A Meta-Analysis of the Rates of Suicide Ideation, Attempts and Deaths in People with Epilepsy

Development and usability of a mobile tool for identification of depression and suicide risk in Fiji

BACKGROUND

In Fiji and other South Pacific island countries, depression and suicide are of great concern. There is a pressing need to rapidly identify those at risk and provide treatment as soon as possible.

OBJECTIVE

Design, develop and test a mobile health tool that enables CHNs to easily and rapidly identify individuals at risk for suicide and depression and provide guidelines for their treatment.

METHODS

Using Android Studio, a native app called ASRaDA was developed that encoded two validated scales: Center for Epidemiological Studies-Depression (CES-D), and Suicide Behavior Questionnaire-Revised (SBQ-R). The usability of the app was measured using the System Usability Scale by community health nurses in Fiji.

RESULTS

Out of a maximim possible of 100 on SUS, ASRaDA was scored at 86.79.

CONCLUSION

Mobile tools with high usability can be designed to aid community health nurses in Fiji and Pacific island counties rapidly identify those at risk for depression and suicide.

Meta-analysis of 5-hydroxytryptamine transporter gene promoter region polymorphism and post-stroke depression

OBJECTIVE

To investigate the relationship between 5-hydroxytryptamine transporter gene promoter region (5-HTTLPR) gene polymorphism and post-stroke depression (PSD).

METHODS

We searched the CNKI, China Science and Technology Journal, China WanFang, PubMed, Embase, and Web of Science databases for studies of the relationship between 5-HTTLPR polymorphism and PSD. Data were evaluated using Stata software.

RESULTS

The L allele was significantly related to the S allele (OR = 0.57, 95% confidence interval (CI) 0.49-0.65). The dominant genotype LL + LS was related to SS (OR = 0.48, 95%CI 0.39-0.59), the recessive genotype LL was related to LS + SS (OR = 0.39, 95%CI: 0.30-0.51), the homozygous genotype LL was related to SS (OR = 0.24, 95%CI 0.18-0.33), and the heterozygous genotype LS was related to SS (OR = 0.55, 95 CI 0.44-0.68). All the differences were significant. Ethnicity subgroup analysis showed significant differences among the five genotypes in both Asians and Caucasians. Hardy-Weinberg equilibrium (HWE) subgroup analysis showed that, after removal of a non-HWE-conforming control group, all five genotypes were significant and genotypes LL, LS + LL, and LS and L allele had beneficial effects on recovery from PSD.

CONCLUSION

5-HTTLPR gene polymorphism is strongly associated with PSD, and the LL, LS + LL, and LS genotypes and L allele may protect against this condition.

Clinical Profiles and Health Services Patterns of Medicaid-Enrolled Youths Who Died by Suicide

Importance

Youth suicide is a major public health problem, and health care settings play a critical role in suicide prevention efforts, but limited data are available to date on health and mental health service use patterns before suicide.

Objective

To compare the clinical profiles and patterns of use of health and mental health care services among children and adolescents who died by suicide and a matched living control group.

Design, Setting, and Participants

This population-based case-control study used Medicaid data from 16 states merged with mortality data. Suicide cases (n = 910) included all youths aged 10 to 18 years who died by suicide from January 1, 2009, to December 31, 2013. Controls (n = 6346) were matched to suicide cases on sex, race, ethnicity, Medicaid eligibility category, state, and age. Data were analyzed from July 18 to November 19, 2019.

Exposures

Use of health and mental health care services.

Main Outcomes and Measures

Health and behavioral health care visits in the 6-month period before the index date (date of suicide). Associations among visits, clinical characteristics, and suicide were examined using logistic regression.

Results

The study population of 7256 Medicaid-enrolled youths included 5292 males (72.9%) with a mean (SD) age of 15.7 (2.0) years at the index date; 3619 (49.9%) were non-Hispanic white. Three hundred seventy-six suicide decedents (41.3%) had a mental health diagnosis in the 6 months before death compared with 1111 controls (17.5%; P < .001). A greater proportion of suicide decedents than controls used services before the index date (in 6 months, 687 suicide decedents [75.5%] vs 3669 controls [57.8%]; odds ratio [OR], 2.39 [95% CI, 2.02-2.82]). Suicide risk was highest among youths with epilepsy (OR, 4.89; 95% CI, 2.81-8.48; P < .001), depression (OR, 3.19; 95% CI, 2.49-4.09; P < .001), schizophrenia (OR, 3.18; 95% CI, 2.00-5.06; P < .001), substance use disorder (OR, 2.65; 95% CI, 1.67-4.20; P < .001), and bipolar disorder (OR, 2.09; 95% CI, 1.58-2.76; P < .001). More mental health visits within the 30 days before the index date were associated with decreased odds of suicide (OR, 0.78; 95% CI, 0.65-0.92; P = .005).

Conclusions and Relevance

This study found that among youths aged 10 to 18 years who were enrolled in Medicaid, clinical characteristics and patterns of use of health care services among suicide decedents were distinct from those of nonsuicide controls. Implementation of suicide screening protocols for youths enrolled in Medicaid, targeted based on the frequency of visits, psychiatric diagnoses, and epilepsy, may have the potential to decrease suicide rates.

Global mapping of interventions to improve quality of life of patients with depression during 1990-2018

PURPOSE

The number of patients with depressive disordered globally increased and affects people of all ages and countries and has a significant and negative impact on the quality of life (QoL). Depression if left untreated may lead to severe consequences. However, there are several types of effective treatments, but often patients need support from health staff to find suitable treatments. This study aims to examine the global trend of the publications as well as the development of interventions for depressing treatment.

METHODS

We download and analyzed 15,976 scientific research from the Web of Science from 1990 to 2018. A text mining based on Latent Dirichlet and terms' co-occurrence in titles and abstracts to identify hidden research topics and research landscapes.

RESULTS

We found that the number of papers related to non-pharmacological treatment (such as cognitive-behavioral, mindfulness, or family and social support) to improve the QoL of patients with depression has increased. The number of papers on this serious health issue in low-middle income countries (LMICs) was not as high as in high-income countries (HICs).

CONCLUSION

It is necessary to increase support of the treatment of depression in LMICs as well as applied non-pharmacological interventions to patients with depression.

Psychometric properties of the psychological strain scales (PSS) in suicide attempters and community controls of rural China

BACKGROUND

Psychological Strain Scales (PSS) were developed to measure four types of strain comprising value strain, deprivation strain, aspiration strain, and coping strain. This study aimed to evaluate the psychometric properties of the Chinese version of 40-item PSS in suicide attempters and community controls of rural China.

METHODS

Data of this study came from the investigation of 132 suicide attempters and their paired community controls matched with the same sex, age (±3 years) and residence in five counties in rural Shandong, China. The Chinese version of PSS, the Center for Epidemiologic Studies Depression Scale (CES-D), the Trait Anxiety Inventory (TAI) and the Self-esteem Scale (SES) were administered and reliability test and validity test of the PSS were conducted.

RESULTS

Cronbach's α and Guttman Spilt-Half coefficient of PSS was 0.942 and 0.842 for suicide attempters, and 0.950 and 0.874 for community controls. For both suicide attempters and community controls, the Exploratory Factor Analysis indicated a one-factor structure of each strain scale, which accorded with the original factor structure proposed by the authors. The scores of the total PSS and four subscales were positively correlated with the scores of CES-D and TAI; and negatively correlated with the score of SES, which indicated a good performance in convergent validity.

LIMITATIONS

This study was limited to its generalizability to the Chinese urban population.

CONCLUSIONS

The Chinese version of the 40-item PSS has satisfactory psychometric properties in terms of reliability and validity in Chinese rural suicide attempters and community controls.

Validation of the Chinese version of the Scale for Suicide Ideation-Worst in adult patients with epilepsy

OBJECTIVE

The aim of this study was to validate the Chinese version of the Scale for Suicide Ideation-Worst (SSI-W) for screening suicide ideation in Chinese adult patients with epilepsy (PWE).

METHOD

A consecutive sample of Chinese adult PWE from a tertiary hospital completed the SSI-W and the suicidality module of the Chinese version of the Mini International Neuropsychiatric Interview (MINI) Plus 5.0.0.

RESULTS

A total of 269 PWE completed the scales. According to the MINI, 59 patients (21.9%) had suicidal ideation. The Cronbach's α coefficient for the SSI-W was 0.96. Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) for the SSI-W was 0.957 (95% confidence interval [CI] = 0.935-0.980). With a cutoff score of 2 points, the SSI-W demonstrated the best psychometric properties: a sensitivity of 95.8%, a specificity of 87.3%, a positive predictive value (PPV) of 56.7%, and a negative predictive value (NPV) of 99.0%. The scores for items 11 (Reason for attempt) and 18 (Final acts) were not significantly different (p > 0.05) in patients with suicidal ideation, while the scores for the other items were significantly different between these groups of patients.

CONCLUSION

The Chinese version of the SSI-W proved to be a reliable and effective assessment tool for screening suicidal ideation in Chinese adult PWE.

Global Lifetime and 12-Month Prevalence of Suicidal Behavior, Deliberate Self-Harm and Non-Suicidal Self-Injury in Children and Adolescents between 1989 and 2018: A Meta-Analysis

OBJECTIVE

This meta-analysis aimed to estimate the global lifetime and 12-month prevalence of suicidal behavior, deliberate self-harm and non-suicidal self-injury in children and adolescents.

METHODS

A systematic search for relevant articles published between 1989 to 2018 was performed in multiple electronic databases. The aggregate 12-month and lifetime prevalence of suicidal behavior, deliberate self-harm, and non-suicidal self-injury were calculated based on the random-effects model. Subgroup analyses were performed to compare the prevalence according to school attendance and geographical regions. Results: A total of 686,672 children and adolescents were included. The aggregate lifetime and 12-month prevalence of suicide attempts was 6% (95% CI: 4.7-7.7%) and 4.5% (95% CI: 3.4-5.9%) respectively. The aggregate lifetime and 12-month prevalence of suicidal plan was 9.9% (95% CI: 5.5-17%) and 7.5% (95% CI: 4.5-12.1%) respectively. The aggregate lifetime and 12-month prevalence of suicidal ideation was 18% (95% CI: 14.2-22.7%) and 14.2% (95% CI: 11.6-17.3%) respectively. The aggregate lifetime and 12-month prevalence of non-suicidal self-injury was 22.1% (95% CI: 16.9-28.4%) and 19.5% (95% CI: 13.3-27.6%) respectively. The aggregate lifetime and 12-month prevalence of deliberate self-harm was 13.7% (95% CI: 11.0-17.0%) and 14.2% (95% CI: 10.1-19.5%) respectively. Subgroup analyses showed that full-time school attendance, non-Western countries, low and middle-income countries, and geographical locations might contribute to the higher aggregate prevalence of suicidal behaviors, deliberate self-harm, and non-suicidal self-injury. Conclusions: This meta-analysis found that non-suicidal self-injury, suicidal ideation, and deliberate self-harm were the three most common suicidal and self-harm behaviors in children and adolescents.

Overview of Federated Facility to Harmonize, Analyze and Management of Missing Data in Cohorts

Cohorts are instrumental for epidemiologically oriented observational studies. Cohort studies usually observe large groups of individuals for a specific period of time to identify the contributing factors to a specific outcome (for instance an illness) and create associations between risk factors and the outcome under study. In collaborative projects, federated data facilities are meta-database systems that are distributed across multiple locations that permit to analyze, combine, or harmonize data from different sources making them suitable for mega- and meta-analyses. The harmonization of data can increase the statistical power of studies through maximization of sample size, allowing for additional refined statistical analyses, which ultimately lead to answer research questions that could not be addressed while using a single study. Indeed, harmonized data can be analyzed through mega-analysis of raw data or fixed effects meta-analysis. Other types of data might be analyzed by e.g., random-effects meta-analyses or Bayesian evidence synthesis. In this article, we describe some methodological aspects related to the construction of a federated facility to optimize analyses of multiple datasets, the impact of missing data, and some methods for handling missing data in cohort studies.

[Suicidological research in epilepsy: problems of methodology]

The review highlights contemporary views on the problem of suicide in patients with epilepsy. The most relevant theories are presented that describe the emergence of suicidal thoughts and the transition to suicidal attempts. Along with a description of risk factors, protective factors, as well as the possible impact of comorbidity, a description of methodological deficiencies in papers on suicide in patients with epilepsy is given. Recommendations for studies related to suicidal behaviour in patients with epilepsy are discussed.

Suicide, Stigma, and Utilizing Social Media Platforms to Gauge Public Perceptions

Introduction: Suicide, a multifaceted complex outcome that arises from numerous biopsychosocial factors, is a public health concern which is growing in numbers despite valiant prevention efforts. There is still a lot of stigma surrounding suicide that needs to be addressed. Social media is growing exponentially and there are many forums where suicidality is being discussed. As a result, we conducted a brief survey on the perception of suicide on social media platforms of Facebook and Reddit in order to gather more information. Results: Of the 152 respondents, 86% believed that suicide is preventable, and 72.85% believed that it is a person's right to die by suicide. About a third (31.79%) had lost someone close to them to suicide. Respondents who did not think suicide was preventable also viewed suicide as either a sign of strength (42.86%) or a revenge act (33.3%). Those who responded that someone close to them died by suicide believed that the media glorified suicide (56.25%) while those who did not lose someone, did not believe that (66.99%). Women (61%) found social media to be a good platform for people to ask for help while men did not (60.61%). Conclusions: We utilized the social media platforms to gauge the perception of suicide and found among the sample of mostly young white respondents, suicide is not stigmatized, most believed it is preventable and it is a person's right to die by suicide. While women found social media to be a good platform to ask for support, men did not, which is in keeping with the trend that women tend to be more willing to seek help. A third of the group had lost someone close to them to suicide which was the national average, who tended to believe that media glorified suicide. Limitations of this study include the fact that those who respond voluntarily to a survey likely have an interest in the topic, and this might not accurately reflect the public opinion and attitude.