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Dev DA, Le GH, Kwan ATH, Wong S, Arulmozhi A, Ceban F, Teopiz KM, Meshkat S, Rosenblat JD, Guillen-Burgos HF, Rhee TG, Ho RC, Cao B, d'Andrea G, Sundberg I, McIntyre RS. Comparing suicide completion rates in bipolar I versus bipolar II disorder: A systematic review and meta-analysis. J Affect Disord 2024; 361:480-488. [PMID: 38901691 DOI: 10.1016/j.jad.2024.06.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 06/03/2024] [Accepted: 06/15/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Bipolar disorder (BD) has a high disease burden and the highest mortality risk in BD comes from suicide. Bipolar disorder type II (BD-II) has been described as a milder form of bipolar disorder; however, extant literature is inconsistent with this description and instead describe illness burden and notably suicidality comparable to persons with bipolar I disorder (BD-I). Towards quantifying the hazard of BD-II, herein we aim via systematic review and meta-analysis to evaluate the rates of completed suicide in BD-I and BD-II. METHOD We conducted a literature search on PubMed, OVID (Embase, Medline) and PsychINFO databases from inception to June 30th, 2023, according to PRISMA guidelines. Articles were selected based on the predetermined eligibility criteria. A meta-analysis was performed, comparing the risk of completed suicide between individuals diagnosed with BD-I to BD-II. RESULTS Four out of eight studies reported higher suicide completion rates in persons living with BD-II when compared to persons living with BD-I; however, two of the studies reported non-significance. Two studies reported significantly higher suicide completion rates for BD-I than BD-II. The pooled odds ratio of BD-II suicide rates to BD-I was 1.00 [95 % CI = 0.75, 1.34]. LIMITATIONS The overarching limitation is the small number of studies and heterogeneity of studies that report on suicide completion in BD-I and BD-II. CONCLUSION Our study underscores the severity of BD-II, with a risk for suicide not dissimilar from BD-I. The greater propensity to depression, comorbidity and rapid-cycling course reported in BD-II are contributing factors to the significant mortality hazard in BD-II.
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Affiliation(s)
- Donovan A Dev
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada; School of Medicine, University College Dublin, Dublin, Ireland; Department of Neuroscience Imaging and Clinical Sciences, University G d'Annunzio, Chieti, Italy.
| | - Gia Han Le
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
| | - Angela T H Kwan
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Sabrina Wong
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.
| | - Akhilan Arulmozhi
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Felicia Ceban
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
| | - Kayla M Teopiz
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada.
| | - Shakila Meshkat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.
| | - Hernan F Guillen-Burgos
- Center for Clinical and Translational Research, Universidad Simón Bolívar, Barranquilla, Colombia; Center for Clinical and Translational Research, Faculty of Medicine, Universidad El Bosque, Bogotá D.C., Colombia; Department of Psychiatry and Mental Health, Pontificia Universidad Javeriana, Bogotá D.C., Colombia..
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA.
| | - Roger C Ho
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 117599, Singapore.; Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Bing Cao
- Key Laboratory of Cognition and Personality (SWU), Faculty of Psychology, Ministry of Education, Southwest University, Chongqing 400715, PR China.
| | - Giacomo d'Andrea
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Isak Sundberg
- Department of Neuroscience Psychiatry, Uppsala University Hospital, Uppsala, Sweden.
| | - Roger S McIntyre
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; School of Medicine, University College Dublin, Dublin, Ireland; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Sharwood LN, Waller M, Draper B, Shand F. Exploring community mental health service use following hospital-treated intentional self-harm among older Australians: a survival analysis. Int Psychogeriatr 2024; 36:405-414. [PMID: 37960921 DOI: 10.1017/s1041610223000959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
OBJECTIVES This study aimed to examine the impact of community mental health (CMH) care following index hospital-treated intentional self-harm (ISH) on all-cause mortality. A secondary aim was to describe patterns of CMH care surrounding index hospital-treated ISH. DESIGN A longitudinal whole-of-population record linkage study was conducted (2014-2019), with index ISH hospitalization (Emergency Department and/or hospital admissions) linked to all available hospital, deaths/cause of death, and CMH data. SETTING Australia's most populous state, New South Wales (NSW) comprised approximately 7.7 million people during the study period. CMH services are provided statewide, to assess and treat non-admitted patients, including post-discharge review. PARTICIPANTS Individuals with an index hospital presentation in NSW of ISH during the study period, aged 45 years or older. INTERVENTION CMH care within 14 days from index, versus not. MEASUREMENTS Cox-proportionate hazards regression analysis evaluated all-cause mortality risk, adjusted for relevant covariates. RESULTS Totally, 24,544 persons aged 45 years or older experienced a nonfatal hospital-treated ISH diagnosis between 2014 and 2019. CMH care was received by 56% within 14 days from index. Survival analysis demonstrated this was associated with 34% lower risk of death, adjusted for age, sex, marital status, index diagnosis, and 14-day hospital readmission (HR 0.66, 95% CI 0.58, 0.74, p < 0.001). Older males and chronic injury conveyed significantly greater risk of death overall. CONCLUSIONS CMH care within 14 days of index presentation for self-harm may reduce the risk of all-cause mortality. Greater effort is needed to engage older males presenting for self-harm in ongoing community mental health care.
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Affiliation(s)
- Lisa N Sharwood
- Black Dog Institute, University of New South Wales, Sydney, Kensington, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- School of Engineering, University of Technology Sydney, Sydney, NSW, Australia
- School of Population Health, University of NSW, Sydney
| | | | - Brian Draper
- Eastern Suburbs Older Persons' Mental Health Service, Randwick, NSW, 2031, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales,Sydney, NSW, Australia
| | - Fiona Shand
- Black Dog Institute, University of New South Wales, Sydney, Kensington, NSW, Australia
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Diószegi J, Rihmer Z, Torzsa P, Pál L, Czifra Á, Gonda X, Sándor J. Psychiatric health care need in Hungary identified by the short screening algorithm of depression and suicide risk used in general medical practices. Sci Rep 2023; 13:14249. [PMID: 37652947 PMCID: PMC10471575 DOI: 10.1038/s41598-023-41437-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/26/2023] [Indexed: 09/02/2023] Open
Abstract
Suicides are often related to depression. General medical practices (GMPs) should play a role in screening depression. We aimed to test the screening algorithm of Rihmer and Torzsa for depression and suicide and determine the prevalence and number of patients in the nationwide representative Hungarostudy 2002 population, and to estimate the corresponding extra health care need in an average GMP and in the Hungarian population in addition to patients who are already cared for by specialized care. The short version of the Beck Hopelessness Scale (BHS) and the Hungarian version of the short form of the Beck Depression Inventory (BDI-9) were used to screen for suicide risk and depression. The prevalence of suicidal thoughts and depression was determined and findings were extrapolated to an average GMP of 1,600 adults and to the population over 25 years of age. This screening would generate a considerable extra psychiatric care to organize and implement in an average GMP and throughout the country. Our findings show that with easily administered screening instruments a significant number of patients likely to have depression can be identified at the primary care level, arguing for the establishment of the extra psychiatric care capacity in Hungary.
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Affiliation(s)
- Judit Diószegi
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Kassai út 26, Debrecen, 4028, Hungary.
| | - Zoltán Rihmer
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Balassa utca 6, Budapest, 1082, Hungary
- National Institute of Mental Health, Neurology and Neurosurgery, Amerikai út 57, Budapest, 1145, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Stáhly u. 7-9, Budapest, 1085, Hungary
| | - László Pál
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Kassai út 26, Debrecen, 4028, Hungary
| | - Árpád Czifra
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Kassai út 26, Debrecen, 4028, Hungary
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Balassa utca 6, Budapest, 1082, Hungary
| | - János Sándor
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Kassai út 26, Debrecen, 4028, Hungary
- ELKH-DE Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Kassai út 26, Debrecen, 4028, Hungary
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Pouquet M, Niare D, Guerrisi C, Blanchon T, Hanslik T, Younes N. [Suicide prevention: How to act?]. Rev Med Interne 2022; 43:375-380. [PMID: 35606205 DOI: 10.1016/j.revmed.2022.03.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 03/04/2022] [Accepted: 03/26/2022] [Indexed: 11/17/2022]
Abstract
Although being complex, suicide is a phenomenon considered as preventable, and its prevention has been made as a public health priority. Some interventions to prevent suicide have been evaluated, such as the education of the healthcare workers, especially in the suicidal assessment (suicidal risk and suicidal emergency/dangerousness), the diagnosis and management of common mental disorders, the care provided after a suicide attempt, the restriction access to common means of suicide, the use of websites to educate the public, or the appropriate reports of suicide in media. Other interventions, even not rigorously evaluated, are implemented in France as in many parts of the world. It is the case of interventions among identified high-risk groups. To be efficient, prevention programs should simultaneously include different strategies targeting several known risk factors for suicide. Clinicians play a crucial role in the suicide prevention strategies.
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Affiliation(s)
- M Pouquet
- Sorbonne université, Inserm, institut Pierre-Louis d'épidémiologie et de santé publique, (IPLESP), 75012 Paris, France.
| | - D Niare
- Sorbonne université, Inserm, institut Pierre-Louis d'épidémiologie et de santé publique, (IPLESP), 75012 Paris, France
| | - C Guerrisi
- Sorbonne université, Inserm, institut Pierre-Louis d'épidémiologie et de santé publique, (IPLESP), 75012 Paris, France
| | - T Blanchon
- Sorbonne université, Inserm, institut Pierre-Louis d'épidémiologie et de santé publique, (IPLESP), 75012 Paris, France
| | - T Hanslik
- Sorbonne université, Inserm, institut Pierre-Louis d'épidémiologie et de santé publique, (IPLESP), 75012 Paris, France; Service de médecine interne, hôpital Ambroise-Paré, Assistance publique-Hôpitaux de Paris, AP-HP, 92100 Boulogne-Billancourt, France; UFR des sciences de la santé Simone-Veil, université de Versailles-Saint-Quentin-en-Yvelines, 78280 Versailles, France
| | - N Younes
- UFR des sciences de la santé Simone-Veil, université de Versailles-Saint-Quentin-en-Yvelines, 78280 Versailles, France; Université Versailles-Saint-Quentin, université Paris Saclay, CESP, Team DevPsy, 94807 Villejuif, France; Centre hospitalier Versailles, service hospitalo-universitaire de psychiatrie de l'adulte et d'addictologie, 78157 Le Chesnay, France; Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
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5
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Geijer J, Baigi A, Aiff H. Inter-rater reliability among psychiatrists when assessing depression according to the Montgomery-Åsberg Depression Rating Scale. Nord J Psychiatry 2021; 75:607-613. [PMID: 34156321 DOI: 10.1080/08039488.2021.1918240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Montgomery-Åsberg Depression Rating Scale (MADRS) is a validated tool for rating the depth of depression. The structured interview guide for the MADRS (SIGMA) is an interview guide that has been developed in order to increase the inter-rater reliability. Patients often meet more than one psychiatrists during their hospitalization for depression. A divergent rating of depression between psychiatrists could affect both the treatment and the outcome. This makes knowledge of the inter-rater reliability among psychiatrists important. AIM The primary aim of this study was to measure the inter-rater reliability between psychiatrists when rating depression using the MADRS. METHODS Ten in-patients, who were diagnosed with depression, were filmed while being interviewed using the SIGMA. The patients were after that instructed to rate themselves using the self-rating version of the MADRS. Ten psychiatrists rated the pre-recorded interviews according to the MADRS. The inter-rater reliability was measured using intra-class correlation (ICC). RESULTS The mean ICC for the total MADRS score was 0.952 (95% CI 0.891-0.986; p<.001) and Cronbach's alpha 0.961. ICC values for each item ranged between 0.866 and 0.978 (p<.001). Cronbach's alpha ranged between 0.905 and 0.984. The ICC values, when comparing the psychiatrists rating to the patients rating, ranged between 0.307 and 0.809 (p<.001). CONCLUSION All of the ICC values in the study, except when comparing the psychiatrists rating to the patients self-rating, were considered to be excellent. This study confirms the findings of reliability found in similar studies which involved fewer raters and not exclusively psychiatrists.
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Affiliation(s)
- Jonas Geijer
- Psychiatric Department of Halland, Region Halland, Psykiatrin i Halland HSH, Halmstad, Sweden
| | - Amir Baigi
- The Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Harald Aiff
- Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Bartova L, Dold M, Fugger G, Kautzky A, Mitschek MMM, Weidenauer A, Hienert MG, Frey R, Mandelli L, Zohar J, Mendlewicz J, Souery D, Montgomery S, Fabbri C, Serretti A, Kasper S. Sex-related effects in major depressive disorder: Results of the European Group for the Study of Resistant Depression. Depress Anxiety 2021; 38:896-906. [PMID: 34110066 PMCID: PMC8453858 DOI: 10.1002/da.23165] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/19/2021] [Accepted: 04/19/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Sex-related effects on the evolution and phenotype of major depressive disorder (MDD) were reported previously. METHODS This European multicenter cross-sectional study compared sociodemographic, clinical, and treatment patterns between males and females in a real-world sample of 1410 in- and outpatients with current MDD. RESULTS Male MDD patients (33.1%) were rather inpatients, suffered from moderate to high suicidality levels, received noradrenergic and specific serotonergic antidepressants (ADs) as first-line AD treatment, generally higher mean AD daily doses, and showed a trend towards a more frequent administration of add-on treatments. Female MDD patients (66.9%) were rather outpatients, experienced lower suicidality levels, comorbid thyroid dysfunction, migraine, asthma, and a trend towards earlier disease onset. CONCLUSIONS The identified divergencies may contribute to the concept of male and female depressive syndromes and serve as predictors of disease severity and course, as they reflect phenomena that were repeatedly related to treatment-resistant depression (TRD). Especially the greater necessity of inpatient treatment and more complex psychopharmacotherapy in men may reflect increased therapeutic efforts undertaken to treat suicidality and to avoid TRD. Hence, considering sex may guide the diagnostic and treatment processes towards targeting challenging clinical manifestations including comorbidities and suicidality, and prevention of TRD and chronicity.
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Affiliation(s)
- Lucie Bartova
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - Markus Dold
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - Gernot Fugger
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - Alexander Kautzky
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | | | - Ana Weidenauer
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - Marius G. Hienert
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - Richard Frey
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - Laura Mandelli
- Department of Biomedical and NeuroMotor SciencesUniversity of BolognaBolognaItaly
| | - Joseph Zohar
- Psychiatric DivisionChaim Sheba Medical CenterTel HashomerIsrael
| | | | - Daniel Souery
- School of MedicineFree University of BrusselsBrusselsBelgium,Psy Pluriel ‐ European Centre of Psychological MedicineBrusselsBelgium
| | - Stuart Montgomery
- Imperial College School of MedicineUniversity of LondonLondonUnited Kingdom
| | - Chiara Fabbri
- Department of Biomedical and NeuroMotor SciencesUniversity of BolognaBolognaItaly,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUnited Kingdom
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor SciencesUniversity of BolognaBolognaItaly
| | - Siegfried Kasper
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria,Center for Brain ResearchMedical University of ViennaViennaAustria
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Ducher JL, Llorca PM, Callahan S, de Chazeron I. Épidémiologie descriptive du risque suicidaire dans le système médical français de médecine générale. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:451-459. [PMID: 32986462 PMCID: PMC8107957 DOI: 10.1177/0706743720961741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Suicide prevention certainly includes a better knowledge of suicide risk in primary care. A number of international publications have shown interest in assessing this risk, but mostly through specific consultant populations: young patients, old patients, anhedonic, depressive, etc. Our study analyses suicide risk prevalence in patients consulting in general medicine for any somatic or psychiatric reason, their pathology or their age. METHOD This cross-sectional study was conducted with adult patients (827 subjects included) who were consulting a French generalist doctor panel randomly selected. They filled a validated self-questionnaire (aRSD) assessing their suicide risk in the 15 preceding days and providing professional and personal data. RESULTS The totally operable 757 files (483 female; 274 male) show that close to a quarter of consultants (24.3%) presents with a positive suicide risk in the 15 days preceding their consultation and 6.3%, reveal a severe risk (aRSD ≥ 7) with ideas and impulses to commit the act. When the reason to consult is psychiatric, 64.6% of these consultants have aRSD positive. One time out of two, the risk is even severe. CONCLUSIONS This data shows how important the suicide risk prevalence is in general medicine. It confirms the main role played by primary care patricians in acting to prevent suicide risk. This data also shows the contribution represented by a self-questionnaire that would rapidly assess the suicide intent while screening, it.
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Affiliation(s)
- J.-L. Ducher
- Ramsay Générale de Santé, Clinique de l’Auzon, 63670 La
Roche-Blanche, France
| | - P.-M. Llorca
- CHU Clermont-Ferrand, Psychiatrie B, Clermont-Ferrand, F-63003, France ; Université
Clermont Auvergne, EA7280, F-63000 Clermont-Ferrand, France
| | - S. Callahan
- Université de Toulouse II - Jean Jaurès, Toulouse, France
| | - I. de Chazeron
- CHU Clermont-Ferrand, Psychiatrie B, Clermont-Ferrand, F-63003, France ; Université
Clermont Auvergne, EA7280, F-63000 Clermont-Ferrand, France
- I. de Chazeron, C.H.U. Clermont-Ferrand -
Psychiatrie B de CHAZERON Ingrid, Rue Montalembert BP 69F-63003
CLERMONT-FERRAND, France Courriel :
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8
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Balard F, Voléry I, Fornezzo É. La construction du suicide des personnes âgées comme problème public. ACTA ACUST UNITED AC 2020. [DOI: 10.3917/gs1.163.0187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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9
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Male depressive traits in relation to violent suicides or suicide attempts: A systematic review. J Affect Disord 2020; 262:55-61. [PMID: 31707247 DOI: 10.1016/j.jad.2019.10.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/09/2019] [Accepted: 10/28/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Male sex is a consistently reported risk factor for violent suicide. It has been suggested that this association may be driven by so-called male depression - as operationalized by the Gotland Male Depression Scale (GMDS). The aim of this systematic review was to investigate if males dying by or attempting suicide with violent methods, display symptoms compatible with male depression. METHODS This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic search of PubMed, Embase and PsycINFO was performed using search terms covering: male sex, violent suicide/suicide attempt, and symptoms of male depression from the GMDS. Subsequently, a qualitative synthesis of studies meeting predefined inclusion criteria was carried out. RESULTS A total of 28 studies reporting on 91,933 violent suicides and 113 violent suicide attempts were included in the qualitative synthesis. The suicide/suicide attempt methods reported in these studies were predominantly shooting, hanging or drowning. The only two symptoms from the GMDS that was reported in relation to violent suicides/suicide attempts was overconsumption of alcohol or drugs and suicide attempts in the biological family. No studies had systematically assessed suicide victims or attempters for symptoms of male depression. LIMITATIONS Publication-, selection-, and information biases may have affected this review. CONCLUSIONS Symptoms of male depression are rarely reported in relation to violent suicides/suicide attempts. The most likely explanation for this finding is that there has been little focus on this potential association. Future studies should address this void.
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Owusu JT, Doty SB, Adjaye-Gbewonyo D, Bass JK, Wilcox HC, Gallo JJ, Spira AP. Association of sleep characteristics with suicidal ideation and suicide attempt among adults aged 50 and older with depressive symptoms in low- and middle-income countries. Sleep Health 2019; 6:92-99. [PMID: 31757754 DOI: 10.1016/j.sleh.2019.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 08/12/2019] [Accepted: 08/26/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Investigate the association of sleep characteristics with suicidal ideation and suicide attempt among middle-aged and older adults with depressive symptoms in five low- and middle-income countries (LMICs). DESIGN Cross-sectional. SETTING China, Ghana, India, Russia, and South Africa. PARTICIPANTS Adults aged ≥50 years with depressive symptoms from the World Health Organization (WHO) Study on Global AGEing and Adult Health (n=2,040). MEASUREMENTS Predictors were self-reported average sleep duration for the past 2 nights (<7 hours (shorter), 7 to <9 hours (reference), ≥9 hours (longer)), sleep quality for the past 2 nights (moderate/good/very good [both nights], poor/very poor [≥1 night]), past-month insomnia symptoms (none/mild, moderate, severe/extreme), and past-day daytime sleepiness. Outcomes were past-year suicidal ideation and suicide attempt. Analyses were adjusted for age, sex, household wealth, marital status, self-rated health, cognitive performance, number of depressive symptoms, and country of residence. RESULTS Participants with poor/very poor sleep quality ≥1 night had greater odds of suicidal ideation (vs. moderate/good/very good sleep quality both nights). Participants with moderate and severe/extreme insomnia symptoms had greater odds of suicidal ideation and suicide attempt (vs. none/mild insomnia symptoms). In moderation analyses, greater insomnia symptoms were associated with higher odds of suicidal ideation among women only and those aged 60-60 years and ≥80 years only. CONCLUSIONS Among middle-aged and older adults with depressive symptoms in LMICs, sleep characteristics are markers of-and potential contributors to-suicidal ideation and suicide attempt, and there was evidence of moderation by age and sex. Interventions aimed at preventing suicide-related outcomes in these populations should consider the role of sleep.
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Affiliation(s)
- J T Owusu
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - S B Doty
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - J K Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Center for Humanitarian Health, Johns Hopkins University, Baltimore, MD, USA
| | - H C Wilcox
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - J J Gallo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA; Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA
| | - A P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA; Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA
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Oquendo MA. Developing effective strategies for the management of depression and suicidal thoughts. BRAZILIAN JOURNAL OF PSYCHIATRY 2019; 41:375. [PMID: 31644776 PMCID: PMC6796824 DOI: 10.1590/1516-4446-2019-0653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Maria A Oquendo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Audouard-Marzin Y, Kopp-Bigault C, Scouarnec P, Walter M. General practitioners training about suicide prevention and risk: A systematic review of literature. Presse Med 2019; 48:767-779. [DOI: 10.1016/j.lpm.2019.05.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 12/25/2018] [Accepted: 05/28/2019] [Indexed: 11/15/2022] Open
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Genuchi MC. The Role of Masculinity and Depressive Symptoms in Predicting Suicidal Ideation in Homeless Men. Arch Suicide Res 2019; 23:289-311. [PMID: 29461153 DOI: 10.1080/13811118.2018.1428705] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Men's suicide rates may be influenced by difficulties recognizing externalizing depressive symptoms in men that adhere to hegemonic masculine gender role norms. The purpose of this study was to investigate the ability of externalizing depressive symptoms, internalizing depressive symptoms, and hegemonic masculinity in predicting the existence and severity of suicidal ideation. Homeless men (n = 94) completed questionnaires at a resource center in the Rocky Mountain Western United States. Internalizing symptoms predicted the existence of suicidal ideation, and both externalizing and internalizing symptoms predicted increased severity of suicidal ideation. The masculine norms violence and playboy were correlated with men's suicidal ideation. An externalizing-internalizing model of predicting suicide in men and men's adherence to certain masculine gender role norms may be valuable to further efforts in suicide assessment and prevention.
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14
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Abstract
Antidepressants and Suicidality: A Contradiction? Abstract. In 2004, the European and American authorities released a black-box warning on antidepressants indicating an association with an increased risk of suicidality (suicidal ideation and behavior) in young people. Until today, this issue remained controversial. The present review gives an overview on the relationship between antidepressant therapy and the risk of suicide and suicidality, respectively: there is no evidence of an increased risk of suicide, but of an increased rate of suicidality during the first period after starting an antidepressant treatment in young patients. Importantly, this risk was not higher than before treatment initiation. However, an intensified supervision is needed especially during the first weeks of treatment. Finally, the risk posed by untreated depression is far greater than a risk associated with antidepressant treatment.
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Affiliation(s)
- Martin Hatzinger
- 1 Klinken für Psychiatrie, Psychotherapie und Psychosomatik, Solothurner Spitäler AG
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15
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Kopp-Bigault C, Audouard-Marzin Y, Scouarnec P, Beauchamp G, Séguin M, Walter M. [French translation and validation of a short version of the Suicide Intervention Response Inventory-2 (SIRI-2-VF)]. Encephale 2017; 44:435-445. [PMID: 29096910 DOI: 10.1016/j.encep.2017.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 07/25/2017] [Accepted: 07/25/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Training health professionals about suicidal crisis is one major line of suicide prevention worldwide. France has one of the highest suicide rates in Europe, and although crisis intervention training has been set up since 2001, there presently is no training assessment tool in the French language for health professionals trained in suicide prevention. In the four levels of Kirpatrick's education pyramid, training that takes place in France today solely assesses level one status, that is to say relative to the level of satisfaction of participants (self-report). This study proposes a validated short French version of the Suicide Intervention Response Inventory-2 (SIRI-2) of Neimeyer & Mc Innes. The SIRI-2 questionnaire assesses the ability of first line intervention in dealing with suicidal individuals. METHODS The translation methodology was inspired from Vallerand's model of cross-cultural back translation. This method is regularly used for translating from the English language to a French version. In order to translate the English version, we used an extensive 7-step methodology implicating several bilingual translators, expert reviewers (psychologists and psychiatrists) and a scientific committee. Participants were 107 students from different French universities and study programs: psychology, medicine and nursing (17 were men; average age was 26.6). Fifteen of these participants answered the SIRI-2-VF on two occasions (separated by a 15-day interval) in order to estimate the temporal stability of the instrument. The scores of the students were compared to six French experts in suicide prevention and with the original expert group who worked on the development of SIRI-2 (n=7). We used Student t Test for construct validity, Cronbach's Alpha for internal consistency and Pearson's correlation coefficient for temporal stability. RESULTS Following a fidelity comparison of the results of the French experts with those of the American experts, ten items presenting the least good fidelity were suppressed in order to obtain a short version of the SIRI-2 containing 15 questions (SIRI-2-VF). Statistical analyses of the short version (15 questions, SIRI-2-VF) showed good validity (difference between experts and subjects is significant: t=31.5, P<0.001) and reliability (good internal consistency: α=0.850 for positive statements and α=0.830 for negative statements, and a temporal stability: r=0.827, bilateral test, P<0.001). CONCLUSIONS This tool should improve the range of specific instruments in French suicidology adapted for French culture of suicide intervention. It is the first tool in France that reaches level 2a of Kirkpatrick's pyramid to assess clinical skills after training in suicidology.
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Affiliation(s)
- C Kopp-Bigault
- University of Strasbourg (EA3071), 67000 Strasbourg, France; Morlaix Hospital, 29600 Brittany, France.
| | - Y Audouard-Marzin
- Collège des hautes études en médecine (CHEM), 29200 Brest, France; CRPV, centre hospitalier universitaire régional de Brest, 29200 Brest, France
| | - P Scouarnec
- Morlaix Hospital, 29600 Brittany, France; Collège des hautes études en médecine (CHEM), 29200 Brest, France; CRPV, centre hospitalier universitaire régional de Brest, 29200 Brest, France
| | - G Beauchamp
- Department of psychoeducation and psychology, université du Québec, Outaouais, Canada
| | - M Séguin
- Department of psychoeducation and psychology, université du Québec, Outaouais, Canada; McGill Group on Suicide Studies, Montréal, Québec, Canada; Québec Network on Suicide Research, Québec, Canada; Centre intégré de santé et service social de l'Outaouais (CISSSO), Outaouais, Canada
| | - M Walter
- Psychiatry Unit, Brest University and Research Hospital, 29200 Brest, France
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Kar N. Factors associated with suicides in Wolverhampton: Relevance of local audits exploring preventability. MEDICINE, SCIENCE, AND THE LAW 2016; 56:245-251. [PMID: 27385769 DOI: 10.1177/0025802416657761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Suicide rates and associated risk factors are known to change over time. The periodic evaluation of suicides in a particular locality may identify specific issues that may help in prevention efforts. The profile of 146 consecutive cases with suicide, open and narrative verdicts between January 2004 and July 2011 in Wolverhampton was studied in order to explore associated factors. Specific information about methods, mental health issues and stressors was collected. There was considerable variation in suicides in different wards of the city, with higher occurrences in inner-city areas. Male suicides were three times more common, and they were significantly younger than in female suicides. Common methods were hanging (52.7%) and poisoning (21.9%) involving a wide range of drugs. Life events were reported in 52.1% suicides, most frequently relational problems (28.1%), followed by physical illness and bereavement. Mental-health factors were associated with 63.0% of suicides, predominantly depression (45.9%) and alcohol and drug abuse (6.8%). The majority of the suicide victims (63.0%) were not in contact with mental-health services, including: most men (68.8%), young suicides up to age 34 (78.6%), the elderly (69.2%) and Asians (70.0%). A considerable proportion of these suicides had mental-health issues, mainly depression (42.4%) and alcohol or drug abuse (6.5%). Significantly more of them (69.6% vs. 22.2%) had stressors compared with suicides known to mental-health services. The findings of the study highlighted risk factors that may help prioritising intervention initiatives. It appears that local suicide audits may complement national information on suicide in designing appropriate local suicide-prevention strategies.
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Abstract
An education program for GPs about treating patients with depressive disorders and panic disorders was implemented in one district in the year 1998. A neighboring district was used as a control. Although the educational program was followed by an increase in referrals for panic disorder in the target district, there was no impact on referrals for depressive disorders, the prescribing of antidepressants by the GPs, or the suicide rate.
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Affiliation(s)
- Tamas Zonda
- Hungarian Association for Suicide Prevention
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18
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Pearson JL. Preventing Late Life Suicide: National Institutes of Health Initiatives. OMEGA-JOURNAL OF DEATH AND DYING 2016. [DOI: 10.2190/fmrg-87w0-yxdk-6efy] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
From a public health perspective, late life suicide is seen primarily as a consequence of untreated mental disorder, particularly depression. However, due to the stigma and agism surrounding mental disorders in late life, there has been limited public awareness that the elderly have the highest rates of suicide, and that they often have treatable depression prior to their suicide. Late life suicide is slowly gaining attention in both the scientific and public arenas. This article reviews in chronological order a number of efforts that have led to heightened awareness and initial public health policy development of late life suicide prevention strategies. The next steps for NIH-sponsored research in late life suicide are described.
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Abstract
Late life suicide is characterized by less warning, higher lethality, and greater prevalence of depression and physical illness than suicide earlier in the lifespan. Suicidal older adults are more likely to seek help from a physician than through mental health channels, and suicide risk often remains undetected. Hopelessness is a prominent feature in older adult suicide. Traditional suicide hotlines receive few calls from older adults, and staff lack training in working with this age group. Despite the difficulties in preventing older adult suicide, however, opportunities exist. Psychotherapeutic and psychopharmacological treatments for depression may be effective in suicidal older adults, although they have not yet been widely tested. Community agencies with specialized programs for older adults show promise. Results are presented from the evaluation of one such agency, the Center for Elderly Suicide Prevention. After receiving agency services, hopelessness improved among clients but not in a comparison group. There were no significant changes in depressive symptoms or life satisfaction. Recommendations for future preventive efforts include: use of medical contacts to screen for depression and suicide; assessment of suicide risk with even small elevations in depressive symptoms; consideration of physical health status and level of hopelessness in assessing suicide risk; research on effective psychotherapies with suicidal older adults; and support of innovative community outreach and intervention programs.
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Affiliation(s)
| | - Patrick Arbore
- Center for Elderly Suicide Prevention and Grief Related Services Goldman Institute on Aging, San Francisco, California
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Tóth MD, Ádám S, Birkás E, Székely A, Stauder A, Purebl G. Gender differences in deliberate self-poisoning in Hungary: analyzing the effect of precipitating factors and their relation to depression. CRISIS 2016; 35:145-53. [PMID: 24491825 DOI: 10.1027/0227-5910/a000245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The suicide rate in Hungary is one of the highest in the European Union, with a male-female ratio of 3.55:1. Suicide rates correlate positively with suicide attempts, for which depression is the most frequent underlying disorder. AIMS The aim of this qualitative study was to examine gender differences in suicide attempts, with a focus on the effect of precipitating factors on depression. METHOD Semistructured interviews were conducted among 150 suicide attempters. Data on circumstances, reason, and method of attempt were recorded. Patients completed the Shortened Beck Depression Inventory, the Beck Hopelessness Scale, the Sense of Coherence Scale, and the Social Support Questionnaire. RESULTS Interpersonal conflict was found to be the most frequent precipitating factor. There were significant gender differences in depressive symptoms among patients with interpersonal conflicts. We found differences in depressive symptoms according to presence or absence of interpersonal conflicts among men, but not among women. Male suicide attempters who indicated interpersonal conflicts had lower levels of depression. CONCLUSION Depressive symptoms are frequent among suicide attempters. However, a subgroup of male attempters reporting interpersonal conflicts are characterized by a lower level of depression. This subgroup of attempters would probably not be detected with depression screening programs and may have an unmet need for other forms of screening and prevention.
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Affiliation(s)
- Mónika Ditta Tóth
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Szilvia Ádám
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Emma Birkás
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - András Székely
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Adrienne Stauder
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - György Purebl
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
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The Impact of Knowledge of Suicide Prevention and Work Experience among Clinical Staff on Attitudes towards Working with Suicidal Patients and Suicide Prevention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:195. [PMID: 26861362 PMCID: PMC4772215 DOI: 10.3390/ijerph13020195] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 01/27/2016] [Accepted: 01/29/2016] [Indexed: 12/19/2022]
Abstract
Suicide-preventive training has shown to influence attitudes. This study aimed at investigating what impact other factors than knowledge might have on attitudes towards work with suicidal patients and suicide prevention. In 2007, 500 health-care staff working in a psychiatric clinic in Stockholm received a questionnaire with items concerning work with suicidal patients to which 358 (71.6%) responded. A set of attitude items were tested using structural equation modelling (LISREL). Three models were found to be satisfactory valid and reliable: Job clarity, Job confidence and Attitudes towards prevention. These were then used in regression analyses as dependent variables with predictors such as experience of work with suicidal patients, perceived sufficient training,age and gender. Perceived sufficient training was consistently the most important predictor for all three attitude concepts (p < 0.01, β = 0.559 for Job clarity; p < 0.01, β = 0.53 for Job confidence; p < 0.01, β = 0.191 for Attitudes towards prevention). Age was another significant predictor for Job clarity (p < 0.05, β = 0.134), as was experience of patient suicide for Job confidence (p < 0.05, β = 0.137). It is concluded that providing suicide preventive education is likely to improve attitudes towards the prevention of suicide, clarity and confidence regarding their role in the care for suicidal patients. These improvements may contribute to the prevention of suicide in health care settings.
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Sinyor M, Tan LPL, Schaffer A, Gallagher D, Shulman K. Suicide in the oldest old: an observational study and cluster analysis. Int J Geriatr Psychiatry 2016; 31:33-40. [PMID: 25809553 DOI: 10.1002/gps.4286] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 02/20/2015] [Accepted: 02/23/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The older population are at a high risk for suicide. This study sought to learn more about the characteristics of suicide in the oldest-old and to use a cluster analysis to determine if oldest-old suicide victims assort into clinically meaningful subgroups. METHODS Data were collected from a coroner's chart review of suicide victims in Toronto from 1998 to 2011. We compared two age groups (65-79 year olds, n = 335, and 80+ year olds, n = 191) and then conducted a hierarchical agglomerative cluster analysis using Ward's method to identify distinct clusters in the 80+ group. RESULTS The younger and older age groups differed according to marital status, living circumstances and pattern of stressors. The cluster analysis identified three distinct clusters in the 80+ group. Cluster 1 was the largest (n = 124) and included people who were either married or widowed who had significantly more depression and somewhat more medical health stressors. In contrast, cluster 2 (n = 50) comprised people who were almost all single and living alone with significantly less identified depression and slightly fewer medical health stressors. All members of cluster 3 (n = 17) lived in a retirement residence or nursing home, and this group had the highest rates of depression, dementia, other mental illness and past suicide attempts. CONCLUSIONS This is the first study to use the cluster analysis technique to identify meaningful subgroups among suicide victims in the oldest-old. The results reveal different patterns of suicide in the older population that may be relevant for clinical care.
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Affiliation(s)
- Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Lynnette Pei Lin Tan
- Department of Psychological Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Damien Gallagher
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Kenneth Shulman
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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23
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Price EC, Gregg JJ, Smith MD, Fiske A. Masculine Traits and Depressive Symptoms in Older and Younger Men and Women. Am J Mens Health 2015; 12:19-29. [PMID: 26634856 DOI: 10.1177/1557988315619676] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Evidence suggests that men who strongly endorse masculine traits display an atypical presentation of depression, including more externalizing symptoms (e.g., anger or substance use), but fewer typical, internalizing symptoms (e.g., depressed mood or crying). This phenomenon has not been adequately explored in older adults or women. The current study used the externalizing subscale of the Masculine Depression Scale in older and younger men and women to detect atypical symptoms. It was predicted that individuals who more strongly endorsed masculine traits would have higher scores on the measure of externalizing symptoms relative to a measure of typical depressive symptoms Center for Epidemiologic Studies-Depression Scale. It was anticipated that results would differ by age-group but not by gender. Multigroup path analysis was used to test the hypothesis. The hypothesized path model, in which endorsement of masculine traits was associated with lower scores on the Center for Epidemiologic Studies-Depression Scale and with scores on the externalizing, but not internalizing, factor of the Masculine Depression Scale, fit the data well. Results differed significantly by age-group and gender. Masculine individuals reported lower levels of typical depressive symptoms relative to externalizing symptoms, but further research is needed within age- and gender groups. Results are consistent with the gendered responding framework and suggest that current assessment tools, which tend to focus on internalizing symptoms of depression, may not detect depression in individuals who endorse masculine traits.
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Affiliation(s)
- Elizabeth C Price
- 1 West Virginia University, Morgantown, WV, USA.,2 Michael E. Debakey VA Medical Center, Houston, TX, USA
| | - Jeffrey J Gregg
- 1 West Virginia University, Morgantown, WV, USA.,3 Durham VA Medical Center, Durham, NC, USA
| | - Merideth D Smith
- 1 West Virginia University, Morgantown, WV, USA.,4 PSIMED Corrections, LLC, Charleston, WV, USA
| | - Amy Fiske
- 1 West Virginia University, Morgantown, WV, USA
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Castelpietra G, Gobbato M, Valent F, Bovenzi M, Barbone F, Clagnan E, Pascolo-Fabrici E, Balestrieri M, Isacsson G. Somatic disorders and antidepressant use in suicides: A population-based study from the Friuli Venezia Giulia region, Italy, 2003-2013. J Psychosom Res 2015; 79:372-7. [PMID: 26526311 DOI: 10.1016/j.jpsychores.2015.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/20/2015] [Accepted: 09/21/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Many somatic disorders are complicated by depression and increase the risk of suicide. Little is known about whether antidepressants might reduce the suicidal risk in patients with somatic disorders. METHODS Data on diagnoses and antidepressant prescriptions were derived from the Social and Health Information System of the Friuli Venezia Giulia Region. Cases were all suicides that occurred in the region during the years 2003-2013 and were sex- and age-matched to controls from the general population. Conditional logistic regression analysis was used to assess the association between suicide and somatic disorders. RESULTS The suicide rate in Friuli Venezia Giulia decreased from 11.3 to 10.7 per 100,000 inhabitants during the years 2003-2013, however patients with somatic disorder had a three times increased risk of suicide. Elderly somatic patients' suicide risk was twice as high as younger patients. The risk increased from 2.6 to 9.8 times as the number of comorbid disorders increased from 1 to 4 and over. Although no significant risk of suicide in patients with somatic disorders was found when patients were adherent to antidepressants, only 11.5% of the suicides was adherent in the year prior to death. CONCLUSIONS Medical illnesses and underlying depressive symptoms may have a synergy effect on the risk of suicide, particularly in older patients and in patients with multiple morbidities. Since medically ill subjects adherent to antidepressants did not show a significant risk of suicide, early identification and adequate treatment of depression in somatic patients should be considered in order to prevent suicide.
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Affiliation(s)
- Giulio Castelpietra
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden; Central Health Directorate/Classification Area, Friuli Venezia Giulia Region, Italian Collaborating Centre for the WHO Family of International Classifications, Udine, Italy.
| | - Michele Gobbato
- Epidemiological Service, Regional Health Directorate, Friuli Venezia Giulia Region, Udine, Italy.
| | - Francesca Valent
- Epidemiological Service, Regional Health Directorate, Friuli Venezia Giulia Region, Udine, Italy.
| | - Massimo Bovenzi
- Department of Medical Sciences, University of Trieste, Trieste, Italy.
| | - Fabio Barbone
- Department of Medical Sciences, University of Trieste, Trieste, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy.
| | - Elena Clagnan
- Epidemiological Service, Regional Health Directorate, Friuli Venezia Giulia Region, Udine, Italy.
| | | | - Matteo Balestrieri
- Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy.
| | - Göran Isacsson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
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Arensman E, Koburger N, Larkin C, Karwig G, Coffey C, Maxwell M, Harris F, Rummel-Kluge C, van Audenhove C, Sisask M, Alexandrova-Karamanova A, Perez V, Purebl G, Cebria A, Palao D, Costa S, Mark L, Tóth MD, Gecheva M, Ibelshäuser A, Gusmão R, Hegerl U. Depression Awareness and Self-Management Through the Internet: Protocol for an Internationally Standardized Approach. JMIR Res Protoc 2015; 4:e99. [PMID: 26251104 PMCID: PMC4705028 DOI: 10.2196/resprot.4358] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/28/2015] [Accepted: 04/28/2015] [Indexed: 11/13/2022] Open
Abstract
Background Depression incurs significant morbidity and confers increased risk of suicide. Many individuals experiencing depression remain untreated due to systemic and personal barriers to care. Guided Internet-based psychotherapeutic programs represent a promising means of overcoming such barriers and increasing the capacity for self-management of depression. However, existing programs tend to be available only in English and can be expensive to access. Furthermore, despite evidence of the effectiveness of a number of Internet-based programs, there is limited evidence regarding both the acceptability of such programs and feasibility of their use, for users and health care professionals. Objective This paper will present the protocol for the development, implementation, and evaluation of the iFightDepression tool, an Internet-based self-management tool. This is a cost-free, multilingual, guided, self-management program for mild to moderate depression cases. Methods The Preventing Depression and Improving Awareness through Networking in the European Union consortium undertook a comprehensive systematic review of the available evidence regarding computerized cognitive behavior therapy in addition to a consensus process involving mental health experts and service users to inform the development of the iFightDepression tool. The tool was implemented and evaluated for acceptability and feasibility of its use in a pilot phase in 5 European regions, with recruitment of users occurring through general practitioners and health care professionals who participated in a standardized training program. Results Targeting mild to moderate depression, the iFightDepression tool is based on cognitive behavioral therapy and addresses behavioral activation (monitoring and planning daily activities), cognitive restructuring (identifying and challenging unhelpful thoughts), sleep regulation, mood monitoring, and healthy lifestyle habits. There is also a tailored version of the tool for young people, incorporating less formal language and additional age-appropriate modules on relationships and social anxiety. The tool is accompanied by a 3-hour training intervention for health care professionals. Conclusions It is intended that the iFightDepression tool and associated training for health care professionals will represent a valuable resource for the management of depression that will complement existing resources for health care professionals. It is also intended that the iFightDepression tool and training will represent an additional resource within a multifaceted approach to improving the care of depression and preventing suicidal behavior in Europe.
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Affiliation(s)
- Ella Arensman
- National Suicide Research Foundation, Cork, Ireland.
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Jensen KB, Morthorst BR, Vendsborg PB, Hjorthøj CR, Nordentoft M. The effect of the mental health first-aid training course offered employees in Denmark: study protocol for a randomized waitlist-controlled superiority trial mixed with a qualitative study. BMC Psychiatry 2015; 15:80. [PMID: 25884517 PMCID: PMC4411756 DOI: 10.1186/s12888-015-0466-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 03/30/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Studies show a high and growing prevalence of mental disorders in the population worldwide. 25% of the general population in Europe will during their lifetime experience symptoms related to a mental disorder. The Mental Health First Aid concept (MHFA) was founded in 2000 in Australia by Kitchener and Jorm, in order to provide the population with mental health first aid skills. The aim of the concept is, through an educational intervention (course), to increase confidence in how to help people suffering from mental health problems. Further, secondary aims are to increase the mental health literacy of the public by increasing knowledge, reduce stigma and initiate more supportive actions leading towards professional care. An investigation of the effect of MHFA offered a Danish population is needed. METHODS The design is a randomized waitlist-controlled superiority trial, in which 500 participants will be allocated to either the intervention group or the control group. The control group will attend the course six months later, hence waiting list design. From fall 2013 to spring 2014 participants will be educated to be "mental health first-aiders" following a manualized, two days MHFA course. All the participants will answer a questionnaire at base-line and at 6 months follow-up. The questionnaire is a back-translation of the questionnaire used in Australian trials. The trial will be complemented by a qualitative study, in which focus groups will be carried out. DISCUSSION Outcomes measured are sensitive to interpretation, hence a challenge to uniform. This trial will add to the use of a mixed-methods design and exemplify how it can strengthen the analysis and take up the challenge of a sensitive outcome. TRIAL REGISTRATION https://clinicaltrials.gov identifier NCT02334020.
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Affiliation(s)
- Kamilla B Jensen
- Copenhagen University Hospital, Research Unit, Mental Health Centre, Copenhagen, Kildegårdsvej 28, entrance 15, 4th floor, DK, 2900, Copenhagen, Denmark.
| | - Britt R Morthorst
- Copenhagen University Hospital, Research Unit, Mental Health Centre, Copenhagen, Kildegårdsvej 28, entrance 15, 4th floor, DK, 2900, Copenhagen, Denmark.
| | - Per B Vendsborg
- Danish Mental Health Foundation, Hejrevej 43, DK, 2400, Copenhagen, Denmark.
| | - Carsten R Hjorthøj
- Copenhagen University Hospital, Research Unit, Mental Health Centre, Copenhagen, Kildegårdsvej 28, entrance 15, 4th floor, DK, 2900, Copenhagen, Denmark.
| | - Merete Nordentoft
- Copenhagen University Hospital, Research Unit, Mental Health Centre, Copenhagen, Kildegårdsvej 28, entrance 15, 4th floor, DK, 2900, Copenhagen, Denmark.
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27
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Hamilton E, Klimes-Dougan B. Gender differences in suicide prevention responses: implications for adolescents based on an illustrative review of the literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:2359-72. [PMID: 25711358 PMCID: PMC4377906 DOI: 10.3390/ijerph120302359] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 02/11/2015] [Indexed: 01/09/2023]
Abstract
Background: There are well-documented gender differences in adolescent suicidal behavior; death by suicide is more common in males, while nonfatal suicide attempts are more common among females. Over the past three decades, researchers have documented the effectiveness of a myriad of suicide prevention initiatives. However, there has been insufficient attention to which types of suicide prevention interventions are effective in changing attitudes and behaviors for young males and females. In this review of the literature, we consider common examples of primarily universal suicide prevention programs from three implementation settings: school-based, community-based, and healthcare-based. Our purpose is to delineate how the potential gender bias in such strategies may translate into youth suicide prevention efforts. Methods: Research in which gender was found to moderate program success was retrieved through online databases. Results: The results that feature programming effects for both males and females are provocative, suggesting that when gender differences are evident, in almost all cases, females seem to be more likely than males to benefit from existing prevention programming. Conclusions: We conclude by considering recommendations that may benefit males more directly. Implications for adolescent suicide prevention in particular are discussed. Personalization of suicide intervention is presented as a promising solution to reduce suicide rates.
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Affiliation(s)
- Emma Hamilton
- Educational Psychology Department, University of Texas at Austin, 1 University Station Austin, TX 78712, USA.
| | - Bonnie Klimes-Dougan
- Department of Psychology, University of Minnesota, 75 East River Road Minneapolis, MN 55455, USA.
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Malakouti SK, Nojomi M, Poshtmashadi M, Hakim Shooshtari M, Mansouri Moghadam F, Rahimi-Movaghar A, Afghah S, Bolhari J, Bazargan-Hejazi S. Integrating a suicide prevention program into the primary health care network: a field trial study in Iran. BIOMED RESEARCH INTERNATIONAL 2015; 2015:193729. [PMID: 25648221 PMCID: PMC4306260 DOI: 10.1155/2015/193729] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 12/10/2014] [Accepted: 12/15/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe and evaluate the feasibility of integrating a suicide prevention program with Primary Health Care services and evaluate if such system can improve screening and identification of depressive disorder, reduce number of suicide attempters, and lower rate of suicide completion. METHODOLOGY This was a quasi-experimental trial in which one community was exposed to the intervention versus the control community with no such exposure. The study sites were two counties in Western Iran. The intervention protocol called for primary care and suicide prevention collaboration at different levels of care. The outcome variables were the number of suicides committed, the number of documented suicide attempts, and the number of identified depressed cases. RESULTS We identified a higher prevalence of depressive disorders in the intervention site versus the control site (χ (2) = 14.8, P < 0.001). We also found a reduction in the rate of suicide completion in the intervention region compared to the control, but a higher prevalence of suicide attempts in both the intervention and the control sites. CONCLUSION Integrating a suicide prevention program with the Primary Health Care network enhanced depression and suicide surveillance capacity and subsequently reduced the number of suicides, especially in rural areas.
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Affiliation(s)
- Seyed Kazem Malakouti
- Mental Health Research Center, Tehran Institute of Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Marzieh Nojomi
- Department of Community Medicine, School of Medicine, Iran University of Medical Sciences, P.O. Box 14155-5988, Iran
| | - Marjan Poshtmashadi
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mitra Hakim Shooshtari
- Mental Health Research Center, Tehran Institute of Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | | | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies (INCAS), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Susan Afghah
- Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Jafar Bolhari
- Mental Health Research Center, Tehran Institute of Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Shahrzad Bazargan-Hejazi
- Department of Psychiatry, Charles R. Drew University of Medicine and Science, 1731 East 120th Street, Los Angeles, CA 90059, USA
- David Geffen School of Medicine at UCLA, CA, USA
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Sit D, Luther J, Buysse D, Dills JL, Eng H, Okun M, Wisniewski S, Wisner KL. Suicidal ideation in depressed postpartum women: Associations with childhood trauma, sleep disturbance and anxiety. J Psychiatr Res 2015; 66-67:95-104. [PMID: 26001587 PMCID: PMC4458196 DOI: 10.1016/j.jpsychires.2015.04.021] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 03/31/2015] [Accepted: 04/24/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Suicide is one of the leading causes of death in postpartum women. Identifying modifiable factors related to suicide risk in mothers after delivery is a public health priority. Our study aim was to examine associations between suicidal ideation (SI) and plausible risk factors (experience of abuse in childhood or as an adult, sleep disturbance, and anxiety symptoms) in depressed postpartum women. METHODS This secondary analysis included 628 depressed mothers at 4-6 weeks postpartum. Diagnosis was confirmed with the Structured Clinical Interview for DSM-IV. We examined SI from responses to the Edinburgh Postnatal Depression Scale-EPDS item 10; depression levels on the Structured Interview Guide for the Hamilton Depression Rating Scale, Atypical Depression Symptoms (SIGH-ADS); plus sleep disturbance and anxiety levels with subscales from the EPDS and SIGH-ADS items on sleep and anxiety symptoms. RESULTS Of the depressed mothers, 496 (79%) 'never' had thoughts of self-harm; 98 (15.6%) 'hardly ever'; and 34 (5.4%) 'sometimes' or 'quite often'. Logistic regression models indicated that having frequent thoughts of self-harm was related to childhood physical abuse (odds ratio-OR = 1.68, 95% CI = 1.00, 2.81); in mothers without childhood physical abuse, having frequent self-harm thoughts was related to sleep disturbance (OR = 1.15, 95% CI = 1.02, 1.29) and anxiety symptoms (OR = 1.11, 95% CI = 1.01, 1.23). DISCUSSION Because women with postpartum depression can present with frequent thoughts of self-harm and a high level of clinical complexity, conducting a detailed safety assessment, that includes evaluation of childhood abuse history and current symptoms of sleep disturbance and anxiety, is a key component in the management of depressed mothers.
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Affiliation(s)
- Dorothy Sit
- School of Medicine, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
| | - James Luther
- Graduate School of Public Health, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA
| | - Daniel Buysse
- School of Medicine, Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John L. Dills
- Graduate School of Public Health, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA
| | - Heather Eng
- Graduate School of Public Health, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA
| | | | - Stephen Wisniewski
- Graduate School of Public Health, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA
| | - Katherine L Wisner
- Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois
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Kavalidou K, McPhedran S, De Leo D. Farmers’ contact with health care services prior to suicide: evidence for the role of general practitioners as an intervention point. Aust J Prim Health 2015; 21:102-5. [DOI: 10.1071/py13077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 07/09/2013] [Indexed: 11/23/2022]
Abstract
Suicide in Australian rural communities has received significant attention from researchers, health practitioners and policymakers. Farmers and agricultural workers have been a focus of particular interest, especially in relation to levels of help seeking for mental health concerns. A less explored area, however, is the level of contact that Australian farming and agriculture workers who die by suicide have had with health providers for physical, rather than mental, health conditions. It is often assumed that farmers and agricultural workers have lower levels of contact with health care services than other rural residents, although this assumption has not been well tested. Using data from the Queensland Suicide Register, this paper describes levels of contact with health care providers in the 3 months before death by suicide among men in farming and agriculture occupations and other occupations in rural Queensland. No significant differences were found in farming and agricultural workers’ levels of contact with a general practitioner when compared with other rural men in Queensland. The current findings lend weight to the view that rural general practitioners represent an important intervention point for farming and agriculture workers at risk of suicide (whether or not those individuals exhibit accompanying psychiatric illness).
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Ghoncheh R, Koot HM, Kerkhof AJFM. Suicide Prevention E-Learning Modules Designed for Gatekeepers. CRISIS 2014; 35:176-85. [DOI: 10.1027/0227-5910/a000249] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: E-learning modules can be a useful method for educating gatekeepers in suicide prevention and awareness. Aims: To review and provide an overview of e-learning modules on suicide prevention designed for gatekeepers and assess their effectiveness. Method: Two strategies were used. First, articles were systematically searched in databases of PubMed, Web of Science, and PsycINFO. Second, Google search was used to find e-learning modules on the Web. Results: The literature search resulted in 448 papers, of which none met the inclusion criteria of this study. The Google search resulted in 130 hits, of which 23 met the inclusion criteria of this review. Organizations that owned the modules were contacted, of which 13 responded and nine were included in this study. The effectiveness of two e-learning modules is currently being tested in a randomized controlled trial (RCT), one organization is planning to test the effectiveness of their module, and one organization has compared their face-to-face training with their online training. Furthermore, the included modules have different characteristics. Conclusion: There is a need for RCTs to study the effectiveness of online modules in this area and to understand which characteristics are essential to create effective e-learning modules to educate gatekeepers in suicide prevention.
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Affiliation(s)
- Rezvan Ghoncheh
- Department of Developmental Psychology and the EMGO+ institute for Health and Care Research, VU University Amsterdam, The Netherlands
- Department of Clinical Psychology and the EMGO+ institute for Health and Care Research, VU University Amsterdam, The Netherlands
| | - Hans M. Koot
- Department of Developmental Psychology and the EMGO+ institute for Health and Care Research, VU University Amsterdam, The Netherlands
| | - Ad J. F. M. Kerkhof
- Department of Clinical Psychology and the EMGO+ institute for Health and Care Research, VU University Amsterdam, The Netherlands
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Richter K, Polazarevska M, Niklewski G. Building a public health network for prevention of suicides in Macedonia in accordance to the German model - “Nuernberg Alliance Against Depression”: “Macedonian Alliance Against Depression”- MAAD. EPMA J 2014. [PMCID: PMC4125809 DOI: 10.1186/1878-5085-5-s1-a93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Kneginja Richter
- Clinic for Psychiatry and Psychotherapy, Nuremberg, Germany,Georg Simon Ohm Technical University for applied sciences, Nuremberg, Germany,Medical Faculty, University Goce Delcev, Stip, Macedonia, FYROM
| | - Mirjana Polazarevska
- Clinic for Psychiatry, Medical Faculty, University Cyril and Methodus, Skopje, Macedonia, FYROM
| | - Günter Niklewski
- Clinic for Psychiatry and Psychotherapy, Nuremberg, Germany,Medical Faculty, University Goce Delcev, Stip, Macedonia, FYROM
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Székely A, Konkolÿ Thege B, Mergl R, Birkás E, Rózsa S, Purebl G, Hegerl U. How to decrease suicide rates in both genders? An effectiveness study of a community-based intervention (EAAD). PLoS One 2013; 8:e75081. [PMID: 24086443 PMCID: PMC3781024 DOI: 10.1371/journal.pone.0075081] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 08/09/2013] [Indexed: 11/18/2022] Open
Abstract
Background The suicide rate in Hungary is high in international comparison. The two-year community-based four-level intervention programme of the European Alliance Against Depression (EAAD) is designed to improve the care of depression and to prevent suicidal behaviour. Our aim was to evaluate the effectiveness of a regional community-based four-level suicide prevention programme on suicide rates. Method The EAAD programme was implemented in Szolnok (population 76,311), a town in a region of Hungary with an exceptionally high suicide rate. Effectiveness was assessed by comparing changes in suicide rates in the intervention region after the intervention started with changes in national suicide rates and those in a control region (Szeged) in the corresponding period. Results For the duration of the programme and the follow-up year, suicide rates in Szolnok were significantly lower than the average of the previous three years (p = .0076). The suicide rate thus went down from 30.1 per 100,000 in 2004 to 13.2 in 2005 (−56.1 %), 14.6 in 2006 (−51.4 %) and 12.0 in 2007 (−60.1 %). This decrease of annual suicide rates in Szolnok after the onset of the intervention was significantly stronger than that observed in the whole country (p = .017) and in the control region (p = .0015). Men had the same decrease in suicide rates as women. As secondary outcome, an increase of emergency calls to the hotline service (200%) and outpatient visits at the local psychiatry clinic (76%) was found. Conclusions These results seem to provide further support for the effectiveness of the EAAD concept. Whilst the majority of suicide prevention programs mainly affect female suicidal behaviour, this programme seems to be beneficial for both sexes. The sustainability and the role of the mediating factors (social service and health care utilization, community attitudes about suicide) should be key points in future research.
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Affiliation(s)
- András Székely
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
- * E-mail:
| | - Barna Konkolÿ Thege
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Roland Mergl
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig AoR, Leipzig, Germany
| | - Emma Birkás
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Sándor Rózsa
- Department of Personality and Health Psychology, Eötvös Loránd University, Budapest, Hungary
| | - György Purebl
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Ulrich Hegerl
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig AoR, Leipzig, Germany
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Richard-Devantoy S, Jollant F. [Suicide in the elderly: age-related specificities?]. SANTE MENTALE AU QUEBEC 2013; 37:151-73. [PMID: 23666286 DOI: 10.7202/1014949ar] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Suicide in the elderly raises the question of our relationship with aging and death. Suicide rate is relatively high in this group and is significantly related to depression widely under-diagnosed in the elderly. Suicidal behaviour in the elderly has clinical specificities including high intentionality and lethality, usually little personal history of suicidal behaviour and low levels of impulsivity-aggression. Suicidal vulnerability could rely on etiopathogenic mechanisms both common and different according to age; for example, a preponderance of early developmental factors and impulsivity-aggression in adolescents and young adults vs. pathological aging in older adults, but partly similar neurocognitive deficits leading individuals not to respond adequately to their environment (itself different with age). Direct comparisons between elderly and younger subjects would be required. The article concludes with a summary of the principles of recognition and management of suicide risk.
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Affiliation(s)
- Stéphane Richard-Devantoy
- McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal (Québec), Canada.
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Gusmão R, Quintão S, McDaid D, Arensman E, Van Audenhove C, Coffey C, Värnik A, Värnik P, Coyne J, Hegerl U. Antidepressant Utilization and Suicide in Europe: An Ecological Multi-National Study. PLoS One 2013; 8:e66455. [PMID: 23840475 PMCID: PMC3686718 DOI: 10.1371/journal.pone.0066455] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 04/29/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Research concerning the association between use of antidepressants and incidence of suicide has yielded inconsistent results and is the subject of considerable controversy. The first aim is to describe trends in the use of antidepressants and rates of suicide in Europe, adjusted for gross domestic product, alcohol consumption, unemployment, and divorce. The second aim is to explore if any observed reduction in the rate of suicide in different European countries preceded the trend for increased use of antidepressants. METHODS Data were obtained for 29 European countries between 1980 and 2009. Pearson correlations were used to explore the direction and magnitude of associations. Generalized linear mixed models and Poisson regression distribution were used to clarify the effects of antidepressants on suicide rates, while an autoregressive adjusted model was used to test the interaction between antidepressant utilization and suicide over two time periods: 1980-1994 and 1995-2009. FINDINGS An inverse correlation was observed in all countries between recorded Standardised Death Rate (SDR) for suicide and antidepressant Defined Daily Dosage (DDD), with the exception of Portugal. Variability was marked in the association between suicide and alcohol, unemployment and divorce, with countries depicting either a positive or a negative correlation with the SDR for suicide. Every unit increase in DDD of an antidepressant per 1000 people per day, adjusted for these confounding factors, reduces the SDR by 0.088. The correlation between DDD and suicide related SDR was negative in both time periods considered, albeit more pronounced between 1980 and 1994. CONCLUSIONS Suicide rates have tended to decrease more in European countries where there has been a greater increase in the use of antidepressants. These findings underline the importance of the appropriate use of antidepressants as part of routine care for people diagnosed with depression, therefore reducing the risk of suicide.
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Affiliation(s)
- Ricardo Gusmão
- CEDOC, Departamento de Saúde Mental, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal ; Departamento de Psiquiatria e Saúde Mental, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
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Miret M, Ayuso-Mateos JL, Sanchez-Moreno J, Vieta E. Depressive disorders and suicide: Epidemiology, risk factors, and burden. Neurosci Biobehav Rev 2013; 37:2372-4. [PMID: 23313644 DOI: 10.1016/j.neubiorev.2013.01.008] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 01/03/2013] [Accepted: 01/04/2013] [Indexed: 10/27/2022]
Abstract
The social and economic impact of mood disorders and suicide is extremely high and may be even higher in coming years, and yet, research in mental health is largely underfunded. This report summarizes the most recent data concerning the epidemiology and burden of depression and suicide, and underlines the most recent initiatives to identify the barriers to effective treatment and prevention of mood disorders. Global cooperation and networks of research networks are proposed. Progress in the understanding of the pathophysiology and subtypes of depression, technological advances, emphasis on early prediction of response and prevention, and a paradigm shift in drug development are crucial to overcome the current challenges posed by increasing rates of depression and suicide.
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Affiliation(s)
- Marta Miret
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Universidad Autónoma de Madrid, Spain
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Almeida OP, Draper B, Snowdon J, Lautenschlager NT, Pirkis J, Byrne G, Sim M, Stocks N, Flicker L, Pfaff JJ. Factors associated with suicidal thoughts in a large community study of older adults. Br J Psychiatry 2012. [PMID: 23209090 DOI: 10.1192/bjp.bp.112.110130] [Citation(s) in RCA: 127] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Thoughts about death and self-harm in old age have been commonly associated with the presence of depression, but other risk factors may also be important. AIMS To determine the independent association between suicidal ideation in later life and demographic, lifestyle, socioeconomic, psychiatric and medical factors. METHOD A cross-sectional study was conducted of a community-derived sample of 21 290 adults aged 60-101 years enrolled from Australian primary care practices. We considered that participants endorsing any of the four items of the Depressive Symptom Inventory -Suicidality Subscale were experiencing suicidal thoughts. We used standard procedures to collect demographic, lifestyle, psychosocial and clinical data. Anxiety and depressive symptoms were assessed with the Hospital Anxiety and Depression Scale. RESULTS The 2-week prevalence of suicidal ideation was 4.8%. Male gender, higher education, current smoking, living alone, poor social support, no religious practice, financial strain, childhood physical abuse, history of suicide in the family, past depression, current anxiety, depression or comorbid anxiety and depression, past suicide attempt, pain, poor self-perceived health and current use of antidepressants were independently associated with suicidal ideation. Poor social support was associated with a population attributable fraction of 38.0%, followed by history of depression (23.6%), concurrent anxiety and depression (19.7%), prevalent anxiety (15.1%), pain (13.7%) and no religious practice (11.4%). CONCLUSIONS Prevalent and past mood disorders seem to be valid targets for indicated interventions designed to reduce suicidal thoughts and behaviour. However, our data indicate that social disconnectedness and stress account for a larger proportion of cases than mood disorders. Should these associations prove to be causal, then interventions that succeeded in addressing these issues would contribute the most to reducing suicidal ideation and, possibly, suicidal behaviour in later life.
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Affiliation(s)
- Osvaldo P Almeida
- Western Australia Centre for Health and Ageing (M573), University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia.
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Embriaco N, Hraiech S, Azoulay E, Baumstarck-Barrau K, Forel JM, Kentish-Barnes N, Pochard F, Loundou A, Roch A, Papazian L. Symptoms of depression in ICU physicians. Ann Intensive Care 2012; 2:34. [PMID: 22839744 PMCID: PMC3543176 DOI: 10.1186/2110-5820-2-34] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 06/26/2012] [Indexed: 11/10/2022] Open
Abstract
Background Work and family are the two domains from which most adults develop satisfaction in life. They also are responsible for stressful experiences. There is a perception in the community that work is increasingly the source of much of our stress and distress. Depressive symptoms may be related to repeated stressful experiences. Intensive care unit (ICU) physicians are exposed to major stressors. However, the existence of depressive symptoms in these doctors has been poorly studied. This study was designed to evaluate the prevalence and associated risk factors of depressive symptoms in junior and senior ICU physicians. Method A one-day national survey was conducted in adult intensive care units (ICU) in French public hospitals. Symptoms of depression were assessed using the Centers of Epidemiologic Studies Depression Scale (CES-D). Results A total of 189 ICUs participated, and 901 surveys were returned (75.8% response rate). Symptoms of depression were found in 23.8% of the respondents using the CES-D scale. Fifty-eight percent of these intensivists presenting symptoms of depression wished to leave their job compared with only 33% of those who did not exhibit signs of depression as assessed by the CES-D scale (p < 0.0001). Multiple logistic regression showed that organizational factors were associated with the presence of depressive symptoms. Workload (long interval since the last nonworking weekend, absence of relief of service until the next working day after a night shift) and impaired relationships with other intensivists were independently associated with the presence of depressive symptoms. A high level of burnout also was related to the presence of depressive symptoms. In contrast, no demographic factors regarding ICU physicians and no factor related to the severity of illness of patients were retained by the model. The quality of relationships with other physicians (from other departments) was associated with the absence of depressive symptoms (protective effect). Conclusions Approximately one of four intensivists presented symptoms of depression. The next step could be to test whether organization modification is associated with less depressive symptoms and less desire to leave the job.
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Affiliation(s)
- Nathalie Embriaco
- Aix-Marseille University, URMITE CNRS-UMR 7278, 13005 Marseille, France; APHM, Hôpital Nord, Réanimation des détresses respiratoires et des infections sévères, 13015, Marseille, France.
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Jensen HV, Munk KP, Madsen SA. Gendering late-life depression? The coping process in a group of elderly men. NORDIC PSYCHOLOGY 2012. [DOI: 10.1027/1901-2276/a000011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Blow FC, Bohnert ASB, Ilgen MA, Ignacio R, McCarthy JF, Valenstein MM, Knox KL. Suicide mortality among patients treated by the Veterans Health Administration from 2000 to 2007. Am J Public Health 2012; 102 Suppl 1:S98-104. [PMID: 22390612 DOI: 10.2105/ajph.2011.300441] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to examine rates of suicide among individuals receiving health care services in Veterans Health Administration (VHA) facilities over an 8-year period. METHODS We included annual cohorts of all individuals who received VHA health care services from fiscal year (FY) 2000 through FY 2007 (October 1, 1999-September 30, 2007; N = 8,855,655). Vital status and cause of death were obtained from the National Death Index. RESULTS Suicide was more common among VHA patients than members of the general US population. The overall rates of suicide among VHA patients decreased slightly but significantly from 2000 to 2007 (P < .001). Male veterans between the ages of 30 and 64 years were at the highest risk of suicide. CONCLUSIONS VHA health care system patients are at elevated risk for suicide and are appropriate for suicide reduction services, although the rate of suicide has decreased in recent years for this group. Comprehensive approaches to suicide prevention in the VHA focus not only on recent returnees from Iraq and Afghanistan but also on middle-aged and older Veterans.
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Affiliation(s)
- Frederic C Blow
- Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC) and Health Services Research and Development Center of Excellence, Ann Arbor, MI, USA.
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Wexler L, Silveira ML, Bertone-Johnson E. Factors associated with Alaska Native fatal and nonfatal suicidal behaviors 2001-2009: trends and implications for prevention. Arch Suicide Res 2012; 16:273-86. [PMID: 23137218 DOI: 10.1080/13811118.2013.722051] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Suicide rates among American Indian and Alaska Native (AI/AN) young people are significantly higher than other ethnic groups in the United States. Not only are there great differences when comparing AI/AN rates and those of other Americans, some tribal groups have very low rates of suicide while other Native communities have much higher rates. Despite this obvious variability, there is little research to help understand the factors associated with these differences. The current study considers the correlates of suicidal behavior in one rural Alaska Native region that suffers disproportionately from suicide. The analysis describes suicide behavior between the years 2001-2009, and considers the characteristics associated with both suicide deaths and nonfatal suicidal behavior. In multivariate analyses we identified gender, method of suicide and history of previous attempt as significant predictors of fatal suicide behavior, similar to results obtained from analyses on the same community's data from the previous decade. This descriptive study can offer some insights to shape prevention efforts in this and other rural, tribal communities.
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Affiliation(s)
- Lisa Wexler
- Community Health Education, Department of Public Health, School of Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts 01003, USA.
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Tsai WP, Lin LY, Chang HC, Yu LS, Chou MC. The effects of the Gatekeeper Suicide-Awareness Program for nursing personnel. Perspect Psychiatr Care 2011; 47:117-25. [PMID: 21707626 DOI: 10.1111/j.1744-6163.2010.00278.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study evaluates whether a short training program can improve nurses' abilities to recognize and effectively respond to patients exhibiting suicidal behavior. DESIGN AND METHODS The study is a randomized controlled trial. Ninety-eight nurses in the experimental group attended the regular monthly continuing education class and a 90-min Gatekeeper Suicide-Awareness Program. Ninety-seven nurses in the control group only attended the regular monthly continuing education class. Before and after the different educational interventions, all the nurses were asked to complete a questionnaire to link demographic data and to access their awareness of suicide warning signs and their responses if encountering a potentially suicidal individual. FINDINGS Nurses who participated in the Gatekeeper Suicide-Awareness Program were much more aware of suicide warning signs and more willing to refer patients for professional counseling. PRACTICE IMPLICATIONS We suggest that nursing personnel's continuing education include a training program for suicide prevention.
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Abstract
Suicide is an important public health problem in the demographic group that forms the bulk of military populations, namely young and middle-aged men. Suicide in the military also has special significance: certain aspects of military service can lead to serious mental disorders that increase the risk of suicidal behaviour. Moreover, military organizations have control over a broad range of factors (notably the direct delivery of mental health care) that could mitigate suicide risk. This article will review the literature on suicide risk in military organizations to answer the important question: Are military personnel at increased risk for suicide? Next, Mann et al.'s (2005) model for specific suicide preventive interventions in civilian settings will be reviewed and then expanded, with an emphasis on identifying special opportunities for suicide prevention in military organizations, including: 1) organizational interventions to mitigate work stress; 2) selection, resilience training, and risk factor reduction; 3) interventions to overcome barriers to care; and 4) systematic quality improvement efforts in mental health care. Finally, the evidence behind comprehensive suicide prevention programmes will be reviewed, with a special focus on the US Air Force's benchmark programme.
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Affiliation(s)
- Mark A Zamorski
- Directorate of Mental Health, Canadian Forces Health Services Group Headquarters, 1745 Alta Vista Drive, Ottawa, Ontario, Canada.
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Pompili M, Innamorati M, Serafini G, Forte A, Cittadini A, Mancinelli I, Calabró G, Dominici G, Lester D, Akiskal HS, Rihmer Z, Iacorossi G, Girardi N, Talamo A, Tatarelli R. Suicide attempters in the emergency department before hospitalization in a psychiatric ward. Perspect Psychiatr Care 2011; 47:23-34. [PMID: 21418070 DOI: 10.1111/j.1744-6163.2010.00263.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The study aims to compare the current suicidal risk of mood disorder patients who had just attempted suicide, as compared with those who had not attempted suicide, admitted to an emergency department (ED), and then hospitalized in a psychiatric unit. METHOD One hundred sixty-one mood disorder patients admitted to the ED were studied. A total of 22.4% of the participants were admitted for a suicide attempt. Patients were assessed for psychopathology and diagnosis. FINDINGS Suicide attempters were nearly 12 times more likely to report ongoing suicidal ideation during the psychiatric evaluation in the ED than nonattempters. Men and women did not differ for current and previous suicide attempts or for ongoing suicidal ideation. PRACTICAL IMPLICATIONS It is important to conduct a suicide risk assessment when individuals are admitted to an ED.
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Affiliation(s)
- Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Functions, Suicide Prevention Center Sant'Andrea Hospital, Sapienza University of Rome, Italy.
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Saini P, Windfuhr K, Pearson A, Da Cruz D, Miles C, Cordingley L, While D, Swinson N, Williams A, Shaw J, Appleby L, Kapur N. Suicide prevention in primary care: General practitioners' views on service availability. BMC Res Notes 2010; 3:246. [PMID: 20920302 PMCID: PMC2958884 DOI: 10.1186/1756-0500-3-246] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 10/01/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary care may be a key setting for suicide prevention. However, comparatively little is known about the services available in primary care for suicide prevention. The aims of the current study were to describe services available in general practices for the management of suicidal patients and to examine GPs views on these services. We carried out a questionnaire and interview study in the North West of England. We collected data on GPs views of suicide prevention generally as well as local mental health service provision. FINDINGS During the study period (2003-2005) we used the National Confidential Inquiry Suicide database to identify 286 general practitioners (GPs) who had registered patients who had died by suicide. Data were collected from GPs and practice managers in 167 practices. Responses suggested that there was greater availability of services and training for general mental health issues than for suicide prevention specifically. The three key themes which emerged from GP interviews were: barriers accessing primary or secondary mental health services; obstacles faced when referring a patient to mental health services; managing change within mental health care services CONCLUSIONS Health professionals have an important role to play in preventing suicide. However, GPs expressed concerns about the quality of primary care mental health service provision and difficulties with access to secondary mental health services. Addressing these issues could facilitate future suicide prevention in primary care.
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Affiliation(s)
- Pooja Saini
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Jean McFarlane Building, University of Manchester, M13 9PL, UK
| | - Kirsten Windfuhr
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Jean McFarlane Building, University of Manchester, M13 9PL, UK
| | - Anna Pearson
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Jean McFarlane Building, University of Manchester, M13 9PL, UK
| | - Damian Da Cruz
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Jean McFarlane Building, University of Manchester, M13 9PL, UK
| | - Caroline Miles
- Centre for Criminology, University of Oxford, Manor Road Building, Manor Road, Oxford, OX1 3UQ, UK
| | - Lis Cordingley
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Jean McFarlane Building, University of Manchester, M13 9PL, UK
| | - David While
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Jean McFarlane Building, University of Manchester, M13 9PL, UK
| | - Nicola Swinson
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Jean McFarlane Building, University of Manchester, M13 9PL, UK
| | - Alyson Williams
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Jean McFarlane Building, University of Manchester, M13 9PL, UK
| | - Jenny Shaw
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Jean McFarlane Building, University of Manchester, M13 9PL, UK
| | - Louis Appleby
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Jean McFarlane Building, University of Manchester, M13 9PL, UK
| | - Navneet Kapur
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Jean McFarlane Building, University of Manchester, M13 9PL, UK
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Reutfors J, Brandt L, Ekbom A, Isacsson G, Sparén P, Osby U. Suicide and hospitalization for mental disorders in Sweden: a population-based case-control study. J Psychiatr Res 2010; 44:741-7. [PMID: 20181360 DOI: 10.1016/j.jpsychires.2010.02.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Revised: 01/26/2010] [Accepted: 02/02/2010] [Indexed: 11/25/2022]
Abstract
The aim of this study was to estimate suicide risk during hospitalization and in the year following discharge for patients with mental disorders. All suicide cases in Sweden 18 years and older, between 1991 and 2003 (N=20,675; 70% male), were individually matched to 10 controls from the general Swedish population. Discharge diagnoses in the year before suicide of any mental disorder, mood disorder, schizophrenia spectrum disorder, and alcohol use disorder were identified from the Swedish Patient Register. Highest suicide risk during hospitalization and in the year following discharge was found for mood disorder [odds ratio (OR) 55 (95% CI, 47-65) for men and 86 (95% CI, 70-107) for women], with the risk peaking in the first week following discharge [OR 177 (95% CI, 78-401) for men and OR 268 (95% CI, 85-846) for women]. Compared to that for mood disorder, the suicide risk for schizophrenia spectrum disorder and alcohol use disorder was about half and more constant over time. The majority of suicide victims with a psychiatric diagnosis had been discharged from psychiatric treatment more than a month before the suicide. Over time, a constant proportion of 25% of the suicide victims had been hospitalized with a mental disorder in the year before suicide (23% of males and 31% of females), despite a significant decrease in psychiatric hospitalizations in the population. In conclusion, suicide risk was found to vary by type of mental disorder, time since discharge, and sex. This should be taken into account when planning suicide preventive efforts.
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Affiliation(s)
- Johan Reutfors
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
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Szumilas M, Kutcher S. Problematic conclusions regarding suicide prevention: A response to ten Have et al, 2009. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2010; 55:398; author reply 398-9. [PMID: 20552747 DOI: 10.1177/070674371005500613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Completed suicide is associated with marital status; being unmarried is associated with a higher suicide rate as compared with being married or living with a partner. Moreover, the region of origin may be particularly important when trying to explain major inequalities in suicide rates across a country. Data were obtained from the Italian Database on Mortality, collected by the Italian Census Bureau (ISTAT) and processed by the Italian National Institute of Health-Statistics Unit. The Italian population in the last Italian census (October 2001) was used to estimate age-standardized mortality rates from suicide by marital status (ICD-9 revision: E950-959) and "natural" causes (ICD-9 revision: 0-280; 320-799). Rate Ratios and 95% confidence intervals were calculated using married individuals as a reference. All analyses were conducted separately for men and women for 2000-2002, the most recent years with data available. Logistic regression analysis was used to compare differences by marital status for suicide versus death from natural causes. There are major inequalities in suicide rates in Italy. The North region has the highest suicide rates both for married and non-married individuals. Sardinia Island has the highest male suicide rate in Italy-23.07 per 100,000 per year-compared with the average national male suicide rate of 13.80, a difference which is significantly higher by 67% (RR: 1.67; 95%CI = 1.40-1.99). In contrast, Sardinia has one of the lowest female suicide rates among the Italian regions, close to that of the South and the Center regions. The North-East is the only region where the suicide rate among divorced men is significantly higher than that of married men. In the South, widowers have the highest suicide rate, with a rate 6-times that of married men (RR = 5.66; 95%CI = 4.46-7.18). Major inequalities in suicide rates by region may derive from different socio-cultural backgrounds, confirming the notion that suicide is a multifaceted phenomenon. The results of the present study indicate that suicide prevention must take into account the social and cultural characteristics of different communities. Moreover, these findings support the notion that marital status may play a central role in influencing suicide.
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Tsai WP, Lin LY, Chang WL, Chang HC, Chou MC. The effects of the suicide awareness program in enhancing community volunteers' awareness of suicide warning signs. Arch Psychiatr Nurs 2010; 24:63-8. [PMID: 20117690 DOI: 10.1016/j.apnu.2009.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Revised: 01/16/2009] [Accepted: 01/30/2009] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to evaluate the effects of the suicide awareness program (SAP) in enhancing community volunteers' awareness of suicide warning signs (SWSs). Seventy-six participants were recruited in this study to complete the Awareness of Suicide Warning Signs Questionnaire before and after they received a 90-minute SAP. After the educational intervention, the mean score of the participants on awareness of SWSs was elevated from 3.97 to 4.53. The percentage of SWSs perceived increased from 46.88% to 84.38%. This shows that the SAP for community volunteers is effective in promoting suicide awareness.
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Affiliation(s)
- Wen-Pei Tsai
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, R.O.C.
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50
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Dahl AA, Krüger MB, Dahl NH, Karlsson H, Von Knorring L, Stordal E. SPIFA-A presentation of the Structured Psychiatric Interview for General Practice. Nord J Psychiatry 2009; 63:443-53. [PMID: 19370449 DOI: 10.3109/08039480902874769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The diagnostic ability of general practitioners (GPs) concerning mental disorders is not optimal, and could be improved by structured diagnostic interviews. Various aspects of the Structured Psychiatric Interview for General Practice (SPIFA) are examined. AIMS The inter-rater reliability of the SPIFA, the time used by GPs and specialists and the GPs satisfaction are examined. The properties of the SPIFA are compared with those of the Prime-MD and the MINI schedules. METHODS Inter-rater reliability of the SPIFA was tested in 336 patients in general practice. The patients were randomized to two interview strategies. Either both GPs and psychiatrists used the SPIFA, or GPs used the SPIFA and psychiatrists a modified version of the SCID for Axis I disorders. The satisfaction was investigated by a questionnaire sent to 1000 GPs who had SPIFA training. RESULTS The SPIFA showed adequate inter-rater reliability for depression, anxiety disorders and increased suicidal risk for both interview strategies. In patients with more than two co-morbid disorders, the inter-rater reliability was poor. The mean duration of SPIFA was 21 min for SPIFA screening and 22 min for SPIFA manual. The 192 GPs responding to the questionnaire were mostly satisfied with the SPIFA. CONCLUSIONS The SPIFA seems to be a reliable, valid and helpful instrument for GPs making diagnoses of mental disorders in their patients. Compared with the Prime MD and the MINI, the SPIFA seemed to have comparable psychometric properties but better feasibility in primary care.
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Affiliation(s)
- Alv A Dahl
- Department of Clinical Cancer Research, The Norwegian Radiumhospital, Rikshospitalet University Hospital, Oslo, Norway.
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