated after criminal courts and Gacaca traditional reconciling trials, suicide could become a serious public health burden if preventive remedial action is not identified.
Collapse
Affiliation(s)
- Wilson Rubanzana
- Department of Epidemiology and Biostatistics, University of Rwanda College of Medicine and Health Sciences, School of Public Health, Kigali, Rwanda Rwanda National Police, Directorate of Medical Service, Kigali, Rwanda
| | - Bethany L Hedt-Gauthier
- Department of Epidemiology and Biostatistics, University of Rwanda College of Medicine and Health Sciences, School of Public Health, Kigali, Rwanda Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | - Joseph Ntaganira
- Department of Epidemiology and Biostatistics, University of Rwanda College of Medicine and Health Sciences, School of Public Health, Kigali, Rwanda
| | - Michael D Freeman
- Oregon Health & Science University, School of Medicine, Portland, Oregon, USA Faculty of Medicine, Section of Forensic Medicine, Umeå University, Umeå, Sweden Faculty of Health Sciences, Department of Forensic Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
58
|
Lee BX, Marotta PL, Blay-Tofey M, Wang W, de Bourmont S. Economic correlates of violent death rates in forty countries, 1962-2008: A cross-typological analysis. AGGRESSION AND VIOLENT BEHAVIOR 2014; 19:729-737. [PMID: 26028985 PMCID: PMC4447485 DOI: 10.1016/j.avb.2014.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Our goal was to identify if there might be advantages to combining two major public health concerns, i.e., homicides and suicides, in an analysis with well-established macro-level economic determinants, i.e., unemployment and inequality. METHODS Mortality data, unemployment statistics, and inequality measures were obtained for 40 countries for the years 1962-2008. Rates of combined homicide and suicide, ratio of suicide to combined violent death, and ratio between homicide and suicide were graphed and analyzed. A fixed effects regression model was then performed for unemployment rates and Gini coefficients on homicide, suicide, and combined death rates. RESULTS For a majority of nation states, suicide comprised a substantial proportion (mean 75.51%; range 0-99%) of the combined rate of homicide and suicide. When combined, a small but significant relationship emerged between logged Gini coefficient and combined death rates (0.0066, p < 0.05), suggesting that the combined rate improves the ability to detect a significant relationship when compared to either rate measurement alone. Results were duplicated by age group, whereby combining death rates into a single measure improved statistical power, provided that the association was strong. CONCLUSIONS Violent deaths, when combined, were associated with an increase in unemployment and an increase in Gini coefficient, creating a more robust variable. As the effects of macro-level factors (e.g., social and economic policies) on violent death rates in a population are shown to be more significant than those of micro-level influences (e.g., individual characteristics), these associations may be useful to discover. An expansion of socioeconomic variables and the inclusion of other forms of violence in future research could help elucidate long-term trends.
Collapse
Affiliation(s)
- Bandy X Lee
- Yale University, New Haven, CT, United States
| | | | | | - Winnie Wang
- Yale University, New Haven, CT, United States
| | | |
Collapse
|
59
|
Kim S, Kim H, Seo DC, Lee DH, Cho HI. Suicidal Ideation and its Correlates among Juvenile Delinquents in South Korea. Osong Public Health Res Perspect 2014; 5:258-65. [PMID: 25389511 PMCID: PMC4225588 DOI: 10.1016/j.phrp.2014.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 08/24/2014] [Accepted: 08/25/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES This study investigated suicidal ideation and its correlates among juvenile delinquents in South Korea. METHODS Suicidal ideation, psychological health status, and health-related behaviors were assessed using a self-administered questionnaire in 1682 juvenile offenders aged between 15 and 18 years in 2012. RESULTS The prevalence of suicidal ideation in juvenile delinquents was 15.2%. Girls were more likely to report suicidal thoughts than boys (30.3% vs. 12.7%). Suicidal ideation was more common among adolescents who were not living with their family prior to entering detention centers (22.6% vs. 13.2%) than their counterparts. The likelihood of suicidal ideation was significantly associated with problem drinking [odds ratio (OR) = 1.84], psychedelic drug use (OR = 2.04), feeling unhappy (OR = 3.05), feeling sad or depressed (OR = 13.37) after controlling for sociodemographic factors, other health behaviors and perceptions. CONCLUSION The present study provides evidence for an association between suicidal ideation and psychological health and health risk behaviors among juvenile delinquents. It also highlights the importance of mental health and behavioral interventions for this population to prevent suicidality.
Collapse
Affiliation(s)
- Suyoung Kim
- Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea
| | - Hyekyeong Kim
- Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea
| | - Dong-Chul Seo
- Department of Health Education and Management, Ewha Womans University, Seoul, Korea
| | - Dong Hwan Lee
- Juvenile Division, Ministry of Justice, Seoul, Korea
| | - Han-Ik Cho
- Korea Association of Health Promotion, College of Medicine, Seoul National University, Seoul, Korea
| |
Collapse
|
60
|
Abstract
OBJECTIVE This study examined the prevalence and correlates of suicidal ideation among U.S. Chinese older adults. METHOD Guided by the community-participatory research approach, the PINE (Population Study of Chinese Elderly in Chicago) study is a population-based epidemiological study conducted from 2011 to 2013 of 3,159 community-dwelling Chinese adults aged 60 years and above in the Greater Chicago area. RESULTS The 2-week prevalence of suicidal ideation, 12-month prevalence of suicidal ideation, and lifetime suicidal ideation were 3.5%, 4.8%, and 9.4%, respectively. Age, sex, marital status, education, income, living arrangement, country of origin, years in the United States, overall health status, quality of life, and health changes over the past year were significantly correlated with suicidal ideation. DISCUSSION Suicidal ideation was common among U.S. Chinese older adults in the Greater Chicago area. Further longitudinal studies should be conducted to explore the risk and protective factors associated with suicidal ideation.
Collapse
Affiliation(s)
- XinQi Dong
- Rush Institute for Healthy Aging, Chicago, IL, USA
| | - Ruijia Chen
- Rush Institute for Healthy Aging, Chicago, IL, USA
| | - Esther Wong
- Chinese American Service League, Chicago, IL, USA
| | | |
Collapse
|
61
|
Suicide later in life: challenges and priorities for prevention. Am J Prev Med 2014; 47:S244-50. [PMID: 25145746 DOI: 10.1016/j.amepre.2014.05.040] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 05/27/2014] [Accepted: 05/28/2014] [Indexed: 11/22/2022]
Abstract
Suicide in later life is a major public health concern in the U.S., where more than 6,000 older adults take their own lives every year. Suicide prevention in this age group is made challenging by the high lethality of older adults' suicidal behavior; few survive their first attempt to harm themselves. Research has revealed that factors in each of five domains place older adults at increased risk for suicide-psychiatric illness, personality traits and coping styles, medical illness, life stressors and social disconnectedness, and functional impairment. Little research has examined the effectiveness of interventions to reduce the toll of suicide in older adulthood. The study of strategies to decrease suicide deaths in later life should emphasize four areas. First is approaches to early detection of older people at risk through improved understanding of multi-dimensional determinants and their interactions. Second is research on the impact of general health promotion that optimizes well-being and independent functioning for older adults on suicide outcomes. Third concerns the study of approaches to the provision of mental health care that is evidence-based, accessible, affordable, acceptable, and integrated with other aspects of care. The fourth area of high priority for research is approaches to improvement of social connectedness and its impact on suicide in older adults.
Collapse
|
62
|
Hottes TS, Ferlatte O, Gesink D. Suicide and HIV as leading causes of death among gay and bisexual men: a comparison of estimated mortality and published research. CRITICAL PUBLIC HEALTH 2014. [DOI: 10.1080/09581596.2014.946887] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
63
|
Suzuki E, Kashima S, Kawachi I, Subramanian SV. Prefecture-level economic conditions and risk of suicide in Japan: a repeated cross-sectional analysis 1975-2010. Eur J Public Health 2014; 24:949-54. [PMID: 24610689 DOI: 10.1093/eurpub/cku023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Geographical inequalities in suicide have risen dramatically across 47 prefectures in Japan since 1995. We sought to examine temporal changes in the associations between prefecture-level economic conditions and completed suicide during the recent 35 years, controlling for individual composition in each prefecture. METHODS Based on quinquennial vital statistics and census data from 1975 to 2010, we analysed the entire population aged 25-64 years. The total number of suicides was 87 553 men and 34 559 women. As indicators of prefecture-level economic conditions, we used average yearly income, average savings and income inequality (measured by Gini coefficients for yearly income). For each sex, we estimated odds ratios and 95% credible intervals for suicide using multilevel logistic regression models, with cells at level 1, years at level 2 and prefectures at level 3. RESULTS Even after adjusting for individual age, occupation and time trends, low average savings at prefecture level were associated with a higher risk of suicide among men (odds ratio in low vs. high savings: 1.13, 95% credible interval: 1.05-1.21), whereas no clear patterns were observed with other economic indicators. When we further examined the associations in year-specific models by conducting a two-level analysis, both average yearly income and average savings were inversely associated with suicide risk in recent years. No clear association was found between income inequality and suicide risk for either sex. CONCLUSION The present findings suggest that low area socioeconomic status may be driving the growing geographical inequalities in suicide in Japan, primarily among men.
Collapse
Affiliation(s)
- Etsuji Suzuki
- 1 Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Saori Kashima
- 2 Department of Public Health and Health Policy, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ichiro Kawachi
- 3 Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
| | - S V Subramanian
- 3 Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
| |
Collapse
|
64
|
Florenzano R, Rodríguez J, Sieverson C, Cataldo E, Pastorino S, Fernández L. Suicidal risk, depression, and religiosity: a study of women in a general hospital in Santiago de Chile. Asia Pac Psychiatry 2014; 6:23-7. [PMID: 24019245 DOI: 10.1111/appy.12102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 08/07/2013] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The purpose of the present study is to compare the role of spiritual and religious beliefs in the prevention of suicidal risk among depressive women with suicidal ideation or attempts, treated in the psychiatric unit of a general hospital in Santiago de Chile (Servicio de Psiquiatría del Hospital del Salvador) between 2010 and 2011. METHOD The relationship among severity of depression, suicidal risk, and religiosity is explored in women treated in Servicio de Psiquiatría del Hospital del Salvador. The sociodemographic and clinical characteristics of believers (n = 121) and nonbelievers (n = 22) were compared, and their global mental health was assessed, as well as their rating in scales for depression, anxiety, aggressivity, and impulsivity. RESULTS Most of the patients self-reported to belong to Catholic or other Christian churches. There were few statistically significant differences between them and nonbelievers, who were younger, had more years of education, were more frequently employed, and lived alone or with their parents. When comparing the least religious and the most religious quartiles, there were no differences in the type of affective disorder, attendance to temples, or self-appraisal of religiosity. Nonbelievers had more history of previous suicidal attempts and had more relatives committing suicide. DISCUSSION In a country where most of the population is believer, self-reported religiosity seems to have a nonsignificant association with suicidality and severity of depression. Our results could be biased given the small number of nonbelievers in the sample.
Collapse
Affiliation(s)
- Ramón Florenzano
- Hospital del Salvador, Santiago, Chile; Universidad del Desarrollo, Santiago, Chile
| | | | | | | | | | | |
Collapse
|
65
|
Lowry R, Crosby AE, Brener ND, Kann L. Suicidal thoughts and attempts among u.s. High school students: trends and associated health-risk behaviors, 1991-2011. J Adolesc Health 2014; 54:100-8. [PMID: 24035267 DOI: 10.1016/j.jadohealth.2013.07.024] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 07/22/2013] [Accepted: 07/22/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe secular trends in suicidal thoughts and attempts and the types of health-risk behaviors associated with suicidal thoughts and attempts among U.S. high school students. METHODS Data were analyzed from 11 national Youth Risk Behavior Surveys conducted biennially during 1991-2011. Each survey employed a nationally representative sample of students in grades 9-12 and provided data from approximately 14,000 students. Using sex-stratified logistic regression models that controlled for race/ethnicity and grade, we analyzed secular trends in the prevalence of suicidal thoughts and attempts. Adjusted prevalence ratios (APR) were calculated to measure associations between suicide risk and a broad range of health-risk behaviors. RESULTS During 1991-2011, among female students, both suicidal thoughts (seriously considered suicide; made a plan to attempt suicide) and attempts (any attempt; attempt with injury requiring medical treatment) decreased significantly; among male students, only suicidal thoughts decreased significantly. During 2011, compared with students with no suicidal thoughts or attempts, the health-risk behaviors most strongly associated with suicide attempts among female students were injection drug use (APR = 12.8), carrying a weapon on school property (APR = 9.7), and methamphetamine use (APR = 8.7); among male students, the strongest associations were for IDU (APR = 22.4), using vomiting/laxatives for weight control (APR = 17.1), and having been forced to have sex (APR = 14.8). CONCLUSIONS School-based suicide prevention programs should consider confidential screening for health-risk behaviors that are strongly associated with suicide attempts to help identify students at increased risk for suicide and provide referrals to suicide and other prevention services (e.g., substance abuse and violence prevention) as appropriate.
Collapse
Affiliation(s)
- Richard Lowry
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia.
| | - Alexander E Crosby
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nancy D Brener
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia
| | - Laura Kann
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia
| |
Collapse
|
66
|
Household survey of pesticide practice, deliberate self-harm, and suicide in the Sundarban region of West Bengal, India. BIOMED RESEARCH INTERNATIONAL 2013; 2013:949076. [PMID: 24224181 PMCID: PMC3810037 DOI: 10.1155/2013/949076] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 07/26/2013] [Accepted: 07/30/2013] [Indexed: 11/18/2022]
Abstract
The toxicological impact and intentional ingestion of pesticides are major public health concerns globally. This study aimed to estimate the extent of deliberate self-harm (DSH) and suicides (suicidal behaviour) and document pesticide practices in Namkhana block of the Sundarban region, India. A cross-sectional study was conducted in 1680 households (21 villages) following a mixed random and cluster design sampling. The survey questionnaire (Household Information on Pesticide Use and DSH) was developed by the research team to elicit qualitative and quantitative information. The Kappa statistic and McNemar's test were used to assess the level of agreement and association between respondents' and investigators' opinions about safe storage of pesticides. Over five years, 1680 households reported 181 incidents of suicidal behaviour. Conflict with family members was the most frequently reported reason for suicidal behaviour (53.6%). The Kappa statistic indicated poor agreement between respondents and investigators about safe storage of pesticides. The pesticide-related annual DSH rate was 158.1 (95% CI 126.2–195.5), and for suicide it was 73.4 (95% CI 52.2–100.3) per 100,000. Unsafe pesticide practice and psychosocial stressors are related to the high rates of suicidal behaviour. An intersectoral approach involving the local governments, agricultural department and the health sector would help to reduce the magnitude of this public health problem.
Collapse
|
67
|
Mohatt NV, Singer JB, Evans AC, Matlin SL, Golden J, Harris C, Burns J, Siciliano C, Kiernan G, Pelleritti M, Tebes JK. A community's response to suicide through public art: stakeholder perspectives from the Finding the Light Within project. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2013; 52:197-209. [PMID: 23743604 PMCID: PMC3865777 DOI: 10.1007/s10464-013-9581-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Suicide is a preventable public health problem and a leading cause of death in the United States. Despite recognized need for community-based strategies for suicide prevention, most suicide prevention programs focus on individual-level change. This article presents seven first person accounts of Finding the Light Within, a community mobilization initiative to reduce the stigma associated with suicide through public arts participation that took place in Philadelphia, Pennsylvania from 2011 through 2012. The stigma associated with suicide is a major challenge to suicide prevention, erecting social barriers to effective prevention and treatment and enhancing risk factors for people struggling with suicidal ideation and recovery after losing a loved one to suicide. This project engaged a large and diverse audience and built a new community around suicide prevention through participatory public art, including community design and production of a large public mural about suicide, storytelling and art workshops, and a storytelling website. We present this project as a model for how arts participation can address suicide on multiple fronts-from raising awareness and reducing stigma, to promoting community recovery, to providing healing for people and communities in need.
Collapse
Affiliation(s)
- Nathaniel V Mohatt
- Division of Prevention and Community Research and The Consultation Center, Department of Psychiatry, Yale University School of Medicine, 389 Whitney Avenue, New Haven, CT 06511-2369, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
68
|
Lesage A, St-Laurent D, Gagné M, Légaré G. [Suicide prevention from a public health perspective]. SANTE MENTALE AU QUEBEC 2013; 37:239-55. [PMID: 23666291 DOI: 10.7202/1014954ar] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Suicide and suicide prevention represent major public health challenges. The public health perspective juxtaposes a multifactor understanding of society's health phenomena to a mobilization around determinants on which actions can be taken. Public health has encountered success with infectious diseases as well as chronic diseases such as hypertension. In this article, the phenomenon of suicide is detailed with data drawn from Quebec, Canada and international research. Population-based suicide prevention policies are generally multimodal, and often involve strategies aiming at improving mental health services. The success of these strategies lies in their steady application and in the close surveillance of this application.
Collapse
Affiliation(s)
- Alain Lesage
- Centre de recherche Fernand-Seguin, Hôpital Louis-H. Lafontaine, Montréal, Québec.
| | | | | | | |
Collapse
|
69
|
Abstract
Suicide prevention must be transformed by integrating injury prevention and mental health perspectives to develop a mosaic of common risk public health interventions that address the diversity of populations and individuals whose mortality and morbidity contribute to the burdens of suicide and attempted suicide. Emphasizing distal preventive interventions, strategies must focus on people and places--and on related interpersonal factors and social contexts--to alter the life trajectories of people before they become suicidal. Attention also must be paid to those in the middle years--the age with the greatest overall burden. We need scientific and social processes that define priorities and assess their potential for reducing what has been a steadily increasing rate of suicide during the past decade.
Collapse
Affiliation(s)
- Eric D Caine
- Injury Control Research Center for Suicide Prevention, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY 14642-8409, USA.
| |
Collapse
|
70
|
[Sociodemographic Characterization of Suicidal Adults Over 60 Years Old: Bogotá 2003-2007]. ACTA ACUST UNITED AC 2013; 43 Suppl 1:56-64. [PMID: 26574114 DOI: 10.1016/j.rcp.2013.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 11/28/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify the major epidemiological and sociodemographic characteristics of suicidal adults over 60 years old in Bogotá between the years 2003 and 2007. METHODOLOGY A descriptive-retrospective study was performed, mainly using information obtained from necropsy reports (n=98), taking into account selected epidemiological variables. The data were systematized using Epi-Info 6.04 software, and were analyzed using contingency tables. RESULTS Suicide victims of this population group are primarily male, having one of the highest suicide rates with respect to the whole population. The presence of chronic and disabling diseases was reported among the main motivations for suicide in males, while for women it was the presence of a mental disorder and/or loss of a loved one. Having family support did not affect suicide rates. The locality that had the highest suicide rates was the district of Los Mártires, and there was no direct relationship between poverty rates or health insurance and the presence of the phenomenon. CONCLUSIONS Although there has been a decrease in suicide rates for the population over 60 years old since 2003, suicide in elderly people remains a predominantly male phenomenon and an important public health problem. Due to its complexity in terms of multiple causes and multidimensionality, the protective and risk factors are just aspects to consider in terms of understanding the phenomenon and its prevention.
Collapse
|
71
|
Conner KR, McCarthy MD, Bajorska A, Caine ED, Tu XM, Knox KL. Mood, anxiety, and substance-use disorders and suicide risk in a military population cohort. Suicide Life Threat Behav 2012; 42:699-708. [PMID: 23094649 PMCID: PMC4863230 DOI: 10.1111/j.1943-278x.2012.00125.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 08/16/2012] [Indexed: 11/28/2022]
Abstract
There are meager prospective data from nonclinical samples on the link between anxiety disorders and suicide or the extent to which the association varies over time. We examined these issues in a cohort of 309,861 U.S. Air Force service members, with 227 suicides over follow-up. Mental disorder diagnoses including anxiety, mood, and substance-use disorders (SUD) were based on treatment encounters. Risk for suicide associated with anxiety disorders were lower compared with mood disorders and similar to SUD. Moreover, the associations between mood and anxiety disorders with suicide were greatest within a year of treatment presentation.
Collapse
Affiliation(s)
- Kenneth R Conner
- Department of Psychiatry, University of Rochester Medical Center, NY 14642, USA.
| | | | | | | | | | | |
Collapse
|
72
|
Webb RT, Shaw J, Stevens H, Mortensen PB, Appleby L, Qin P. Suicide risk among violent and sexual criminal offenders. JOURNAL OF INTERPERSONAL VIOLENCE 2012; 27:3405-3424. [PMID: 22610829 DOI: 10.1177/0886260512445387] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Risk of suicide in people who have perpetrated specific forms of violent or sexual criminal offenses has not been quantified accurately or precisely. Also, gender comparisons have not been possible due to sparse data problems in the smaller studies that have been conducted to date. We therefore aimed to estimate these effects in the whole Danish population over a 26-year period. By completely interlinking national criminal, psychiatric, sociodemographic and cause-specific mortality registers, we conducted a nested case-control study of more than 27,000 adult suicides, during 1981-2006, and more than half a million age and gender-matched living controls. Elevated suicide risk was found in male sexual offenders. Risk was even higher among violent offenders, with greater effect sizes seen in females. It was markedly raised with serious violence, reaching a peak in relation to homicide or attempted homicide: male odds ratio (OR) 12.0, 95% confidence interval (CI) [8.3, 17.3]; female OR 30.9, CI [11.9, 80.6]. Following adjustment for psychiatric and social risk factors, relative risk in violent offenders was comparable to that seen among nonviolent offenders. These findings underline the importance of understanding why some people are violent toward themselves as well as other people, and why suicide risk is so much higher in people who have perpetrated serious acts of violence. They also indicate a clear need for developing effective multiagency interventions that effectively tackle both forms of destructive behavior.
Collapse
Affiliation(s)
- Roger T Webb
- Centre for Suicide Prevention, University of Manchester, Oxford Road, Manchester, England.
| | | | | | | | | | | |
Collapse
|
73
|
Elderly suicide rates: the importance of a non-linear relationship with distal risk and protective factors. Int Psychogeriatr 2012; 24:1363-7. [PMID: 22583544 DOI: 10.1017/s1041610212000750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The elderly population size is increasing worldwide due to prolonged life expectancy and falling birth rates. Traditionally, suicide rates increase with age. For example, a recent cross-national study of 62 developing and developed countries reported an increase in suicide rates with aging in males and females in 25 and 27 countries respectively (Shah, 2007a). Thus, suicides in the elderly are an important public health concern. While much is known about proximal (individual level) risk and protective factors for elderly suicides (e.g. Conwell et al., 1991; Cattell and Jolley, 1995; Harwood et al., 2001), less is known about more distal (societal or population level) risk and protective factors (Rehkopf and Buka, 2006). Moreover, detailed knowledge of these distal factors may have greater public health relevance for the development of comprehensive prevention strategies (Knox et al., 2004).
Collapse
|
74
|
Abstract
Evidence favours the population approach over high-risk approaches to suicide prevention, but methodological problems may have obscured the contribution of the latter. This editorial uses the findings of a recent evaluation of a high-risk approach used in England to consider the role of high-risk interventions in national suicide prevention strategies.
Collapse
|
75
|
Parkar SR, Nagarsekar BB, Weiss MG. Explaining suicide: identifying common themes and diverse perspectives in an urban Mumbai slum. Soc Sci Med 2012; 75:2037-46. [PMID: 22917750 DOI: 10.1016/j.socscimed.2012.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Revised: 07/01/2012] [Accepted: 07/02/2012] [Indexed: 10/28/2022]
Abstract
Rates, demographics and diagnostics, which are the focus of many studies of suicide, may provide an insufficient account without adequate consideration of psychological, social and cultural contexts and motives. Furthermore, reported explanations of suicide are shaped not only by events but also the relationship of survivor respondents explaining the suicide. An explanatory model interview for sociocultural autopsy has been used to assess underlying problems and perceived causes. This study in a low-income community of Mumbai in 2003-2004 compared accounts of the closest family survivors and more distant relationships. Our study design distinguished series-level agreement (i.e., consistency of accounts within a group) and case-level agreement for particular cases. Serious mental illness was the perceived cause reported by a respondent in either group for 22.0% of index suicides, but case-level agreement was only 6.0%. Regarding financial stressors, more closely related family respondents focused on acute stressors instead of enduring effects of poverty. Case-level agreement was high for marital problems, but low for other sources of family conflict. Tension was a feature of suicide reported in both groups, but case-level agreement on tension as a perceived cause was low (kappa = 0.14). The role of alcohol as a perceived cause of suicide had high series level agreement (46.0% in both groups) and case-level agreement (kappa = 0.60), suggesting comparable community and professional views of its significance. The study shows that it is relevant and feasible to consider general community patterns and particular survivor interests. Findings from this study recommend an approach to sociocultural autopsy to assess reasons for suicide in community studies. Findings clarify diverse views of underlying problems motivating suicide that should be considered to make mental health care more effective in assessing risk and preventing suicide.
Collapse
|
76
|
Cutcliffe JR, Links PS, Harder HG, Balderson K, Bergmans Y, Eynan R, Ambreen M, Nisenbaum R. Understanding the risks of recent discharge: the phenomenological lived experiences--“existential angst at the prospect of discharge”. CRISIS 2012; 33:21-9. [PMID: 21940246 DOI: 10.1027/0227-5910/a000096] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Evidence indicates that people whose mental health problems lead them to require psychiatric hospitalization are at a significantly increased risk of suicide, and that the time immediately following discharge after such hospitalizations is a particularly high-risk time. AIMS This paper reports on phenomenological findings from a federally funded, mixed-methods study that sought to better understand the observed increased risk for suicide following discharge from an inpatient psychiatric service. METHODS A purposive sample of 20 recently discharged former suicidal inpatients was obtained. Data were collected in hermeneutic interviews lasting between 1 h and 2 h and analyzed according to van (1997) interpretation of hermeneutic phenomenology. RESULTS Two key themes, "existential angst at the prospect of discharge" and "trying to survive while living under the proverbial 'sword of Damocles'" were induced. Each of these was comprised of five themes with the first key theme (which is the focus of this paper) encompassing the following: "Feeling scared, anxious, fearful and/or stressed," "Preparedness," "Leaving the place of safety," "Duality and ambivalence," and "Feel like a burden." CONCLUSIONS Early exploration of and reconciling of patients' expectations regarding inpatient care for their suicidality would be empirically based interventions that could diminish the postdischarge risk for further suicide attempts.
Collapse
|
77
|
Abstract
Limitation of access to lethal methods used for suicide--so-called means restriction--is an important population strategy for suicide prevention. Many empirical studies have shown that such means restriction is effective. Although some individuals might seek other methods, many do not; when they do, the means chosen are less lethal and are associated with fewer deaths than when more dangerous ones are available. We examine how the spread of information about suicide methods through formal and informal media potentially affects the choices that people make when attempting to kill themselves. We also discuss the challenges associated with implementation of means restriction and whether numbers of deaths by suicide are reduced.
Collapse
Affiliation(s)
- Paul S F Yip
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong SAR, China
| | | | | | | | | | | |
Collapse
|
78
|
Singh S, Manjula M, Philip M. Suicidal risk and childhood adversity: a study of Indian college students. Asian J Psychiatr 2012; 5:154-9. [PMID: 22813659 DOI: 10.1016/j.ajp.2012.02.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 02/20/2012] [Accepted: 02/23/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND The study was undertaken in response to reported increase in deaths due to suicide and suicidal behaviors in the youth. AIM The objectives of the study were to assess childhood adversity and suicidal risk and to study the relationship between adverse childhood experiences and suicidal risk, in Indian students. METHOD A cross sectional study design was conducted with 436 undergraduate students in the age range of 18-25. Suicidal risk was assessed using Scale for Suicidal Ideation and Beck's Hopelessness Scale. Parental Bonding Instrument and Early Trauma Inventory-Self Report (Short Form) were used to assess adverse childhood experiences. RESULTS Suicidal risk in terms of suicidal ideation and hopelessness was reported by 15% and 9%, respectively. Physical abuse is the most common form of early trauma, experienced in both males and females. Males experienced significantly more traumatic experiences in all domains. Affectionless control, which is considered as the pathogenic form of parent child bonding, is widely reported. A moderate degree of association exists between suicidal risk and early exposure to trauma. Higher suicidal ideation, hopelessness and trauma are reported in respondents with affectionless parental control and neglectful parenting. CONCLUSION The study provides evidence of correlation between suicidal risk and childhood adversity in the Indian setting.
Collapse
Affiliation(s)
- Saumya Singh
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560 029, India
| | | | | |
Collapse
|
79
|
Knox KL, Kemp J, McKeon R, Katz IR. Implementation and early utilization of a Suicide Hotline for veterans. Am J Public Health 2012; 102 Suppl 1:S29-32. [PMID: 22390596 DOI: 10.2105/ajph.2011.300301] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Suicide crisis lines have a respected history as a strategy for reducing deaths from suicide and suicidal behaviors. Until recently, however, evidence of the effectiveness of these crisis lines has been sparse. Studies published during the past decade suggest that crisis lines offer an alternative to populations who may not be willing to engage in treatment through traditional mental health settings. Given this promising evidence, in 2007, the Department of Veterans Affairs in collaboration with the Department of Health and Human Services' Substance Abuse and Mental Health Administration implemented a National Suicide Hotline that is staffed 24 hours a day, 7 days a week, by Veterans Affairs clinical staff. We report here on the implementation of this suicide hotline and our early observations of its utilization in a largely male population.
Collapse
Affiliation(s)
- Kerry L Knox
- Department of Veterans Affairs and Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY 14424, USA.
| | | | | | | |
Collapse
|
80
|
Handley TE, Inder KJ, Kelly BJ, Attia JR, Kay-Lambkin FJ. Urban-rural influences on suicidality: gaps in the existing literature and recommendations for future research. Aust J Rural Health 2012; 19:279-83. [PMID: 22098210 DOI: 10.1111/j.1440-1584.2011.01235.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Suicide is a major public health issue of particular concern among rural populations, which experience a consistently higher suicide rate than urban areas. Although extensive research efforts have been directed towards understanding suicidality and related factors, there is a continued lack of clinically useful factors to target preventive measures, particularly among some regional and demographic groups. This suggests limitations in the conceptualisation of this important construct. A review of the literature was undertaken, using a snowballing and saturation approach. Literature was considered relevant if it addressed the research question 'what are the current limitations in research on urban/rural influences on suicidality?' Findings were used to develop a set of guidelines to inform future research. A number of gaps in existing research relevant to limitations in rural suicide research were identified: inconsistencies in terminology; a focus on high-end suicidal behaviours; a disproportionate focus on urban populations; a dominance of cross-sectional research; and a high use of clinical samples. These limitations are discussed in terms of their implications for rural suicidality, and are used to support the development of recommendations for future research, with a focus on encouraging consistency and standardisation. A number of limitations can be identified in existing research on suicide. Targeting these specific areas can be an important step in addressing the current gaps in knowledge relating to rural suicide prevention.
Collapse
Affiliation(s)
- Tonelle E Handley
- Centres for Brain and Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia.
| | | | | | | | | |
Collapse
|
81
|
Abstract
OBJECTIVE : Cancer patients are at heightened risk of suicide. Clinical correlates of suicidal ideation in advanced cancer patients were examined to identify those at risk and to inform the development of interventions to reduce suicidal ideation in this vulnerable group. METHODS : Coping with Cancer (CwC) is an NCI- and NIMH-funded multiinstitutional investigation examining psychosocial influences on the quality of life and care of advanced cancer patients. Baseline face-to-face interviews that assessed mental and physical functioning, coping, spirituality, and use of mental health services were conducted with 700 advanced cancer patients. RESULTS : Compared with patients without suicidal ideation, the 8.9% of patients who reported suicidal thoughts were more likely to be white and report no affiliation with an organized religion (p < 0.05). Adjusted analyses revealed that cancer patients who met criteria for current panic disorder (adjusted odds ratio [95% confidence interval] 3.24 [1.01-10.4]) and posttraumatic stress disorder (3.97 [1.13-14.1]), who accessed mental health services (3.70 [2.07-6.67]), particularly psychotherapy (2.62 [1.20-5.71]), who were not feeling well physically, and who lacked a sense of self-efficacy, spirituality, and being supported were more likely than others to report thoughts of suicide (p < 0.05). CONCLUSIONS : Advanced cancer patients who report suicidal thoughts are more likely to meet criteria for posttraumatic stress disorder and panic disorder, feel unsupported, lack a religious affiliation, spirituality, and a sense of self-efficacy, and experience more physical distress. Palliative care interventions that promote a sense of self-efficacy, spirituality, and support while minimizing physical distress may offer promise for reducing suicidal thoughts in this at-risk group.
Collapse
Affiliation(s)
- Ryan J. Spencer
- Department of Obstetrics, Gynecology and Reproductive Medicine, Brigham and Women’s Hospital, Boston, MA 02115
| | - Alaka Ray
- Department of Medicine, Massachusetts General Hospital, Boston, MA 02114
| | - William F. Pirl
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114
| | - Holly G. Prigerson
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA 02115
- Center for Psycho-Oncology and Palliative Care Research, Dana-Farber Cancer Institute, Boston, MA, 02115
| |
Collapse
|
82
|
|
83
|
Knox KL, Bossarte RM. Suicide prevention for veterans and active duty personnel. Am J Public Health 2012; 102 Suppl 1:S8-9. [PMID: 22390608 DOI: 10.2105/ajph.2011.300593] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
84
|
Fässberg MM, van Orden KA, Duberstein P, Erlangsen A, Lapierre S, Bodner E, Canetto SS, Leo DD, Szanto K, Waern M. A systematic review of social factors and suicidal behavior in older adulthood. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 9:722-45. [PMID: 22690159 PMCID: PMC3367273 DOI: 10.3390/ijerph9030722] [Citation(s) in RCA: 197] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 02/16/2012] [Accepted: 02/22/2012] [Indexed: 01/21/2023]
Abstract
Suicide in later life is a global public health problem. The aim of this review was to conduct a systematic analysis of studies with comparison groups that examined the associations between social factors and suicidal behavior (including ideation, non-fatal suicidal behavior, or deaths) among individuals aged 65 and older. Our search identified only 16 articles (across 14 independent samples) that met inclusion criteria. The limited number of studies points to the need for further research. Included studies were conducted in Canada (n = 2), Germany (n = 1), Hong Kong (n = 1), Japan (n = 1), Singapore (n = 1), Sweden (n = 2), Taiwan (n = 1), the U.K. (n = 2), and the U.S. (n = 3). The majority of the social factors examined in this review can be conceptualized as indices of positive social connectedness-the degree of positive involvement with family, friends, and social groups. Findings indicated that at least in industrialized countries, limited social connectedness is associated with suicidal ideation, non-fatal suicidal behavior, and suicide in later life. Primary prevention programs designed to enhance social connections as well as a sense of community could potentially decrease suicide risk, especially among men.
Collapse
Affiliation(s)
- Madeleine Mellqvist Fässberg
- Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Wallinsgatan 6, 43141 Mölndal, Sweden;
| | - Kimberly A. van Orden
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY 14642, USA; (K.A.O.); (P.D.)
| | - Paul Duberstein
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY 14642, USA; (K.A.O.); (P.D.)
| | - Annette Erlangsen
- Department of Mental Health, Johns Hopkins School of Public Health, 624 North Broadway, S850, Baltimore, MD 21205, USA;
| | - Sylvie Lapierre
- Département de Psychologie, Université du Québec à Trois-Rivières, 3351 des Forges blvd., Trois-Rivières, QC G9A 5H7, Canada;
| | - Ehud Bodner
- The Interdisciplinary Department of Social Sciences and the Music Department, Bar-Ilan University, Ramat-Gan, Israel;
| | - Silvia Sara Canetto
- Department of Psychology, Colorado State University, Fort Collins, CO 80523, USA;
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, National Centre of Excellence in Suicide Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, and Life Promotion Clinic, Mt Gravatt Campus, Griffith University,176 Messines Ridge Road, Mt Gravatt, QLD 4122, Australia;
| | - Katalin Szanto
- Western Psychiatric Institute and Clinic, University of Pittsburgh, 3811 O’Hara Street, Pittsburgh, PA 15260, USA;
| | - Margda Waern
- Department of Psychiatry and Neurochemistry, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Blå Stråket 15, 41345 Gothenburg, Sweden
- Author to whom correspondence should be addressed; ; Tel.: +46-702-272-205; Fax: +46-31-828-163
| |
Collapse
|
85
|
McCarthy MD, Thompson SJ, Knox KL. Use of the Air Force Post-Deployment Health Reassessment for the identification of depression and posttraumatic stress disorder: public health implications for suicide prevention. Am J Public Health 2012; 102 Suppl 1:S60-5. [PMID: 22390604 DOI: 10.2105/ajph.2011.300580] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Military members are required to complete the Post-Deployment Health Assessment on return from deployment and the Post-Deployment Health Reassessment (PHDRA) 90 to 180 days later, and we assessed the PDHRA's sensitivity and specificity in identifying posttraumatic stress disorder (PTSD) and depression after a military deployment among US Air Force personnel. METHODS We computed the PDHRA's sensitivity and specificity for depression and PTSD and developed a structural model to suggest possible improvements to it. RESULTS For depression, sensitivity and specificity were 0.704 and 0.651, respectively; for PTSD, they were 0.774 and 0.650, respectively. Several variables produced significant direct effects on depression and trauma, suggesting that modifications could increase its sensitivity and specificity. CONCLUSIONS The PDHRA was moderately effective in identifying airmen with depression and PTSD. It identified behavioral health concerns in many airmen who did not develop a diagnostic mental health condition. Its low level of specificity may result in reduced barriers to care and increased support services, key components of a public health approach to suicide prevention, for airmen experiencing subacute levels of distress after deployment, which may, in part, account for lower suicide rates among airmen after deployment.
Collapse
|
86
|
Britton PC, Ilgen MA, Valenstein M, Knox K, Claassen CA, Conner KR. Differences between veteran suicides with and without psychiatric symptoms. Am J Public Health 2012; 102 Suppl 1:S125-30. [PMID: 22390586 DOI: 10.2105/ajph.2011.300415] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Our objective was to examine all suicides (n = 423) in 2 geographic areas of the Veterans Health Administration (VHA) over a 7-year period and to perform detailed chart reviews on the subsample that had a VHA visit in the last year of life (n = 381). METHODS Within this sample, we compared a group with 1 or more documented psychiatric symptoms (68.5%) to a group with no such symptoms (31.5%). The groups were compared on suicidal thoughts and behaviors, somatic symptoms, and stressors using the χ(2) test and on time to death after the last visit using survival analyses. RESULTS Veterans with documented psychiatric symptoms were more likely to receive a suicide risk assessment, and have suicidal ideation and a suicide plan, sleep problems, pain, and several stressors. These veterans were also more likely to die in the 60 days after their last visit. CONCLUSIONS Findings indicated presence of 2 large and distinct groups of veterans at risk for suicide in the VHA, underscoring the value of tailored prevention strategies, including approaches suitable for those without identified psychiatric symptoms.
Collapse
Affiliation(s)
- Peter C Britton
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs Medical Center, Canandaigua, NY 14424, USA.
| | | | | | | | | | | |
Collapse
|
87
|
Links P, Nisenbaum R, Ambreen M, Balderson K, Bergmans Y, Eynan R, Harder H, Cutcliffe J. Prospective study of risk factors for increased suicide ideation and behavior following recent discharge. Gen Hosp Psychiatry 2012; 34:88-97. [PMID: 21997244 DOI: 10.1016/j.genhosppsych.2011.08.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 08/10/2011] [Accepted: 08/12/2011] [Indexed: 10/16/2022]
Abstract
OBJECTIVE The purpose of this study is to prospectively examine the association between predictors from the three thematic areas - suicidality, personal risk factors and patient care factors - and the occurrence of postdischarge suicide ideation and behavior in recently discharged patients. METHODS The design is a prospective cohort study of all patients admitted to an inner city inpatient psychiatric service with a lifetime history of suicidal behavior and current suicidal ideation. Predictors of suicide ideation at 1, 3 and 6 months following discharge and suicide behavior over the 6 months of follow-up were examined. RESULTS The incidence of death by suicide during the study period was 3.3% [95% confidence interval (CI)=0.9%-8.3%], and 39.4% (95% CI=30.0%-49.5%) of the surviving participants reported self-injury or suicide attempts within 6 months of hospital discharge. Risk factors such as recent suicide attempts, levels of depression, hopelessness and impulsivity were predictive of increased suicide ideation or behavior after discharge from the inpatient service. CONCLUSIONS The high risk of suicide ideation, suicide attempts and suicide demonstrated in these recently discharged patients supports the need to develop selective prevention strategies.
Collapse
Affiliation(s)
- Paul Links
- Suicide Studies Research Unit at St. Michael's Hospital, Toronto, Ontario, Canada.
| | | | | | | | | | | | | | | |
Collapse
|
88
|
Shah A. Elderly suicide rates: a replication of cross-national comparisons and association with sex and elderly age-bands using five year suicide data. J Inj Violence Res 2011; 3:80-4. [PMID: 21498970 PMCID: PMC3134928 DOI: 10.5249/jivr.v3i2.64] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 03/04/2010] [Indexed: 12/02/2022] Open
Abstract
Background: Suicide rates generally increase with age. A recent cross-national study, using one-year cross-sectional data on suicide rates identified regional and cross-national patterns for elderly suicide rates. However, findings from studies using one-year cross-sectional data on suicide rates may be open to bias because of random year on year fluctuations in elderly suicide rates. Methods: One-year average of suicide rates for both sexes in the age-bands 65-74 and 75+ years were calculated from data on suicide rates for five consecutive years ascertained from the World Health Organization. Cross-national variations were examined by segregating different countries into four quartiles of suicide rates. Results: There was wide cross-national variation in elderly suicide rates. Elderly suicide rates were the lowest in Caribbean and Arabic/Islamic countries, and the highest in central and eastern European, countries emerging from the former Soviet Union, some oriental and some west European countries. Conclusions: The regional and cross-national patterns for elderly suicide rates observed in this study were almost identical to a similar earlier study using one-year cross-sectional data on suicide rates. This suggests that the findings of both studies were accurate and robust, and potential explanations for the observed cross-national variations in elderly suicide rates requires further study.
Collapse
Affiliation(s)
- Ajit Shah
- University of Central Lancashire, Preston, United Kingdom.
| |
Collapse
|
89
|
Hooghe M, Vanhoutte B. An ecological study of community-level correlates of suicide mortality rates in the Flemish region of Belgium, 1996-2005. Suicide Life Threat Behav 2011; 41:453-64. [PMID: 21707729 DOI: 10.1111/j.1943-278x.2011.00047.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
An ecological study of age-standardized suicide rates in Belgian communities (1996-2005) was conducted using spatial regression techniques. Community characteristics were significantly related to suicide rates. There was mixed support for the social integration perspective: single person households were associated with higher suicide rates, while religious participation was unrelated and both immigration and the presence of non-European inhabitants had a negative impact. Deprivation had a positive relation with suicide. Population density had a negative influence on suicide rates. Areas with older populations had higher suicide risks than expected. A spatial contagion effect of neighboring communities was present for men. In the conclusion, hypotheses are presented on why an aging population could be associated with higher suicide rates in the community.
Collapse
Affiliation(s)
- Marc Hooghe
- Department of Political Science, University of Leuven, Leuven, Belgium.
| | | |
Collapse
|
90
|
Hirsch JK, Webb JR, Jeglic EL. Forgiveness, depression, and suicidal behavior among a diverse sample of college students. J Clin Psychol 2011; 67:896-906. [PMID: 21633957 DOI: 10.1002/jclp.20812] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Depression and suicide are significant public health concerns for college-age young adults. Meaning-based characteristics, such as forgiveness, a voluntary coping process involving offering, feeling, or seeking a change from negative to positive cognitions, behaviors, and affect toward a transgressor, may buffer such poor mental health outcomes. Utilizing mediation analyses, we examined cross-sectional associations between forgiveness, depression, and suicidal behavior in a diverse student sample reporting mild to severe depressive symptoms. The effect of self-forgiveness on suicidal behavior was fully mediated by depression; self-forgiveness was associated with depression and, in turn, with suicidal behavior. Forgiveness of others was directly associated with suicidal behavior. Prospective research is needed, yet self and other-forgiveness may be appropriate targets for promotion in suicide prevention efforts.
Collapse
Affiliation(s)
- Jameson K Hirsch
- Department ofPsychology, East Tennessee State University, 420 Rogers Stout Hall, Box 70649, Johnson City, TN 37614,
| | | | | |
Collapse
|
91
|
Abstract
This article makes the case that late-life suicide is a cause for great concern that warrants ongoing attention from researchers, health care providers, policy makers, and society at large. It reviews the evidence for factors that place older adults at risk for suicide, or protect them from it. The authors introduce the notion that suicide preventive interventions target individuals or groups at different levels of risk at different points on the developmental trajectory toward death by suicide, offering examples and recommending their strategic, combined application to create an effective, community-level response to the mounting problem of suicide in older adults.
Collapse
Affiliation(s)
- Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY 14642, USA.
| | - Kimberly Van Orden
- Instructor, Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd., Rochester, NY 14642, Phone: 585-275-5176, Fax: 585-273-1066
| | - Eric D. Caine
- Professor and John Romano Chair, Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd., Rochester, NY 14642, Phone: 585-275-3574, Fax: 585-273-1066
| |
Collapse
|
92
|
Smith EG, Craig TJ, Ganoczy D, Walters H, Valenstein M. Treatment of Veterans with depression who died by suicide: timing and quality of care at last Veterans Health Administration visit. J Clin Psychiatry 2011; 72:622-9. [PMID: 20868636 PMCID: PMC3039698 DOI: 10.4088/jcp.09m05608blu] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Accepted: 11/03/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To examine the recency and quality of the last Veterans Health Administration (VHA) visit for patients with depression who died by suicide. METHOD We obtained services and pharmacy data for all 1,843 VHA patients with diagnosed depressive disorders (DSM-IV criteria) who died by suicide from April 1999 through September 2004. We ascertained the location and timing of their final VHA visit. For visits occurring within 30 days of suicide, we examined 3 quality indicators: (1) evidence that mental illness was a focus of the final visit, (2) adequacy of antidepressant dosage, and (3) recent receipt of mental health services. RESULTS Just over half of the patients (51%) with depression diagnoses had a VHA visit within 30 days of suicide. A minority of these patients (43%) died by suicide within 30 days of a final visit with mental health services, although 64% had received such services within 91 days of their suicide. Among the 57% of patients who died by suicide within 30 days and who were seen in non-mental health settings for their final visit, only 34% had a mental health condition coded at the final visit, and only 41% were receiving adequate dosages of antidepressant (versus 55% for those last seen by mental health services) (P < .0005). CONCLUSIONS Veterans Health Administration patients with depression who died by suicide within 30 days of their final visit received relatively high rates of mental health services, but most final visits still occurred in non-mental health settings. Increased referrals to mental health services, attention to mental health issues in non-mental health settings, and focus on antidepressant treatment adequacy by all providers might have reduced suicide risks for these patients.
Collapse
|
93
|
Dai J, Chiu H, Conner KR, Chan S, Hou Z, Yu X, Caine E. Suicidal ideation and attempts among rural Chinese aged 16-34 years--socio-demographic correlates in the context of a transforming China. J Affect Disord 2011; 130:438-46. [PMID: 21106251 PMCID: PMC3085596 DOI: 10.1016/j.jad.2010.10.042] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 10/26/2010] [Accepted: 10/26/2010] [Indexed: 11/15/2022]
Abstract
BACKGROUND The distinctive epidemiologic profile of suicide in China, with notably high rates among rural young adult females, invites examination of possible underlying risk factors. Although there are accumulating data regarding the epidemiology of suicide among youth and young adults in China, there are meager data on suicidal ideation and attempts despite its importance. METHODS Our study in 2005-06 sought to identify all potentially suitable rural participants, aged 16-34 years, from 10 representative villages in rural Sichuan Province. We conducted structured interviews regarding a range of socio-demographic characteristics and suicidal morbidity. RESULTS 1654 of a potential 3008 participants participated; lifetime and one-year prevalence were: suicidal ideation (18.8% and 5.2%), serious ideation (8.6% and 2.3%), planning (5.8% and 1.5%), and attempt (2.7% and 0.5%). Comparisons among strata of socio-demographic characteristics showed more prevalent suicidal ideation associated with: female gender, lower education, poorer financial perception, greater rurality of residence, and marital status of "never married" or "others". Suicidal attempt was associated with: female gender and a marital status of "others". LIMITATIONS The study was carried out in one province and caution is required when considering other rural regions of China. There were a substantial number of unapproachable subjects because of their migrant work at distant sites. CONCLUSIONS Our results revealed an apparently higher prevalence for suicide ideation and planning compared with residents of other countries, but a lower prevalence for attempts. These data suggests that the relatively high rate of suicide in rural China reflects an elevated case fatality ratio due to chosen methods. The results also revealed unique patterns for correlates with the occurrence of ideation and attempts.
Collapse
Affiliation(s)
- J. Dai
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China,Center for the Study and Prevention of Suicide, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY USA
| | - H.F.K. Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China,Corresponding Author. Department of Psychiatry, Tai Po Hospital, Ground Floor, Multi-centre, No. 9 Chuen On Road, Tai Po, NT, Hong Kong. . Telephone (852) 2607-6027, Fax (852) 2667-8308
| | - K. R. Conner
- Center for the Study and Prevention of Suicide, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY USA
| | - S.S.M. Chan
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Z.J. Hou
- Sichuan College of Traditional Chinese Medicine, Mianyang, Sichuan, China
| | - X. Yu
- Institute of Mental Health, Peking University School of Medicine, Beijing, China
| | - E.D. Caine
- Center for the Study and Prevention of Suicide, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY USA
| |
Collapse
|
94
|
Shah A. A replication of the relationship between adversity earlier in life and elderly suicide rates using five years cross-national data. J Inj Violence Res 2011; 4:7-9. [PMID: 21502793 PMCID: PMC3291286 DOI: 10.5249/jivr.v4i1.65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 03/05/2010] [Indexed: 11/15/2022] Open
Abstract
Background: Although life-long adversity has been suggested as a protective factor for elderly suicides, studies examining protective factors for elderly suicides are scarce. A cross-national study examining the relationship between elderly suicide rates and several proxy measures of adversity earlier in life was undertaken to replicate earlier findings by using five consecutive years data on elderly suicide rates from a more recent data set and by adding two more proxy measures of adversity early in life. Methods: The relationship between elderly suicide rates and five proxy measures of adversity earlier in life was examined using data from the World Health Organization and the United Nations data banks with Spearman’s correlation coefficient. The five proxy measures of adversity early in life were: the percentage of children under the age of 5 years who were under weight, the percentage of children under the age of 5 years who were under height, the percentage of infants with low birth weight babies, the percentage of the general population with sustainable access to improved sanitation and the percentage of the general population with sustainable access to an improved water source. Results: Generally, elderly suicide rates were lower in countries with higher adversity early in life. The only exceptions were in females aged 75+ years where this association only approached statistical significance for the percentage of children under the age of 5 years who were under weight and the percentage of children under the age of 5 years who were under height. Conclusions: The current study using a more recent data set and a five years data on elderly suicide rates along with two additional proxy measures of adversity early in life was able to replicate the findings of the earlier study. This suggests that the findings of the earlier study were accurate and robust.
Collapse
Affiliation(s)
- Ajit Shah
- University of Central Lancashire, Preston, United Kingdom.
| |
Collapse
|
95
|
Shah A. The relationship between elderly suicide rates and different components of education: a cross-national study. J Inj Violence Res 2011; 4:52-7. [PMID: 21502785 PMCID: PMC3426901 DOI: 10.5249/jivr.v4i2.75] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Accepted: 04/04/2010] [Indexed: 11/26/2022] Open
Abstract
Background: Two recent studies reported a curvilinear (U-shaped) between elderly suicide rates and educational attainment measured by the United Nation’s Education Index. A study examining the curvilinear (U-shaped) relationship between elderly suicide rates and the individual components of the Education Index (adult literacy rate, percentage of children of relevant age group enrolled in primary schools and percentage of children of relevant age group enrolled for secondary schools) and one other measure of educational attainment (youth literacy rate) was undertaken to partial out the effects of the individual components of Education Index on elderly suicides. Methods: A cross-national study examining the relationship between elderly suicide rates (Y-axis) and different measures of educational attainment (X-axis) was undertaken using data from the World Health Organization and the United Nations data banks using Curve estimation regression models. Results: The relationship between elderly suicide rates with the adult literacy rate, the percentage of children of relevant age group enrolled for secondary schools and the youth literacy rate was curvilinear (U-shaped curve). This relationship was absent with the percentage of children of relevant age group enrolled in primary schools. Conclusion: Given the cross-sectional study design, a causal relationship between elderly suicide rates and measures of educational attainment, including the adult literacy rate, the percentage of children of relevant age group enrolled for secondary schools and the youth literacy rate, cannot be assumed. However, the findings suggest that future studies of elderly suicide rates and educational attainment should focus on the adult literacy rate, the percentage of children of relevant age group enrolled for secondary schools and the youth literacy rate as measures of educational attainment.
Collapse
Affiliation(s)
- Ajit Shah
- University of Central Lancashire, Preston, United Kingdom and Consultant Psychiatrist, West London Mental Health NHS Trust, London, United Kingdom.
| |
Collapse
|
96
|
Walker RL, Flowers KC. Effects of race and precipitating event on suicide versus nonsuicide death classification in a college sample. Suicide Life Threat Behav 2011; 41:12-20. [PMID: 21309820 PMCID: PMC3939706 DOI: 10.1111/j.1943-278x.2010.00008.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Race group differences in suicide death classification in a sample of 109 Black and White university students were examined. Participants were randomly assigned to read three vignettes for which the vignette subjects' race (only) varied. The vignettes each described a circumstance (terminal illness, academic failure, or relationship difficulties) that preceded the vignette subject's ambiguously premature death. Participants were asked to describe "what happened." Black participants were significantly less likely than White participants to attribute a vignette target's death to suicide and also less likely to report that suicide is acceptable. Implications for future research and prevention efforts are discussed.
Collapse
Affiliation(s)
- Rheeda L Walker
- Department of Psychology, University of Georgia, Athens, GA 30602-3013, USA.
| | | |
Collapse
|
97
|
Warner CH, Appenzeller GN, Parker JR, Warner C, Diebold CJ, Grieger T. Suicide prevention in a deployed military unit. Psychiatry 2011; 74:127-41. [PMID: 21688964 DOI: 10.1521/psyc.2011.74.2.127] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Military suicide and parasuicidal behaviors have been increasing over the last several years, with rates highest in the deployed environment. This article presents a deployment cycle-specific suicide prevention plan utilized during one U.S. Army division's 15-month deployment to Iraq. METHODS Education, identification, and intervention programs were implemented at each phase of the deployment cycle based on the specific unit activities and predicted stressors. RESULTS During the deployment, there was an annual suicide rate of 16/100,000 within the trial cohort, compared to a theater rate of 24/100,000. Peaks in suicidal ideation and behaviors occurred during months two, six, and twelve of deployment. CONCLUSIONS A deployment cycle prevention program may decrease rates of suicide in the combat environment. This program may serve as a model for other suicide prevention programs.
Collapse
|
98
|
Velligan D, Sajatovic M, Valenstein M, Riley WT, Safren S, Lewis-Fernandez R, Weiden P, Ogedegbe G, Jamison J. Methodological challenges in psychiatric treatment adherence research. ACTA ACUST UNITED AC 2010; 4:74-91. [PMID: 20643631 DOI: 10.3371/csrp.4.1.6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Reflecting an increasing awareness of the importance of treatment adherence on outcomes in psychiatric populations, the National Institute of Mental Health (NIMH) convened a panel of treatment adherence researchers on September 27-28, 2007 to discuss and articulate potential solutions for dealing with methodological adherence research challenges. Panel discussions and presentations were augmented with targeted review of the literature on specific topics, with a focus on adherence to medication treatments in adults with serious mental illness. The group discussed three primary methodological areas: participants, measures, and interventions. When selecting patients for adherence-enhancing interventions (AEIs), a three-tier model was proposed that draws from the universal (targeting all patients receiving medication treatment for a specific condition, regardless of current adherence), selective (targeting patients at risk for nonadherence), and indicated (targeting patients who are currently nonadherent) prevention model and emphasizes careful patient characterization in relevant domains and appropriate matching of interventions to the selected population. Proposals were also made to reduce problematic selection biases in patient recruitment and retention. The panel addressed the pros and cons of various methods that can be used to measure adherence, and concluded that it is appropriate to use multiple measures whenever possible. Finally, the panel identified a broad range of intervention approaches, and conditions under which these interventions are likely to be most effective at reducing barriers to adherence and reinforcing adherence behavior.
Collapse
Affiliation(s)
- Dawn Velligan
- Department of Psychiatry, Mail Stop 7797, The University of Texas Health Science Center, 7704 Floyd Curl Drive, San Antonio, TX 78229-3900, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
99
|
Goldston DB, Walrath CM, McKeon R, Puddy RW, Lubell KM, Potter LB, Rodi MS. The Garrett Lee Smith memorial suicide prevention program. Suicide Life Threat Behav 2010; 40:245-56. [PMID: 20560746 PMCID: PMC3107991 DOI: 10.1521/suli.2010.40.3.245] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In response to calls for greater efforts to reduce youth suicide, the Garrett Lee Smith (GLS) Memorial Act has provided funding for 68 state, territory, and tribal community grants, and 74 college campus grants for suicide prevention efforts. Suicide prevention activities supported by GLS grantees have included education, training programs (including gatekeeper training), screening activities, infrastructure for improved linkages to services, crisis hotlines, and community partnerships. Through participation in both local- and cross-site evaluations, GLS grantees are generating data regarding the local context, proximal outcomes, and implementation of programs, as well as opportunities for improvement of suicide prevention efforts.
Collapse
|
100
|
Rockett IRH, Wang S, Stack S, De Leo D, Frost JL, Ducatman AM, Walker RL, Kapusta ND. Race/ethnicity and potential suicide misclassification: window on a minority suicide paradox? BMC Psychiatry 2010; 10:35. [PMID: 20482844 PMCID: PMC2891687 DOI: 10.1186/1471-244x-10-35] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 05/19/2010] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Suicide officially kills approximately 30,000 annually in the United States. Analysis of this leading public health problem is complicated by undercounting. Despite persisting socioeconomic and health disparities, non-Hispanic Blacks and Hispanics register suicide rates less than half that of non-Hispanic Whites. METHODS This cross-sectional study uses multiple cause-of-death data from the US National Center for Health Statistics to assess whether race/ethnicity, psychiatric comorbidity documentation, and other decedent characteristics were associated with differential potential for suicide misclassification. Subjects were 105,946 White, Black, and Hispanic residents aged 15 years and older, dying in the US between 2003 and 2005, whose manner of death was recorded as suicide or injury of undetermined intent. The main outcome measure was the relative odds of potential suicide misclassification, a binary measure of manner of death: injury of undetermined intent (includes misclassified suicides) versus suicide. RESULTS Blacks (adjusted odds ratio [AOR], 2.38; 95% confidence interval [CI], 2.22-2.57) and Hispanics (1.17, 1.07-1.28) manifested excess potential suicide misclassification relative to Whites. Decedents aged 35-54 (AOR, 0.88; 95% CI, 0.84-0.93), 55-74 (0.52, 0.49-0.57), and 75+ years (0.51, 0.46-0.57) showed diminished misclassification potential relative to decedents aged 15-34, while decedents with 0-8 years (1.82, 1.75-1.90) and 9-12 years of education (1.43, 1.40-1.46) showed excess potential relative to the most educated (13+ years). Excess potential suicide misclassification was also apparent for decedents without (AOR, 3.12; 95% CI, 2.78-3.51) versus those with psychiatric comorbidity documented on their death certificates, and for decedents whose mode of injury was "less active" (46.33; 43.32-49.55) versus "more active." CONCLUSIONS Data disparities might explain much of the Black-White suicide rate gap, if not the Hispanic-White gap. Ameliorative action would extend from training in death certification to routine use of psychological autopsies in equivocal-manner-of-death cases.
Collapse
Affiliation(s)
- Ian RH Rockett
- Department of Community Medicine and the Injury Control Research Center, PO Box 9190 West Virginia University, Morgantown, West Virginia, 26506, USA
| | - Shuhui Wang
- National Institute for Occupational Safety and Health, 1095 Willowdale Road, Morgantown, West Virginia, 26505-2845, USA
| | - Steven Stack
- Department of Criminal Justice, 2305 FAB, Wayne State University, Detroit, Michigan, 48202, USA
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Mt Gravatt, Queensland, 4122, Australia
| | - James L Frost
- Department of Pathology, PO Box 9203, West Virginia University, Morgantown, West Virginia, 26506, USA
| | - Alan M Ducatman
- Department of Community Medicine and the Injury Control Research Center, PO Box 9190 West Virginia University, Morgantown, West Virginia, 26506, USA
| | - Rheeda L Walker
- Department of Psychology, Psychology Building, University of Georgia, Athens, Georgia, 30602-3013, USA
| | - Nestor D Kapusta
- Medical University of Vienna, Department of Psychoanalysis and Psychotherapy, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| |
Collapse
|