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Hetrick SE, Hobbs M, Fortune S, Marek L, Wiki J, Boden JM, Theodore R, Ruhe T, Kokaua JJ, Thabrew H, Milne B, Bowden N. Proximity of alcohol outlets and presentation to hospital by young people after self-harm: A retrospective geospatial study using the integrated data infrastructure. Aust N Z J Psychiatry 2024; 58:152-161. [PMID: 37888830 PMCID: PMC10838485 DOI: 10.1177/00048674231203909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
OBJECTIVES There is a well-established association between alcohol use, misuse, intoxication and self-harm, the latter of which is associated with suicide. This study aimed to better understand the association between proximity to alcohol outlets and the likelihood of young people presenting to hospital following self-harm. METHODS This was a nationwide retrospective geospatial study using data from the New Zealand Integrated Data Infrastructure using population-level data for 10-29-year-olds for the 2018 and 2017 calendar years. Presentations to hospital following self-harm were identified using the national minimum data set. Proximity to alcohol outlets was defined in road network distance (in kilometres) and ascertained using Integrated Data Infrastructure geospatial data. Alternative measures of proximity were employed in sensitivity analyses. Complete-case two-level random intercept logistic regression models were used to estimate the relationship between alcohol outlet proximity and hospital presentation for self-harm. Adjusted models included sex, age, ethnicity, area-level deprivation, urbanicity and distance to nearest medical facility. Analyses were also stratified by urbanicity. RESULTS Of the 1,285,368 individuals (mean [standard deviation] age 20.0 [5.9] years), 7944 (0.6%) were admitted to hospital for self-harm. Overall, the odds of presenting to hospital for self-harm significantly decreased as the distance from the nearest alcohol outlet increased, including in adjusted models (adjusted odds ratio 0.980; 95% confidence interval = [0.969-0.992]); the association was robust to changes in the measure of alcohol proximity. The effect direction was consistent across all categorisations of urbanicity, but only statistically significant in large urban areas and rural areas. CONCLUSIONS The findings of this study show a clear association between young people's access to alcohol outlets and presentation to hospital for self-harm and may provide a mandate for government policies and universal interventions to reduce young people's access to alcohol outlets. Further research regarding causative mechanisms is needed.
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Affiliation(s)
- Sarah E Hetrick
- Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
- Suicide Prevention Office, Auckland, New Zealand
- A Better Start: E Tipu e Rea National Science Challenge, Auckland, New Zealand
| | - Matthew Hobbs
- Te Taiwhenua o te Hauora–GeoHealth Laboratory, University of Canterbury, Christchurch, Canterbury, New Zealand
- Te Kaupeka Oranga, Faculty of Health, University of Canterbury, Christchurch, Canterbury, New Zealand
- The Cluster for Community and Urban Resilience (CURe), University of Canterbury, Christchurch, Canterbury, New Zealand
| | - Sarah Fortune
- Department of Social and Community Health, School of Population Health, Faculty of Medical and Health Sciences, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
| | - Lukas Marek
- Te Taiwhenua o te Hauora–GeoHealth Laboratory, University of Canterbury, Christchurch, Canterbury, New Zealand
- Te Kaupeka Oranga, Faculty of Health, University of Canterbury, Christchurch, Canterbury, New Zealand
| | - Jesse Wiki
- Epidemioloigy and Biostatistics, Faculty of Medical and Health Sciences, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
| | - Joseph M Boden
- Christchurch Health and Development Study, University of Otago, Christchurch, Canterbury, New Zealand
| | - Reremoana Theodore
- National Centre for Lifecourse Research, University of Otago, Dunedin, New Zealand
| | - Troy Ruhe
- Va’a O Tautai – Centre for Pacific Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Jesse J Kokaua
- National Centre for Lifecourse Research, University of Otago, Dunedin, New Zealand
- Va’a O Tautai – Centre for Pacific Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Hiran Thabrew
- Te Ara Hāro, Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
| | - Barry Milne
- A Better Start: E Tipu e Rea National Science Challenge, Auckland, New Zealand
- School of Social Sciences and Centre of Methods and Policy Application in the Social Sciences (COMPASS), The University of Auckland, Auckland, New Zealand
| | - Nicholas Bowden
- A Better Start: E Tipu e Rea National Science Challenge, Auckland, New Zealand
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
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Ayre K, Liu X, Howard LM, Dutta R, Munk-Olsen T. Self-harm in pregnancy and the postnatal year: prevalence and risk factors. Psychol Med 2023; 53:2895-2903. [PMID: 37449482 PMCID: PMC10235666 DOI: 10.1017/s0033291721004876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Self-harm in pregnancy or the year after birth ('perinatal self-harm') is clinically important, yet prevalence rates, temporal trends and risk factors are unclear. METHODS A cohort study of 679 881 mothers (1 172 191 pregnancies) was conducted using Danish population register data-linkage. Hospital treatment for self-harm during pregnancy and the postnatal period (12 months after live delivery) were primary outcomes. Prevalence rates 1997-2015, in women with and without psychiatric history, were calculated. Cox regression was used to identify risk factors. RESULTS Prevalence rates of self-harm were, in pregnancy, 32.2 (95% CI 28.9-35.4)/100 000 deliveries and, postnatally, 63.3 (95% CI 58.8-67.9)/100 000 deliveries. Prevalence rates of perinatal self-harm in women without a psychiatric history remained stable but declined among women with a psychiatric history. Risk factors for perinatal self-harm: younger age, non-Danish birth, prior self-harm, psychiatric history and parental psychiatric history. Additional risk factors for postnatal self-harm: multiparity and preterm birth. Of psychiatric conditions, personality disorder was most strongly associated with pregnancy self-harm (aHR 3.15, 95% CI 1.68-5.89); psychosis was most strongly associated with postnatal self-harm (aHR 6.36, 95% CI 4.30-9.41). For psychiatric disorders, aHRs were higher postnatally, particularly for psychotic and mood disorders. CONCLUSIONS Perinatal self-harm is more common in women with pre-existing psychiatric history and declined between 1997 and 2015, although not among women without pre-existing history. Our results suggest it may be a consequence of adversity and psychopathology, so preventative intervention research should consider both social and psychological determinants among women with and without psychiatric history.
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Affiliation(s)
- Karyn Ayre
- Section of Women's Mental Health, Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, London, UK
| | - Xiaoqin Liu
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Louise M. Howard
- Section of Women's Mental Health, Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, London, UK
| | - Rina Dutta
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, London, UK
- Academic Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Trine Munk-Olsen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Sara G, Wu J, Uesi J, Jong N, Perkes I, Knight K, O’Leary F, Trudgett C, Bowden M. Growth in emergency department self-harm or suicidal ideation presentations in young people: Comparing trends before and since the COVID-19 first wave in New South Wales, Australia. Aust N Z J Psychiatry 2023; 57:58-68. [PMID: 35266405 PMCID: PMC9791324 DOI: 10.1177/00048674221082518] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Self-harm presentations in children and young people have increased internationally over the last decade. The COVID-19 pandemic has the potential to worsen these trends. OBJECTIVE To describe trends in emergency department self-harm or suicidal ideation presentations for children and young people in New South Wales before and since the COVID-19 pandemic. METHODS We studied presentations for self-harm or suicidal ideation by 10- to 24-year-olds to New South Wales emergency departments, using interrupted time series analysis to compare annualised growth before COVID (2015 to February 2020) and since COVID (March 2020 to June 2021). Subgroup analyses compared age group, gender, triage category, rurality and disadvantage. Time series decomposition via generalised additive models identified long-term, seasonal and short-term trends. RESULTS Self-harm or suicidal ideation presentations by young people in New South Wales increased by 8.4% per annum pre-COVID. Growth accelerated since COVID, to 19.2% per annum, primarily due to increased presentations by females aged 13-17 years (47.1% per annum since COVID, from 290 per 10,000 in 2019 to 466 per 10,000 in 2021). Presentations in males aged 10-24 years did not increase since COVID (105.4 per 10,000 in 2019, 109.8 per 10,000 in 2021) despite growing 9.9% per annum before COVID. Presentation rates accelerated significantly in socio-economically advantaged areas. Presentations in children and adolescents were strongly linked to school semesters. CONCLUSION Emergency department self-harm or suicidal ideation presentations by New South Wales young people grew steadily before COVID. Understanding the sustained increase remains a priority. Growth has increased since COVID particularly for adolescent females, but not among adolescent males. Surprisingly, the largest post-COVID increases in annual growth occurred in socio-economically advantaged and urban regions. The COVID-19 pandemic appears to have added new challenges, particularly in females in the developmentally critical early adolescent and teenage years.
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Affiliation(s)
- Grant Sara
- NSW Ministry of Health, St Leonards, NSW, Australia,Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia,Grant Sara, NSW Ministry of Health, Locked Mail Bag 2030, St Leonards, NSW 1590, Australia.
| | - Jianyun Wu
- NSW Ministry of Health, St Leonards, NSW, Australia
| | - John Uesi
- NSW Ministry of Health, St Leonards, NSW, Australia
| | - Nancy Jong
- NSW Ministry of Health, St Leonards, NSW, Australia
| | - Iain Perkes
- Faculty of Medicine and Health, School of Psychiatry and School of Women’s and Children’s Health, University of New South Wales, Kensington, NSW, Australia,Department of Psychological Medicine, Sydney Children’s Hospitals Network Randwick, Randwick, NSW, Australia
| | - Katherine Knight
- Psychological Medicine, The Sydney Children’s Hospitals Network Randwick and Westmead, Westmead, NSW, Australia
| | - Fenton O’Leary
- Emergency Department, Children’s Hospital at Westmead, Westmead, NSW, Australia,The University of Sydney Children’s Hospital Westmead Clinical School, Sydney, NSW, Australia
| | - Carla Trudgett
- Department of Psychological Medicine, Sydney Children’s Hospitals Network Randwick, Randwick, NSW, Australia
| | - Michael Bowden
- NSW Ministry of Health, St Leonards, NSW, Australia,Department of Psychological Medicine, Sydney Children’s Hospitals Network Randwick, Randwick, NSW, Australia,Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Chidiac AS, Buckley NA, Noghrehchi F, Cairns R. Paracetamol (acetaminophen) overdose and hepatotoxicity: mechanism, treatment, prevention measures, and estimates of burden of disease. Expert Opin Drug Metab Toxicol 2023; 19:297-317. [PMID: 37436926 DOI: 10.1080/17425255.2023.2223959] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/05/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION Paracetamol is one of the most used medicines worldwide and is the most common important poisoning in high-income countries. In overdose, paracetamol causes dose-dependent hepatotoxicity. Acetylcysteine is an effective antidote, however despite its use hepatotoxicity and many deaths still occur. AREAS COVERED This review summarizes paracetamol overdose and toxicity (including mechanisms, risk factors, risk assessment, and treatment). In addition, we summarize the epidemiology of paracetamol overdose worldwide. A literature search on PubMed for poisoning epidemiology and mortality from 1 January 2017 to 26 October 2022 was performed to estimate rates of paracetamol overdose, liver injury, and deaths worldwide. EXPERT OPINION Paracetamol is widely available and yet is substantially more toxic than other analgesics available without prescription. Where data were available, we estimate that paracetamol is involved in 6% of poisonings, 56% of severe acute liver injury and acute liver failure, and 7% of drug-induced liver injury. These estimates are limited by lack of available data from many countries, particularly in Asia, South America, and Africa. Harm reduction from paracetamol is possible through better identification of high-risk overdoses, and better treatment regimens. Large overdoses and those involving modified-release paracetamol are high-risk and can be targeted through legislative change.
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Affiliation(s)
- Annabelle S Chidiac
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, Australia
- New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia
| | - Nicholas A Buckley
- New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia
- Faculty of Medicine and Health, School of Medical Sciences, Discipline of Biomedical Informatics and Digital Health, The University of Sydney, Sydney, Australia
| | - Firouzeh Noghrehchi
- Faculty of Medicine and Health, School of Medical Sciences, Discipline of Biomedical Informatics and Digital Health, The University of Sydney, Sydney, Australia
| | - Rose Cairns
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, Australia
- New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia
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Dolsen EA, Nishimi K, LeWinn KZ, Byers AL, Tripp P, Woodward E, Khan AJ, Marx BP, Borsari B, Jiha A, Neylan TC, O'Donovan A. Identifying correlates of suicide ideation during the COVID-19 pandemic: A cross-sectional analysis of 148 sociodemographic and pandemic-specific factors. J Psychiatr Res 2022; 156:186-193. [PMID: 36252348 PMCID: PMC9553642 DOI: 10.1016/j.jpsychires.2022.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/09/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has created a global health crisis, with disproportionate effects on vulnerable sociodemographic groups. Although the pandemic is showing potential to increase suicide ideation (SI), we know little about which sociodemographic characteristics or COVID-19 experiences are associated with SI. Our United States-based sample (n = 837 adults [mean age = 37.1 years]) completed an online survey during August-September 2020. The study utilized an online convenience sample from a prior study, which was enriched for exposure to trauma and experiences of posttraumatic stress symptoms. We assessed SI using the Beck Depression Inventory-II. Traditional (i.e., logistic regression) and machine learning (i.e., LASSO, random forest) methods evaluated associations of 148 self-reported COVID-19 factors and sociodemographic characteristics with current SI. 234 participants (28.0%) reported SI. Twenty items were significantly associated with SI from logistic regression. Of these 20 items, LASSO identified seven sociodemographic characteristics (younger age, lower income, single relationship status, sexual orientation other than heterosexual as well as specifically identifying as bisexual, non-full-time employment, and living in a town) and six COVID-19 factors (not engaging in protective COVID-19 behaviors, receiving mental health treatment (medication and/or psychotherapy) due to the COVID-19 pandemic, socializing during the pandemic, losing one's job due to COVID-19, having a friend with COVID-19, and having an acquaintance with COVID-19) associated with SI. Random forest findings were largely consistent with LASSO. These findings may inform multidisciplinary research and intervention work focused on understanding and preventing adverse mental health outcomes such as SI during and in the aftermath of the pandemic.
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Affiliation(s)
- Emily A. Dolsen
- Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco. San Francisco, CA, USA,Mental Illness Research Education and Clinical Centers, San Francisco Veterans Affairs Health Care System. San Francisco, CA, USA,Corresponding author. 4150 Clement Street, Building 8, San Francisco, CA, USA
| | - Kristen Nishimi
- Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco. San Francisco, CA, USA,Mental Illness Research Education and Clinical Centers, San Francisco Veterans Affairs Health Care System. San Francisco, CA, USA
| | - Kaja Z. LeWinn
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco. San Francisco, CA, USA
| | - Amy L. Byers
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco. San Francisco, CA, USA,Research Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA,Department of Medicine, Division of Geriatrics, University of California, San Francisco, CA, USA
| | - Paige Tripp
- Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco. San Francisco, CA, USA
| | - Eleanor Woodward
- Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco. San Francisco, CA, USA
| | - Amanda J. Khan
- Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco. San Francisco, CA, USA
| | - Brian P. Marx
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA,Boston University School of Medicine, USA
| | - Brian Borsari
- Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco. San Francisco, CA, USA
| | - Ahmad Jiha
- Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco. San Francisco, CA, USA
| | - Thomas C. Neylan
- Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco. San Francisco, CA, USA,Mental Illness Research Education and Clinical Centers, San Francisco Veterans Affairs Health Care System. San Francisco, CA, USA
| | - Aoife O'Donovan
- Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco. San Francisco, CA, USA.
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Campeau A, Champagne AS, McFaull SR. Sentinel surveillance of substance-related self-harm in Canadian emergency departments, 2011 - 19. BMC Public Health 2022; 22:974. [PMID: 35568831 PMCID: PMC9107222 DOI: 10.1186/s12889-022-13287-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/19/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Self-harm is a public health concern that can result in serious injury or death. This study provides an overview of emergency department (ED) visits for patients presenting with substance-related self-harm. METHODS Cases of self-harm in the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) database were extracted (April 2011 to September 2019; N = 15,682), using various search strategies to identify substance-related self-harm cases for patients 10 years and older. Cases involving alcohol, cannabis, illicit drugs, or medications (or any combinations of these) were included. Additional variables, including age and sex, location and the severity of injury (hospital admission) were examined. Proportionate injury ratios (PIR) were used to compare emergency department outcomes of self-harm and unintentional injuries involving substance use. Time trends were quantified using Joinpoint regression. For cases requiring hospital admission, text fields were analyzed for contextual factors. RESULTS A total of 9470 substance-related self-harm cases were reported (28.1% of all intentional injury cases), representing 820.0 records per 100,000 eCHIRPP records. While age patterns for both sexes were similar, the number of cases for females was significantly higher among 15-19 year olds. Over half (55%) of cases that identified substance type involved medications, followed by multi-type substance use (19.8%). In the ED, there were proportionally more treatments, observations, and admissions presenting with substance-related self-harm compared to substance-related unintentional injury cases. Among those aged 20+ years, a statistically significant increasing trend of 15.9% per year was observed, while among those aged 10-19 years a significant annual percent change of 16.9% was noted (2011 to 2019). Text field analysis demonstrated suicide attempt or ideation was a reoccurring theme among all age groups. Poor mental health status or conflict with family or an intimate partner were reported stressors, depending on age group. Additional self-harming injuries, such as cutting, were reported among all age groups. CONCLUSION Our study found that hospital admission for substance-related self-harm was highest for patients aged 15-19 years, especially females, and that they were more likely to use medications. The statistically significant increasing trend of cases found between 2011 and 2019 is notable. Patients showed multiple types of adversities, demonstrating the complexity of this issue.
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Lazarević KK, Dolićanin ZĆ, Stojanović MM, Bogdanović DČ, Milićević SR. Violent deaths among adolescents in Serbia: past, present and future. Cent Eur J Public Health 2022; 29:279-283. [PMID: 35026066 DOI: 10.21101/cejph.a6502] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/25/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of the study was to determine the trend and methods of violent deaths (suicide and homicide) in adolescents aged 15-19 years in Serbia. METHODS Mortality database was drawn from the Statistical Office of Serbia from the 1997-2019 period. To calculate the annual percentage change (APC) of mortality rate (MR) with corresponding 95% confidence interval we used join point regression analysis. Statistical analyses were also performed using the chi-square test and Spearman's rho correlation. RESULTS The average suicide rate was 3.65 per 100,000 and homicide rate was 1.36 per 100,000 adolescents. The boys to girls ratio was 4.2 for suicides and 2.7 for homicides. Among girls, suicide rate significantly decreased (APC -20.7%; 95% CI -32.5 to -6.8) and homicide rate insignificantly decreased (APC -19.3%; 95% CI -37.8 to 5.1). Among boys, suicide rate significantly decreased (APC -4.6%; 95% CI -7.0 to -2.0) as well as homicide rate (APC -7.7%; 95% CI -11.5 to -4.3). The most common method of suicide was hanging (195, 44.3%) and nearly one third (198, 32.6%) of violent deaths were caused by firearms. Significantly negative correlation was observed between the Human Development Index (HDI), gross domestic product (GDP) per capita and MR due to suicides and homicides among both genders (p < 0.05). CONCLUSIONS Increase of GDP and HDI, national preventive intervention and strict application of the provisions of the law regarding the possession and storage of weapons must be implemented in order to continue reducing violent deaths among adolescents.
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Affiliation(s)
- Konstansa K Lazarević
- Department for Biomedical Science, State University of Novi Pazar, Novi Pazar, Serbia
| | - Zana Ć Dolićanin
- Department for Biomedical Science, State University of Novi Pazar, Novi Pazar, Serbia
| | | | - Dragan Č Bogdanović
- Department for Biomedical Science, State University of Novi Pazar, Novi Pazar, Serbia
| | - Saša R Milićević
- Department for Biomedical Science, State University of Novi Pazar, Novi Pazar, Serbia
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McIntyre RS, Lui LM, Rosenblat JD, Ho R, Gill H, Mansur RB, Teopiz K, Liao Y, Lu C, Subramaniapillai M, Nasri F, Lee Y. Suicide reduction in Canada during the COVID-19 pandemic: lessons informing national prevention strategies for suicide reduction. J R Soc Med 2021; 114:473-479. [PMID: 34551280 PMCID: PMC8532219 DOI: 10.1177/01410768211043186] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective The objective of this research was to evaluate the impact of federal, public health and social support programs on national suicide rates in Canada. Design Cross-sectional study. Setting Canadian National Database (i.e., Statistics Canada) and Statista. Participants Population-level data, and economic and consumer market data. Main Outcome Measures Suicide mortality data, population data and unemployment data were obtained from available statistical databases (e.g. Statistics Canada). We quantified suicide rate by dividing the total number of suicide deaths by the national population expressed as a rate per 100,000 population. Results Overall suicide mortality rate decreased in Canada from 10.82 deaths per 100,000 in the March 2019 - February 2020 period to 7.34 per 100,000 (i.e. absolute difference of 1300 deaths) in the March 2020 - February 2021 period. The overall Canadian unemployment rate changed from an average monthly rate of 5.7% in 2019 to 9.5% in 2020. Conclusion Our results indicate that for the first post-pandemic interval evaluated (i.e., March 2020 - February 2021), suicide rates in Canada decreased against a background of extraordinary public health measures intended to mitigate community spread of COVID-19. An externality of public health measures was a significant rise in national unemployment rates in population measures of distress. Our results suggest that government interventions that broadly aim to reduce measures of insecurity (i.e., economic, housing, health), and timely psychiatric services, should be prioritised as part of a national suicide reduction strategy, not only during but after termination of the COVID-19 pandemic.
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Affiliation(s)
- Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON M5T 2S8, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A8, Canada.,Department of Pharmacology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Leanna Mw Lui
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON M5T 2S8, Canada
| | - Joshua D Rosenblat
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON M5T 2S8, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A8, Canada.,Department of Pharmacology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 medical Dr, Singapore, 117597, Singapore.,Institute for Health Innovation and Technology, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore 119077, Singapore
| | - Hartej Gill
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON M5T 2S8, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Rodrigo B Mansur
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON M5T 2S8, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Kayla Teopiz
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON M5T 2S8, Canada
| | - Yuhua Liao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 135 Xingang W Rd, Bin Jiang Lu, Haizhu Qu, Guangzhou Shi, Guangdong Sheng, China.,Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, 7 Huaming Road, Nanshan, Shenzhen City, Guangdong Province, China
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 135 Xingang W Rd, Bin Jiang Lu, Haizhu Qu, Guangzhou Shi, Guangdong Sheng, China
| | - Mehala Subramaniapillai
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON M5T 2S8, Canada
| | - Flora Nasri
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON M5T 2S8, Canada
| | - Yena Lee
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON M5T 2S8, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
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Guerra O, Eboreime E. The Impact of Economic Recessions on Depression, Anxiety, and Trauma-Related Disorders and Illness Outcomes-A Scoping Review. Behav Sci (Basel) 2021; 11:119. [PMID: 34562956 PMCID: PMC8464685 DOI: 10.3390/bs11090119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022] Open
Abstract
In the wake of a global economic recession secondary to the COVID-19 pandemic, this scoping review seeks to summarize the current quantitative research on the impact of economic recessions on depression, anxiety, traumatic disorders, self-harm, and suicide. Seven research databases (PsycINFO, MEDLINE, Embase, Web of Science: Core Collection, National Library of Medicine PubMed, PubMed Central, and Google Scholar) were searched for keywords returning 3412 preliminary results published since 2008 in Organisation for Economic Coordination and Development (OECD)nations. These were screened by both authors for inclusion/exclusion criteria resulting in 127 included articles. Articles included were quantitative studies in OECD countries assessing select mental disorders (depression, anxiety, and trauma-/stress-related disorders) and illness outcomes (self-harm and suicide) during periods of economic recession. Articles were limited to publication from 2008 to 2020, available online in English, and utilizing outcome measures specific to the disorders and outcomes specified above. A significant relationship was found between periods of economic recession and increased depressive symptoms, self-harming behaviour, and suicide during and following periods of recession. Results suggest that existing models for mental health support and strategies for suicide prevention may be less effective than they are in non-recession times. It may be prudent to focus public education and medical treatments on raising awareness and access to supports for populations at higher risk, including those vulnerable to the impacts of job or income loss due to low socioeconomic status preceding the recession or high levels of financial strain, those supporting others financially, approaching retirement, and those in countries with limited social safety nets. Policy makers should be aware of the potential protective nature of unemployment safeguards and labour program investment in mitigating these negative impacts. Limited or inconclusive data were found on the relationship with traumatic disorders and symptoms of anxiety. In addition, research has focused primarily on the working-age adult population with limited data available on children, adolescents, and older adults, leaving room for further research in these areas.
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Affiliation(s)
- Olivia Guerra
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada;
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10
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Paracetamol-related intentional drug overdose among young people: a national registry study of characteristics, incidence and trends, 2007-2018. Soc Psychiatry Psychiatr Epidemiol 2021; 56:773-781. [PMID: 33146859 DOI: 10.1007/s00127-020-01981-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 10/24/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE Incidence rates of hospital-presenting self-harm are highest in people under 25 years and are reportedly increasing in some countries. Intentional drug overdose (IDO) is the most common self-harm method among young people, with paracetamol the drug most frequently used. This study aimed to describe the characteristics, incidence, and temporal trends in paracetamol-related IDO among young people. METHODS Data from the National Self-Harm Registry Ireland on hospital-presenting self-harm by individuals aged 1024 years during 2007-2018 were examined. Annual IDO rates per 100,000 were calculated by age and gender. Joinpoint regression analyses and incidence rate ratios were used to examine trends in the incidence of paracetamol-related IDO. RESULTS During the study, 10,985 paracetamol-related IDOs were recorded. The incidence of paracetamol-related IDO among young people increased by 9% between 2007 and 2018 (IRR 1.09 95% CI 1.00-1.19), with the highest annual percentage change (APC) in females aged 18-24 years (APC 1.2%). Conversely, rates of paracetamol-related IDO among males aged 18-24 years decreased significantly (APC 1.6%). Between 2013 and 2018, excesses of 386 and 151 paracetamol-related IDOs were observed in females aged 10-17 and 18-24 years, respectively, and 42 excess presentations were observed for males aged 10-17 years. There were 107 fewer presentations than expected for males aged 18-24 years. CONCLUSION The increase in paracetamol-related IDO among specific groups of young people, particularly young females is an issue of growing concern. Interventions targeting IDO among young people are needed, incorporating measures to address the availability of paracetamol and aftercare following IDO.
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11
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Daly C, Griffin E, McMahon E, Corcoran P, Webb RT, Witt K, Ashcroft DM, Arensman E. Repeat Self-Harm Following Hospital-Presenting Intentional Drug Overdose among Young People-A National Registry Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176159. [PMID: 32854234 PMCID: PMC7504369 DOI: 10.3390/ijerph17176159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/09/2020] [Accepted: 08/10/2020] [Indexed: 11/20/2022]
Abstract
Background: The incidence of hospital-presenting self-harm peaks among young people, who most often engage in intentional drug overdose (IDO). The risk of self-harm repetition is high among young people and switching methods between self-harm episodes is common. However, little is known about their patterns of repetition and switching following IDO. This study aimed to investigate repeat self-harm and method-switching following hospital-presenting IDO among young people. Methods: Data from the National Self-Harm Registry Ireland on hospital-presenting self-harm by individuals aged 10–24 years during 2009–2018 were examined. Cox proportional hazards regression models with associated hazard ratios (HRs), survival curves and Poisson regression models with risk ratios (RRs), were used to examine risk factors for repetition and method-switching. Results: During 2009–2018, 16,800 young people presented following IDO. Within 12 months, 2136 young people repeated self-harm. Factors associated with repetition included being male (HR = 1.13, 95% CI: 1.03–1.24), aged 10–17 years (HR = 1.29, 95% CI: 1.18–1.41), consuming ≥ 50 tablets (HR = 1.27, 95% CI: 1.07–1.49) and taking benzodiazepines (HR = 1.67, 95% CI: 1.40–1.98) or antidepressants (HR = 1.36, 95% CI: 1.18–1.56). The cumulative risk for switching method was 2.4% (95% CI: 2.2–2.7). Method-switching was most likely to occur for males (RR = 1.36; 95% CI: 1.09–1.69) and for those who took illegal drugs (RR = 1.63; 95% CI: 1.19–2.25). Conclusion: Young males are at increased risk of repeat self-harm and method-switching following IDO and the type and quantity of drugs taken are further indicators of risk. Interventions targeting IDO among young people are needed that ensure that mental health assessments are undertaken and which address access to drugs.
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Affiliation(s)
- Caroline Daly
- National Suicide Research Foundation, Cork 021, Ireland; (E.G.); (E.M.); (P.C.); (E.A.)
- Correspondence: ; Tel.: +353-21-420-5551
| | - Eve Griffin
- National Suicide Research Foundation, Cork 021, Ireland; (E.G.); (E.M.); (P.C.); (E.A.)
- School of Public Health, University College Cork, Cork 021, Ireland
| | - Elaine McMahon
- National Suicide Research Foundation, Cork 021, Ireland; (E.G.); (E.M.); (P.C.); (E.A.)
- School of Public Health, University College Cork, Cork 021, Ireland
| | - Paul Corcoran
- National Suicide Research Foundation, Cork 021, Ireland; (E.G.); (E.M.); (P.C.); (E.A.)
- School of Public Health, University College Cork, Cork 021, Ireland
| | - Roger T. Webb
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester M13, UK; (R.T.W.); (D.M.A.)
- Division of Psychology & Mental Health, Centre for Mental Health and Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester M13, UK
| | - Katrina Witt
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria 3052, Australia;
| | - Darren M. Ashcroft
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester M13, UK; (R.T.W.); (D.M.A.)
- Division of Pharmacy & Optometry, Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester M13, UK
| | - Ella Arensman
- National Suicide Research Foundation, Cork 021, Ireland; (E.G.); (E.M.); (P.C.); (E.A.)
- School of Public Health, University College Cork, Cork 021, Ireland
- Australian Institute for Suicide Research and Prevention, Griffith University, Queensland 4122, Australia
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12
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Malla A, Frampton A, Mansouri BI. Youth Mental Health Services: Promoting Wellness or Treating Mental Illness? CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:531-535. [PMID: 32319321 PMCID: PMC7492887 DOI: 10.1177/0706743720920033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Ashok Malla
- Department of Psychiatry, Douglas Hospital Research Centre,
McGill University, Montreal, Quebec, Canada
- Douglas Hospital Research Centre, ACCESS Open Minds,
Montreal, Quebec, Canada
| | - Alyssa Frampton
- National Youth Council, ACCESS Open Minds, Montreal, Quebec,
Canada
| | - Bilal Issaoui Mansouri
- Department of Psychiatry, Douglas Hospital Research Centre,
McGill University, Montreal, Quebec, Canada
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Arensman E, Troya MI, Nicholson S, Sadath A, Cully G, Ramos Costa AP, Benson R, Corcoran P, Griffin E, Williamson E, Eustace J, Shiely F, Browne J, Rigby J, Jeffers A, Cassidy E. Study protocol for the implementation and evaluation of the Self-harm Assessment and Management for General Hospitals programme in Ireland (SAMAGH). BMC Health Serv Res 2020; 20:590. [PMID: 32600390 PMCID: PMC7322837 DOI: 10.1186/s12913-020-05254-x] [Citation(s) in RCA: 3] [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: 03/19/2020] [Accepted: 04/26/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Previous self-harm is one of the strongest predictors of future self-harm and suicide. Increased risk of repeated self-harm and suicide exists amongst patients presenting to hospital with high-risk self-harm and major self-harm repeaters. However, so far evidence-based training in the management of self-harm for mental health professionals is limited. Within this context, we aim to develop, implement and evaluate a training programme, SAMAGH, Self-harm Assessment and Management Programme for General Hospitals in Ireland. SAMAGH aims to (a) reduce hospital-based self-harm repetition rates and (b) increase rates of mental health assessments being conducted with self-harm patients. We also aim to evaluate the training on self-harm knowledge, attitudes, and skills related outcomes of healthcare professionals involved in the training. METHODS/DESIGN The study will be conducted in three phases. First, the SAMAGH Training Programme has been developed, which comprises two parts: 1) E-learning Programme and 2) Simulation Training. Second, SAMAGH will be delivered to healthcare professionals from general hospitals in Ireland. Third, an outcome and process evaluation will be conducted using a pre-post design. The outcome evaluation will be conducted using aggregated data from the National Self-Harm Registry Ireland (NSHRI) on self-harm repetition rates from all 27 public hospitals in Ireland. Aggregated data based on the 3-year average (2016, 2017, 2018) self-harm repetition rates prior to the implementation of the SAMAGH will be used as baseline data, and NSHRI data from 6 and 12 months after the implementation of SAMAGH will be used as follow-up. For the process evaluation, questionnaires and focus groups will be administered and conducted with healthcare professionals who completed the training. DISCUSSION This study will contribute to the evidence base regarding the effectiveness of an evidence informed training programme that aims to reduce repeated hospital self-harm presentations and to improve compliance with self-harm assessment and management. This study is also expected to contribute to self-harm and suicide training with the possibility of being translated to other settings. Its feasibility will be evaluated through a process evaluation.
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Affiliation(s)
- Ella Arensman
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland.
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland.
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia.
| | - M Isabela Troya
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Sarah Nicholson
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Anvar Sadath
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Grace Cully
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Ana Paula Ramos Costa
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Ruth Benson
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Paul Corcoran
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Eve Griffin
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Eileen Williamson
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Joe Eustace
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- Health Research Board Clinical Research Facility-Cork, University College Cork, Cork, Ireland
| | - Frances Shiely
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
- Health Research Board Clinical Research Facility-Cork, University College Cork, Cork, Ireland
| | - John Browne
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
| | - Jan Rigby
- Centre for Health Geoinformatics & Department of Geography, Maynooth University, Maynooth, Ireland
| | - Anne Jeffers
- National Clinical Programme for the Assessment and Management of Patients presenting to the Emergency Department following Self-Harm, Office of the National Clinical Advisor and Group Lead, Dr. Steeven's Hospital, Dublin, Ireland
| | - Eugene Cassidy
- Department of Psychiatry and Neurobehavioral Science, University College Cork, Acute Mental Health Unit, Cork University Hospital, Wilton, Ireland
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Steeg S, Webb RT, Ibrahim S, Appleby L, Kapur N. Suicide rates and voting choice in the UK's 2016 national Brexit referendum on European Union membership: cross-sectional ecological investigation across England's local authority populations. BJPsych Open 2020; 6:e57. [PMID: 32475363 PMCID: PMC7345594 DOI: 10.1192/bjo.2020.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Individual- and area-level risk factors for suicide are relatively well-understood but the role of macro social factors such as alienation, social fragmentation or 'anomie' is relatively underresearched. Voting choice in the 2016 referendum on the UK's membership of the European Union (EU) provides a potential measure of anomie. AIMS To examine associations between percentage 'Leave' votes in the EU referendum and suicide rates in 2015-2017, the period just prior to, and following, the referendum. METHOD National cross-sectional ecological study of 315 English local authority populations. Associations between voting choice in the EU referendum and age-standardised suicide rates, averaged for the years 2015, 2016 and 2017, were examined. RESULTS Overall there was a weak, but statistically significant, positive correlation between the local authority-level percentage 'Leave' vote in 2016 and the suicide rate 2015-2017: Pearson's correlation coefficient, r = 0.17; P = 0.003. This relationship was explained by populations having an older age distribution, being more deprived and lacking ethnic diversity. However, there was divergence (likelihood ratio test for interaction, χ2 = 7.2, P = 0.007) in the observed associations between London and the provincial regions with Greater London having a moderately strong negative association (r = -0.40; P = 0.02) and the rest of England a weak positive association (r = 0.17; P = 0.004). CONCLUSIONS Deprivation, older age distribution and a lack of ethnic diversity seems to explain raised suicide risk in Brexit-voting communities. A greater sense of alienation among people feeling 'left behind'/'left out' may have had some influence too, although multilevel modelling of individual- versus area-level data are needed to examine these complex relationships. The incongruent ecological relationship observed for London likely reflect its distinct social, economic and health context.
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Affiliation(s)
- Sarah Steeg
- Centre for Mental Health and Safety, Manchester Academic Health Science Centre, University of Manchester, UK
| | - Roger T Webb
- Centre for Mental Health and Safety, Manchester Academic Health Science Centre, University of Manchester; and NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
| | - Saied Ibrahim
- Centre for Mental Health and Safety, Manchester Academic Health Science Centre, University of Manchester, UK
| | - Louis Appleby
- Centre for Mental Health and Safety, Manchester Academic Health Science Centre, University of Manchester, UK
| | - Nav Kapur
- Centre for Mental Health and Safety, Manchester Academic Health Science Centre, University of Manchester; NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester; and Greater Manchester Mental Health NHS Foundation Trust, UK
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Affiliation(s)
- Roger S. McIntyre
- Mood Disorders Psychopharmacology Unit, Poul Hansen Depression Centre, University Health NetworkTorontoONCanada,Institute of Medical Science, University of TorontoTorontoONCanada,Department of Psychiatry, University of TorontoTorontoONCanada,Brain and Cognition Discovery FoundationTorontoONCanada,Department of Pharmacology, University of TorontoTorontoONCanada
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, Poul Hansen Depression Centre, University Health NetworkTorontoONCanada,Institute of Medical Science, University of TorontoTorontoONCanada
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Gardner W. Denmark's success in reducing adolescent self-harm. Soc Psychiatry Psychiatr Epidemiol 2020; 55:423-424. [PMID: 32008062 DOI: 10.1007/s00127-019-01818-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022]
Affiliation(s)
- William Gardner
- Children's Hospital of Eastern Ontario (CHEO) Senior Research Chair in Child and Adolescent Psychiatry, University of Ottawa, Ottawa, ON, Canada.
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Ray JG, Guttmann A, Silveira J, Park AL. Mortality in a cohort of 3.1 million children, adolescents and young adults. J Epidemiol Community Health 2020; 74:260-268. [PMID: 31915240 PMCID: PMC7035693 DOI: 10.1136/jech-2019-213365] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/09/2019] [Accepted: 12/15/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Many youth deaths occur in the first year of life, from prematurity and anomalies. Detailing mortality after age 1 year may differentially guide preventive strategies in children, adolescents and young adults. METHODS A cohort study in Ontario, Canada comprised 3 139 698 children born from 1990 to 2016. Adjusted HR (aHR) for death between 1 and 24 years were generated, comparing demographic variables and parity. RESULTS After a median of 13.7 years of follow-up, 6930 deaths occurred between ages 1 and 24 years (incidence rate 17.0 per 100 000 person-years), peaking at age 23 years (43.7 per 100 000). The aHR for death was higher among males than females (1.44, 95% CI 1.37 to 1.51), rural versus urban areas (1.48, 95% CI 1.39 to 1.58), lowest versus highest income areas (1.39, 95% CI 1.29 to 1.51) and at parity 1 (1.16, 95% CI 1.10 to 1.23), parity 2 (1.34, 95% CI 1.23 to 1.45), parity 3+ (1.96, 95% CI 1.74 to 2.21), each relative to a child without an older sibling. Among males, the proportion of deaths due to injury jumped from 30% before age 15 years to 65% thereafter, and in females, from 28% to 51%. Intentional self-harm/assault explained 11% of injury-related deaths among males before age 15 years, and 20% thereafter, with respective figures of 18% and 17% for females. Deaths outside of hospital increased with age, from 35% at age 1 year, to 66% at age 22 years. CONCLUSION There is a heightened susceptibility of dying starting at age 15 years, especially among males, from injury, and arising outside of hospital.
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Affiliation(s)
- Joel G Ray
- Medicine, and Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada .,Psychiatry, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Astrid Guttmann
- ICES, Toronto, Ontario, Canada.,Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jose Silveira
- Psychiatry, University of Toronto, Toronto, Ontario, Canada
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