1
|
Davies M, Horsdal HT, Antonsen S, Sigsgaard T, Fan CC, Thompson WK, Pedersen CB, Sabel CE. The complexities of suicide: a multilevel survival analysis examining individual, familial and neighbourhood determinants of suicide risk using Danish register-based data. Psychol Med 2023; 53:6356-6365. [PMID: 36515183 DOI: 10.1017/s0033291722003701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Suicide risk is complex and nuanced, and how place impacts suicide risk when considered alongside detailed individual risk factors remains uncertain. We aimed to examine suicide risk in Denmark with both individual and neighbourhood level risk factors. METHODS We used Danish register-based data to identify individuals born in Denmark from 1972, with full parental information and psychiatric diagnosis history. We fitted a two-level survival model to estimate individual and neighbourhood determinants on suicide risk. RESULTS We identified 1723 cases of suicide in Denmark during the follow-up period from 1982 to 2015. Suicide risk was explained mainly by individual determinants. Parental comorbidities, particularly maternal schizophrenia [incidence rate ratio (IRR): 2.29, 95% CI 1.56-3.16] and paternal death (2.29, 95% CI 1.31-3.72) partly explained suicide risk when adjusted for all other determinants. The general contextual effect of suicide risk across neighbourhoods showed a median incidence rate ratio (MRR) of 1.13 (1.01-1.28), which was further reduced with full adjustment. Suicide risk increased in neighbourhoods with a higher proportion of manual workers (IRR: 1.08; 1.03-1.14), and decreased with a higher population density (IRR: 0.89; 0.83-0.96). CONCLUSION Suicide risk varies mainly between individuals, with parental comorbidities having the largest effect on suicide risk. Suicide risk was less impacted by neighbourhood, though, albeit to a lesser extent than individual determinants, some characteristics were associated with suicide risk. Suicide prevention policies might consider targeting interventions towards individuals more vulnerable due to particular parental comorbidities, whilst taking into account that some neighbourhood characteristics might exacerbate this risk further.
Collapse
Affiliation(s)
- Megan Davies
- Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
- BERTHA Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark
| | - Henriette Thisted Horsdal
- BERTHA Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
| | - Sussie Antonsen
- BERTHA Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
| | - Torben Sigsgaard
- BERTHA Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Chun Chieh Fan
- Department of Radiology, Population Neuroscience and Genetics Lab, University of California San Diego, La Jolla, CA, USA
| | - Wesley K Thompson
- Division of Biostatistics and Department of Radiology, Population Neuroscience and Genetics Lab, University of California San Diego, La Jolla, CA, USA
| | - Carsten Bøcker Pedersen
- BERTHA Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark
| | - Clive E Sabel
- BERTHA Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Health Research Institute, University of Canberra, Canberra, Australia
| |
Collapse
|
2
|
The application of spatial analysis to understanding the association between area-level socio-economic factors and suicide: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02441-z. [PMID: 36805762 DOI: 10.1007/s00127-023-02441-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 02/02/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND Little is known about what impact the use of different spatial methodological approaches may have on understanding the relationship between area-level socio-economic factors and suicide. METHODS In this systematic review, we searched PubMed, Embase, CINAHL and PsycInfo for original empirical studies examining the relationship between socio-economic factors and suicide with a spatial lens, published up to January 22, 2022. Data on applied spatial methods, indicators of socio-economic factors, and risk of suicide related to socio-economic factors were extracted. The protocol for this systematic review was registered with PROSPERO (CRD42021251387). RESULTS A systematic search yielded 6290 potentially relevant results; 58 studies met the inclusion criteria for review. Of the 58 included studies, more than half of the studies (n = 34; 58.6%) used methods that accounted for spatial effects in analyses of the association between socio-economic factors and suicide or examined spatial autocorrelation, while 24 (41.4%) studies applied univariate and multivariate models without considering spatial effects. Bayesian hierarchical models and spatial regression models were commonly used approaches to correct for spatial effects. The risk of suicide relating to socio-economic factors varied greatly by local areas and between studies using various socio-economic indicators. Areas with higher deprivation, higher unemployment, lower income, and lower education level were more likely to have higher suicide risk. There was no significant difference in results between studies using conventional versus spatial statistic methods. CONCLUSION An increasing number of studies have applied spatial methods, including Bayesian spatial models and spatial regression models, to explore the relationship between area-level socio-economic factors and suicide. This review of spatial studies provided further evidence that area-level socio-economic factors are generally inversely associated with suicide risk, with or without accounting for spatial autocorrelation.
Collapse
|
3
|
Peltzman T, Gottlieb DJ, Levis M, Shiner B. The role of race in rural-urban suicide disparities. J Rural Health 2021; 38:346-354. [PMID: 34128267 DOI: 10.1111/jrh.12603] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the role that race-ethnicity plays in modifying the observed rural-urban disparity in suicide among Veteran Health Administration (VHA) users. METHODS We performed a retrospective cohort study of 10,737,864 VHA users between 2003 and 2017, using cross-linked VHA medical records and National Death Index mortality data to assess longitudinal race-stratified rural-urban differences in age- and sex-adjusted annual suicide rates. We used Poisson regression and generated incident rate ratios (IRRs) to formally assess the impact of race on the rural-urban suicide disparity. Given evidence of effect modification, we performed additional race-stratified Poisson regression models. FINDINGS Rurality is significantly associated with a higher risk of suicide in models which do not control for race (IRR = 1.14, 95% CI: 1.10-1.17). However, when race is added to the model, rural residence is no longer significant (0.98, CI: 0.95-1.01). Stratified models demonstrate that rural residence is significantly associated with a higher suicide risk among Hispanic VHA users (1.41, CI: 1.11-1.79), but it is not substantially associated with suicide among White (0.97, CI: 0.94-1.00) and Black (1.03, CI: 0.86-1.23) VHA users. White VHA users have considerably higher suicide rates than Black and Hispanic VHA users, though the suicide rate among Hispanic VHA users, particularly those in rural settings, increased markedly over the period of observation. CONCLUSIONS Race significantly modifies the relationship between rural residence and suicide risk. Studies seeking to assess suicide disparity between rural and urban VHA user populations must include adjustment or stratification by race.
Collapse
Affiliation(s)
| | - Daniel J Gottlieb
- VA Medical Center, White River Junction, Vermont, USA.,Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Maxwell Levis
- VA Medical Center, White River Junction, Vermont, USA.,Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Brian Shiner
- VA Medical Center, White River Junction, Vermont, USA.,Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA.,Veterans Rural Health Resource Center, White River Junction, Vermont, USA
| |
Collapse
|
4
|
Lehrer S, Rheinstein PH. Breast Cancer, Alzheimer's Disease, and APOE4 Allele in the UK Biobank Cohort. J Alzheimers Dis Rep 2021; 5:49-53. [PMID: 33681716 PMCID: PMC7902990 DOI: 10.3233/adr-200266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Cognitive problems are common in breast cancer patients. The apolipoprotein E4 (APOE4) gene, a risk factor for Alzheimer’s disease (AD), may be associated with cancer-related cognitive decline. Objective: To further evaluate the effects of the APOE4 allele, we studied a cohort of patients from the UK Biobank (UKB) who had breast cancer; some also had AD. Methods: Our analysis included all subjects with invasive breast cancer. Single nucleotide polymorphism (SNP) data for rs 429358 and rs 7412 was used to determine APOE genotypes. Cognitive function as numeric memory was assessed with an online test (UKB data field 20240). Results: We analyzed data from 2,876 women with breast cancer. Of the breast cancer subjects, 585 (20%) carried the APOE4 allele. Numeric memory scores were significantly lower in APOE4 carriers and APOE4 homozygotes than non-carriers (p = 0.046). 34 breast cancer subjects (1.1%) had AD. There was no significant difference in survival among genotypes ɛ3/ɛ3, ɛ3/ɛ4, and ɛ4/ɛ4. Conclusion: UKB data suggest that cognitive problems in women with breast cancer are, for the most part, mild, compared with other sequelae of the disease. AD, the worst cognitive problem, is relatively rare (1.1%) and, when it occurs, APOE genotype has little impact on survival.
Collapse
Affiliation(s)
- Steven Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | |
Collapse
|
5
|
Martinez-Ales G, Hernandez-Calle D, Khauli N, Keyes KM. Why Are Suicide Rates Increasing in the United States? Towards a Multilevel Reimagination of Suicide Prevention. Curr Top Behav Neurosci 2020; 46:1-23. [PMID: 32860592 PMCID: PMC8699163 DOI: 10.1007/7854_2020_158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Suicide, a major public health concern, takes around 800,000 lives globally every year and is the second leading cause of death among adolescents and young adults. Despite substantial prevention efforts, between 1999 and 2017, suicide and nonfatal self-injury rates have experienced unprecedented increases across the United States - as well as in many other countries in the world. This chapter reviews the existing evidence on the causes behind increased suicide rates and critically evaluates the impact of a range of innovative approaches to suicide prevention. First, we briefly describe current trends in suicide and suicidal behaviors and relate them to recent time trends in relevant suicide risk markers. Then, we review the existing evidence in suicide prevention at the individual and the population levels, including new approaches that are currently under development. Finally, we advocate for a new generation of suicide research that examines causal factors beyond the proximal and clinical and fosters a socially conscious reimagining of suicidal prevention. To this end, we emphasize the need for the conceptualization of suicide and suicidal behaviors as complex phenomena with causes at several levels of organization. Future interdisciplinary research and interventions should be developed within a multilevel causal framework that can better capture the social, economic, and political settings where suicide, as a process, unfolds across the life course.
Collapse
Affiliation(s)
- Gonzalo Martinez-Ales
- Columbia University Mailman School of Public Health, New York, NY, USA.
- Universidad Autónoma de Madrid School of Medicine, Madrid, Spain.
| | | | - Nicole Khauli
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Katherine M Keyes
- Columbia University Mailman School of Public Health, New York, NY, USA
| |
Collapse
|
6
|
Martínez-Alés G, Keyes KM. Fatal and Non-fatal Self-Injury in the USA: Critical Review of Current Trends and Innovations in Prevention. Curr Psychiatry Rep 2019; 21:104. [PMID: 31522256 PMCID: PMC7027360 DOI: 10.1007/s11920-019-1080-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW To examine current trends in suicide and self-injury in the USA, as well as potential contributors to their change over time, and to reflect on innovations in prevention and intervention that can guide policies and programs to reduce the burden of suicide and self-injury in the USA. RECENT FINDINGS Suicide and non-fatal self-injury are on the rise in the USA. Reasons for such trends over time remain speculative, although they seem linked to coincident increases in mood disorders and drug use and overdose. Promising innovative prevention and intervention programs that engage new technologies, such as machine learning-derived prediction tools and computerized ecologic momentary assessments, are currently in development and require additional evidence. Recent increases in fatal and non-fatal self-harm in the USA raise questions about the causes, interventions, and preventive measures that should be taken. Most innovative prevention efforts target individuals seeking to improve risk prediction and access to evidence-based care. However, as Durkheim pointed out over 100 years ago, suicide rates vary enormously between societal groups, suggesting that certain causal factors of suicide act and, hence, should be targeted at an ecological level. In the next generation of suicide research, it is critical to examine factors beyond the proximal and clinical to allow for a reimagining of prevention that is life course and socially focused.
Collapse
Affiliation(s)
- Gonzalo Martínez-Alés
- Columbia Mailman School of Public Health, 722W 168th St, Suite 1030, New York, NY, 10032, USA.
- Universidad Autónoma de Madrid School of Medicine, Madrid, Spain.
| | - Katherine M Keyes
- Columbia Mailman School of Public Health, 722W 168th St, Suite 1030, New York, NY, 10032, USA
| |
Collapse
|
7
|
Tammes P. Associating Locality-Level Characteristics With Surviving the Holocaust: A Multilevel Approach to the Odds of Being Deported and to Risk of Death Among Jews Living in Dutch Municipalities. Am J Epidemiol 2019; 188:896-906. [PMID: 30689689 DOI: 10.1093/aje/kwz015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 11/14/2022] Open
Abstract
Characteristics of the localities in which Jews lived have received little attention in research on Holocaust-related deaths. We examined associations between locality-level and individual-level characteristics with the odds of being deported by applying multilevel mixed-effects logistic regression models to data for about 118,000 Jews in 102 Dutch municipalities listed in 1941-1942 and linked to postwar victims and returnees lists. We examined associations between individual-level characteristics and risk of death of deported Jews in multilevel mixed-effects Weibull regression models. Locality-level characteristics, per standard deviation increase, associated with higher deportation chance were more collaborating policemen (OR = 1.07, 95% CI: 1.02, 1.12), strongest segregation mentality (OR = 2.01, 95% CI: 1.15, 3.50), and less employment in agriculture (OR = 0.95, 95% CI: 0.88, 1.01). Higher percentage of Catholics (OR = 0.81, 95% CI: 0.70, 0.94) and stronger electoral support for the National Socialist Movement (OR = 0.90, 95% CI: 0.85, 0.97) unexpectedly reduced deportation chance. Individual-level characteristics associated with lower deportation chance were female sex, ages 0-5 or 15-30 years, and being immigrants, intermarried, or converts to Christianity. Deported males aged 15-30 years had reduced risk of death between July 1942 and July 1943 but increased risk thereafter, consistent with young adult men being selected for work after deportation but this selection not offering long-term protection. Holocaust survival chances were influenced by both locality-level and individual-level characteristics.
Collapse
Affiliation(s)
- Peter Tammes
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
8
|
Pinzari L, Mazumdar S, Girosi F. A framework for the identification and classification of homogeneous socioeconomic areas in the analysis of health care variation. Int J Health Geogr 2018; 17:42. [PMID: 30514383 PMCID: PMC6278138 DOI: 10.1186/s12942-018-0162-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Detecting the variation of health indicators across similar areas or peer geographies is often useful if the spatial units are socially and economically meaningful, so that there is a degree of homogeneity in each unit. Indices are frequently constructed to generate summaries of socioeconomic status or other measures in geographic small areas. Larger areas may be built to be homogenous using regionalization algorithms. However, there are no explicit guidelines in the literature for the grouping of peer geographies based on measures such as area level socioeconomic indices. Moreover, the use of an index score becomes less meaningful as the size of an area increases. This paper introduces an easy to use statistical framework for the identification and classification of homogeneous areas. We propose the Homogeneity and Location indices to measure the concentration and central value respectively of an areas' socioeconomic distribution. We also provide a transparent set of criteria that a researcher can follow to establish whether a set of proposed geographies are acceptably homogeneous or need further refining. RESULTS We applied our framework to assess the socioeconomic homogeneity of the commonly used SA3 Australian census geography. These results showed that almost 60% of the SA3 census units are likely to be socioeconomically heterogeneous and hence inappropriate for presenting area level socioeconomic disadvantage. We also showed that the Location Index is a more robust descriptive measure of the distribution compared to other measures of central tendency. Finally, the methodology proposed was used to analyse the age-standardized variation of GP attenders in a metropolitan area. The results suggest that very high GP attenders (20+ visits) live in SA3s with the most socioeconomic disadvantage. The findings revealed that households with low income and families with children and jobless parents are the major drivers for discerning disadvantaged communities. CONCLUSION Reporting indicators rates for geographies grouped according to similarity may be useful for the analysis of geographic variation. The use of a framework for the identification of meaningful peer geographies would be beneficial to health planners and policy makers by providing realistic and valid peer group geographies.
Collapse
Affiliation(s)
- Ludovico Pinzari
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia.
- Capital Markets CRC, Sydney, NSW, Australia.
| | - Soumya Mazumdar
- Population Health Intelligence Group, Healthy People and Places Unit, South Western Sydney Local Health District, New South Wales Health, Sydney, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Federico Girosi
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- Capital Markets CRC, Sydney, NSW, Australia
| |
Collapse
|
9
|
Grigoroglou C, Munford L, Webb RT, Kapur N, Doran T, Ashcroft DM, Kontopantelis E. Association between a national primary care pay-for-performance scheme and suicide rates in England: spatial cohort study. Br J Psychiatry 2018; 213:600-608. [PMID: 30058517 DOI: 10.1192/bjp.2018.143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pay-for-performance policies aim to improve population health by incentivising improvements in quality of care.AimsTo assess the relationship between general practice performance on severe mental illness (SMI) and depression indicators under a national incentivisation scheme and suicide risk in England for the period 2006-2014. METHOD Longitudinal spatial analysis for 32 844 small-area geographical units (lower super output areas, LSOAs), using population-structure adjusted numbers of suicide as the outcome variable. Negative binomial models were fitted to investigate the relationship between spatially estimated recorded quality of care and suicide risk at the LSOA level. Incidence rate ratios (IRRs) were adjusted for deprivation, social fragmentation, prevalence of depression and SMI as well as other 2011 Census variables. RESULTS No association was found between practice performance on the mental health indicators and suicide incidence in practice localities (IRR=1.000, 95% CI 0.998-1.002). IRRs indicated elevated suicide risks linked with area-level social fragmentation (1.030; 95% CI 1.027-1.034), deprivation (1.013, 95% CI 1.012-1.014) and rurality (1.059, 95% CI 1.027-1.092). CONCLUSIONS Primary care has an important role to play in suicide prevention, but we did not observe a link between practices' higher reported quality of care on incentivised mental health activities and lower suicide rates in the local population. It is likely that effective suicide prevention needs a more concerted, multiagency approach. Better training in suicide prevention for general practitioners is also essential. These findings pertain to the UK but have relevance to other countries considering similar programmes.Declaration of interestNone.
Collapse
Affiliation(s)
- Christos Grigoroglou
- NIHR School for Primary Care Research,Centre for Primary Care,Division of Population Health, Health Services Research and Primary Care,University of Manchester, Manchester Academic Health Sciences Centre (MAHSC),UK
| | - Luke Munford
- Research Fellow in Health Economics,Centre for Health Economics,Division of Population Health, Health Services Research and Primary Care,University of Manchester, Manchester Academic Health Sciences Centre (MAHSC),UK
| | - Roger T Webb
- Professor in Mental Health Epidemiology,Centre for Mental Health and Safety,University of Manchester, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC),UK
| | - Nav Kapur
- Professor of Psychiatry and Population Health,Centre for Suicide Prevention,University of Manchester, Greater Manchester Mental Health Trust and NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC),UK
| | - Tim Doran
- Professor of Health Policy,Department of Health Sciences,University of York,UK
| | - Darren M Ashcroft
- Professor of Pharmacoepidemiology,Centre for Pharmacoepidemiology and Drug Safety,School of Health Sciences,Faculty of Biology, Medicine and Health,University of Manchester, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC),UK
| | - Evangelos Kontopantelis
- Professor of Data Science and Health Services Research,Faculty of Biology, Medicine and Health,University of Manchester, Manchester Academic Health Sciences Centre (MAHSC),UK
| |
Collapse
|
10
|
Younès N, Rivière M, Plancke L, Leroyer A, Blanchon T, Azevedo Da Silva M, Melchior M. Work intensity in men and work-related emotional demands in women are associated with increased suicidality among persons attending primary care. J Affect Disord 2018; 235:565-573. [PMID: 29698918 DOI: 10.1016/j.jad.2018.04.075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/06/2018] [Accepted: 04/10/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND A large proportion of persons died by suicide are employed at the time of death and work-related factors partly contribute to suicide risk. Our aim was to examine the association between multiple aspects of work organization and suicidal ideation in a study conducted in primary care. METHODS Data came from a study of 2027 working patients attending a GP representative of patients in the Nord Pas-de-Calais region in France (April-August 2014). Suicidality was assessed using the MINI (Mini International Neuropsychiatric Interview). Six emergent worked-related factors were explored (work intensity, emotional demands, autonomy, social relationships at work, conflict of values, insecurity of work). Several covariates were considered: patient's and GP's characteristics, and area-level data (material and social deprivation, psychiatrist and GPs' density, suicide attempts and suicide rates). RESULTS 8.0% of participants reported suicidal ideation in the preceding month (7.5% of men and 8.6% of women, p = .03). In multivariate analyses adjusted for covariates, suicidality was significantly associated with work intensity (OR = 1.65; 95%CI [1.18-2.31]) in men and with work-related emotional demands (OR = 1.35; 95%CI [1.01-1.80]) in women. Area-level data were not associated. LIMITATIONS Our cross-sectional study cannot assess the direction of the relationships under study. CONCLUSION Our results emphasise a central role for GPs in suicide prevention among workers and highlight the importance of work-related factors with regard to suicidality in primary care.
Collapse
Affiliation(s)
- N Younès
- EA 40-47 University of Versailles Saint-Quentin, Versailles, France; Academic Unit of Psychiatry for Adults, Versailles Hospital, Versailles, France.
| | - M Rivière
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013 Paris, France; Department of Infectious Diseases, Centre Hospitalier Régional, Orléans, France
| | - L Plancke
- Fédération régionale de recherche en psychiatrie et santé mentale Hauts-de-France, Lille, France
| | - A Leroyer
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, EA 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000 Lille, France
| | - T Blanchon
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013 Paris, France
| | - M Azevedo Da Silva
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013 Paris, France; EA 40-47 University of Versailles Saint-Quentin, Versailles, France
| | - M Melchior
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013 Paris, France
| |
Collapse
|
11
|
Martínez-Alés G, Mascayano F, Bravo-Ortiz MF. Suicide: Contexts and persons. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2018; 12:253-254. [PMID: 30057286 DOI: 10.1016/j.rpsm.2018.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/27/2018] [Accepted: 05/25/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Gonzalo Martínez-Alés
- Servicio de Psiquiatría, Hospital Universitario La Paz, Madrid, España; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España.
| | - Franco Mascayano
- Escuela Mailman de Salud Pública, Universidad de Columbia, Nueva York, EE. UU
| | - María Fe Bravo-Ortiz
- Servicio de Psiquiatría, Hospital Universitario La Paz, Madrid, España; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
| |
Collapse
|
12
|
Peters EM, John A, Bowen R, Baetz M, Balbuena L. Neuroticism and suicide in a general population cohort: results from the UK Biobank Project. BJPsych Open 2018; 4:62-68. [PMID: 29971148 PMCID: PMC6020311 DOI: 10.1192/bjo.2017.12] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 12/12/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Neuroticism has often been linked to suicidal thoughts and behaviour. AIMS To examine whether neuroticism is associated with suicide deaths after adjusting for known risks. METHOD UK Biobank participants (n = 389 365) were assessed for neuroticism as well as social, demographic and health-related variables at study entry and followed for up to 10 years. Suicide risk was modelled using Cox regression stratified by gender. RESULTS Neuroticism increased the risk of suicide in both men (hazard ratio (HR) = 1.15, 95% CI 1.09-1.22) and women (HR = 1.16, 95% CI 1.06-1.27). In a subsample who were assessed for mood disorders, neuroticism remained a significant predictor for women (HR 1.25, 95% CI 1.03-1.51) but not for men. CONCLUSIONS Screening and therapeutic interventions for neuroticism may be important for early suicide prevention. DECLARATION OF INTEREST None.
Collapse
Affiliation(s)
- Evyn M. Peters
- Department of Psychiatry, University of
Saskatchewan, Saskatoon, SK,
Canada
| | - Ann John
- Swansea University Medical School and the Farr
Institute, Swansea, Wales,
UK
| | - Rudy Bowen
- Department of Psychiatry, University of
Saskatchewan, Saskatoon, SK,
Canada
| | - Marilyn Baetz
- Department of Psychiatry, University of
Saskatchewan, Saskatoon, SK,
Canada
| | - Lloyd Balbuena
- Department of Psychiatry, University of
Saskatchewan, Saskatoon, SK,
Canada
| |
Collapse
|
13
|
Kim K, Kim SW, Myung W, Han CE, Fava M, Mischoulon D, Papakostas GI, Seo SW, Cho H, Seong JK, Jeon HJ. Reduced orbitofrontal-thalamic functional connectivity related to suicidal ideation in patients with major depressive disorder. Sci Rep 2017; 7:15772. [PMID: 29150619 PMCID: PMC5693996 DOI: 10.1038/s41598-017-15926-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 11/04/2017] [Indexed: 11/25/2022] Open
Abstract
Despite recent developments in neuroimaging, alterations of brain functional connectivity in major depressive disorder (MDD) patients with suicidal ideation are poorly understood. This study investigated specific changes of suicidal ideation in functional connectivity of MDD patients. Whole brain functional connectivity in 46 patients with MDD (23 with suicidal ideation and 23 without) and 36 age- and gender- matched healthy controls were compared using resting-state functional Magnetic Resonance Imaging (fMRI) analyzed with network-based statistics (NBS) and graph-theoretical methods. Decreased functional connectivity in a characterized sub-network was observed in patients with MDD and suicidal ideation (FDR-adjusted p < 0.05). The sub-network included the regions of the fronto-thalamic circuits in the left hemisphere. The network measures of the left superior frontal gyrus, pars orbitalis (r = -0.40, p = 0.009), left thalamus (r = -0.41, p = 0.009), and right thalamus (r = -0.51, p = -0.002) were shown, through graph theoretical analysis, to be significantly negatively correlated with severity of suicidal ideation. The reduced functional connectivity in left orbitofrontal-both thalamic regions with suicidal ideation in MDD were inversely proportional to the severity of suicidality independent from depression severity. These findings suggest problems with decision-making and information integration in MDD patients with suicidal ideation.
Collapse
Affiliation(s)
- Kiwon Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
- National Institute of Dementia, Seongnam, South Korea
| | - Sung-Woo Kim
- School of Biomedical Engineering, College of Health Science, Korea University, Seoul, South Korea
| | - Woojae Myung
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Cheol E Han
- Department of Electronics and Information Engineering, College of Science & Technology, Korea University, Sejong, South Korea
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - George I Papakostas
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hana Cho
- Department of Physiology, Sungkyunkwan University School of Medicine, Samsung Biomedical Research Institute, Suwon, South Korea
| | - Joon-Kyung Seong
- School of Biomedical Engineering, College of Health Science, Korea University, Seoul, South Korea.
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
- Department of Health Sciences & Technology, Department of Medical Device Management & Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea.
| |
Collapse
|
14
|
Cairns JM, Graham E, Bambra C. Area-level socioeconomic disadvantage and suicidal behaviour in Europe: A systematic review. Soc Sci Med 2017; 192:102-111. [DOI: 10.1016/j.socscimed.2017.09.034] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 06/21/2017] [Accepted: 09/20/2017] [Indexed: 11/16/2022]
|
15
|
Näyhä S. Suicide mortality in Finnish Lapland by small areas, with reference to temporal trends. Int J Circumpolar Health 2016; 68:224-34. [DOI: 10.3402/ijch.v68i3.18332] [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
|
16
|
Windfuhr K, While D, Kapur N, Ashcroft DM, Kontopantelis E, Carr MJ, Shaw J, Appleby L, Webb RT. Suicide risk linked with clinical consultation frequency, psychiatric diagnoses and psychotropic medication prescribing in a national study of primary-care patients. Psychol Med 2016; 46:3407-3417. [PMID: 27650367 DOI: 10.1017/s0033291716001823] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Little is known about the precursors of suicide risk among primary-care patients. This study aimed to examine suicide risk in relation to patterns of clinical consultation, psychotropic drug prescribing, and psychiatric diagnoses. METHOD Nested case-control study in the Clinical Practice Research Datalink (CPRD), England. Patients aged ⩾16 years who died by suicide during 2002-2011 (N = 2384) were matched on gender, age and practice with up to 20 living control patients (N = 46 899). RESULTS Risk was raised among non-consulting patients, and increased sharply with rising number of consultations in the preceding year [⩾12 consultations v. 1: unadjusted odds ratio (OR) 6.0, 95% confidence interval (CI) 4.9-7.3]. Markedly elevated risk was also associated with the prescribing of multiple psychotropic medication types (⩾5 types v. 0: OR 62.6, CI 44.3-88.4) and with having several psychiatric diagnoses (⩾4 diagnoses v. 0: OR 31.1, CI 19.3-50.1). Risk was also raised among patients living in more socially deprived localities. The confounding effect of multiple psychotropic drug types largely accounted for the rising risk gradient observed with increasing consultation frequency. CONCLUSIONS A greater proportion of patients with several psychiatric diagnoses, those prescribed multiple psychotropic medication types, and those who consult at very high frequency might be considered for referral to mental health services by their general practitioners. Non-consulters are also at increased risk, which suggests that conventional models of primary care may not be effective in meeting the needs of all people in the community experiencing major psychosocial difficulties.
Collapse
Affiliation(s)
- K Windfuhr
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness,University of Manchester,UK
| | - D While
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness,University of Manchester,UK
| | - N Kapur
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness,University of Manchester,UK
| | - D M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety,Manchester Pharmacy School and NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre,University of Manchester,UK
| | - E Kontopantelis
- Centre for Health Informatics,Institute of Population Health,University of Manchester,UK
| | - M J Carr
- Centre for Mental Health and Safety,University of Manchester,UK
| | - J Shaw
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness,University of Manchester,UK
| | - L Appleby
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness,University of Manchester,UK
| | - R T Webb
- Centre for Mental Health and Safety,University of Manchester,UK
| |
Collapse
|
17
|
Law CK, Kõlves K, De Leo D. Influences of population-level factors on suicides in older adults: a national ecological study from Australia. Int J Geriatr Psychiatry 2016; 31:384-91. [PMID: 26343391 DOI: 10.1002/gps.4343] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/20/2015] [Accepted: 07/17/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The relationship between older adult suicide rates and population-level variables has been examined in a few studies. Therefore, the objective of the present study is to analyse the extent to which population-level factors are associated with suicide by older persons in Australia, from an ecological perspective. METHODS Suicide rates for older adults aged 65 years and over were calculated for 68 observation units at Statistical Areas Level 4 in Australia for 2002-2011. The 2011 Census of Population and Housing was used for population-level variables. Analysis on standardised suicide mortality ratios and Poisson regression were performed to examine geographical and gender differences. RESULTS Between 2002 and 2011, a total of 3133 suicides of persons aged 65 years and above (men: n = 2418, 77.1%) was identified with an average annual rate of 10.1 per 100,000 persons. Suicide rates in older adults vary widely between different geographical regions in Australia. The multivariate estimates of contextual factors showed that the risk of suicide was positively associated with the sex ratio (incidence risk ratio (IRR) = 1.053, 95%CI = 1.016-1.092), the proportion of those in tenant household (IRR = 1.120, 95%CI = 1.081-1.160) and Australian residents born in North-West Europe (IRR = 1.058, 95%CI = 1.022-1.095). Significant gender variations were found. CONCLUSIONS Specific factors increasing risk of suicide for older adults on SA4 level in Australia were living in areas with a higher proportion of male population, a higher proportion of tenant household dwellers and a higher proportion of immigrants from North-West Europe. The different influences of population-level factor on suicide between older men and women indicate the need for targeted suicide prevention activities.
Collapse
Affiliation(s)
- Chi-Kin Law
- Australian Institute for Suicide Research and Prevention, National Centre of Excellence in Suicide Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Brisbane, Queensland, Australia.,The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, National Centre of Excellence in Suicide Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Brisbane, Queensland, Australia
| | - 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, Griffith University, Brisbane, Queensland, Australia
| |
Collapse
|
18
|
Loureiro A, Costa C, Almendra R, Freitas Â, Santana P. The socio-spatial context as a risk factor for hospitalization due to mental illness in the metropolitan areas of Portugal. CAD SAUDE PUBLICA 2015; 31 Suppl 1:219-31. [DOI: 10.1590/0102-311x00090514] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 03/24/2015] [Indexed: 11/21/2022] Open
Abstract
Abstract This study’s aims are: (i) identifying spatial patterns for the risk of hospitalization due to mental illness and for the potential risk resulting from contextual factors with influence on mental health; and (ii) analyzing the spatial association between risk of hospitalization due to mental illness and potential risk resulting from contextual factors in the metropolitan areas of Lisbon and Porto, Portugal. A cross-sectional ecological study was conducted by applying statistical methods for assessing spatial dependency and heterogeneity. Results reveal a spatial association between risk of hospitalization due to mental illness and potential risk resulting from contextual factors with a statistical relevance of moderate intensity. 20% of the population under study lives in areas with a simultaneously high potential risk resulting from contextual factors and risk of hospitalization due to mental illness. Porto Metropolitan Area show the highest percentage of population living in parishes with a significantly high risk of hospitalization due to mental health, which puts forward the need for interventions on territory-adjusted contextual factors influencing mental health.
Collapse
Affiliation(s)
| | | | | | | | - Paula Santana
- Universidade de Coimbra, Portugal; Universidade de Coimbra, Portugal
| |
Collapse
|
19
|
Laszlo AM, Hulman A, Csicsman J, Bari F, Nyari TA. The use of regression methods for the investigation of trends in suicide rates in Hungary between 1963 and 2011. Soc Psychiatry Psychiatr Epidemiol 2015; 50:249-56. [PMID: 24990277 DOI: 10.1007/s00127-014-0926-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 06/22/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE Suicide rates in Hungary have been analyzed from different aspects in recent decades. However, only descriptive rates have been reported. The aim of our epidemiological study was to characterize the pattern of annual rates of suicide in Hungary during the period 1963-2011 by applying advanced statistical methods. METHODS Annual suicide rates per 100,000 population (>6 years) for gender, age group and suicide method were determined from published frequency tables and reference population data obtained from the Hungarian Central Statistical Office. Trends and relative risks of suicide were investigated using negative binomial regression models overall and in stratified analyses (by gender, age group and suicide method). Joinpoint regression analyses were additionally applied to characterize trends and to find turning points during the period 1963-2011. RESULTS Overall, 178,323 suicides (50,265 females and 128,058 males) were committed in Hungary during the investigated period. The risk of suicide was higher among males than females overall, in all age groups and for most suicide methods. The annual suicide rate exhibited a significant peak in 1982 and remained basically constant after 2006. Different segmented patterns were observed for the suicide rates in the various age groups. CONCLUSIONS Suicide rates revealed segmented linear pattern. This is the first detailed trend analysis with risk estimates obtained via joinpoint and negative binomial regression methods simultaneously for age-specific suicide frequencies in Hungary.
Collapse
Affiliation(s)
- Anna M Laszlo
- Department of Medical Physics and Informatics, Faculty of Medicine, University of Szeged, Korányi fasor 9, 6720, Szeged, Hungary,
| | | | | | | | | |
Collapse
|
20
|
The influence of deprivation on suicide mortality in urban and rural Queensland: an ecological analysis. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1919-28. [PMID: 24919445 DOI: 10.1007/s00127-014-0905-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 05/26/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE A trend of higher suicide rates in rural and remote areas as well as areas with low socioeconomic status has been shown in previous research. Little is known whether the influence of social deprivation on suicide differs between urban and rural areas. This investigation aims to examine how social deprivation influences suicide mortality and to identify which related factors of deprivation have a higher potential to reduce suicide risk in urban and rural Queensland, Australia. METHODS Suicide data from 2004 to 2008 were obtained from the Queensland Suicide Register. Age-standardized suicide rates (15+ years) and rate ratios, with a 95% confidence interval, for 38 Statistical Subdivisions (SSDs) in Queensland were calculated. The influence of deprivation-related variables on suicide and their rural-urban difference were modelled by log-linear regression analyses through backward elimination. RESULTS Among the 38 SSDs in Queensland, eight had a higher suicide risk while eleven had a lower rate. Working-age males (15-59 years) had the most pronounced geographic variation in suicide rate. In urban areas, suicide rates were positively associated with tenant households in public housing, Aboriginal and Torres Strait Islander people, the unemployment rate and median individual income, but inversely correlated with younger age and households with no internet access. In rural areas, only tenant households in public housing and households with no internet access heightened the risk of suicide, while a negative association was found for younger and older persons, low-skilled workers or labourers, and families with low income and no cars. CONCLUSIONS The extent to which social deprivation contributes to suicide mortality varies considerably between rural and urban areas.
Collapse
|
21
|
Telisinghe PU, Colombage SM. Patterns of suicide in Brunei Darussalam and comparison with neighbouring countries in South East Asia. J Forensic Leg Med 2013; 22:16-9. [PMID: 24485414 DOI: 10.1016/j.jflm.2013.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 10/22/2013] [Accepted: 11/18/2013] [Indexed: 11/25/2022]
Abstract
A retrospective study of suicides in Brunei Darussalam (Brunei) over a 20 year period from 1991-2010 was conducted by analysing the post-mortem examination and external examination reports and other relevant records. The suicide rate in Brunei is very low (1.9 deaths per 100,000 per year). The majority of the victims were expatriates 82(66%) and hanging was the commonest mode of suicide both in expatriate and local population. The study showed that the suicide rate among the Bruneian Malays was the lowest (0.5 deaths per 100,000 per year) among the different nationalities. The study highlights the demographics and socio-economic background of the victims, methods used in committing suicide, suicide rates in different ethnic groups and predisposing factors. The results of this study would be of use for taking preventive measures to minimize the incidence of suicide.
Collapse
Affiliation(s)
- P U Telisinghe
- RIPAS Hospital, Bandar Seri Begawan BA 1710, Brunei Darussalam
| | | |
Collapse
|
22
|
Najafi F, Hasanzadeh J, Moradinazar M, Faramarzi H, Nematollahi A. An epidemiological survey of the suicide incidence trends in the southwest iran: 2004-2009. Int J Health Policy Manag 2013; 1:219-22. [PMID: 24596868 DOI: 10.15171/ijhpm.2013.40] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 09/02/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Elimination of suicide attempts is impossible, but they can be reduced dramatically by an organized planning. The present study aimed to survey the suicide trends in Fars province (Iran), during 2004-2009 to better understand the prevalence and status of suicide. METHODS This survey was a cross-sectional study. The demographic data were collected from the civil status registry between 2004 and 2009. Suicide and suicide attempt data were collected of three sources including the affiliated hospitals of Shiraz University of Medical Sciences, mortality data of Vice Chancellery of Health in Fars province and data from forensic medicine. Then, they were analyzed by Excel and SPSS. Chi-square and regression analyses were used for data analysis. RESULTS During the study, 10671 people attempted suicide, of which 5697 (53%) were women and 4974 (47%) were men. Among them, 1047 people (9.8%) died, of which 363 (34%) were women and 679 (64%) were men. There was a significant relationship between gender and fatal suicide. The mean suicide attempt for both genders was 53 per 100,000 and 49, 57 for men and women, respectively. The trends in the incidence of Suicidal attempts were decreasing. CONCLUSION Without implementing effective preventive measures, the health care system in Iran will face a further burden of fatal suicides among young people. Therefore; enhancing the primary health care and specialized mental health services for those with unsuccessful suicide attempts can effectively reduce the burden of suicide.
Collapse
Affiliation(s)
- Farid Najafi
- Research Center for Environmental Determinants of Health (RCEDH), School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Jafar Hasanzadeh
- Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Moradinazar
- Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossain Faramarzi
- Department of Social Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Nematollahi
- Department of Statistics, College of Sciences, Shiraz University, Shiraz, Iran
| |
Collapse
|
23
|
Qi X, Hu W, Page A, Tong S. Spatial clusters of suicide in Australia. BMC Psychiatry 2012; 12:86. [PMID: 22824367 PMCID: PMC3464902 DOI: 10.1186/1471-244x-12-86] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 07/23/2012] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Understanding the spatial distribution of suicide can inform the planning, implementation and evaluation of suicide prevention activity. This study explored spatial clusters of suicide in Australia, and investigated likely socio-demographic determinants of these clusters. METHODS National suicide and population data at a statistical local area (SLA) level were obtained from the Australian Bureau of Statistics for the period of 1999 to 2003. Standardised mortality ratios (SMR) were calculated at the SLA level, and Geographic Information System (GIS) techniques were applied to investigate the geographical distribution of suicides and detect clusters of high risk in Australia. RESULTS Male suicide incidence was relatively high in the northeast of Australia, and parts of the east coast, central and southeast inland, compared with the national average. Among the total male population and males aged 15 to 34, Mornington Shire had the whole or a part of primary high risk cluster for suicide, followed by the Bathurst-Melville area, one of the secondary clusters in the north coastal area of the Northern Territory. Other secondary clusters changed with the selection of cluster radius and age group. For males aged 35 to 54 years, only one cluster in the east of the country was identified. There was only one significant female suicide cluster near Melbourne while other SLAs had very few female suicide cases and were not identified as clusters. Male suicide clusters had a higher proportion of Indigenous population and lower median socio-economic index for area (SEIFA) than the national average, but their shapes changed with selection of maximum cluster radii setting. CONCLUSION This study found high suicide risk clusters at the SLA level in Australia, which appeared to be associated with lower median socio-economic status and higher proportion of Indigenous population. Future suicide prevention programs should focus on these high risk areas.
Collapse
Affiliation(s)
- Xin Qi
- Queensland University of Technology, Brisbane, Australia
| | - Wenbiao Hu
- University of Queensland, Brisbane, Australia
| | - Andrew Page
- University of Queensland, Brisbane, Australia
| | - Shilu Tong
- Queensland University of Technology, Brisbane, Australia
| |
Collapse
|
24
|
Martiello MA, Giacchi MV. Ecological study of isolation and suicide in Tuscany (Italy). Psychiatry Res 2012; 198:68-73. [PMID: 22386571 DOI: 10.1016/j.psychres.2011.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Revised: 10/12/2011] [Accepted: 11/17/2011] [Indexed: 10/28/2022]
Abstract
The purpose of the study was to investigate the association between suicide and demographic and socio-economic measures in Tuscany. Data on standardized rates of suicide from 1997 to 2005 in addition to census-derived variables, income and abstention were derived from the Mortality register, the 2001 Census, the Tax Agency and the Regional Electoral Office databases. Pearson's correlation and stepwise multiple regression analyses (unweighted and weighted by population) were used to analyze the association between suicide rates and demographic and socio-economic measures for the 34 health districts for both males and females. The correlation analyses showed that suicide was significantly associated with many variables in men, but only with old age in women. The multiple regression analyses showed that the best predictors in men were education, single person households and isolated houses (only education and single person households in the weighted model). For women, the best predictors were the proportion of elderly people and income (this was also true for the weighted model, but in the opposite order). An ecological correlation between suicide and measures of economic deprivation and social fragmentation was found in both men and women. Among the best predictors, isolated houses may act as a marker for remoteness and isolation on a small scale.
Collapse
|
25
|
Abstract
Suicide is second to only accidental death as the leading cause of mortality in young men across the world. Although suicide rates for young men have fallen in some high-income and middle-income countries since the 1990s, wider mortality measures indicate that rates remain high in specific regions, ethnic groups, and socioeconomic groups within those nations where rates have fallen, and that young men account for a substantial proportion of the economic cost of suicide. High-lethality methods of suicide are preferred by young men: hanging and firearms in high-income countries, pesticide poisoning in the Indian subcontinent, and charcoal-burning in east Asia. Risk factors for young men include psychiatric illness, substance misuse, lower socioeconomic status, rural residence, and single marital status. Population-level factors include unemployment, social deprivation, and media reporting of suicide. Few interventions to reduce suicides in young men have been assessed. Efforts to change help-seeking behaviour and to restrict access to frequently used methods hold the most promise.
Collapse
Affiliation(s)
- Alexandra Pitman
- University College London Mental Health Sciences Unit, London, UK.
| | | | | | | |
Collapse
|
26
|
Suicides by country of birth groupings in England and Wales: age-associated trends and standardised mortality ratios. Soc Psychiatry Psychiatr Epidemiol 2011; 46:197-206. [PMID: 20145906 DOI: 10.1007/s00127-010-0188-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2008] [Accepted: 01/21/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Suicide rates in England and Wales have declined in recent years. A better understanding of age-associated trends in different ethnic groups may inform strategies to sustain this decline. MATERIALS AND METHODS This study examines suicide rates and age-associated trends in England and Wales by country of birth (used as a proxy for ethnicity) using the latest available national mortality data. RESULTS The main findings were (a) suicide rates were generally higher in males than females in all age bands in all country of birth groups except the China group, where suicides rates were higher in females than males in the older age bands; (b) male suicide rates increased with ageing in the Indian sub-continent group and female suicide rates increased with ageing in the Africa and China groups; (c) male standardised mortality ratios (SMRs) were generally higher in the younger age bands in the Eastern Europe and Caribbean groups and generally lower in the Australasian, Middle East and Western Europe groups; (d) male SMRs were generally higher in the older age bands in Eastern Europe, Caribbean, Australasian and Western Europe groups and lower in all age bands in the Indian sub-continent group, and (e) female SMRs were generally higher in the older age bands in the China, Africa and Caribbean groups. CONCLUSION There is a need for epidemiological data on suicides in BME groups, including age-associated trends, trends over time, risk and protective factors and methods of suicide to inform suicide prevention strategies.
Collapse
|
27
|
Chang SS, Sterne JA, Wheeler BW, Lu TH, Lin JJ, Gunnell D. Geography of suicide in Taiwan: Spatial patterning and socioeconomic correlates. Health Place 2011; 17:641-50. [DOI: 10.1016/j.healthplace.2011.01.003] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 12/25/2010] [Accepted: 01/07/2011] [Indexed: 10/18/2022]
|
28
|
Rezaeian M, Dunn G, St Leger S, Appleby L. Application of commercial software to the classification of suicide cases: a brief report. VIOLENCE AND VICTIMS 2011; 26:533-540. [PMID: 21882673 DOI: 10.1891/0886-6708.26.4.533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Mosaic Profiler software was used to classify suicide and open verdict cases during 1996 to 1998 in England and within England, for the London and the North West regions. The classification system was based on the socioeconomic characteristics of the last place of residence of the cases at the level of postcode. The results highlighted that deprived areas and areas that contain elderly population or those areas that suffer from lack of social cohesion are overrepresented, whereas affluent areas are underrepresented. All of these, although in the larger scale, seem to support the results of other studies. Nevertheless, more studies would be required before one can fully evaluate the application of the Mosaic Profiler in the field of spatial epidemiology.
Collapse
Affiliation(s)
- Mohsen Rezaeian
- School of Medicine, Rafsanjan University of Medical Sciences, Iran.
| | | | | | | |
Collapse
|
29
|
Roberts SE, Jaremin B, Chalasani P, Rodgers SE. Suicides among seafarers in UK merchant shipping, 1919-2005. Occup Med (Lond) 2009; 60:54-61. [DOI: 10.1093/occmed/kqp133] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
30
|
Abstract
BACKGROUND Hungary previously had one of the highest suicide rates in the world, but experienced major social and economic changes from 1990 onwards. We aimed to investigate the antecedents of suicide in Hungary. We hypothesised that suicide in Hungary would be associated with both risk factors for suicide as identified in Western studies, and experiences related to social and economic restructuring. METHODS We carried out a controlled psychological autopsy study. Informants for 194 cases (suicide deaths in Budapest and Pest County 2002-2004) and 194 controls were interviewed by clinicians using a detailed schedule. RESULTS Many of the demographic and clinical risk factors associated with suicide in other settings were also associated with suicide in Hungary; for example, being unmarried or having no current relationship, lack of other social contacts, low educational attainment, history of self-harm, current diagnosis of affective disorder (including bipolar disorder) or personality disorder, and experiencing a recent major adverse life event. A number of variables reflecting experiences since economic restructuring were also associated with suicide; for example, unemployment, concern over work prospects, changes in living standards, practising religion. Just 20% of cases with evidence of depression at the time of death had received antidepressants. CONCLUSION Suicide rates in Hungary are falling. Our study identified a number of risk factors related to individual-level demographic and clinical characteristics, and possibly recent societal change. Improved management of psychiatric disorder and self-harm may result in further reductions in suicide rates.
Collapse
|
31
|
Rezaeian M. Islam and suicide: a short personal communication. OMEGA-JOURNAL OF DEATH AND DYING 2009; 58:77-85. [PMID: 19112876 DOI: 10.2190/om.58.1.e] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Islamic countries display lower suicide rates compared to the other countries of the world. Since most studies dealing with the relationships between Islam and suicide have focused on the extent of the problem and not the underlying mechanisms, the focus of this brief communication is to provide a rather more in-depth discussion regarding the mechanism of this relation. It also covers issues which may have an adverse effect on suicide within Islamic countries and consequently tries to sketch a path ahead in the area of suicide research within the Islamic countries.
Collapse
Affiliation(s)
- Mohsen Rezaeian
- Social Medicine Department, Rafsanjan Medical School, Rafsanjan, Iran.
| |
Collapse
|
32
|
Shah A. Are age-related trends in suicide rates associated with life expectancy and socio-economic factors? Int J Psychiatry Clin Pract 2009; 13:16-20. [PMID: 24946117 DOI: 10.1080/13651500802271241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background. A recent cross-national study reported that suicide rates increased, decreased or remained unchanged with increasing age in individual countries. The relationship between age-related trends in suicide rates and child mortality rates, life expectancy and socio-economic factors was examined. Methods. Countries with an increase, decrease and no change in suicide rates with increasing age were ascertained from an earlier study (Shah, 2007a, International Psychogeriatrics, 19, 1141), which analysed data from the World Health Organisation (WHO). The relationship between age-related trends in suicide rates and (i) child mortality rates, (ii) life expectancy and (iii) markers of socio-economic status (per capita gross national domestic product (GDP) and the Gini coeffcient) was examined using data from the WHO and the United Nations. Results. The main findings were: (i) child mortality rates were significantly lower in countries with an increase in suicide rates with increasing age when compared to countries without a change in suicide rates with increasing age in males; (ii) life expectancy was significantly higher in countries with an increase in suicide rates with increasing age when compared to countries without a change in suicide rates with increasing age in males; and (iii) the Gini coefficient was significantly lower in countries with an increase in suicide rates with increasing age when compared to countries without a change or a decline in suicide rates with increasing age in females. Conclusions. Potential explanations for these findings and the interaction of life expectancy and socio-economic factors with other factors that differentially influence suicide rates in different age and sex groups requires further examination.
Collapse
Affiliation(s)
- Ajit Shah
- Ageing, Ethnicity and Mental Health, University of Central Lancashire, Preston, UK
| |
Collapse
|
33
|
Corcoran P, Arensman E, Perry IJ. The area-level association between hospital-treated deliberate self-harm, deprivation and social fragmentation in Ireland. J Epidemiol Community Health 2008; 61:1050-5. [PMID: 18000126 DOI: 10.1136/jech.2006.055855] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The extensive literature on the area-level association between socioeconomic characteristics and suicide indicates that the more deprived and socially fragmented an area, the higher its suicide rate. Relatively few studies have examined the association between the incidence of non-fatal suicidal behaviour and area characteristics. AIM This study investigated the area-level association between hospital-treated deliberate self-harm, deprivation and social fragmentation in Ireland. METHODS During 2002-2004, the Irish National Registry of Deliberate Self Harm collected data on self-harm presentations to 38 of Ireland's 40 hospital accident and emergency (A&E) departments, using a standardised methodology that included geocoding patient addresses to small-area level. Annual deliberate self-harm incidence rates and levels of deprivation and social fragmentation were examined nationally and by geographic area. Negative binomial regression was used to investigate the small-area association between deliberate self-harm, deprivation and social fragmentation. RESULTS During 2002-2004, an estimated 32 777 deliberate self-harm presentations to A&E departments were made by 25 797 individuals. The total, male and female annual incidence rates were 204, 172 and 237 per 100 000, respectively. There were striking geographic differences in deliberate self-harm presentation rates which were largely explained by the distribution of deprivation, fragmentation, age and gender, and interactions between these factors. Deprivation, rather than fragmentation, had the stronger independent effect on small-area rates of self-harm. CONCLUSIONS The highest rates of hospital-treated deliberate self-harm in Ireland are in deprived urban areas. Priority should be given to these areas when implementing community-based interventions aimed at reducing suicidal behaviour.
Collapse
Affiliation(s)
- Paul Corcoran
- National Suicide Research Foundation, 1 Perrott Avenue, College Road, Cork, Ireland.
| | | | | |
Collapse
|
34
|
Shah A, Bhat R, Mackenzie S, Koen C. A cross-national study of the relationship between elderly suicide rates and life expectancy and markers of socioeconomic status and health care. Int Psychogeriatr 2008; 20:347-60. [PMID: 17506909 DOI: 10.1017/s1041610207005352] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Socioeconomic status may influence cross-national variations in elderly suicide rates. METHODS The relationship between suicide rates in both sexes in the age-bands 65-74 years and 75+ years and (i) life expectancy, (ii) measures of socioeconomic status (per capita gross national domestic product (GDP) and the Gini coeffcient), and (iii) measures of the quality and quantity of available healthcare services (the proportion of GDP spent on health, per capita expenditure on health and child mortality rates) was examined using data from the World Health Organization and the United Nations. RESULTS The main findings were: (i) a significant negative correlation between the Gini coefficient and suicide rates for both sexes in both age-bands; (ii) a significant positive correlation between per capita expenditure on health and suicide rates for both sexes in both age-bands; (iii) the significant positive correlation between the proportion of GDP spent on health and suicide rates was only evident in males in both age-bands; (iv) a significant negative correlation between child mortality rates and suicide rates for both sexes in both age-bands; and, (v) the significant positive correlation between life expectancy and suicide rates was evident in females in both age-bands. CONCLUSIONS A potentially testable model with five sequential stages was proposed to explain these findings.
Collapse
Affiliation(s)
- Ajit Shah
- Centre for Ethnicity and Health, University of Central Lancashire, Preston, UK.
| | | | | | | |
Collapse
|
35
|
Shah A. The relationship between suicide rates and age: an analysis of multinational data from the World Health Organization. Int Psychogeriatr 2007; 19:1141-52. [PMID: 17433118 DOI: 10.1017/s1041610207005285] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Suicide rates generally increase with age. With the emergence of studies from several countries without an increase in suicides rates with aging, a cross-national study examining the relationship between suicide rates and age was undertaken. METHODS The relationship between suicide rates and age was examined by ascertaining suicide rates in both sexes in seven age-bands 16-24 years, 25-34 years, 35-44 years, 45-54 years, 55-64 years, 65-74 years and 75+ years, from the World Health Organization website for all the listed countries (N = 62). RESULTS The main findings were: (i) there was a significant increase in suicide rates with increasing age in males and females in 25 and 27 countries respectively; (ii) there was no significant increase in suicide rates with increasing age in males and females in 31 and 29 countries respectively; (iii) suicide rates were the highest in the younger age-bands in countries without a significant increase in male suicides rates with increasing age; (iv) countries without a significant increase in the suicide rate with increasing age in both sexes, females only and males only demonstrated regional clustering; and, (v) in a small number of countries suicide rates declined with increasing age. CONCLUSIONS Potential explanations for regional and cross-national variations in the relationship between suicide rates and age require further study.
Collapse
Affiliation(s)
- Ajit Shah
- West London Mental Health NHS Trust and Imperial College School of Medicine, London, UK.
| |
Collapse
|
36
|
Rezaeian M, Dunn G, St Leger S, Appleby L. Do hot spots of deprivation predict the rates of suicide within London boroughs? Health Place 2007; 13:886-93. [PMID: 17468030 DOI: 10.1016/j.healthplace.2007.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Revised: 02/24/2007] [Accepted: 02/27/2007] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The ecological associations between suicide rates and different indices of deprivation within London have been investigated at least for half a century. In the present study, the association between rates of suicide with newly developed hot spots of deprivation index within London boroughs have been studied taking into account the results of the spatial dependency between suicide rates in nearby boroughs. METHODS Suicide data were provided by the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. The hot spots index of deprivation and the population counts were provided by the Department of the Environment, Transport and the Region (DETR) and Office for the National Statistics (ONS), respectively. RESULTS The results show that there is no strong spatial dependency between suicide rates in the London boroughs, the 'hot spots' index of deprivation predicts the rates of suicide in males 30-49, better than other age and sex groups. The rate of suicide decreases with decreasing deprivation as indicated by the 'hot spots' index. CONCLUSION These findings suggest that at the London boroughs the 'hot spots' index of deprivation (together with other socio-economic and social fragmentation indices) should be considered as a potential explanatory variable to explain the effects of age on rates of suicide in men and women.
Collapse
Affiliation(s)
- Mohsen Rezaeian
- Biostatistics Group, Division of Epidemiology and Health Sciences, The University of Manchester, UK.
| | | | | | | |
Collapse
|
37
|
Rezaeian M, Dunn G, St Leger S, Appleby L. Geographical epidemiology, spatial analysis and geographical information systems: a multidisciplinary glossary. J Epidemiol Community Health 2007; 61:98-102. [PMID: 17234866 PMCID: PMC2465628 DOI: 10.1136/jech.2005.043117] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2006] [Indexed: 11/04/2022]
Abstract
We provide a relatively non-technical glossary of terms and a description of the tools used in spatial or geographical epidemiology and associated geographical information systems. Statistical topics included cover adjustment and standardisation to allow for demographic and other background differences, data structures, data smoothing, spatial autocorrelation and spatial regression. We also discuss the rationale for geographical epidemiology and specific techniques such as disease clustering, disease mapping, ecological analyses, geographical information systems and global positioning systems.
Collapse
Affiliation(s)
- Mohsen Rezaeian
- Biostatistics Group, Division of Epidemiology & Health Sciences, The University of Manchester, Manchester, UK.
| | | | | | | |
Collapse
|
38
|
Rezaeian M, Dunn G, St Leger S, Appleby L. Ecological association between suicide rates and indices of deprivation in the north west region of England: the importance of the size of the administrative unit. J Epidemiol Community Health 2006; 60:956-61. [PMID: 17053284 PMCID: PMC2465472 DOI: 10.1136/jech.2005.043109] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVE Most published research on the ecological relationship between suicide rates and indices of deprivation uses only one level of population aggregation - for example, by local authorities. These ecological associations have been studied at both the local authority and the electoral ward level. METHODS Data on all deaths for which suicide or an open verdict was returned between 1996 and 1998 in the North West Government Office Region (NWGOR) of England (2336 cases) were the subject of this study. These data were provided by the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. The income and employment indices of deprivation and the population counts were provided by the Department of the Environment, Transport and the Regions, and the Office for National Statistics, respectively. RESULTS Modelling data at the local authority and ward levels in the NWGOR showed that although at the local authorities level there are no significant associations between suicide rates and two indices, at the ward level there are significant associations. The direction of these associations is such that with an increase in the quartile ranks of each index (ie, with improving the situation of a ward in terms of that index), the rate of suicide decreases. CONCLUSION A lack of effect was found once we move from ward to local authority level. This may happen because of the non-homogeneous nature of the local authorities in terms of their income and employment indices. In this sense, wards are more homogeneous. This means that in examining ecological risk factors, a balance was found between large areas (diluted effects but greater power) and small areas.
Collapse
Affiliation(s)
- Mohsen Rezaeian
- Biostatistics Group, Division of Epidemiology and Health Sciences, University of Manchester, Manchester, UK.
| | | | | | | |
Collapse
|