Suicide and marital status in Northern Ireland

The temporal relationship between marriage and risk for suicidal ideation

BACKGROUND

Marriage is consistently identified as a protective factor for suicidality, but it remains unclear whether this relationship varies by time elapsed since the transition to marriage.

METHODS

Participants were 15,870 individuals (52 % female, mean age = 44.63 years, age range = 18-99 years) from the Collaborative Psychiatric Epidemiology Surveys. Cox proportional hazards models were used to test the relationship between marriage, as well as time elapsed since the transition to marriage (0-5 years, 6-10 years, or 11+ years), and suicidal ideation. Years of education and race and ethnicity were included as covariates, and analyses were stratified by sex. Separate hazard ratios were estimated for individuals aged <30 years and 30+ years to address violations of the proportionality assumption.

RESULTS

Being married was associated with lower risk for suicidal ideation across age and sex. Among individuals aged <30 years, marriage was reliably associated with lower risk for suicidal ideation, regardless of the time elapsed since marriage. For individuals aged 30+ years, being married for 0-5 years or 6-10 years was associated with increased risk for suicidal ideation, particularly in females. Being married for 11+ years was associated with decreased risk across sex.

LIMITATIONS

Analyses focused on participants' first marriage and did not examine mediators of the association between marriage and suicidal ideation.

CONCLUSIONS

Overall, being married protects against suicidal ideation. However, among individuals aged 30 years or older, the first 10 years of marriage are associated with elevated risk for suicidal thoughts, and clinical outreach may be warranted.

Risk factors for suicidal ideation in a chronic illness

Suicide is an urgent concern for people with chronic illnesses, particularly for those with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Prior work has examined suicide risk in this illness, but few studies have examined specific risk factors. This study uses binary logistic regression to identify physical, social, and demographic risk and protective factors for suicidal ideation in ME/CFS (N = 559). The results indicate sleep-related symptoms, stigma, disability status, physical functioning, and marital status as risk factors for suicidal ideation in this group. These findings highlight the importance of education, de-stigmatization, and the search for effective disease-modifying treatments for ME/CFS.

Single and combined effects of marital status, education attainment, and employment status on suicide among working-age population: A case-control study in South Korea

Background

Suicide in the working-age population is an important public health issue. This group is heterogeneous regarding marital status, education level, and employment status, which are generally important socioeconomic factors for suicide, and has a wide age range. This study aims to explore the individual and combined effect of these socioeconomic factors on suicide in different age groups among the working-age population.

Methods

This study utilized a population-based case-control design for the working-age population in South Korea. Suicide cases were identified in Korean Governmental Death Registry from 2008 to 2017, and eight controls from Korea Community Health Survey were matched to each case by gender, age group, and year of suicide. Conditional logistic regression models estimated the relationship between marital status and socioeconomic status (SES) including educational attainment and employment status and suicide and examined the combined effect of the SES indicators and marital status on suicide.

Results

Low education, single status, and unemployment or economically inactive status were associated with suicide, but their magnitude varied across SES indicators. The association between SES and suicide was more pronounced in younger adults. The suicide risk was highest among divorced women aged 25–34 years (OR = 7.93; 95% CI: 7.21–8.72). Individuals experiencing two social adversities among SES or marital status had a significantly increased suicide risk. Those who are divorced and unemployed or economically inactive have the highest suicide risk, specifically among men aged 24–35 years (OR = 17.53; 95% CI: 14.96–20.55).

Conclusions

Marital status, education attainment, and employment status have a separate and combined impact on suicide among the working-age population. Specifically, the divorced and unemployed or economically inactive status amplified suicide risk, predominantly among young adults. Monitoring and intervention for those young adults should be considered for suicide prevention.

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Using a case-control design, we were able to demonstrate single as well as the combined impact of socioeconomic status on suicide.

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Poor SES was associated with suicide, but its magnitude varied across SES indicators. The suicide risk was highest among divorced adults.

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Individuals with two different types of poor SES and single status had an increased suicide risk. Specifically, those who are divorced and unemployed or economically inactive have the highest suicide risk.

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The pattern of the association between socioeconomic status and suicide was dependent on age. The association between SES and marital status and suicide was more pronounced in younger adults.

The future of divorce support: Is "digital" enough in presence of conflict?

Divorce conflict is the main driver of adverse postdivorce health adjustments among divorcing families. Despite the growing potential of online divorce support programs, there is concern that such solutions might not be sufficient to impact health-related disparities among high-conflict divorcees. The present study examined the effectiveness of the digital "Cooperation after Divorce" intervention as a function of conflict among 1856 recently divorced Danish residents. Linear mixed-effect regression modeling suggested that, although higher levels of divorce conflict at judicial divorce predicted worse health outcomes up to 1 year following divorce, the effectiveness of the digital divorce intervention did not vary as a function of the initial level of divorce conflict. Individuals in the intervention group with higher conflict in divorce still reported worse health at 12 months follow-up than those with lower levels of divorce conflict; however, much lower than the control group.

The Applicability of Linehan Risk Assessment Scale: a Cross-Sectional Study from Alexandria Poison Centre, Egypt, During the COVID-19 Pandemic

Background/Objective

Suicide is a critical health problem that is significantly rising during the COVID-19 pandemic worldwide, yet it is still under-reported in Egypt. To date, a deficiency of a reliable scale to probe the risk factors underlying suicide liability among patients with deliberate self-poisoning. The study’s objective was to offer a snapshot of the pattern of self- poisoning in Egypt during the COVID-19 pandemic.

Methods

Using the Linehan Risk Assessment and Management Protocol LRAMP, a psychological assessment was applied to evaluate vulnerable patients needing urgent psychiatric support and emphasize the influence of previous suicidal behaviors. A cross-sectional study was conducted on all patients admitted to Alexandria Poison Centre with deliberate self-poisoning biosocial and poisoning data that were recorded in a specially designed sheet. All patients were interviewed for underlying risk factors and protective factors for suicidal behavior.

Results

Significant relation was recorded between previous suicidal attempts and psychiatric diseases. CNS depressant drugs and rodenticides recorded the highest frequency. The calculated score (suicide and protective factors) was higher in patients with previous suicidal attempts.

Conclusion

The study was the first to test the applicability of Linehan scale in Alexandria Poison Centre. The results are promising; however, multicenter replication of the concluded findings will be valuable.

Development of a Checklist for Predicting Suicidality Based on Risk and Protective Factors: The Gwangju Checklist for Evaluation of Suicidality

OBJECTIVE

The aim of the study was to develop a checklist for mental health clinicians to predict and manage suicidality.

METHODS

A literature review of the risk and protective factors for suicide was conducted to develop a checklist for evaluating suicidality.

RESULTS

The fixed risk factors included sex (male), age (older individuals), history of childhood adversity, and a family history of suicide. Changeable risk factors included marital status (single), economic status (poverty), physical illness, history of psychiatric hospitalization, and history of suicide attempts. Recent discharge from a mental hospital and a recent history of suicide attempts were also included. Manageable risk factors included depression (history and current), alcohol problems (frequent drinking and alcohol abuse), hopelessness, agitation, impulsivity, impaired reality testing, and command hallucinations. Protective factors included responsibility to family, social support, moral objections to suicide, religiosity, motivation to get treatment, ability to cope with stress, and a healthy lifestyle. A final score was assigned based on the sum of the risk and protective factor scores.

CONCLUSION

We believe that the development of this checklist will help mental health clinicians to better assess those at risk for suicidal behavior. Further studies are necessary to validate the checklist.

Sex-based differences in the predisposing factors of overdose: A retrospective study

Drug overdose is one of the common events encountered in the emergency department (ED). The aim of the present study was to investigate the sex difference and predisposing factors of overdose in the ED. Data of 299 patients with self-poisoning reported at our poison center from January 2018 to August 2019 were retrospectively analyzed. Study cases categorized using the International Classification of Diseases, Tenth Revision coding system, which include codes T36 to T50, were selected. Data were collected including Glasgow Coma Scale scores and vital signs upon arrival (including body temperature, heart rate, systolic blood pressure, and diastolic blood pressure, sex, age, marital status, arrival time, season on admission, previous suicide attempts, psychiatric history, related comorbidities, recent arguments, categories of overdose with or without concurrent ethanol use, length of hospital stay, and survival to discharge) were analyzed. The top three types of substances that were frequently involved in drug overdose were benzodiazepine (42.9%), mixed medications (32.1%), and acetaminophen (6.1%). The 196 enrolled patients were aged 14 to 92 years (mean ± standard deviation, 39.2±18.3), and of these patients, male intentional overdose patients were 8.1 years older than their female counterparts (45.3±19.5 vs. 37.2±17.5, respectively; P<0.05). Most intentional overdose cases occurred during the spring season (n=63, 32.1%), especially in male patients (n=28, 57.1%; P<0.001). Approximately 11.2% (22/196) and 2% (4/196) of the total patients were admitted to the Toxicology ward and intensive care units, respectively. The length of hospital stay was 2±4.1 days. In summary, it is suggested that physicians notify the suicide prevention centers to be on alert for middle-aged men who are facing conflicts, especially during the spring season.

Comparing characteristics of suicide to non-suicide drug poisoning deaths, by sex, in Ireland

BACKGROUND

Suicide by drug poisoning is potentially preventable; however, evidence on associated risk factors by sex is limited.

AIM

To assist in understanding how individual and social contextual factors, and specific drugs, influence risk of suicide compared to non-suicide drug poisoning deaths, and how this differs by sex.

METHODS

Data were extracted from the National Drug-Related Deaths Index. Analysis included univariable and multivariable logistic regression to estimate unadjusted and adjusted odds ratios (OR) and 95% confidence intervals (CI) for factors associated with suicide drug poisoning deaths (SDPD) (primary outcome) compared with non-suicide drug poisoning deaths (NSDPD) and stratified by sex.

RESULTS

SDPD accounted for 240 (22%) of 1114 poisoning deaths, the majority among men (n = 147, 61%). Increasing age, mental ill health (AOR 7.85, 95% CI: 5.46-11.28), chronic pain (AOR 5.57, 95% CI: 3.28-9.46), and history of previous overdose (AOR 5.06, 95% CI: 3.39-7.56) were associated with increased odds of SDPD, with similar results for both sexes. The main drugs associated with SDPD were non-opioid analgesics (OR 4.06 [95% CI 2.66-6.18]), antipsychotics (OR 2.42 [95% CI 1.63-3.60]) and antidepressants (OR 2.18 [95% CI 1.59-2.97]). Pregabalin was associated with SDPD among women only.

LIMITATIONS

Secondary analysis of coronial data on drug poisoning deaths therefore findings may not be relevant to suicide deaths in general.

CONCLUSIONS

Ongoing monitoring for signs of suicidal intent in individuals with mental illness, chronic pain, overdose, and/or prescribed mental health medications may identify individuals in need of additional intervention.

Romantic Relationships and Mental Health During the COVID-19 Pandemic in Austria: A Population-Based Cross-Sectional Survey

Background

Previous studies suggest that romantic relationships can be beneficial to mental health, but may also be a major stressor depending on specific relationship characteristics. Studies examining the role of romantic relationship in mental health are scarce. This study aimed to investigate differences in mental health with regards to relationship characteristics.

Methods

We assessed individuals’ mental health, i.e., suicidal ideation (via Beck Scale for Suicidal Ideation, BSS), depression (via Patient Health Questionnaire, PHQ-9), anxiety (Hospital Anxiety and Depression Scale, HADS), experience of psychological and physical violence, including changes in suicidal ideation and anxiety compared to before the pandemic, and relationship characteristics (i.e., relationship status, satisfaction, and commitment as well as family structure) with online questionnaires in a population-based cross-sectional study with 3,012 respondents in Austria during the COVID-19 pandemic.

Results

There were small to medium–sized group differences with regards to relationship status and satisfaction (η_p²: 0.011–0.056). Most mental health outcomes were less favorable in singles than in individuals in happy relationships, but scores for anxiety (p < 0.001), psychological (p < 0.001) and physical violence (p < 0.001), and the probability of experiencing an increase in anxiety compared to before the pandemic (p < 0.01) were lower in singles as compared to those with low relationship satisfaction. Furthermore, scores for suicidal ideation (p > 0.001) and psychological (p > 0.01) and physical violence (p > 0.01) were highest in individuals in relationships with low commitment and with a child living in the same household, but effect sizes were small (η_p²: 0.004–0.015).

Conclusion

During the COVID-19 pandemic, as compared to singles, mental health appeared worse in individuals with low relationship satisfaction and those in a relationship with low commitment and with a child in the household. Living in a happy relationship was associated with somewhat better mental health.

The relationship between marital status and multifactorial sleep in Japanese day workers

Unmarried people often have disorderly lifestyles, and sleep problems (e.g., insomnia, short sleep duration, social jetlag) are becoming more complex due to the modern 24-h society. To improve health promotion measures for unmarried people, this study examined the relationship between marital status and sleep assessed as a multifactorial structure (phase, quality, quantity) in Japanese day workers. A cross-sectional survey was conducted with employees at five workplaces in Japan. Participants indicated their marital status, and the 3-Dimensional Sleep Scale measured sleep condition. We used scale cutoff values to define poor sleep phase, quality, and quantity (scores below the cutoff). "All poor sleep" and "all good sleep" were defined as when all scores were below or above the cutoff, respectively. Data from 786 participants (578 men, 208 women) were analyzed. Multivariate analysis showed that being unmarried was significantly related to poor sleep phase, quality, and quantity, with increased odds ratios. In unmarried participants, odds ratios (OR) were highest for poor sleep quantity in men (OR: 2.15) and poor sleep phase in women (OR: 2.73). All poor sleep showed the highest odds ratio for both unmarried men (OR: 2.74) and women (OR: 6.13), while unmarried men showed significantly decreased odds ratios for all good sleep (OR: 0.51). The finding that being unmarried was more closely associated with poor sleep quality and quantity in men, and more closely associated with poor sleep phase in women, could greatly contribute to creating measures to promote improved sleep in unmarried people.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41105-021-00357-2.

Psychiatric and psycho-social characteristics of suicide completers: a 13-year comprehensive evaluation of psychiatric case records and post-mortem findings

Currently, there are limited data comparing demographic and clinical characteristics of individuals who died by probable suicide and who did and did not previously attend mental health services (MHSs). This study compared demographic and clinical factors for both groups, in a Western region of Ireland over a 13-year period. Postmortem reports between January 1, 2006 and March 31, 2019 were reviewed for 400 individuals who died by probable suicide. Relevant sociodemographic and clinical data were extracted from individuals’ lifetime case notes. One hundred and fifty nine individuals (40%) had attended MHSs at some stage (“attendee”). Hanging was the most common method of suicide (61%), followed by drowning (18%) for both attendees and nonattendees of MHSs, with more violent methods utilized overall by nonattendees (p = 0.028). Sixty-eight percent of individuals who previously attempted hanging subsequently died utilizing this method. A higher proportion of attendees were female compared to nonattendees of MHSs (28.9 vs. 14.5%, p = 0.001). Recurrent depressive disorder (55%) was the most common diagnosed mental health disorder. For individuals with a diagnosis of schizophrenia, 39% had antipsychotic medications detectable in their toxicology reports. In conclusion, the majority of people who died by probable suicide had never had contact with MHSs, and nonattendees overall were more likely to utilize violent methods of suicide. Nonconcordance with psychotropic medications in psychotic patients and previous hanging attempt were highlighted as potential risk factors for death by probable suicide.

Socio-economic determinants of suicide rates in transforming China: A spatial-temporal analysis from 1990 to 2015

Background

China has experienced dramatic social changes in the last three decades. This study aimed to investigate socio-economic factors related to suicide rates in China from 1990 to 2015, and examine how the impacts of these factors on suicide rates changed over time.

Methods

Suicide rates in 31 provinces in mainland China between 1990 and 2015 were obtained from the Global Burden of Disease (GBD) Study 2019. Temporal-spatial modelling was applied to assess the effects of GDP per capita, urbanization, migration, employment, divorce, proportions of children and older adults on provincial overall, male and female suicide rates.

Findings

The overall suicide rate in China declined from 18·1 /100,000 in 1990 to 8·6 /100,000 in 2015, with considerable spatial variation in the magnitude of decline across provinces. The protective effects of increasing in GDP per capita, and urbanization, on provincial suicide rate were strong in 1990 (log GDP: -3·56 [95% CI: -6·15, -0·96], urbanisation: -0·07 [-0·14, -0·01]), however these effects were negligible by 2015. The association between employment and suicide rates has shifted from positive to negative over the study period, while migration remained a constant risk factor for high suicide rates (0·04 [0.00, 0·09]).

Interpretation

This study highlighted the dynamic effects of economic and social factors on suicide rates in the context of transforming China. To maintain further reductions in suicide rates cannot rely simply on improving people's materialistic and economic conditions. A more holistic approach to improve overall population well-being is needed.

Funding

Humanities and Social Sciences Prestigious Fellowship (37000320) and the General Research Fund (17611619) at the University of Hong Kong.

The use of religious and personal resources in coping with stress during COVID-19 for Palestinians

The Palestinian community in Israel has experienced significant stressors historically, yet little research has assessed the strategies these individuals cope with stress. The COVID-19 pandemic provided an opportunity to assess coping resources among Palestinian adults. The present study explored the religious and personal resources adopted by Palestinians living in Israel to cope with the stress caused by the COVID-19 outbreak, and whether differences in using these resources were attributed to selective demographic variables. The sample consisted of 985 Palestinian adults, 58% of whom are women and 42% are men. Participants' ages ranged from 18 to 50 years old (M = 35.8, SD =14.48), and they were chosen using convenience sampling from the Palestinian community living in Israel. Participants completed self-report questionnaires to report on their personal resources for coping with stress. Palestinian adults who participated in this study tended to rely more on faith in God, optimism, social and family support, having the self-control and self-efficacy, as well as subjective well-being, as resources for coping caused by crises like the COVID-19 pandemic. Also, there were significant differences on these coping resources that attributed to selective demographic variables. The findings were discussed with relation to previous studies.

A case series study of an innovative community-based brief psychological model for men in suicidal crisis

OBJECTIVES

To conduct a 1-year evaluation of James' Place, a suicidal crisis centre delivering a clinical intervention in a community setting.

DESIGN

A case series study, following men entering the service during the first year of operation.

PARTICIPANTS

Men experiencing a suicidal crisis referred to the service (N = 265), with N = 176 going on to engage in therapy.

INTERVENTION

The James' Place Model is a therapeutic intervention offered to men who are in a suicidal crisis. Trained therapists provide a range of therapeutic approaches and interventions, focusing on decreasing suicidal distress and supporting men to develop resilience and coping strategies.

MAIN OUTCOME MEASURES

CORE-34 Clinical Outcome Measure (CORE-OM).

RESULTS

For all subscales of the CORE-OM there was a significant reduction in mean scores between assessment and discharge (p < 0.001), with all outcomes demonstrating a large effect size. All reductions illustrated a clinically significant change or a reliable change.

CONCLUSIONS

Our results support the use of the James' Place Model for men in suicidal distress to aid in potentially preventing suicides in this high-risk group of the population.HighlightsEvaluates a brief psychological clinical intervention delivered in the community.Model effectively reduces suicide risk and findings can inform future services.Accessed men receiving an innovative intervention at the time of suicidal crisis.

Suicide Risk Factors among Polish Adults Aged 65 or Older in 2000-2018 Compared with Selected Countries Worldwide

The aim of this study was to determine the tendencies of change in suicide frequency among Polish adults aged 65 or older, recognize the importance of available socio-demographic data (age, sex, marital status, and education attainment level) and provide an in-depth psychological understanding of the obtained results. We analysed the influence of education and marital status on suicide risk in the Polish adult population aged 65 or older, which has not been previously presented in publications related to the Central Statistical Office or any other research. Our results indicated that male adults aged 65 or older that were single or divorced and with a lower education had a higher risk of death by suicide. In female adults aged 65 or older, those with higher education and who were divorced or married had a higher risk of fatal suicide behaviour meanwhile, single women and widows had a lower risk. The dominant method of suicide among Polish older adults was suicide by hanging, regardless of sex; female older adults were more likely to die by suicide by poisoning or jumping from a height, and male older adults were more likely to die by shooting with a firearm. Although data from recent years highlights a downward trend for suicide rates in Polish older adults, the problem cannot be considered solved.

A Case Series Study of Help-Seeking among Younger and Older Men in Suicidal Crisis

Due to the continuing high suicide rates among young men, there is a need to understand help-seeking behaviour and engagement with tailored suicide prevention interventions. The aim of this study was to compare help-seeking among younger and older men who attended a therapeutic centre for men in a suicidal crisis. In this case series study, data were collected from 546 men who were referred into a community-based therapeutic service in North West England. Of the 546 men, 337 (52%) received therapy; 161 (48%) were aged between 18 and 30 years (mean age 24 years, SD = 3.4). Analyses included baseline differences, symptom trajectories for the CORE-34 Clinical Outcome Measure (CORE-OM), and engagement with the therapy. For the CORE-OM, there was a clinically significant reduction in mean scores between assessment and discharge (p < 0.001) for both younger and older men. At initial assessment, younger men were less affected by entrapment (46% vs. 62%; p = 0.02), defeat (33% vs. 52%; p = 0.01), not engaging in new goals (38% vs. 47%; p = 0.02), and positive attitudes towards suicide (14% vs. 18%; p = 0.001) than older men. At discharge assessment, older men were significantly more likely to have an absence of positive future thinking (15% vs. 8%; p = 0.03), have less social support (45% vs. 33%; p = 0.02), and feelings of entrapment (17% vs. 14%; p = 0.02) than younger men. Future research needs to assess the long-term effects of help-seeking using a brief psychological intervention for young men in order to understand whether the effects of the therapy are sustainable over a period of time following discharge from the service.

The mental and physical health profile of people who died by suicide: findings from the Suicide Support and Information System

PURPOSE

There is limited research on the associations between factors relating to mental and physical health in people who died by suicide.

METHODS

Consecutive suicide cases were included in a psychological autopsy study as part of the Suicide Support and Information System in southern Ireland. Chi-square tests and logistic regression analysis were used to examine factors associated with recorded presence or absence of mental and physical health problems.

RESULTS

The total sample comprised 307 suicide cases, the majority being male (80.1%). Sixty-five percent had a history of self-harm and 34.6% of these cases had not been seen or treated following previous self-harm, although most (80.3%) had a history of recent GP attendance. Mental health diagnoses were present in 84.8% of cases where this variable was documented, and among these, 60.7% had a history of substance misuse and 30.6% had physical health problems. Variables associated with mental illness included gender, older age, previous self-harm episode(s), and presence of drugs in toxicology at time of death. Variables associated with physical illness included older age, death by means other than hanging, and previous self-harm episode(s).

CONCLUSIONS

Different factors associated with suicide were identified among people with mental and physical illness and those with and without a diagnosis, and need to be taken into account in suicide prevention. The identified factors highlight the importance of integrated care for dual-diagnosis presentations, restricting access to means, and early recognition and intervention for people with high-risk self-harm.

Suicidal behavior among people with epilepsy in Northwest Ethiopia: A comparative cross-sectional study

INTRODUCTION

Premature mortality is common in people with epilepsy, but the causes vary where suicide is considered as one of the commonest.

OBJECTIVE

The objective of this study was to compare suicidal behavior between people with epilepsy and the general population and identify associated factors in Northwest Ethiopia.

METHODS

We have conducted a comparative cross-sectional study in Northwest Ethiopia. We have selected people with epilepsy from outpatient departments and the comparisons from the general population. Suicidal behavior was assessed by the revised version of Suicidal Behaviors Questionnaire (SBQ-R). Logistic regression was implemented to look for associations between factors and the dependent variable.

RESULTS

The prevalence of suicidal behavior in people with epilepsy was 18.2%, significantly higher than the community sample, which was 9.8% (p-value = .001). This difference persists in the multivariable logistic regression model by which the odds of suicidal behavior in people with epilepsy was two times more as compared to the community sample. Other variables positively associated with suicidal behavior for the overall sample were depressive symptoms, no formal education, divorced/widowed marital status, and higher perceived criticism. Better social support was protective factor for suicidal behavior.

CONCLUSION

The proportion of suicidal behavior is twofold higher in people with epilepsy than the general population. Routine screening for suicide risk should be an integral part of epilepsy treatment.

"Divorce burnout" among recently divorced individuals

Traditionally, the concept of burnout has been applied to the workspace but recent research suggests its applicability to more general contexts such as the family sphere. The present study applies burnout to the divorce context and (a) proposes and statistically tests the Divorce Burnout Model (DBM), (b) investigates the contribution of sociodemographic variables and divorce characteristics to burnout scores, and (c) investigates the relationship between burnout scores and the number of sick days and days of absence from work. Using a cross-sectional design and a sample of 1,856 recently divorced Danish citizens, multigroup confirmatory factor analysis verified the DBM´s good fit to data. Using this model, for men, it was found that fewer previous divorces, former spouse initiation of divorce, not having a new partner and a higher degree of conflict significantly predicted higher levels of divorce burnout. For women, lower income, former spouse divorce initiation, not having a new partner, and a higher level of conflict significantly predicted higher levels of divorce burnout. Across gender, burnout scores were found to significantly predict number of sick days and days of absence from work in the past 3 months over and above sociodemographic variables, divorce related characteristics, and depressive symptoms.

Suicide in Northern Ireland: epidemiology, risk factors, and prevention

The rates of suicide and self-harm in Northern Ireland are high, and have increased from 143 registered suicides in 1996 to 313 in 2010 and 318 in 2015. This Review summarises the epidemiology of suicidal behaviour, as well as the evidence from a small number of studies that have identified risk factors associated with high suicide rates in Northern Ireland. These risk factors were mental illness, trauma, exposure to the conflict known as the Troubles, deprivation, relationship problems, employment difficulties, financial difficulties, being LGBT, childhood adversities, and alcohol or drug use. We highlight the key challenges and opportunities for suicide prevention, emphasising a so-called lifespan approach. More needs to be done to address the relationship between substance misuse and suicide. Future research and prevention efforts should also focus on the transgenerational effect of the conflict, youth suicide, suicide prevention in minority groups, and the criminal justice context. The provision of and access to suicide-specific psychosocial interventions need to be prioritised, more support for people in crisis is required, as well as interventions for mental illness. Protect Life 2, the national suicide prevention strategy, needs to be implemented in full. Given the legacy of conflict in Northern Ireland, all suicide prevention efforts should be trauma informed.

Anxiety, depression and associated factors among recently divorced individuals

Background: In divorce research, studies using large samples, very recently divorced individuals and validated measures of depression and anxiety with available background populations for comparison are missing.Aims: This study aimed to investigate symptoms of depression and anxiety among recently divorced Danes and assess the explanatory power of relevant sociodemographic- and divorce-related variables on these symptoms.Methods: The study utilized an online cross-sectional design and a total of 1856 Danish citizens recruited through the Danish State Administration. Average scores for depression and anxiety were compared to the Danish background population and regression analyses were conducted to assess the explanatory power of sociodemographic- and divorce characteristics on symptoms of depression and anxiety.Results: Divorcees reported significantly higher levels of both depressive and anxiety symptoms than the background population with a large proportion of the sample scoring equal to or higher than generally recommended cut-off values for risk of suffering from a psychiatric diagnosable case of depression or anxiety. Both sociodemographic- and divorce characteristics were predictive of symptoms of depression and anxiety.Conclusion: The findings underline the relevance of public health intervention targeting symptoms of depression and anxiety among recently divorced individuals.

Prevalence and correlates of suicidality in Andalusia (Spain): Results of the epidemiological study PISMA-ep

BACKGROUND

Suicidality is an important public health problem. Hence, the aims of this study are to report prevalence rates and correlates of suicidality in Andalusia (Southern Spain).

METHODS

This is a cross-sectional household survey conducted on a representative sample of adults living in Andalusia. 4507 subjects were interviewed using the Mini International Neuropsychiatric Interview (MINI) to assess suicidality and standardized instruments were employed to evaluate associated variables. A multivariate logistic regression analysis was used to explore independent associations with suicidality.

RESULTS

Current prevalence of suicidality was 6.4%, 4.4% showed death wish, 1.4% had ideas of self-harm, 2.4% had suicidal thoughts, 1.1% had a suicidal plan, 0.6% had attempted suicide during the month prior to the interview, and, lastly, 2.6% reported to have had any sort of suicide attempt during his/her previous life. Independent factors associated with suicidality were being female, older age, not having a stable couple, lower levels of social support, having had physical childhood abuse experience, having experienced an increasing number of stressful life events, higher neuroticism scores, having a family history of mental disorder and nicotine or drugs dependence.

LIMITATIONS

The instrument employed to measure suicidality is a screening tool rather than a more in-depth diagnostic measure. We have not included all potential correlates of suicidality. This is a cross-sectional study which cannot establish causal relationships between exposures and outcomes.

CONCLUSIONS

This is the first epidemiological study in Andalusia on suicidality offering important results of clinical interest for suicide prevention.

A Durkheimian Theorization of Scottish Suicide Rates, 2011–2017

This article examines recent aggregate statistical data generated by Scottish Government medical bodies concerning suicide rates and the social contexts of those who die by suicide. It compares rates and trends with international studies. Inherent in the data sets explored are indications suggesting that suicide is patterned by variables such as gender, employment, class and marital status. Neoliberalism increases social disparities that influence patterns of suicide, resulting in anomie and alienation, disproportionately impacting the already disenfranchised. Using recent statistical data (2011–2017), the article offers a theorization of suicide through the lens of Emile Durkheim’s social causation model of suicide. Suicide is associated with risk factors inherent in social structures and political processes.

Suicide mortality and marital status for specific ages, genders, and education levels in South Korea: Using a virtually individualized dataset from national aggregate data

BACKGROUND

Previous studies in Eastern as well as Western countries have shown a relationship between marital status and suicide mortality. However, to date, no Korean study has calculated national suicide rates by marital status for specific genders, ages, and education levels. This study investigated whether the relationship between marital status and suicide differs by age, gender, and educational attainment, and analyzed the effect of marital status on suicide risk after controlling for these socio-demographic variables.

METHODS

Using national mortality data from 2015, and aggregated census data from 2010 in South Korea, we created a virtually individualized dataset with multiple weighting algorithms, including individual socio-demographic characteristics and suicide rates across the entire population.

RESULTS

The findings show that the following groups faced the highest relative suicide risks: 1) divorced men of all ages and men aged more than 75 years, particularly divorced men aged more than 75; and 2) never-married men aged 55-64 years, and never-married women of lower education status.

LIMITATIONS

We did not account for important variables such as mental health, substance abuse, employment insecurity, social integration, perceived loneness, and family income which we were unable to access.

CONCLUSIONS

This current research extends prior theoretical and methodological work on suicide, aiding efforts to reduce suicide mortality in South Korea.

Short- and Long-term Effects of Case Management on Suicide Prevention among Individuals with Previous Suicide Attempts: a Survival Analysis

BACKGROUND

This study examined the long-term preventive effects of a case management service on suicide reattempts, and clarified the factors related to suicide reattempts.

METHODS

We reviewed the medical records of suicide attempters who visited the emergency department of Ulsan University Hospital from August 28, 2013 to July 31, 2017. A 4-week case management service was provided to consenting participants, either face-to-face or by telephone. Using survival analysis, we analyzed differences in the time to the next emergency department visit for a suicide attempt according to whether participants completed the case management service. We also assessed which characteristics of participants were associated with suicide reattempts.

RESULTS

We found no overall difference in time to suicide reattempt between case-managed participants and controls over the entire observation period (median period: 19 months). However, in the first 24 weeks after the initial suicide attempt, the case-managed group showed a longer time to reattempt than did the control group (log-rank test = 4.243; P = 0.039). A higher risk of reattempt was found among participants with the medical benefit type of health insurance compared to those with national health insurance (hazard ratio [HR], 5.134; P < 0.001) and among participants aged 20-39 compared to those aged ≥ 60 (HR, 3.502; P = 0.05).

CONCLUSION

Case management had only short-term benefits (within 24 weeks of initial suicide attempt). Risk factors for suicide reattempts were having a medical benefit health insurance and being aged 20-39 years.

Suicidal ideation in adult ADHD: Gender difference with a specific psychopathological profile

OBJECTIVE

To investigate suicidal ideation (SI) in patients with adult ADHD (aADHD), and its association with gender and psychopathology.

METHODS

Case-control study with 206 participants (patients = 103/healthy controls = 103; matched on gender, age, and education). SI was assessed by the Beck-I Depression-Inventory. The Conners' Adult ADHD Rating Scale (CAARS) was used to characterize the ADHD symptom-domains.

RESULTS

Compared to controls, the likelihood of SI was significantly higher in females with ADHD (odds ratio[OR] = 25.0 (95%CI:2.98-200.0); the difference was not significant in males (OR = 2.09 (95%CI:0.75-5.81). In females, "Problems with Self-Concept" scores on the CAARS showed the closest association with SI (OR = 5.60,95%CI:2.34-13.41]), while in males it was "Impulsivity" scores (OR = 3.01,95%CI:1.50-6.06).

CONCLUSION

Our findings extend previously described transdiagnostic associations of specific psychopathological risk factors to aADHD, including problems with self-concept and impulsivity, which are robustly associated with suicidality across diagnostic boundaries. In addition, they indicate that these associations exhibit pronounced gender-specificity in aADHD.

Suicide amongst people with intellectual disability: An Australian online study of disability support staff experiences and perceptions

BACKGROUND

Individuals with intellectual disability (ID) have a higher likelihood of exposure to identified risk factors for suicide when compared with the general community and have been recognised as being both capable of forming intent for suicide and acting on this intent. However, in spite of research outlining these concerns from the 1970s, there remains a dearth of studies that examine suicide amongst the population of people with ID.

METHOD

An online cross-sectional survey was purposively developed, with questions aimed at identifying both the experiences and current practices of support staff who assist people with ID in relation to suicide, suicidal behaviour and suicide assessment. It was undertaken across both rural and metropolitan areas in Australia. The survey was open for a period of 12 months. A total of 139 respondents (109 female/30 male), with a mean age of 41 and an average 12 years of experience in supporting people with ID, completed the tool.

RESULTS

A total of nine suicides by people with ID were reported. Seventy-seven per cent of the respondents reported that they had individuals with ID display suicidal behaviours, and 76% noted that a person had specifically talked about wishing to end their life. Only four participants (3%) noted that they did not support individuals with a dual diagnosis of ID and mental health concern. Sixty per cent of participants reported that no one in their organisation had ever completed a suicide risk assessment, and only 28% reported that they would do a suicide risk assessment if an individual that they supported was diagnosed with a mental health issue.

CONCLUSIONS

The current findings indicate that support staff recognise the capacity of people with ID to conceptualise suicide, note the existence of suicidal discussions and behaviours and report on actual suicides. This represents one of the few Australian studies that has specifically considered suicide amongst this cohort of people and reinforces the fact that suicide is not unknown in this population. The data indicate a possible divide between the reports of people with ID actively talking about and acting on suicidal thoughts and the lack of any proactive use of any tools to assess for this risk.

Demographic and Clinical Characteristics of Completed Suicides in Mexico City 2014-2015

Objective: To analyze sex differences in demographic and clinical characteristics of individuals who died by suicide in Mexico City. Method: Statistical analysis of residents of Mexico City whose cause of death was suicide, during two years period from January 2014 to December 2015, with a coroner's report. Suicide mortality rates were calculated by age, sex, and location within the city. The Chi-squared test was used to assess statistical differences. Results: From January 2014 to December 2015, 990 residents of Mexico City died by suicide (men: 78.28%, women: 21.72%). Among males, the highest mortality rates were among the groups of 20-24 and 75-79 years old, whereas in women, the group with the highest mortality rate was 15 to 19 years old. 74% of the sample used hanging as suicide method. However, men had higher rates of a positive result in the toxicology test (40%) (p < 0.05). There was no concordance between male and female suicide by city jurisdictions. Conclusion: Our results provide evidence that the characteristics of Mexico City's residents who committed suicide had significant sex-related differences, including where they used to live. Understanding the contributory factors associated with completed suicide is essential for the development of effective preventive strategies.

The Burden of Suicide in Rural Bangladesh: Magnitude and Risk Factors

The aim of the paper is to quantify the burden and risk factors of fatal and non-fatal suicidal behaviors in rural Bangladesh. A census was carried out in seven sub-districts encompassing 1.16 million people. Face-to-face interviews were conducted at the household level. Descriptive analyses were done to quantify the burden and Poisson regression was run to determine on risk factors. The estimated rates of fatal and non-fatal suicide were 3.29 and 9.86 per 100,000 person years (PY) observed, respectively. The risk of suicide was significantly higher by 6.31 times among 15-17 and 4.04 times among 18-24 olds compared to 25-64 years old. Married adolescents were 22 times more likely to commit suicide compared to never-married people. Compared to Chandpur/Comilla district, the risk of suicide was significantly higher in Narshingdi. Students had significantly lower risk of non-fatal suicidal behavior compared to skilled laborers. The risk of non-fatal suicidal behavior was lower in Sherpur compared to Chandpur/Comilla. Among adolescents, unskilled laborers were 16 times more likely to attempt suicide than students. The common methods for fatal and non-fatal suicidal behaviors were hanging and poisoning. Suicide is a major public health problem in Bangladesh that needs to be addressed with targeted interventions.

Demographics as predictors of suicidal thoughts and behaviors: A meta-analysis

BACKGROUND

Certain demographic factors have long been cited to confer risk or protection for suicidal thoughts and behaviors. However, many studies have found weak or non-significant effects. Determining the effect strength and clinical utility of demographics as predictors is crucial for suicide risk assessment and theory development. As such, we conducted a meta-analysis to determine the effect strength and clinical utility of demographics as predictors.

METHODS

We searched PsycInfo, PubMed, and GoogleScholar for studies published before January 1st, 2015. Inclusion criteria required that studies use at least one demographic factor to longitudinally predict suicide ideation, attempt, or death. The initial search yielded 2,541 studies, 159 of which were eligible. A total of 752 unique statistical tests were included in analysis.

RESULTS

Suicide death was the most commonly studied outcome, followed by attempt and ideation. The average follow-up length was 9.4 years. The overall effects of demographic factors studied in the field as risk factors were significant but weak, and that of demographic factors studied as protective factors were non-significant. Adjusting for publication bias further reduced effect estimates. No specific demographic factors appeared to be strong predictors. The effects were consistent across multiple moderators.

CONCLUSIONS

At least within the narrow methodological constraints of the existing literature, demographic factors were statistically significant risk factors, but not protective factors. Even as risk factors, demographics offer very little improvement in predictive accuracy. Future studies that go beyond the limitations of the existing literature are needed to further understand the effects of demographics.

Use of New Technologies in the Prevention of Suicide in Europe: An Exploratory Study

BACKGROUND

New technologies are an integral component of today's society and can complement existing suicide prevention programs. Here, we analyzed the use of new technologies in the prevention of suicide in 8 different European countries.

OBJECTIVE

The aim of this paper was to assess the opinions of professionals in incorporating such resources into the design of a suicide prevention program for the region of Zamora in Spain. This investigation, encompassed within the European project entitled European Regions Enforcing Actions against Suicide (EUREGENAS), includes 11 regions from 8 different countries and attempts to advance the field of suicide prevention in Europe.

METHODS

Using a specifically designed questionnaire, we assessed the opinions of 3 different groups of stakeholders regarding the use, frequency of use, facilitators, content, and format of new technologies for the prevention of suicide. The stakeholders were comprised of policy and public management professionals, professionals working in the area of mental health, and professionals related to the social area and non-governmental organizations (NGOs). A total of 416 participants were recruited in 11 regions from 8 different European countries.

RESULTS

The utility of the new technologies was valued positively in all 8 countries, despite these resources being seldom used in those countries. In all the countries, the factors that contributed most to facilitating the use of new technologies were accessibility and free of charge. Regarding the format of new technologies, the most widely preferred formats for use as a tool for the prevention of suicide were websites and email. The availability of information about signs of alarm and risk factors was the most relevant content for the prevention of suicide through the use of new technologies. The presence of a reference mental health professional (MHP) was also considered to be a key aspect. The countries differed in the evaluations given to the different formats suggesting that the cultural characteristics of the country should be taken into account.

CONCLUSIONS

New technologies are much appreciated resources; however they are not often underused in the field of suicide prevention. The results of this exploratory study show that new technologies are indeed useful resources and should be incorporated into suicide prevention programs.

Marital Status and Problem Gambling Among Australian Older Adults: The Mediating Role of Loneliness

Problem gambling rates in older adults have risen dramatically in recent years and require further investigation. Limited available research has suggested that social needs may motivate gambling and hence problem gambling in older adults. Un-partnered older adults may be at greater risk of problem gambling than those with a partner. The current study explored whether loneliness mediated the marital status-problem gambling relationship, and whether gender moderated the mediation model. It was hypothesised that the relationship between being un-partnered and higher levels of loneliness would be stronger for older men than older women. A community sample of Australian men (n = 92) and women (n = 91) gamblers aged from 60 to 90 years (M = 69.75, SD = 7.28) completed the UCLA Loneliness Scale and the Problem Gambling Severity Index. The results supported the moderated mediation model, with loneliness mediating the relationship between marital status and problem gambling for older men but not for older women. It appears that felt loneliness is an important predictor of problem gambling in older adults, and that meeting the social and emotional needs of un-partnered men is important.

Education as a predictor of antidepressant and anxiolytic medication use after bereavement: a population-based record linkage study

Purpose

Educational attainment has been shown to be positively associated with mental health and a potential buffer to stressful events. One stressful life event likely to affect everyone in their lifetime is bereavement. This paper assesses the effect of educational attainment on mental health post-bereavement.

Methods

By utilising large administrative datasets, linking Census returns to death records and prescribed medication data, we analysed the bereavement exposure of 208,332 individuals aged 25–74 years. Two-level multi-level logistic regression models were constructed to determine the likelihood of antidepressant medication use (a proxy of mental ill health) post-bereavement given level of educational attainment.

Results

Individuals who are bereaved have greater antidepressant use than those who are not bereaved, with over a quarter (26.5 %) of those bereaved by suicide in receipt of antidepressant medication compared to just 12.4 % of those not bereaved. Within individuals bereaved by a sudden death, those with a university degree or higher qualifications are 73 % less likely to be in receipt of antidepressant medication compared to those with no qualifications, after full adjustment for demographic, socio-economic and area factors (OR 0.27, 95 % CI 0.09,0.75). Higher educational attainment and no qualifications have an equivalent effect for those bereaved by suicide.

Conclusions

Education may protect against poor mental health, as measured by the use of antidepressant medication, post-bereavement, except in those bereaved by suicide. This is likely due to the improved cognitive, personal and psychological skills gained from time spent in education.

Electronic supplementary material

The online version of this article (doi:10.1007/s11136-016-1440-1) contains supplementary material, which is available to authorized users.

Men's vulnerability--women's resilience: from widowhood to late-life repartnering

BACKGROUND

The ongoing increase in life expectancy resulting in people living longer after the death of a lifelong spouse along with the stresses of widowhood is likely to increase the phenomenon of repartnering in old age. The aim of this article is to learn about the attributed meanings of late-life repartnering among older repartnered widows and widowers dealing with widowhood.

METHODS

The experiences of 27 couples (54 participants), in which both partners were widowed, were chosen from two larger studies on late-life repartnering: one took a dyadic perspective (interviewing both partners), and the other took an intergenerational approach (interviewing both partners and offspring). Criterion sampling in both studies used the criteria of widowers who repartnered above age 65 and widows above age 60, remarried or not, living separately, or under the same roof, and who had children and grandchildren from a lifelong marriage that had ended with the death of their spouse. All semi-structured interviews were recorded, transcribed verbatim, and analyzed based on grounded theory principles and dyadic analysis adapted to families.

RESULTS

Present a grounded model indicating gender differences in dealing with the death of a lifelong spouse. Men tended to experience vulnerability whereas women tended to experience resilience.

CONCLUSIONS

These findings make an innovative contribution by showing the reversal of gender inequality in old age, and gender differences between widows' and widowers' coping with widowhood, even though both repartnered. They are discussed in light of (critical) feminist gerontology including contribution to theory development and implications for practice.

Tracking search engine queries for suicide in the United Kingdom, 2004-2013

OBJECTIVES

First, to determine if a cyclical trend is observed for search activity of suicide and three common suicide risk factors in the United Kingdom: depression, unemployment, and marital strain. Second, to test the validity of suicide search data as a potential marker of suicide risk by evaluating whether web searches for suicide associate with suicide rates among those of different ages and genders in the United Kingdom.

STUDY DESIGN

Cross-sectional.

METHODS

Search engine data was obtained from Google Trends, a publicly available repository of information of trends and patterns of user searches on Google. The following phrases were entered into Google Trends to analyse relative search volume for suicide, depression, job loss, and divorce, respectively: 'suicide'; 'depression + depressed + hopeless'; 'unemployed + lost job'; 'divorce'. Spearman's rank correlation coefficient was employed to test bivariate associations between suicide search activity and official suicide rates from the Office of National Statistics (ONS).

RESULTS

Cyclical trends were observed in search activity for suicide and depression-related search activity, with peaks in autumn and winter months, and a trough in summer months. A positive, non-significant association was found between suicide-related search activity and suicide rates in the general working-age population (15-64 years) (ρ = 0.164; P = 0.652). This association is stronger in younger age groups, particularly for those 25-34 years of age (ρ = 0.848; P = 0.002).

CONCLUSIONS

We give credence to a link between search activity for suicide and suicide rates in the United Kingdom from 2004 to 2013 for high risk sub-populations (i.e. male youth and young professionals). There remains a need for further research on how Google Trends can be used in other areas of disease surveillance and for work to provide greater geographical precision, as well as research on ways of mitigating the risk of internet use leading to suicide ideation in youth.

Associations between marital and educational status and risk of completed suicide in Hungary

BACKGROUND

Suicide rates in Hungary are notoriously high. According to the literature, marital and educational status are associated with suicidal behaviour and these associations are somewhat influenced by gender. Since in Hungary these associations have not yet been investigated by means of large-scale multivariate epidemiological studies we aimed to investigate these in the current paper.

METHOD

Census data on marital and educational status, age and gender from 1980, 1990, 2001 and 2011 were used for the general population. Corresponding data from the same years for suicide victims derived from the Hungarian Demographic Register. Suicide victims younger than 20 years were excluded. Negative binomial regression analyses were used to reveal the effects of the above variables on suicide. All statistical procedures were conducted using Stata 12 software (StataCorp. 2011).

RESULTS

Female gender, young age, higher educational attainment and marriage were significantly associated with decreased risks of suicide. Intriguingly, effects of educational and marital status on suicide were stronger in males.

LIMITATIONS

Data on the length of the periods between changes in marital status and suicides were unavailable. Our four categories are not suitable to cover the whole gamut of marital statuses in a modern society (e.g. we did not have a specific category for people living in cohabitation). Ecological study design.

CONCLUSION

We found that in Hungary between 1980 and 2011 the effects of some frequently investigated societal factors (e.g. educational and marital status) on suicide risk were very similar to those found in the majority of other countries. The effects of studied determinants of suicide have not changed dramatically over the past three decades in Hungary.

Approach and treatment of suicidal behavior in the clinical practice of different groups of health professionals in Spain: results of the project euregena

According to the WHO (World Health Organization) and the European Union, suicide is considered to be a health problem of prime importance and to be one of the principal causes of unnatural death. In Spain, the number of suicides has increased 12% since 2005 . The Research Project "European Regions Enforcing Actions against Suicide (EUREGENAS), funded by the Health Program 2008-2013, has as main objective the description of an integrated model of Mental Health orientated to the prevention of suicide. The differences that allow distinguishing the meaning of prevention in suicide behavior are described and explained through a qualitative methodological strategy and through the creation of discussion groups formed by different groups of health professionals. The results highlight the existing differences between the diverse health professionals who come more in contact with this problem and it shows as well the coincidence of meaning that suicide has to be considered as a priority in the field of health.

A 2-year psychological autopsy study of completed suicides in the athens greater area, Greece

OBJECTIVE

To study the characteristics of a sample of suicide victims from the Athens Greater Area using the psychological autopsy method for the first time in Greece.

METHODS

We studied all recorded cases of completed suicide for the 2-year time period November 2007-October 2009 collecting data from the victims' forensic records as well as from the completion of a psychological autopsy questionnaire.

RESULTS

335 persons were recorded as suicide victims. We contacted relatives of 256 victims interviewing those of 248 of them (96.9%). The differences regarding sex, marital and employment status between our sample and the general population were statistically significant (p<0.001). The male/female ratio was 3:1. Comparatively more victims were divorced, separated or single and a greater proportion were pensioners or unemployed. 26.0% of the victims had history of prior attempts (64.4% once, 20.3% twice and 15.3% more times). 42.6% were taking psychiatric medication-significantly more women than men according to blood tests; 14.2% had been hospitalized in a psychiatric clinic the year prior to their death. 84.8% have deceased at the place of suicide and 15.2% died in the hospital; 80.3% died indoors and 19.7% outdoors. Men died primarily by hanging or shooting by a firearm while women preferred jumping from height instead (p<0.001). As many as 48.8% had expressed their intention to die to their relatives; 26.6% left a suicide note.

CONCLUSION

Our study has shown that the psychological autopsy method is applicable and widely accepted yielding results comparable to the international literature. Specific parameters associated with suicide have been studied for the first time in Greece.

Marital status and suicidal ideation among Australian older adults: the mediating role of sense of belonging

BACKGROUND

Marriage has been identified as a protective factor in relation to suicide among older adults. The current study aimed to investigate whether sense of belonging mediated the marital status-suicidal ideation relationship, and whether gender moderated the mediation model. It was hypothesized that the relationship between being widowed and lower levels of sense of belonging, and between lower levels of belonging and higher levels of suicidal ideation, would be stronger for older men than older women.

METHODS

A community sample of Australian men (n = 286) and women (n = 383) aged from 65 to 98 years completed the psychological subscale of the Sense of Belonging Instrument and the suicide subscale of the General Health Questionnaire.

RESULTS

The results supported the moderated mediation model, with gender influencing the marital status-sense of belonging relation. For men, widowhood was associated with lower levels of belongingness, whereas for women, marital status was unrelated to sense of belonging.

CONCLUSIONS

It would appear crucial to develop and implement interventions which assist older men to find new ways to feel important and valued after the death of their spouse.

Timing of access to secondary healthcare services and lower extremity amputations in patients with diabetes: a case-control study

OBJECTIVE

To investigate the association between timing of patient access to secondary healthcare services for diabetes management and lower extremity amputation (LEA) among patients with diabetes.

RESEARCH DESIGN AND METHODS

A case-control study was conducted in the secondary healthcare system in Ireland. Cases were 116 patients with diabetes who underwent a first major non-traumatic LEA between 2006 and 2012. Controls were 348 patients with diabetes, over 45 years, admitted to the same hospital as an emergency or electively, frequency-matched for gender, type of diabetes, and year. Data were collected for 7 years prior to the event year. ORs for LEA in patients with diabetes comparing early versus late referral from primary to secondary healthcare were calculated.

RESULTS

Statistically significant risk factors associated with LEA in patients with diabetes included being single, chronic kidney disease, hypertension, and hyperglycemia. Documented retinopathy was a significant protective factor. In unconditional logistic regression analysis adjusted for potential confounders, there was no evidence of a reduced risk of LEA among patients referred earlier to secondary healthcare for diabetes management.

CONCLUSIONS

Specialist referral may need to occur earlier than the 7-year cut-off used to demonstrate an effect on reducing LEA risk. Documented retinopathy was associated with reduced risk of LEA, most likely as a proxy for better self-care. Variation in the management of diabetes in primary care may also be impacting on outcomes. Efforts to develop more integrated care between primary and secondary services may be beneficial, rather than focusing on timing of referral to secondary healthcare.

Why Might Men Be More at Risk of Suicide After a Relationship Breakdown? Sociological Insights

Relationship breakdown constitutes a major risk factor for suicide ideation and completion. Although no definitive conclusion can be reached about a gender differential in susceptibility to this factor, several studies have identified that there is an elevated risk factor in men following divorce and separation. This article presents an overview of sociological explanations that may be employed to understand this phenomenon. There is discussion of the changing nature of intimacy, men's loss of honor, marriage as a more positive experience for men than for women, control in relationships, the increasing importance of the care of children for men, and men's social networks. The article concludes with possible implications for policy and practice.

Overall, gender and social inequalities in suicide mortality in Iran, 2006-2010: a time trend province-level study

OBJECTIVES

Suicide is a major global health problem imposing a considerable burden on populations in terms of disability-adjusted life years. There has been an increasing trend in fatal and attempted suicide in Iran over the past few decades. The aim of the current study was to assess overall, gender and social inequalities across Iran's provinces during 2006-2010.

DESIGN

Ecological study.

SETTING

The data on distribution of population at the provinces were obtained from the Statistical Centre of Iran. The data on the annual number of deaths caused by suicide in each province were gathered from the Iranian Forensic Medicine Organization.

METHODS

Suicide mortality rate per 100,000 population was calculated. Human Development Index was used as the provinces' social rank. Gini coefficient, rate ratio and Kunst and Mackenbach relative index of inequality were used to assess overall, gender and social inequalities, respectively. Annual percentage change was calculated using Joinpoint regression.

RESULTS

Suicide mortality has slightly increased in Iran during 2006-2010. There was a substantial and constant overall inequality across the country over the study period. Male-to-female rate ratio was 2.34 (95% CI 1.45 to 3.79) over the same period. There were social inequalities in suicide mortality in favour of people in better-off provinces. In addition, there was an increasing trend in these social disparities over time, although it was not statistically significant.

CONCLUSIONS

We found substantial overall, gender and social disparities in the distribution of suicide mortality across the provinces in Iran. The findings showed that men in the provinces with low socioeconomic status are at higher risk of suicide mortality. Further analyses are needed to explain these disparities.

Factors associated with suicidal ideation and attempts in Spain for different age groups. Prevalence before and after the onset of the economic crisis

BACKGROUND

Little is known about whether the prevalence of suicidal ideation and attempts has changed in the wake of the economic crisis. The aim of this study was to estimate current prevalence of suicidal ideation and attempts in the general population in Spain, to compare it with the prevalence found before the economic crisis, and to analyse the factors associated with suicidality in different age groups.

METHODS

A total of 4583 non-institutionalised adults were interviewed in a cross-sectional household survey of a nationally representative sample in Spain. Several modules of an adapted version of the Composite International Diagnostic Interview were administered to the participants, and logistic regression models were employed in each age group.

RESULTS

Lifetime prevalence of suicidal ideation and attempts in Spain were respectively, 3.67% and 1.46%. Mental disorders presented the highest significant effects on lifetime suicidal ideation. Marital status, heavy alcohol consumption, and occupational status were associated with lifetime suicidal ideation in people aged 18-49, whereas loneliness was associated with the 50-64 group, and financial problems with the 65+ group. A younger age, poor health status and the presence of depression were all associated with lifetime suicide attempts.

LIMITATIONS

The cross-sectional design of the study represents a methodological limitation.

CONCLUSIONS

The current prevalence of suicidal ideation and attempts in Spain is similar to the one found ten years ago, before the recent economic crisis. The factors associated with suicidality vary among age groups. Suicide prevention programmes should focus on early detection and prevention for depression and anxiety disorders.

The effects of involuntary job loss on suicide and suicide attempts among young adults: evidence from a matched case-control study

OBJECTIVE

To assess the influence of involuntary job loss on suicide and attempted suicide in young adults.

METHOD

A population-based case-control study of young adults (18-34 years) was conducted in New South Wales, Australia. Cases included both suicides (n=84) and attempts (n=101). A structured interview was conducted with next of kin (for suicide cases) and suicide attempters admitted to hospital. Controls selected from the general population were matched to cases by age and sex. Job dismissal or redundancy (involuntary job loss) in the 12 months before suicide or attempt was the main study variable of interest. Suicide and attempts were modelled separately and in combination as outcomes using conditional logistic regression modelling. The analysis was also adjusted for marital status, socio-economic status and diagnosis of an affective or anxiety disorder.

RESULTS

Following adjustment for other variables, involuntary job loss was associated with an odds ratio of 1.82 for suicide and attempted suicide (combined) (95% CI 0.98 to 3.37; p=0.058). Low socio-economic status was associated with an odds ratio of 3.80 for suicide and attempted suicide (95% CI 2.16 to 6.67; p<0.001) compared to high socio-economic status (after adjustment). Diagnosis of a mental disorder was associated with a 7.87 (95% CI 5.16 to 12.01; p<0.001) odds ratio of suicide and attempted suicide compared to no diagnosis (after adjustment). Involuntary job loss was associated with increased odds of suicide and attempts when these were modelled separately, but results did not reach statistical significance.

CONCLUSIONS

Involuntary job loss was associated with increased odds of suicide and attempted suicide. The strength of this relationship was attenuated after adjustment for socio-economic status and mental disorders, which indicates that these may have a stronger influence on suicide than job loss.

Suicide risk among individuals with sleep disturbances in Japan: a case-control psychological autopsy study

OBJECTIVE

This case-control psychological autopsy study aimed to explore a relationship between sleep disturbances and suicide among Japanese, as well as determine the importance and usability of screening for sleep disturbances in suicide prevention.

METHODS

A semi-structured interview was conducted with the close family members of 49 adult suicide completers and 145 gender-, age-, and residential municipality-matched living controls. The survey included sections on demographics, sleep disturbances, and mental disorders. Conditional logistic regression analyses were performed to compare sleep disturbance prevalence between the two groups.

RESULTS

A significantly higher prevalence of sleep disturbances was found among the suicide group (75.5%) compared to the controls (11.0%) (odds ratio [OR]=21.6, p<0.001). The association remained significant after adjusting for mental disorders (OR=12.7, p<0.001). The population attributable risk percent of suicide associated with sleep disturbances and mental disorders was estimated to be 56.4% and 35.3%, respectively.

CONCLUSIONS

The study confirmed that sleep disturbances are an important risk factor of suicide, independent of mental disorders. Sleep disturbances accounted for a greater proportion of suicide cases than did mental disorders in the Japanese population given the higher prevalence, and could thus be considered an important target in suicide prevention in Japan.

Availability of mental health service providers and suicide rates in Slovenia: a nationwide ecological study

AIM

To investigate the influence of socioeconomic factors, mental health service availability, and prevalence of mental disorders on regional differences in the suicide rate in Slovenia.

METHODS

The effects of different socioeconomic factors, mental health service availability, and mental disorders factors on suicide rates from 2000-2009 were analyzed using a general linear mixed model (GLMM). Pearson correlations were used to explore the direction and magnitude of associations.

RESULTS

Among socioeconomic factors, unemployment rate ranked as the most powerful predictor of suicide and an increase of one unit in the unemployment rate increased regional suicide rate by 2.21 (β=2.21, 95% confidence intervals [CI]=1.87-2.54, P<0.001). On the other hand, higher marriage/divorce ratio was negatively related to the suicide rate and an increase of one unit in marriage/divorce ratio reduced regional suicide rate by 1.16 (β=-1.16, 95% CI=-2.20 to -0.13, P<0.031). The most influential mental health service availability parameter was higher psychiatrist availability (4 psychiatrists and more working at outpatient clinics per 100 000 inhabitants), which was negatively correlated with the suicide rate and reduced regional suicide rate by 2.95 (β=-2.95, 95% CI=-4.60 to -1.31, P=0.002). Another negatively correlated factor was the antidepressant/anxiolytic ratio higher than 0.5, which reduced the regional suicide rate by 2.32 (β=-2.32, 95% CI=-3.75 to -0.89, P=0.003). Among mental health disorders, only the prevalence of alcohol use disorders was significantly related to the regional suicide rates and an increase of one unit in the prevalence of alcohol use disorders per 1000 inhabitants increased the regional suicide rate by 0.02 (β=0.02, 95% CI=0.01- 0.03, P=0.008).

CONCLUSIONS

Besides unemployment, which was a very strong predictor of suicide rates, unequal availability of mental health services and quality of depressive disorder treatment may contribute to variations in suicide rates in different regions.

Suicide in Hungary-epidemiological and clinical perspectives

Annual suicide rates of Hungary were unexpectedly high in the previous century. In our narrative review, we try to depict, with presentation of the raw data, the main descriptive epidemiological features of the Hungarian suicide scene of the past decades. Accordingly, we present the annual suicide rates of the period mentioned and also data on how they varied by gender, age, urban vs. rural living, seasons, marital status, etc. Furthermore, the overview of trends of other factors that may have influenced suicidal behavior (e.g., alcohol and tobacco consumption, antidepressant prescription, unemployment rate) in the past decades is appended as well. Based on raw data and also on results of the relevant papers of Hungarian suicidology we tried to explain the observable trends of the Hungarian suicide rate. Eventually, we discuss the results, the possibilities, and the future tasks of suicide prevention in Hungary.

Can demographic and exposure characteristics predict levels of social support in survivors from a natural disaster?

Objective

Lack of social support is a strong predictor for poor mental health after disasters. Psychosocial post-disaster interventions may benefit from targeting survivors at risk of low support, yet it is unknown whether demographic and disaster exposure characteristics are associated with social support. This study assessed if age, gender, educational status, cohabitation, and disaster exposure severity predicted aspects of informal social support in a cohort of Swedish survivors from the 2004 Southeast Asian tsunami.

Methods

The participants were 3,536 disaster survivors who responded to a mail survey 14 months after the disaster (49% response rate). Their perceptions of present emotional support, contact with others, tangible support, negative support and overall satisfaction with informal support were assessed with the Crisis Support Scale and analysed in five separate ordinal regressions.

Results

Demographic factors and exposure severity explained variation in social supports although the effect size and predictive efficiency were modest. Cohabitation and female gender were associated with both more positive and more negative support. Single-household men were at risk for low emotional support and younger women were more likely to perceive negative support. Higher education was associated with more positive support, whereas no clear pattern was found regarding age as a predictor. Disaster exposure severity was associated with more negative support and less overall support satisfaction.

Conclusions

After a disaster that entailed little disruptions to the community the associations between demographic characteristics and social support concur with findings in the general population. The findings suggest that psychosocial disaster interventions may benefit from targeting specific groups of survivors.