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Dai Y, Jiang T, Gaer W, Poon KT. Workplace Objectification Leads to Self-Harm: The Mediating Effect of Depressive Moods. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2023:1461672231213898. [PMID: 38047443 DOI: 10.1177/01461672231213898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
In the current research, we aimed to extend the literature on workplace objectification and contribute to employees' well-being by exploring whether and how workplace objectification increases self-harm as well as the coping strategy that may weaken the effect. Employing archive data analytic, correlational, longitudinal, and experimental designs, we found that workplace objectification was associated with, or led to, self-harm, irrespective of whether such actions provided an escape from work. This effect could not be simply ascribed to the negative nature of workplace objectification. We further found that depressive moods mediated this effect. The detrimental effect of workplace objectification on self-harm was lessened when employees perceived higher alternatives in life. Theoretical and managerial implications were discussed.
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Affiliation(s)
- Yuwan Dai
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| | - Tonglin Jiang
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| | - Wangchu Gaer
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| | - Kai-Tak Poon
- Department of Psychology and Centre for Psychosocial Health, The Educational University of Hong Kong, Hong Kong, China
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Miyazaki H, Hino K, Ito T, Abe T, Nomoto M, Furuno T, Takeuchi I, Hishimoto A. Relationship of emergency department visits for suicide attempts with meteorological and air pollution conditions. J Affect Disord 2023; 333:154-160. [PMID: 37080497 DOI: 10.1016/j.jad.2023.04.057] [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: 12/06/2022] [Revised: 04/03/2023] [Accepted: 04/14/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Environmental factors such as meteorological and air pollution conditions have been identified as risk factors for suicide. This study aimed to clarify the relationship of the number of visits to the emergency department for suicide attempts with meteorological and air pollution conditions. METHODS This cross-sectional study included patients who attempted suicide and were transported to Yokohama City University Medical Center from April 2005 to March 2022. The meteorological conditions recorded at the time of transport included mean atmospheric pressure, mean temperature, maximum temperature, minimum temperature, mean humidity, wind speed, and sunshine hours, and the air pollution conditions included SO2 (ppm), NO (ppm), NO2 (ppm), NOX (ppm), OX (ppm), CH4 (ppmC), NMHC (ppmC), THC (ppmC), SPM (μg/m3), and PM2.5 (μg/m3). Poisson regression analysis was used to examine the association between the number of suicide attempts and the meteorological and air pollution conditions. Subgroup analyses were conducted by classifying the subjects according to the means of suicide attempt; comparisons were performed using t-tests. RESULTS The study included 1737 patients. Multivariate Poisson regression analyses revealed a significant positive relationship between the number of suicide attempts and SO2 levels and a significant negative relationship between the number of suicide attempts and NO levels. When subjects were divided by means of suicide attempt, different relationships with meteorological and air pollution conditions were observed. CONCLUSION Meteorological and air pollution conditions are environmental factors that can enable a more detailed understanding of suicide behavior according to the means of suicide attempts.
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Affiliation(s)
- Hidehito Miyazaki
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan; Psychiatric Center, Yokohama City University Medical Center, 4-57 Urafunecho, Minamiku, Yokohama, Kanagawa 232-0024, Japan; Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, 4-57 Urafunecho, Minamiku, Yokohama, Kanagawa 232-0024, Japan; Numazu-chuo Hospital, 24-1 Nakase-cho, Numazu, Shizuoka 410-8575, Japan.
| | - Kousuke Hino
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan; Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, 4-57 Urafunecho, Minamiku, Yokohama, Kanagawa 232-0024, Japan; Numazu-chuo Hospital, 24-1 Nakase-cho, Numazu, Shizuoka 410-8575, Japan
| | - Tsubasa Ito
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan; Psychiatric Center, Yokohama City University Medical Center, 4-57 Urafunecho, Minamiku, Yokohama, Kanagawa 232-0024, Japan
| | - Takeru Abe
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, 4-57 Urafunecho, Minamiku, Yokohama, Kanagawa 232-0024, Japan
| | - Munetaka Nomoto
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan; Psychiatric Center, Yokohama City University Medical Center, 4-57 Urafunecho, Minamiku, Yokohama, Kanagawa 232-0024, Japan
| | - Taku Furuno
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan; Psychiatric Center, Yokohama City University Medical Center, 4-57 Urafunecho, Minamiku, Yokohama, Kanagawa 232-0024, Japan
| | - Ichiro Takeuchi
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, 4-57 Urafunecho, Minamiku, Yokohama, Kanagawa 232-0024, Japan
| | - Akitoyo Hishimoto
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
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Guo Q, Li S, Shen J, Lu J. Thermal demands and its interactions with environmental factors account for national-level variation in aggression. Front Psychol 2022; 13:911159. [PMID: 36186386 PMCID: PMC9524539 DOI: 10.3389/fpsyg.2022.911159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 08/24/2022] [Indexed: 12/03/2022] Open
Abstract
Literature shows that psychological phenomena, including values (e.g., individualism vs. collectivism), personality, and behaviors (e.g., prosocial and aggressive behavior), are geographically clustered. The effects of temperature on interpersonal and intergroup aggression have been studied by many social psychologists. To date the interactions between temperature and other geographical factors have not been addressed. This study is aiming to examine the effects of thermal demands and the moderating effects of natural geographical factors on aggressive behavior at national level. Data for 156 societies was obtained from publicly available databases. Consistent with the life-history theory, results of this study showed that aggressive behavior has a positive relationship with heat demands, and a negative relationship with cold demands. Aggressive behavior is also positively correlated with sunlight and altitude, and negatively correlated with coastline vicinity. Forest, coastline vicinity, and rainfall moderated the effect of thermal demands on aggressive behavior. In societies with more forests, with more rainfall, and closer to coastline, the negative effects of cold demands on aggressive behavior are stronger.
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Hernæs KH, Skyrud KD. The impact of daylight on suicide rates. ECONOMICS AND HUMAN BIOLOGY 2022; 46:101151. [PMID: 35717823 DOI: 10.1016/j.ehb.2022.101151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
Since Durkheim and Morselli found a spring peak in suicides in the late 19th century, researchers have presented possible explanations, including daylight variation, for this seasonal pattern. Our identification strategy exploits the idiosyncratic variation in daylight within Norwegian regions, arising from the country's substantial latitudinal range. We use full population data for a period of 45 years in a pre-registered research design. We find a small and non-significant relationship: One extra hour of daylight increases the suicide rate by merely 0.75 % (95 % CI: -0.4 % to 1.9 %).
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Affiliation(s)
- Kjersti Helene Hernæs
- Norwegian Institute of Public Health, Cluster for Health Services Research, Oslo, Norway.
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Lesinskienė S, Kinčinienė O, Šambaras R, Žilinskas E. Analysis of Attempted Suicide in a Pediatric Setting: Extracted Notes for Clinical Practice and Complexity of Help. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148604. [PMID: 35886454 PMCID: PMC9317875 DOI: 10.3390/ijerph19148604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/04/2022] [Accepted: 07/12/2022] [Indexed: 12/10/2022]
Abstract
Background and Objectives: Suicidality among adolescents is a global mental health issue. However, the post-suicidal care of minors is insufficient and lacks complexity, as repeated attempts occur. Further, little is known about the social (i.e., family setting) and psychological (for example, exposure to bullying, suicidality, or addiction within a close environment) backgrounds of minors who engage in suicidal behavior in Lithuania. Thus, the aim of our study was to evaluate and compare psychosocial factors that may influence minors’ decisions to attempt suicide for the first time and then repeatedly and to extract notes for future clinical practice. Materials and Methods: Data from 187 cases of suicide attempts by minors treated at the Children’s Hospital of Vilnius University Santara Clinics from January 2011 to January 2018 was obtained and analyzed. Results: The data showed that 48.7% of minors hospitalized because of a suicide attempt had a history of previous suicide attempts. Minors who attempted suicide repeatedly were more often engaged in non-suicidal self-injurious behavior (p = 0.033). Further, a small number had experienced suicide within their close surroundings (p = 0.045). The comparative analysis did not reveal any significant differences in psychosocial backgrounds between first-time attempters and those who attempted suicide for at least a second time. Conclusions: Social and psychological support after a suicide attempt in a pediatric setting is lacking efficiency, as minors who repeatedly attempt suicide suffer from similar psychosocial burdens. Complex and targeted follow-up care is needed.
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Affiliation(s)
- Sigita Lesinskienė
- Clinic of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania;
- Correspondence: (S.L.); (O.K.)
| | - Odeta Kinčinienė
- Clinic of Children’s Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania
- Correspondence: (S.L.); (O.K.)
| | - Rokas Šambaras
- Clinic of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania;
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Fountoulakis KN, Fountoulakis NK. Climate rather than economic variables might have caused increase in US homicide but not suicide rates during the Great Depression. Psychiatry Res 2022; 309:114378. [PMID: 35051880 DOI: 10.1016/j.psychres.2021.114378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND It is widely believed that during the Great Depression (1929-1933) there was a rise in suicidal rates which was causally related to the increase in unemployment. There are no studies on the effect the Great Depression had on homicidal rates METHODS: The data concerning suicide, homicide, economic and climatic variables for the years 1900-1940 for the whole of the US were gathered from the US Center for Disease Control, the Maddison Project, the National Bureau of Economic Research and the National Climatic Data Center. Time Series Analysis was performed. RESULTS The results are inconclusive on the role of economic factors but preclude any role of climate on suicidal rates during the years 1900-1940 in the US. Suicidal rates might have a 24-years periodicity, however much longer time series are needed to confirm this. On the contrary they strongly suggest an effect of higher temperatures on homicidal rates after 1922. CONCLUSIONS The results of the current study suggest a direct and clear effect of climate (higher temperatures) on the increasing homicidal rates in the US after 1922 but failed to establish a causal relationship between suicide rates and economic or climate variables. These should be considered together with increasing concerns on the possible effect of climate change on mental health.
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Patterns of suicide deaths in Hungary between 1995 and 2017. SSM Popul Health 2021; 16:100958. [PMID: 34815998 PMCID: PMC8592871 DOI: 10.1016/j.ssmph.2021.100958] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/16/2021] [Accepted: 11/04/2021] [Indexed: 11/29/2022] Open
Abstract
Hungary has had one of the highest suicide mortality rates in the world for decades. Investigating seasonality of suicide deaths is essential as its findings could be key elements in the prevention. In our study we have analyzed the seasonal effect in suicide mortality in relation to possible risk factors in Hungary during 1995–2017. Data on the numbers of suicide deaths were obtained from a published online database. Negative binomial regression was employed to investigate the effect of possible risk factors and seasonal and annual trends in suicide rates. The seasonal effect was further investigated, adding a significant risk factor from the “initial” negative binomial regression. The suicide risk was significantly (p < 0.001) higher in men than in women (incidence rate ratio: 3.48), and it increased with age and decreased with education level. Marriage was a protective factor against suicide. Annual suicide mortality declined significantly (p < 0.001 for trend) from 36.7 (95% confidence interval: 35.5–37.9) to 16.5 (15.7–17.3) per 100,000 persons per year during the study period. Significant seasonality was found in suicide rates with a peak in late June. Similar peaks were observed at each level of each risk factor. There were differences in peaks by suicide method. The peak of non-violent suicides was in early June; suicides committed by violent methods peaked half a month later. This study suggests that there was a significant seasonal effect on suicide deaths between 1995 and 2017, which remained significant even in the presence of each risk factor. To our knowledge, this has been the first study to investigate the seasonal pattern so extensively in Hungary. Our findings confirm that the environmental effects are involved in the etiology of suicide mortality. Significant seasonality was found in suicide rates with a peak in late June. Seasonal effect remained almost unchanged after adjusting sociodemographic factors. There were differences in seasonal peaks by suicide method. Environmental effects are involved in the etiology of suicide mortality.
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Bergmans RS, Larson P, Bennion E, Mezuk B, Wozniak MC, Steiner AL, Gronlund CJ. Short-term exposures to atmospheric evergreen, deciduous, grass, and ragweed aeroallergens and the risk of suicide in Ohio, 2007-2015: Exploring disparities by age, gender, and education level. ENVIRONMENTAL RESEARCH 2021; 200:111450. [PMID: 34102161 PMCID: PMC8404218 DOI: 10.1016/j.envres.2021.111450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/27/2021] [Accepted: 05/29/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Seasonal trends in suicide mortality are observed worldwide, potentially aligning with the seasonal release of aeroallergens. However, only a handful of studies have examined whether aeroallergens increase the risk of suicide, with inconclusive results thus far. The goal of this study was to use a time-stratified case-crossover design to test associations of speciated aeroallergens (evergreen, deciduous, grass, and ragweed) with suicide deaths in Ohio, USA (2007-2015). METHODS Residential addresses for 12,646 persons who died by suicide were linked with environmental data at the 4-25 km grid scale including atmospheric aeroallergen concentrations, maximum temperature, sunlight, particulate matter <2.5 μm, and ozone. A case-crossover design was used to examine same-day and 7-day cumulative lag effects on suicide. Analyses were stratified by age group, gender, and educational level. RESULTS In general, associations were null between aeroallergens and suicide. Stratified analyses revealed a relationship between grass pollen and same-day suicide for women (OR = 3.84; 95% CI = 1.44, 10.22) and those with a high school degree or less (OR = 2.03; 95% CI = 1.18, 3.49). CONCLUSIONS While aeroallergens were generally not significantly related to suicide in this sample, these findings provide suggestive evidence for an acute relationship of grass pollen with suicide for women and those with lower education levels. Further research is warranted to determine whether susceptibility to speciated aeroallergens may be driven by underlying biological mechanisms or variation in exposure levels.
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Affiliation(s)
- Rachel S Bergmans
- Institute for Social Research, University of Michigan, Ann Arbor, MI, 48106, USA.
| | - Peter Larson
- Institute for Social Research, University of Michigan, Ann Arbor, MI, 48106, USA
| | - Erica Bennion
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Briana Mezuk
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Matthew C Wozniak
- Department of Climate and Space Sciences and Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Allison L Steiner
- Department of Climate and Space Sciences and Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Carina J Gronlund
- Institute for Social Research, University of Michigan, Ann Arbor, MI, 48106, USA
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Shiner B, Peltzman T, Cornelius SL, Gui J, Jiang T, Riblet N, Gottlieb DJ, Watts BV. Influence of contextual factors on death by suicide in rural and urban settings. J Rural Health 2021; 38:336-345. [PMID: 33900641 DOI: 10.1111/jrh.12579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To examine the association between contextual factors, represented by geographic and community health variables, and suicide among rural and urban Department of Veterans Affairs health care users (VA users). METHODS We performed a retrospective cohort study of 12,700,847 VA users between 2003 and 2017. We assigned contextual factors based on individuals' home address at the ZIP Code (area deprivation), county (sunlight exposure, altitude, and community health), and state level (firearm ownership), using publicly available data sources. We grouped contextual factors by quintiles or prespecified thresholds, depending on the nature of each variable. We obtained mortality data from the National Death Index. We measured the effect of living in a place with the highest versus lowest level of each contextual factor on odds of suicide using logistic regression, adjusting for individual compositional factors abstracted from VA electronic medical records data. We used random forest modeling to build prediction models for suicide based on contextual factors among rural and urban veterans. FINDINGS Almost all contextual factors we examined were significantly associated with suicide among rural and urban VA users, even after adjusting for individual compositional factors. However, no contextual variables were strong protective or risk factors (0.5<OR>2.0), and prediction models leveraging these contextual factors had poor accuracy among both rural (0.51, 95% CI: 0.48-0.54) and urban (0.53, 95% CI: 0.51-0.55) VA users. CONCLUSIONS A wide variety of contextual factors is significantly associated with suicide among rural and urban VA users. However, the factors we measured contributed very little to individual-level suicide risk.
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Affiliation(s)
- Brian Shiner
- VA Medical Center, White River Junction, Vermont, USA.,Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | | | | | - Jiang Gui
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Tammy Jiang
- Boston University School of Public Heath, Boston, Massachusetts, USA
| | - Natalie Riblet
- VA Medical Center, White River Junction, Vermont, USA.,Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Daniel J Gottlieb
- VA Medical Center, White River Junction, Vermont, USA.,Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Bradley V Watts
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA.,Veterans Rural Health Resource Center, White River Junction, Vermont, USA.,VA Office of Systems Redesign and Improvement, Washington, DC, USA
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Abstract
AIMS We aimed to investigate the heterogeneity of seasonal suicide patterns among multiple geographically, demographically and socioeconomically diverse populations. METHODS Weekly time-series data of suicide counts for 354 communities in 12 countries during 1986-2016 were analysed. Two-stage analysis was performed. In the first stage, a generalised linear model, including cyclic splines, was used to estimate seasonal patterns of suicide for each community. In the second stage, the community-specific seasonal patterns were combined for each country using meta-regression. In addition, the community-specific seasonal patterns were regressed onto community-level socioeconomic, demographic and environmental indicators using meta-regression. RESULTS We observed seasonal patterns in suicide, with the counts peaking in spring and declining to a trough in winter in most of the countries. However, the shape of seasonal patterns varied among countries from bimodal to unimodal seasonality. The amplitude of seasonal patterns (i.e. the peak/trough relative risk) also varied from 1.47 (95% confidence interval [CI]: 1.33-1.62) to 1.05 (95% CI: 1.01-1.1) among 12 countries. The subgroup difference in the seasonal pattern also varied over countries. In some countries, larger amplitude was shown for females and for the elderly population (≥65 years of age) than for males and for younger people, respectively. The subperiod difference also varied; some countries showed increasing seasonality while others showed a decrease or little change. Finally, the amplitude was larger for communities with colder climates, higher proportions of elderly people and lower unemployment rates (p-values < 0.05). CONCLUSIONS Despite the common features of a spring peak and a winter trough, seasonal suicide patterns were largely heterogeneous in shape, amplitude, subgroup differences and temporal changes among different populations, as influenced by climate, demographic and socioeconomic conditions. Our findings may help elucidate the underlying mechanisms of seasonal suicide patterns and aid in improving the design of population-specific suicide prevention programmes based on these patterns.
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Effects of Forest Therapy on Health Promotion among Middle-Aged Women: Focusing on Physiological Indicators. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124348. [PMID: 32560522 PMCID: PMC7344639 DOI: 10.3390/ijerph17124348] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/09/2020] [Accepted: 06/13/2020] [Indexed: 01/18/2023]
Abstract
Women experience more stress in middle age than in other life stages, and health in middle age is vital, because it influences the quality of life in old age. In this study, the effects of a forest therapy program on physiological changes in 53 middle-aged women (divided into two groups) who lived in the city were examined. One group participated in a three-day program in the forest, followed by three days in the city; the other group participated in a three-day program in the city, followed by three days in the forest. Forest experiments were conducted in a “healing forest,” and urban experiments were conducted near a university campus. Blood tests were performed to evaluate the physiological effects of forest therapy. Differences in serotonin levels and vitamin D levels were verified before and after the forest (experimental group) and urban (control group) programs through paired t-tests. Statistically significant increases in serotonin levels were noted for participants in the forest program; vitamin D levels also increased, but not by statistically significant values. The findings of this study verify that forest therapy programs promote health among middle-aged women, and may prevent disease and improve quality of life.
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Su MK, Chan PY, Hoffman RS. The seasonality of suicide attempts: a single poison control center perspective. Clin Toxicol (Phila) 2020; 58:1034-1041. [PMID: 32141348 DOI: 10.1080/15563650.2020.1733591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Suicide attempts by poisoning are increasing and suicide occurrence may be associated with seasonality. We performed a retrospective analysis of poisoning exposure data from a single Poison Control Center (PCC) to determine if suicide attempts were associated with season, day of the week, and/or US holidays.Methods: We analyzed exposure cases identified as "intentional overdose - suspected suicide attempt" over 2009-2012. We used singular spectrum analysis (SSA) to detect cyclic patterns in the data and then performed Poisson regression and t-tests to determine if the number of cases were associated with season, day of the week, and US holidays.Results: There were 42,578 cases of "intentional overdose - suspected suicide" during the study period. Singular Spectrum Analysis (SSA) showed that the number of cases associated with poisoning suicide attempts peaked in the Spring and dipped in the Fall. Regression analysis showed higher numbers of suspected suicide attempts from intentional overdose in spring compared with winter by 1.07 times (p = 0.003), and on Sunday (p < 0.001), Monday (p < 0.001), and Thursday (p = 0.02) compared with Saturday by at least 1.09 times. No significant difference was seen for most holidays except for lower numbers of cases around Christmas (3 days before and after; 22.0 vs. 32.3 on control dates, p < 0.001).Conclusions: Suicide attempts by poisoning are associated with season of the year and some days of the week. Further research is required determine reasons for these associations and implementation of public health interventions.
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Affiliation(s)
- Mark K Su
- New York City Poison Control Center, New York, NY, USA.,Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, NY, USA
| | - Pui Ying Chan
- Bureau of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Robert S Hoffman
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, NY, USA
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A study of the epidemiology and risk factors for attempted suicide and suicide among non-psychiatric inpatients in 48 general hospitals in Hubei province, China, 2015-2017. Gen Hosp Psychiatry 2020; 63:21-29. [PMID: 31230862 DOI: 10.1016/j.genhosppsych.2019.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/06/2019] [Accepted: 06/04/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This was a large-scale epidemiological survey of non-psychiatric inpatient attempted suicides/suicides in general hospitals in China, allowing a detailed quantitative analysis of the characteristics of inpatient attempted suicides/suicides. METHODS The incidence, inpatient demographic and behavioral characteristics, and risk factors for attempted suicide/suicide were explored through a survey of non-psychiatric inpatients admitted to 48 general hospitals, between 2015 and 2017. A Vector Error Correction model was established to explore hospital variables as predictors of inpatient attempted suicide/suicide using the annual numbers of inpatient attempted suicides/suicides, undergraduate or above nurses per total number of nurses, and number of beds per nurse in a tertiary general hospital, between 1998 and 2017. RESULTS The incidence of attempted suicide/suicide among inpatients in general hospitals was 3.26/100,000 admissions. 180 inpatient attempted suicides/suicides were reported, which were associated with particular inpatient demographic and behavioral characteristics and a specific temporal and spatial distribution. Incidence of attempted suicide/suicide was higher in inpatients aged ≥60 years, with junior high school or lower level of education, in secondary general hospitals, suffering from malignant tumors or chronic diseases. Number of beds/nurse had a significant impact on the incidence of inpatient attempted suicide/suicide. CONCLUSION We recommend that general hospital administrators establish a targeted approach to inpatient suicide prevention efforts in their hospitals.
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Tubbs AS, Perlis ML, Basner M, Chakravorty S, Khader W, Fernandez F, Grandner MA. Relationship of Nocturnal Wakefulness to Suicide Risk Across Months and Methods of Suicide. J Clin Psychiatry 2020; 81:19m12964. [PMID: 32097547 PMCID: PMC8121668 DOI: 10.4088/jcp.19m12964] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/11/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Insomnia is a risk factor for suicide, and the risk of suicide after accounting for population wakefulness is disproportionately highest at night. This study investigated whether this risk varied across months and/or methods of suicide. METHODS Time, date, method (eg, firearm, poisoning), and demographic information for 35,338 suicides were collected from the National Violent Death Reporting System for the years 2003-2010. Time of fatal injury was grouped into 1-hour bins and compared to the estimated hourly proportion of the population awake from the American Time Use Survey for 2003-2010. Negative binomial modeling then generated hourly incidence risk ratios (IRRs) of suicide. Risks were then aggregated into 4 categories: morning (6:00 am to 11:59 am), afternoon (noon to 5:59 pm), evening (6:00 pm to 11:59 pm), and night (midnight to 5:59 am). RESULTS The risk of suicide was higher at night across all months (P < .001) and methods (P < .001). The mean nocturnal IRR across months was 3.18 (SD = 0.314), with the highest IRR in May (3.90) and the lowest in November (2.74). The mean (SD) nocturnal IRR across methods was 3.09 (0.472), with the highest IRR for fire (3.75) and the lowest for drowning (2.44). Additionally, nocturnal risk was elevated within all demographics (all P < .001). However, there were no month-by-time or method-by-time interactions across demographics (all P > .05). CONCLUSIONS Regardless of month or method, the incidence risk of suicide at night is higher than at any other time of day. Additionally, demographic subgroups did not differentially experience higher risks across months or mechanisms at night.
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Affiliation(s)
- Andrew S Tubbs
- Department of Psychiatry, University of Arizona, College of Medicine, PO Box 245002, Tucson, AZ 85724-5002. .,Sleep and Health Research Program, Department of Psychiatry, University of Arizona, Tucson, Arizona, USA
| | - Michael L Perlis
- University of Pennsylvania, Department of Psychiatry, Philadelphia, Pennsylvania, USA
| | - Mathias Basner
- University of Pennsylvania, Department of Psychiatry, Philadelphia, Pennsylvania, USA
| | - Subhajit Chakravorty
- University of Pennsylvania, Department of Psychiatry, Philadelphia, Pennsylvania, USA
| | - Waliuddin Khader
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona, Tucson, Arizona, USA,Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - Fabian Fernandez
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - Michael A Grandner
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona, Tucson, Arizona, USA
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15
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Shen J, Tower J. Effects of light on aging and longevity. Ageing Res Rev 2019; 53:100913. [PMID: 31154014 DOI: 10.1016/j.arr.2019.100913] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/17/2019] [Accepted: 05/29/2019] [Indexed: 12/11/2022]
Abstract
Increasing evidence suggests an important role for light in regulation of aging and longevity. UV radiation is a mutagen that can promote aging and decrease longevity. In contrast, NIR light has shown protective effects in animal disease models. In invertebrates, visible light can shorten or extend lifespan, depending on the intensity and wavelength composition. Visible light also impacts human health, including retina function, sleep, cancer and psychiatric disorders. Possible mechanisms of visible light include: controlling circadian rhythms, inducing oxidative stress, and acting through the retina to affect neuronal circuits and systems. Changes in artificial lighting (e.g., LEDs) may have implications for human health. It will be important to further explore the mechanisms of how light affects aging and longevity, and how light affects human health.
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16
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Yang CT, Yip PSF, Cha ES, Zhang Y. Seasonal changes in suicide in South Korea, 1991 to 2015. PLoS One 2019; 14:e0219048. [PMID: 31251776 PMCID: PMC6599115 DOI: 10.1371/journal.pone.0219048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 06/14/2019] [Indexed: 11/26/2022] Open
Abstract
Seasonality of suicidal behavior has been widely reported in many epidemiological studies with a well replicated suicide peak in spring followed by a trough in winter season. Research from some regions over the past few decades has shown a diminishing seasonal pattern of suicides and this introduced a new perspective on the suicide study. Data on all suicide deaths from the period 1991 to 2015 was extracted from the South Korean National Death Registration data set which was made available by Statistics Korea. Our findings confirmed a strong seasonal effect of suicides in South Korea throughout the study period and a marked diminishing pattern was observed since the period of 2006–2010. The rhythm of suicides kept changing across the time intervals with a spring peak followed by a second peak in late summer/autumn. The seasonality varied across age groups and the seasonal effect among the Korean elderly suicides was still found to be significant though a diminishing pattern was observed recently.
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Affiliation(s)
- Chi Ting Yang
- Department of Statistics and Actuarial Science, The University of Hong Kong, Hong Kong
| | - Paul S. F. Yip
- Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
- * E-mail: (PSFY); (YZ)
| | - Eun Shil Cha
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Yi Zhang
- Institute of Population and Labor Economics, The Chinese Academy of Social Sciences, Bejing, People’s Republic of China
- * E-mail: (PSFY); (YZ)
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17
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Aguglia A, Serafini G, Solano P, Giacomini G, Conigliaro C, Salvi V, Mencacci C, Romano M, Aguglia E, Amore M. The role of seasonality and photoperiod on the lethality of suicide attempts: A case-control study. J Affect Disord 2019; 246:895-901. [PMID: 30795496 DOI: 10.1016/j.jad.2018.12.094] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/19/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The risk factors related to suicidal behaviors are complex and not yet fully known. Several studies underline how suicide results from the combination of psycho-social, biological, cultural, and environmental factors. The aim of this study was to investigate the potential role of seasonality and photoperiod on high-lethality suicide attempts (HLSA) compared with low-lethality suicide attempts (LLSA) in a sample of psychiatric inpatients. METHODS After attempting suicide, subjects were admitted in the emergency/psychiatric ward of the IRCCS Ospedale Policlinico San Martino from 1st August 2013 to 31st July 2018. Socio-demographic and clinical characteristics were collected. RESULTS The sample consisted of four hundred thirty-two individuals admitted for suicide attempt. One hundred thirty-three subjects (30.8%) of the sample committed a HLSA. The HLSA group peaked in the months with a higher sunlight exposure (June and July). Bivariate correlation analyses between seasonality/photoperiod in the whole sample and HLSA were positively associated with summer and highest solar intensity period. LIMITATIONS Data were limited to a single hospital, patients' seasonal environment, meteorological variables and psychological factors. In addition, the presence of acute life-events fostering the suicidal crisis has not been investigated. CONCLUSIONS The current study provides a novel perspective on the questions surrounding the impact of seasonality and daylight exposure on lethality of suicide attempts. further studies are needed to provide deeper understandings on the delicate molecular network that links suicide behaviors, seasonality and daylight in order to develop more effective prevention and treatment strategies in the future.
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Affiliation(s)
- Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics Maternal and Child Health, University of Genoa, Section of Psychiatry, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics Maternal and Child Health, University of Genoa, Section of Psychiatry, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paola Solano
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics Maternal and Child Health, University of Genoa, Section of Psychiatry, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gabriele Giacomini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics Maternal and Child Health, University of Genoa, Section of Psychiatry, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Claudia Conigliaro
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics Maternal and Child Health, University of Genoa, Section of Psychiatry, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Virginio Salvi
- Department of Neuroscience, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Claudio Mencacci
- Department of Neuroscience, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Miroslav Romano
- Department of Experimental and Clinical Medicine, Psychiatric Clinic University Hospital "Gaspare Rodolico", University of Catania, Catania, Italy
| | - Eugenio Aguglia
- Department of Experimental and Clinical Medicine, Psychiatric Clinic University Hospital "Gaspare Rodolico", University of Catania, Catania, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics Maternal and Child Health, University of Genoa, Section of Psychiatry, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Morton DP. Combining Lifestyle Medicine and Positive Psychology to Improve Mental Health and Emotional Well-being. Am J Lifestyle Med 2018; 12:370-374. [PMID: 30283261 PMCID: PMC6146362 DOI: 10.1177/1559827618766482] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Darren P. Morton
- Lifestyle Research Centre, Avondale College of Higher Education, Cooranbong, NSW, Australia
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19
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Dixon PG, Kalkstein AJ. Where are weather-suicide associations valid? An examination of nine US counties with varying seasonality. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2018; 62:685-697. [PMID: 27822625 DOI: 10.1007/s00484-016-1265-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/19/2016] [Accepted: 10/20/2016] [Indexed: 05/11/2023]
Abstract
There has been much research on the associations between weather variables and suicide rates. However, the state of understanding has remained rather stagnant due to many contradictory findings. The purpose of this project is to examine a larger database of suicides that includes a longer and more recent period of record (1975-2010) across numerous locations in the USA. In all, we examine nine total counties (and the primary city associated with them) with a special effort made to compare locations with varying degrees of temperature seasonality: Cook (Chicago), Fulton (Atlanta), King (Seattle), Los Angeles (Los Angeles), Maricopa (Phoenix), Miami-Dade (Miami), Philadelphia (Philadelphia), Salt Lake (Salt Lake City), and St. Louis (St. Louis). We first examine the unique seasonal cycle in suicides evident in each locale and then use distributed lag nonlinear modeling (DLNM) to relate the suicide data to daily surface temperatures. Results suggest that a late spring/summer peak generally exists in suicide rates, and above average temperatures are associated with increased suicide risk in almost all study counties. Further, it appears that these associations can be found in both mid-latitude and sub-tropical climate types.
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Affiliation(s)
- P Grady Dixon
- Department of Geosciences, Fort Hays State University, 600 Park St, Hays, KS, USA.
| | - Adam J Kalkstein
- Department of Geography and Environmental Engineering, United States Military Academy, West Point, New York, USA
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20
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Brewerton TD, Putnam KT, Lewine RR, Risch SC. Seasonality of cerebrospinal fluid monoamine metabolite concentrations and their associations with meteorological variables in humans. J Psychiatr Res 2018; 99:76-82. [PMID: 29427844 PMCID: PMC5849528 DOI: 10.1016/j.jpsychires.2018.01.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 01/07/2018] [Accepted: 01/11/2018] [Indexed: 12/18/2022]
Abstract
Seasonal variations in neurotransmitter parameters have been previously reported in humans. However, these studies have involved small sample sizes and have not examined possible relationships with meteorological variables. We compared cerebrospinal fluid (CSF) concentrations of the major monoamine neurotransmitter metabolites (5-HIAA, HVA, and MHPG) in 188 healthy controls (80 men, 108 women) in relationship to age, sex, BMI, and available meteorological variables. All subjects had a lumbar puncture (LP) performed at 9 a.m. after overnight stay. Meteorological data for the day prior to LP were obtained from the National Climatic Association and included the photoperiod, percent sunshine, temperature (max, min, mean), barometric pressure, relative humidity, amount of precipitation and sky cover. Results revealed differences across seasons and cross-seasons for CSF 5-HIAA (p ≤ .05), with post-hoc differences emerging between spring versus summer and fall and between x-spring and x-summer (p ≤ .05). Differences were also found across seasons for CSF HVA (p ≤ .05) with post-hoc differences between spring versus fall. CSF 5-HIAA was significantly inversely correlated with maximum (r = -.28, p ≤ .02), minimum (r = -.24, p ≤ .04), and mean temperature (r = -.28, p ≤ .02) in men. In women, 5-HIAA (r = -.22, p ≤ .02) and HVA (r = -.28, p ≤ .003) were significantly correlated with relative humidity. These data confirm previous findings of variations in serotonin and dopamine metabolites across the year and highlight possible underlying mechanisms involving meteorological changes, which may result in alterations in neurophysiology and behavior.
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Affiliation(s)
- Timothy D. Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425-0742
| | - Karen T. Putnam
- Department of Psychiatry, University of North Carolina Chapel Hill, Chapel Hill, NC
| | - Richard R.J. Lewine
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY
| | - S. Craig Risch
- Department of Psychiatry, University of California at San Francisco, San Francisco, CA
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21
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Asirdizer M, Kartal E, Etli Y, Tatlisumak E, Gumus O, Hekimoglu Y, Keskin S. The effect of altitude and climate on the suicide rates in Turkey. J Forensic Leg Med 2018; 54:91-95. [PMID: 29334635 DOI: 10.1016/j.jflm.2017.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 10/31/2017] [Accepted: 12/30/2017] [Indexed: 11/19/2022]
Abstract
Suicide is one of the most important public health problems. There was an association between suicide and several factors such as psychiatric diseases and psychological characteristics, somatic illness, cultural, socioeconomic, familial, occupational and individual risk factors. Also, high altitude and climatic factors including high temperature, cloudiness, more sunshine and low rainfalls were defined as some of these risk factors in the literature. In this study, we aimed to investigate correlation between suicide rates and altitudes of all cities in Turkey and between suicide rates and climatic factors including Rainfall Activity Index, Winter Mean Temperatures, Summer Mean Temperatures and Temperature Difference between January and July previously defined by several authors in the broad series in Turkey. In Turkey, 29865 suicidal deaths occurred in 10 years period between 2006 and 2015. Of them, 21020 (70.4%) were males and 8845 (29.6%) were females. In this study, we found that high altitude above 1500 m, winter median temperature lower than -10 °C and hard temperature changes above 25 °C between winter and summer of settlements were important factors that affected on female suicide rates appropriate to knowledge which defined in previous studies. In conclusion, we suggested that the associations among suicide rates with altitudes and climate should be studied in wider series obtained from different countries for reaching more reliable results.
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Affiliation(s)
- Mahmut Asirdizer
- Department of Forensic Medicine, Medical Faculty of Van Yuzuncu Yil University, Van, Turkey.
| | - Erhan Kartal
- Department of Forensic Medicine, Medical Faculty of Inonu University, Malatya, Turkey.
| | - Yasin Etli
- Department of Forensic Medicine, Medical Faculty of Van Yuzuncu Yil University, Van, Turkey.
| | - Ertugrul Tatlisumak
- Department of Anatomy, Medical Faculty of Celal Bayar University, Manisa, Turkey.
| | | | - Yavuz Hekimoglu
- Department of Forensic Medicine, Medical Faculty of Namik Kemal University, Tekirdag, Turkey.
| | - Sıddık Keskin
- Department of Biostatistics, Medical Faculty of Van Yuzuncu Yil University, Van, Turkey.
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22
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Akkaya-Kalayci T, Vyssoki B, Winkler D, Willeit M, Kapusta ND, Dorffner G, Özlü-Erkilic Z. The effect of seasonal changes and climatic factors on suicide attempts of young people. BMC Psychiatry 2017; 17:365. [PMID: 29141599 PMCID: PMC5688742 DOI: 10.1186/s12888-017-1532-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 11/07/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Seasonal changes and climatic factors like ambient temperature, sunlight duration and rainfall can influence suicidal behavior. METHODS This study analyses the relationship between seasonal changes and climatic variations and suicide attempts in 2131 young patients in Istanbul, Turkey. RESULTS In our study sample, there was an association between suicide attempts in youths and seasonal changes, as suicide attempts occurred most frequently during summer in females as well as in males. Furthermore, there was a positive correlation between the mean temperature over the past 10 days and temperature at the index day and suicide attempts in females. After seasonality effects were mathematically removed, the mean temperature 10 days before a suicide attempt remained significant in males only, indicating a possible short-term influence of temperature on suicide attempts. CONCLUSIONS This study shows an association between suicide attempts of young people and climatic changes, in particular temperature changes as well as seasonal changes. Therefore, the influence of seasonal changes and climatic factors on young suicide attempters should get more attention in research to understand the biopsychosocial mechanisms playing a role in suicide attempts of young people. As suicide attempts most frequently occur in young people, further research is of considerable clinical importance.
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Affiliation(s)
- Türkan Akkaya-Kalayci
- 0000 0000 9259 8492grid.22937.3dOutpatient Clinic of Transcultural Psychiatry and Migration Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Benjamin Vyssoki
- 0000 0000 9259 8492grid.22937.3dDepartment for Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Dietmar Winkler
- 0000 0000 9259 8492grid.22937.3dDepartment for Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Matthaeus Willeit
- 0000 0000 9259 8492grid.22937.3dDepartment for Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Nestor D. Kapusta
- 0000 0000 9259 8492grid.22937.3dDepartment of Psychoanalysis and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Georg Dorffner
- 0000 0000 9259 8492grid.22937.3dSection of Artificial Intelligence, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Freyung 6/2, 1010 Vienna, Austria
| | - Zeliha Özlü-Erkilic
- Outpatient Clinic of Transcultural Psychiatry and Migration Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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23
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Morton DP, Hinze J, Craig B, Herman W, Kent L, Beamish P, Renfrew M, Przybylko G. A Multimodal Intervention for Improving the Mental Health and Emotional Well-being of College Students. Am J Lifestyle Med 2017; 14:216-224. [PMID: 32231487 DOI: 10.1177/1559827617733941] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/17/2017] [Accepted: 09/07/2017] [Indexed: 01/07/2023] Open
Abstract
This study examined the effectiveness of a 10-week multimodal intervention for improving the mental health and emotional well-being of college students when included as a mandatory component of the students' course of study. A total of 67 students (20.9 ± 5.4 years, 30 male/37 female) participated in the intervention that introduced a variety of evidence-based strategies for improving mental health and emotional well-being from the Lifestyle Medicine and Positive Psychology literature. Significant reductions were recorded in symptoms of depression (-28%, P < .05), anxiety (-31%, P < .05), and stress (-28%, P < .01), whereas significant improvements were observed in mental health (18%, P < .01), vitality (14%, P < .01) and overall life satisfaction (8%, P < .05). Effect sizes were larger than those reported by studies that have examined the individual effectiveness of the strategies incorporated into the intervention, suggesting a compounding effect. Stratified analyses indicated that participants with the lowest measures of mental health and emotional well-being at baseline experienced the greatest benefits. The findings of the study suggest that meaningful improvements in the mental health and emotional well-being of college students can be achieved, and potentially magnified, by utilizing a multidisciplinary approach involving evidence-based strategies from Lifestyle Medicine and Positive Psychology.
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Affiliation(s)
- Darren P Morton
- Lifestyle Research Centre (DPM, BC, LK, MR, GP), Avondale College of Higher Education, Cooranbong, NSW, Australia.,Faculty of Education, Business and Science (JH, WH, PB), Avondale College of Higher Education, Cooranbong, NSW, Australia
| | - Jason Hinze
- Lifestyle Research Centre (DPM, BC, LK, MR, GP), Avondale College of Higher Education, Cooranbong, NSW, Australia.,Faculty of Education, Business and Science (JH, WH, PB), Avondale College of Higher Education, Cooranbong, NSW, Australia
| | - Bevan Craig
- Lifestyle Research Centre (DPM, BC, LK, MR, GP), Avondale College of Higher Education, Cooranbong, NSW, Australia.,Faculty of Education, Business and Science (JH, WH, PB), Avondale College of Higher Education, Cooranbong, NSW, Australia
| | - Wendi Herman
- Lifestyle Research Centre (DPM, BC, LK, MR, GP), Avondale College of Higher Education, Cooranbong, NSW, Australia.,Faculty of Education, Business and Science (JH, WH, PB), Avondale College of Higher Education, Cooranbong, NSW, Australia
| | - Lillian Kent
- Lifestyle Research Centre (DPM, BC, LK, MR, GP), Avondale College of Higher Education, Cooranbong, NSW, Australia.,Faculty of Education, Business and Science (JH, WH, PB), Avondale College of Higher Education, Cooranbong, NSW, Australia
| | - Peter Beamish
- Lifestyle Research Centre (DPM, BC, LK, MR, GP), Avondale College of Higher Education, Cooranbong, NSW, Australia.,Faculty of Education, Business and Science (JH, WH, PB), Avondale College of Higher Education, Cooranbong, NSW, Australia
| | - Melanie Renfrew
- Lifestyle Research Centre (DPM, BC, LK, MR, GP), Avondale College of Higher Education, Cooranbong, NSW, Australia.,Faculty of Education, Business and Science (JH, WH, PB), Avondale College of Higher Education, Cooranbong, NSW, Australia
| | - Geraldine Przybylko
- Lifestyle Research Centre (DPM, BC, LK, MR, GP), Avondale College of Higher Education, Cooranbong, NSW, Australia.,Faculty of Education, Business and Science (JH, WH, PB), Avondale College of Higher Education, Cooranbong, NSW, Australia
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24
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Hernández OH, Hernández-Sánchez JA, Flores-Gutiérrez JD. Annual fluctuations of sunlight and suicides in a region South of the Tropic of Cancer. BIOL RHYTHM RES 2017. [DOI: 10.1080/09291016.2017.1366720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Oscar Hernando Hernández
- Centro de Investigaciones Biomédicas, Universidad Autónoma de Campeche, San Francisco de Campeche, México
- Hospital General de Especialidades “Dr. Javier Buenfil Osorio”, Secretaría de Salud, San Francisco de Campeche, México
| | | | - José Daniel Flores-Gutiérrez
- Dpto. de Astronomía Galáctica y Planetaria, Instituto de Astronomía, Universidad Nacional Autónoma de México, Ciudad de México, México
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25
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Kuivalainen S, Vehviläinen-Julkunen K, Louheranta O, Putkonen A, Repo-Tiihonen E, Tiihonen J. Seasonal variation of hospital violence, seclusion and restraint in a forensic psychiatric hospital. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2017; 52:1-6. [PMID: 28506820 DOI: 10.1016/j.ijlp.2017.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 12/14/2016] [Accepted: 05/02/2017] [Indexed: 06/07/2023]
Abstract
Several epidemiological studies have reported seasonal patterns in both violent and self-destructive behaviour. However, a few studies on hospital violence have found contradictory results. The aim of this study was to investigate whether there was any seasonal variation of violence in a forensic psychiatric hospital providing care for persons suffering from psychotic disorders and violent or self-destructive behaviour. Seasonal variation of the prevalence of seclusion and restraint was also investigated. Reports of violent incidents and seclusion and restraint statistics from between 2007 and 2012 were examined with Poisson regression analysis. There was significant variation in the prevalence of seclusion and restraint between months (p<0.001), and between seasons (p<0.001). Monthly prevalence of seclusion and restraint was the lowest in January compared to other months. In comparison, the prevalence of seclusion and restraint was lower in winter than in other seasons. In a hospital with persons suffering from psychotic disorders, no significant variation of violence or self-destructive behaviour was found, similarly as in the society. By contrast, the prevalence of seclusion and restraint showed marked seasonality. Variation in the prevalence of seclusion and restraint was not consistent with the variance in violence, which implies that the use of coercive measures is related to seasonal variation among staff.
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Affiliation(s)
- Satu Kuivalainen
- Niuvanniemi Hospital, Department of Forensic Psychiatry, University of Eastern Finland, Niuvankuja 65, FI-70240 Kuopio, Finland.
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Sciences, University of Eastern Finland, Yliopistonranta 1 C, FI-70200 Kuopio, Finland.
| | - Olavi Louheranta
- Niuvanniemi Hospital, Department of Forensic Psychiatry, University of Eastern Finland, Niuvankuja 65, FI-70240 Kuopio, Finland.
| | - Anu Putkonen
- Niuvanniemi Hospital, Department of Forensic Psychiatry, University of Eastern Finland, Niuvankuja 65, FI-70240 Kuopio, Finland.
| | - Eila Repo-Tiihonen
- Niuvanniemi Hospital, Department of Forensic Psychiatry, University of Eastern Finland, Niuvankuja 65, FI-70240 Kuopio, Finland.
| | - Jari Tiihonen
- Niuvanniemi Hospital, Department of Forensic Psychiatry, University of Eastern Finland, Niuvankuja 65, FI-70240 Kuopio, Finland; Karolinska Institutet, Department of Clinical Neuroscience, Byggnad R5, SE-17176 Stockholm, Sweden.
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Jee HJ, Cho CH, Lee YJ, Choi N, An H, Lee HJ. Solar radiation increases suicide rate after adjusting for other climate factors in South Korea. Acta Psychiatr Scand 2017; 135:219-227. [PMID: 27987216 DOI: 10.1111/acps.12676] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Previous studies have indicated that suicide rates have significant seasonal variations. There is seasonal discordance between temperature and solar radiation due to the monsoon season in South Korea. We investigated the seasonality of suicide and assessed its association with climate variables in South Korea. METHOD Suicide rates were obtained from the National Statistical Office of South Korea, and climatic data were obtained from the Korea Meteorological Administration for the period of 1992-2010. We conducted analyses using a generalized additive model (GAM). First, we explored the seasonality of suicide and climate variables such as mean temperature, daily temperature range, solar radiation, and relative humidity. Next, we identified confounding climate variables associated with suicide rate. To estimate the adjusted effect of solar radiation on the suicide rate, we investigated the confounding variables using a multivariable GAM. RESULTS Suicide rate showed seasonality with a pattern similar to that of solar radiation. We found that the suicide rate increased 1.008 times when solar radiation increased by 1 MJ/m2 after adjusting for other confounding climate factors (P < 0.001). CONCLUSION Solar radiation has a significant linear relationship with suicide after adjusting for region, other climate variables, and time trends.
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Affiliation(s)
- Hee-Jung Jee
- Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea
| | - Chul-Hyun Cho
- Department of Psychiatry, Korea University College of Medicine, Seoul, South Korea
| | - Yu Jin Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
| | - Nari Choi
- Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea
| | - Hyonggin An
- Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea
| | - Heon-Jeong Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, South Korea
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Seregi B, Kapitány B, Maróti-Agóts Á, Rihmer Z, Gonda X, Döme P. Weak associations between the daily number of suicide cases and amount of daily sunlight. Prog Neuropsychopharmacol Biol Psychiatry 2017; 73:41-48. [PMID: 27776950 DOI: 10.1016/j.pnpbp.2016.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 10/07/2016] [Accepted: 10/18/2016] [Indexed: 11/29/2022]
Abstract
Several environmental factors with periodic changes in intensity during the calendar year have been put forward to explain the increase in suicide frequency during spring and summer. In the current study we investigated the effect of averaged daily sunshine duration of periods with different lengths and 'lags' (i.e. the number of days between the last day of the period for which the averaged sunshine duration was calculated and the day of suicide) on suicide risk. We obtained data on daily numbers of suicide cases and daily sunshine duration in Hungary from 1979 to 2013. In order to remove the seasonal components from the two time series (i.e. numbers of suicide and sunshine hours) we used the differencing method. Pearson correlations (n=22,950) were calculated to reveal associations between sunshine duration and suicide risk. The final sample consisted of 122,116 suicide cases. Regarding the entire investigated period, after differencing, sunshine duration and number of suicides on the same days showed a distinctly weak, but highly significant positive correlation in the total sample (r=0.067; p=1.17*10-13). Positive significant correlations (p˂0.0001) between suicide risk on the index day and averaged sunshine duration in the previous days (up to 11days) were also found in the total sample. Our results from a large sample strongly support the hypothesis that sunshine has a prompt, but very weak increasing effect on the risk of suicide (especially violent cases among males). The main limitation is that possible confounding factors were not controlled for.
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Affiliation(s)
- Bernadett Seregi
- Faculty of Veterinary Science, University of Veterinary Science, István u. 2, 1078 Budapest, Hungary
| | - Balázs Kapitány
- Demographic Research Institute of the Hungarian Central Statistical Office, Buday László u. 1-3, 1204 Budapest, Hungary
| | - Ákos Maróti-Agóts
- Faculty of Veterinary Science, University of Veterinary Science, István u. 2, 1078 Budapest, Hungary
| | - Zoltán Rihmer
- Department of Psychiatry and Psychotherapy, Semmelweis University, Faculty of Medicine, Kútvölgyi út 4, 1125 Budapest, Hungary; National Institute of Psychiatry and Addictions, Laboratory for Suicide Research and Prevention, Lehel u. 59, 1135 Budapest, Hungary
| | - Xénia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Faculty of Medicine, Kútvölgyi út 4, 1125 Budapest, Hungary; National Institute of Psychiatry and Addictions, Laboratory for Suicide Research and Prevention, Lehel u. 59, 1135 Budapest, Hungary; MTA-SE Neuropsychopharmacology, Neurochemistry Research Group, Hungarian Academy of Sciences, Nagyvárad tér 4, 1089 Budapest, Hungary
| | - Péter Döme
- Department of Psychiatry and Psychotherapy, Semmelweis University, Faculty of Medicine, Kútvölgyi út 4, 1125 Budapest, Hungary; National Institute of Psychiatry and Addictions, Laboratory for Suicide Research and Prevention, Lehel u. 59, 1135 Budapest, Hungary.
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Abstract
The prediction of suicidal behavior is a complex task. To fine-tune targeted preventative interventions, predictive analytics (i.e. forecasting future risk of suicide) is more important than exploratory data analysis (pattern recognition, e.g. detection of seasonality in suicide time series). This study sets out to investigate the accuracy of forecasting models of suicide for men and women. A total of 101 499 male suicides and of 39 681 female suicides - occurred in Italy from 1969 to 2003 - were investigated. In order to apply the forecasting model and test its accuracy, the time series were split into a training set (1969 to 1996; 336 months) and a test set (1997 to 2003; 84 months). The main outcome was the accuracy of forecasting models on the monthly number of suicides. These measures of accuracy were used: mean absolute error; root mean squared error; mean absolute percentage error; mean absolute scaled error. In both male and female suicides a change in the trend pattern was observed, with an increase from 1969 onwards to reach a maximum around 1990 and decrease thereafter. The variances attributable to the seasonal and trend components were, respectively, 24% and 64% in male suicides, and 28% and 41% in female ones. Both annual and seasonal historical trends of monthly data contributed to forecast future trends of suicide with a margin of error around 10%. The finding is clearer in male than in female time series of suicide. The main conclusion of the study is that models taking seasonality into account seem to be able to derive information on deviation from the mean when this occurs as a zenith, but they fail to reproduce it when it occurs as a nadir. Preventative efforts should concentrate on the factors that influence the occurrence of increases above the main trend in both seasonal and cyclic patterns of suicides.
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Affiliation(s)
- Antonio Preti
- a Center for Liaison Psychiatry and Psychosomatics, University Hospital, University of Cagliari , Cagliari , Italy
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Coimbra DG, Pereira E Silva AC, de Sousa-Rodrigues CF, Barbosa FT, de Siqueira Figueredo D, Araújo Santos JL, Barbosa MR, de Medeiros Alves V, Nardi AE, de Andrade TG. Do suicide attempts occur more frequently in the spring too? A systematic review and rhythmic analysis. J Affect Disord 2016; 196:125-37. [PMID: 26921865 DOI: 10.1016/j.jad.2016.02.036] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 01/25/2016] [Accepted: 02/06/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Seasonal variations in suicides have been reported worldwide, however, there may be a different seasonal pattern in suicide attempts. The aim of this study was to perform a systematic review on seasonality of suicide attempts considering potential interfering variables, and a statistical analysis for seasonality with the collected data. METHOD Observational epidemiological studies about seasonality in suicide attempts were searched in PubMed, Web of Science, LILACS and Cochrane Library databases with terms attempted suicide, attempt and season. Monthly or seasonal data available were evaluated by rhythmic analysis softwares. RESULTS Twenty-nine articles from 16 different countries were included in the final review. It was observed different patterns of seasonality, however, suicide attempts in spring and summer were the most frequent seasons reported. Eight studies indicated differences in sex and three in the method used for suicide attempts. Three articles did not find a seasonal pattern in suicide attempts. Cosinor analysis identified an overall pattern of seasonal variation with a suggested peak in spring, considering articles individually or grouped and independent of sex and method used. A restricted analysis with self-poisoning in hospital samples demonstrated the same profile. LIMITATIONS Grouping diverse populations and potential analytical bias due to lack of information are the main limitations. CONCLUSIONS The identification of a seasonal profile suggests the influence of an important environmental modulator that can reverberate to suicide prevention strategies. Further studies controlling interfering variables and investigating the biological substrate for this phenomenon would be helpful to confirm our conclusion.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Antonio Egidio Nardi
- Panic & Respiration Laboratory, Institute of Psychiatry, Federal University of Rio de Janeiro, National Institute for Translational Medicine (INCT-TM), Rio de Janeiro, Brazil
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Silveira ML, Wexler L, Chamberlain J, Money K, Spencer RMC, Reich NG, Bertone-Johnson ER. Seasonality of suicide behavior in Northwest Alaska: 1990-2009. Public Health 2016; 137:35-43. [PMID: 27021788 DOI: 10.1016/j.puhe.2016.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 02/06/2016] [Accepted: 02/12/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Suicide is a leading cause of death worldwide, and disproportionately affects Indigenous populations. Seasonal suicide patterns are variable in the literature, and could offer novel approaches to the timing and focus of prevention efforts if better understood. With a suicide surveillance system in place since 1989, this study offers an unprecedented opportunity to explore seasonal variations in both fatal and non-fatal suicide behavior in an Indigenous Arctic region. STUDY DESIGN Cross-sectional. METHODS In this descriptive study, we analyzed data collected from 1990 to 2009 in the rural northwest region of Alaska, both graphically and using the chi-squared test for multinomials. RESULTS We found a significant monthly variation for suicide attempts, with a peak in suicide behavior observed between April and August (P = 0.0002). Monthly variation was more pronounced among individuals ≤29 years of age, and was present in both males and females, although the seasonal pattern differed by sex. CONCLUSIONS Our findings of a significant seasonal pattern in suicide behavior, with monthly variation (summer peak) in non-fatal suicide behavior among younger age groups, and among both males and females can assist planners in targeting subpopulations for prevention at different times of the year.
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Affiliation(s)
- M L Silveira
- Department of Biostatistics & Epidemiology, School of Public Health & Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - L Wexler
- Division of Community Health Education, Department of Public Health, School of Public Health & Health Sciences, University of Massachusetts, Amherst, MA, USA.
| | - J Chamberlain
- Swiss Paraplegic Research, Nottwil, Switzerland; Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - K Money
- Women's Psychological Services, USA
| | - R M C Spencer
- Department of Psychological & Brain Sciences, University of Massachusetts, Amherst, MA, USA
| | - N G Reich
- Department of Biostatistics & Epidemiology, School of Public Health & Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - E R Bertone-Johnson
- Department of Biostatistics & Epidemiology, School of Public Health & Health Sciences, University of Massachusetts, Amherst, MA, USA
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Fountoulakis KN, Savopoulos C, Zannis P, Apostolopoulou M, Fountoukidis I, Kakaletsis N, Kanellos I, Dimellis D, Hyphantis T, Tsikerdekis A, Pompili M, Hatzitolios AI. Climate change but not unemployment explains the changing suicidality in Thessaloniki Greece (2000-2012). J Affect Disord 2016; 193:331-8. [PMID: 26796233 DOI: 10.1016/j.jad.2016.01.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 12/26/2015] [Accepted: 01/08/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Recently there was a debate concerning the etiology behind attempts and completed suicides. The aim of the current study was to search for possible correlations between the rates of attempted and completed suicide and climate variables and regional unemployment per year in the county of Thessaloniki, Macedonia, northern Greece, for the years 2000-12. MATERIAL AND METHODS The regional rates of suicide and attempted suicide as well as regional unemployment were available from previous publications of the authors. The climate variables were calculated from the daily E-OBS gridded dataset which is based on observational data RESULTS Only the male suicide rates correlate significantly with high mean annual temperature but not with unemployment. The multiple linear regression analysis results suggest that temperature is the only variable that determines male suicides and explains 51% of their variance. Unemployment fails to contribute significantly to the model. There seems to be a seasonal distribution for attempts with mean rates being higher for the period from May to October and the rates clearly correlate with temperature. The highest mean rates were observed during May and August and the lowest during December and February. Multiple linear regression analysis suggests that temperature also determines the female attempts rate although the explained variable is significant but very low (3-5%) CONCLUSION Climate variables and specifically high temperature correlate both with suicide and attempted suicide rates but with a different way between males and females. The climate effect was stronger than the effect of unemployment.
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Affiliation(s)
| | - Christos Savopoulos
- 1st Propedeutic Dept of Internal Medicine, School of Medicine, Aristotle University, AHEPA Hospital, Thessaloniki, Greece.
| | - Prodromos Zannis
- Department of Meteorology and Climatology, School of Geology, Aristotle University of Thessaloniki, Greece.
| | | | - Ilias Fountoukidis
- Internal Medicine Department, Agios Pavlos Hospital, Thessaloniki, Greece.
| | - Nikolaos Kakaletsis
- 1st Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital of Thessaloniki, Greece.
| | - Ilias Kanellos
- 1st Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital of Thessaloniki, Greece.
| | - Dimos Dimellis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Greece.
| | - Thomas Hyphantis
- Department of Psychiatry, Ioannina School of Medicine, Ioannina, Greece.
| | - Athanasios Tsikerdekis
- Department of Meteorology and Climatology, School of Geology, Aristotle University of Thessaloniki, Greece.
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Apostolos I Hatzitolios
- 1st Propedeutic Dept of Internal Medicine, School of Medicine, Aristotle University, AHEPA Hospital, Thessaloniki, Greece.
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Fernández-Niño JA, Astudillo-García CI, Bojorquez-Chapela I, Morales-Carmona E, Montoya-Rodriguez AA, Palacio-Mejia LS. The Mexican Cycle of Suicide: A National Analysis of Seasonality, 2000-2013. PLoS One 2016; 11:e0146495. [PMID: 26752641 PMCID: PMC4709116 DOI: 10.1371/journal.pone.0146495] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 12/17/2015] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Suicide is a complex and multifactorial phenomenon with growing importance to public health. An increase in its occurrence has been observed in Mexico over the past 10 years. The present article analyzes the secular trend in suicide at the national level between the years 2000 and 2013. MATERIALS AND METHODS All suicides during the study period (n = 64,298, of which 82.11% were men) were characterized using a spectral decomposition of the time series and a wavelet analysis to evaluate the effect of seasonal changes, type of area (urban versus rural) and sex. RESULTS A seasonal pattern was observed with statistically significant cycles every 12 months, where peaks were identified in May but only for men in urban zones as of the year 2007. In addition, specific days of the year were found to have a higher frequency of suicides, which coincided with holidays (New Year, Mother's Day, Mexican Independence Day and Christmas). CONCLUSION A wavelet analysis can be used to decompose complex time series. To the best of our knowledge, this is the first application of this technique to the study of suicides in developing countries. This analysis enabled identifying a seasonal pattern among urban men in Mexico. The identification of seasonal patterns can help to create primary prevention strategies, increase the dissemination of crisis intervention strategies and promote mental health. These strategies could be emphasized during specific periods of the year and directed towards profiles with a higher risk.
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Affiliation(s)
- Julián Alfredo Fernández-Niño
- Information Center for Decisions in Public Health (CENIDSP), National Institute of Public Health of Mexico, Cuernavaca, Mexico
| | | | | | - Evangelina Morales-Carmona
- Information Center for Decisions in Public Health (CENIDSP), National Institute of Public Health of Mexico, Cuernavaca, Mexico
| | | | - Lina Sofia Palacio-Mejia
- Information Center for Decisions in Public Health (CENIDSP), National Institute of Public Health of Mexico, Cuernavaca, Mexico
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Relationship of suicide rates with climate and economic variables in Europe during 2000-2012. Ann Gen Psychiatry 2016; 15:19. [PMID: 27508001 PMCID: PMC4977895 DOI: 10.1186/s12991-016-0106-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 07/22/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND It is well known that suicidal rates vary considerably among European countries and the reasons for this are unknown, although several theories have been proposed. The effect of economic variables has been extensively studied but not that of climate. METHODS Data from 29 European countries covering the years 2000-2012 and concerning male and female standardized suicidal rates (according to WHO), economic variables (according World Bank) and climate variables were gathered. The statistical analysis included cluster and principal component analysis and categorical regression. RESULTS The derived models explained 62.4 % of the variability of male suicidal rates. Economic variables alone explained 26.9 % and climate variables 37.6 %. For females, the respective figures were 41.7, 11.5 and 28.1 %. Male suicides correlated with high unemployment rate in the frame of high growth rate and high inflation and low GDP per capita, while female suicides correlated negatively with inflation. Both male and female suicides correlated with low temperature. DISCUSSION The current study reports that the climatic effect (cold climate) is stronger than the economic one, but both are present. It seems that in Europe suicidality follows the climate/temperature cline which interestingly is not from south to north but from south to north-east. This raises concerns that climate change could lead to an increase in suicide rates. The current study is essentially the first successful attempt to explain the differences across countries in Europe; however, it is an observational analysis based on aggregate data and thus there is a lack of control for confounders.
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Makris GD, Reutfors J, Larsson R, Isacsson G, Ösby U, Ekbom A, Ekselius L, Papadopoulos FC. Serotonergic medication enhances the association between suicide and sunshine. J Affect Disord 2016; 189:276-81. [PMID: 26454332 DOI: 10.1016/j.jad.2015.09.056] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 09/18/2015] [Accepted: 09/25/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND An association between suicide and sunshine has been reported. The effect of sunshine on hormones and neurotransmitters such as serotonin has been hypothesized to exert a possible triggering effect on susceptible individuals. The aim of this study is to examine if there is an association between sunshine and suicide, adjusting for season, and if such an association differs between individuals on different antidepressants. METHODS By using Swedish Registers and the Swedish Meteorological and Hydrological Institute we obtained information, including forensic data on antidepressive medication for 12,448 suicides and data on monthly sunshine duration. The association between monthly suicide and sunshine hours was examined with Poisson regression analyses while stratifying for sex and age and controlling for time trend and season. These analyses were repeated in different groups of antidepressant treatment. RESULTS We found a significantly increased suicide risk with increasing sunshine in both men and women. This finding disappeared when we adjusted for season. Among both men and women treated with selective serotonin reuptake inhibitors (SSRIs) there was a positive association between sunshine and suicide even after adjustment for season and time trend for suicide. Pair comparisons showed that the sunshine-suicide association was stronger among men treated with SSRIs compared to other antidepressant medications or no medication at all. LIMITATIONS Other meteorological factors were not controlled (i.e. temperature) for in the analyses. CONCLUSIONS There is an enhanced association between sunshine and suicide among those with SSRI medication, even after adjusting for season. This may have interesting theoretical and clinical implications.
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Affiliation(s)
- Georgios D Makris
- Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala University, Uppsala SE-751 85, Sweden.
| | - Johan Reutfors
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Rolf Larsson
- Department of Mathematics, Uppsala University, Uppsala, Sweden
| | - Göran Isacsson
- Department of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Psychiatry, Tiohundra AB, Norrtälje, Sweden
| | - Urban Ösby
- Department of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Psychiatry, Tiohundra AB, Norrtälje, Sweden
| | - Anders Ekbom
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Lisa Ekselius
- Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala University, Uppsala SE-751 85, Sweden
| | - Fotios C Papadopoulos
- Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala University, Uppsala SE-751 85, Sweden
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Abstract
OBJECTIVES Suicide rates have widely been reported to peak in spring and summer. A frequent hypothesis is that increased sunlight exposure alters biological mechanisms. However, few attempts have been made to systematically untangle the putative suicidogenic risk of sunlight exposure from that of seasonality. We examined whether average hours of daily sunlight in a month confer additional risk over month of year when predicting monthly suicide rates. DESIGN Historical population-based ecological longitudinal study. SETTING AND PARTICIPANTS We used 3 longitudinal studies (n=31,060 suicides) with monthly suicide and meteorological data from Greece (1992-2001), Victoria, Australia (1990-1998) and Norway (1969-2009). INTERVENTION We used a negative binomial regression to observe (1) the association of month of year with suicides, adjusting for different sunlight exposures, and (2) the association of sunlight exposure with suicides, adjusting for month of year. We then investigated claims that suicides were associated with daily sunlight exposures, defined by us as 2550 sunlight exposure combinations corresponding to a 1-50 days exposure window with lags of 0-50 days. RESULTS Using monthly data, the association between month of year and suicides remained after adjusting for mean daily hours of sunlight and change in the mean daily hours of sunlight. Adjusted for month of year, the associations between sunlight exposure and suicides became non-significant and attenuated towards the null (the coefficient estimate for mean daily hours of sunlight decreased in absolute magnitude by 72%). The findings were consistent across all 3 cohorts, both when analysed separately and combined. When investigating daily sunlight exposures, we found no significant results after correcting for multiple testing. CONCLUSIONS Using monthly data, the robustness of our month of year effects, combined with the transient and modest nature of our sunlight effects, suggested that the association between sunlight exposure and suicide was a proxy for the association between seasonality and suicide.
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Affiliation(s)
| | - Deborah Azrael
- Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Fotios C Papadopoulos
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
| | - Gavin W Lambert
- Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Matthew Miller
- Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
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Patrick RP, Ames BN. Vitamin D and the omega-3 fatty acids control serotonin synthesis and action, part 2: relevance for ADHD, bipolar disorder, schizophrenia, and impulsive behavior. FASEB J 2015; 29:2207-22. [PMID: 25713056 DOI: 10.1096/fj.14-268342] [Citation(s) in RCA: 291] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/04/2015] [Indexed: 01/22/2023]
Abstract
Serotonin regulates a wide variety of brain functions and behaviors. Here, we synthesize previous findings that serotonin regulates executive function, sensory gating, and social behavior and that attention deficit hyperactivity disorder, bipolar disorder, schizophrenia, and impulsive behavior all share in common defects in these functions. It has remained unclear why supplementation with omega-3 fatty acids and vitamin D improve cognitive function and behavior in these brain disorders. Here, we propose mechanisms by which serotonin synthesis, release, and function in the brain are modulated by vitamin D and the 2 marine omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Brain serotonin is synthesized from tryptophan by tryptophan hydroxylase 2, which is transcriptionally activated by vitamin D hormone. Inadequate levels of vitamin D (∼70% of the population) and omega-3 fatty acids are common, suggesting that brain serotonin synthesis is not optimal. We propose mechanisms by which EPA increases serotonin release from presynaptic neurons by reducing E2 series prostaglandins and DHA influences serotonin receptor action by increasing cell membrane fluidity in postsynaptic neurons. We propose a model whereby insufficient levels of vitamin D, EPA, or DHA, in combination with genetic factors and at key periods during development, would lead to dysfunctional serotonin activation and function and may be one underlying mechanism that contributes to neuropsychiatric disorders and depression. This model suggests that optimizing vitamin D and marine omega-3 fatty acid intake may help prevent and modulate the severity of brain dysfunction.
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Affiliation(s)
- Rhonda P Patrick
- Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, California, USA
| | - Bruce N Ames
- Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, California, USA
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Dixon PG, Sinyor M, Schaffer A, Levitt A, Haney CR, Ellis KN, Sheridan SC. Association of weekly suicide rates with temperature anomalies in two different climate types. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:11627-44. [PMID: 25402561 PMCID: PMC4245634 DOI: 10.3390/ijerph111111627] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 10/27/2014] [Accepted: 11/07/2014] [Indexed: 11/16/2022]
Abstract
Annual suicide deaths outnumber the total deaths from homicide and war combined. Suicide is a complex behavioral endpoint, and a simple cause-and-effect model seems highly unlikely, but relationships with weather could yield important insight into the biopsychosocial mechanisms involved in suicide deaths. This study has been designed to test for a relationship between air temperature and suicide frequency that is consistent enough to offer some predictive abilities. Weekly suicide death totals and anomalies from Toronto, Ontario, Canada (1986-2009) and Jackson, Mississippi, USA (1980-2006) are analyzed for relationships by using temperature anomaly data and a distributed lag nonlinear model. For both analysis methods, anomalously cool weeks show low probabilities of experiencing high-end suicide totals while warmer weeks are more likely to experience high-end suicide totals. This result is consistent for Toronto and Jackson. Weekly suicide totals demonstrate a sufficient association with temperature anomalies to allow some prediction of weeks with or without increased suicide frequency. While this finding alone is unlikely to have immediate clinical implications, these results are an important step toward clarifying the biopsychosocial mechanisms of suicidal behavior through a more nuanced understanding of the relationship between temperature and suicide.
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Affiliation(s)
- P Grady Dixon
- Department of Geosciences, Fort Hays State University, Hays, KS 67601, USA.
| | - Mark Sinyor
- Sunnybrook Health Sciences Centre, Department of Psychiatry, University of Toronto, Toronto, ON M4N 3M5, Canada.
| | - Ayal Schaffer
- Sunnybrook Health Sciences Centre, Department of Psychiatry, University of Toronto, Toronto, ON M4N 3M5, Canada.
| | - Anthony Levitt
- Sunnybrook Health Sciences Centre, Department of Psychiatry, University of Toronto, Toronto, ON M4N 3M5, Canada.
| | - Christa R Haney
- Department of Geosciences, Mississippi State University, Mississippi State, MS 39762, USA.
| | - Kelsey N Ellis
- Department of Geography, University of Tennessee, Knoxville, TN 37996, USA.
| | - Scott C Sheridan
- Department of Geography, Kent State University, Kent, OH 44242, USA.
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Lim AY, Lee AR, Hatim A, Tian-Mei S, Liu CY, Jeon HJ, Udomratn P, Bautista D, Chan E, Liu SI, Chua HC, Hong JP. Clinical and sociodemographic correlates of suicidality in patients with major depressive disorder from six Asian countries. BMC Psychiatry 2014; 14:37. [PMID: 24524225 PMCID: PMC3937022 DOI: 10.1186/1471-244x-14-37] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 02/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND East Asian countries have high suicide rates. However, little is known about clinical and sociodemographic factors associated with suicidality in Asian populations. The aim of this study was to evaluate the factors associated with suicidality in patients with major depressive disorder (MDD) from six Asian countries. METHODS The study cohort consisted of 547 outpatients with MDD. Patients presented to study sites in China (n = 114), South Korea (n = 101), Malaysia (n = 90), Singapore (n = 40), Thailand (n = 103), and Taiwan (n = 99). All patients completed the Mini-International Neuropsychiatric Interview (MINI), the Montgomery-Asberg Depression Rating Scale (MADRS), the Global Severity Index(SCL-90R), the Fatigue Severity Scale, the 36-item short-form health survey, the Sheehan Disability Scale, and the Multidimensional Scale of Perceived Social Support (MSPSS). Patients were classified as showing high suicidality if they scored ≥ 6 on the MINI suicidality module. Multivariate logistic regression analysis was used to examine sociodemographic and clinical factors related to high suicidality. RESULTS One hundred and twenty-five patients were classed as high suicidality. Unemployed status (adjusted odds ratio [OR] 2.43, p < 0.01), MADRS score (adjusted OR 1.08), p < 0.001, and GSI (SCL-90R) score (adjusted OR 1.06, p < 0.01) were positively related to high suicidality. Hindu (adjusted OR 0.09, p < 0.05) or Muslim (adjusted OR 0.21, p < 0.001) religion and MSPSS score (adjusted OR 0.82, p < 0.05) were protective against high suicidality. CONCLUSIONS A variety of sociodemographic and clinical factors were associated with high suicidality in Asian patients with MDD. These factors may facilitate the identification of MDD patients at risk of suicide.
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Affiliation(s)
- Ah-Young Lim
- Department of Psychiatry, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Ah-Rong Lee
- Department of Psychiatry, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Ahmad Hatim
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Si Tian-Mei
- Peking University Institute of Mental Health, Beijing, China
| | - Chia-Yih Liu
- Department of Psychiatry, Chang Gung Medical Center and Chang Gung University, Tao-Yuan County, Taiwan
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Dianne Bautista
- Singapore Clinical Research Institute, Singapore, Singapore,Duke-National University of Singapore, Singapore, Singapore
| | - Edwin Chan
- Singapore Clinical Research Institute, Singapore, Singapore,Duke-National University of Singapore, Singapore, Singapore
| | - Shen-Ing Liu
- Department of Psychiatry, Mackay Memorial Hospital, New Taipei City, Taiwan
| | - Hong Choon Chua
- Institute of Mental Health, Woodbridge Hospital, Singapore, Singapore
| | - Jin Pyo Hong
- Department of Psychiatry, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea.
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Ishii N, Terao T, Araki Y, Kohno K, Mizokami Y, Arasaki M, Iwata N. Risk factors for suicide in Japan: a model of predicting suicide in 2008 by risk factors of 2007. J Affect Disord 2013; 147:352-4. [PMID: 23261137 DOI: 10.1016/j.jad.2012.11.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 11/20/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study aims to comprehensively investigate the causal relationship between suicide and its risk factors in a longitudinal design. METHODS A model was derived in which suicide rate in 2008 was longitudinally and comprehensively predicted by potential risk factors recorded one year before (2007) which included personal and interpersonal factors, medical factors, economic factors, climate factors, alcoholic factors, and ω-3 fatty-acid factors. RESULTS In males, elderly population rate and complete unemployment rate predicted SMR of suicide significantly and positively whereas marriage rate and annual postal savings per person predicted SMR of suicide significantly and negatively. Also in females, complete unemployment rate predicted SMR of suicide significantly and positively whereas annual mean temperature predicted SMR of suicide significantly and negatively. LIMITATIONS The limitations of this study are that predictions are based on the data of only the recent two years, that these epidemiological data cannot be always extrapolated to individuals, and that other factors should be taken into consideration to female suicide. CONCLUSIONS The present findings suggest that male suicide may be accounted for by older age, more complete employment rate, less marriage rate and less annual postal savings whereas female suicide may be accounted for by more complete employment rate and lower annual mean temperature.
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Affiliation(s)
- Nobuyoshi Ishii
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Oita, Japan
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Seasonality of suicidal behavior. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 9:531-47. [PMID: 22470308 PMCID: PMC3315262 DOI: 10.3390/ijerph9020531] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 01/11/2012] [Accepted: 01/26/2012] [Indexed: 11/28/2022]
Abstract
A seasonal suicide peak in spring is highly replicated, but its specific cause is unknown. We reviewed the literature on suicide risk factors which can be associated with seasonal variation of suicide rates, assessing published articles from 1979 to 2011. Such risk factors include environmental determinants, including physical, chemical, and biological factors. We also summarized the influence of potential demographic and clinical characteristics such as age, gender, month of birth, socioeconomic status, methods of prior suicide attempt, and comorbid psychiatric and medical diseases. Comprehensive evaluation of risk factors which could be linked to the seasonal variation in suicide is important, not only to identify the major driving force for the seasonality of suicide, but also could lead to better suicide prevention in general.
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Praschak-Rieder N, Willeit M. Imaging of seasonal affective disorder and seasonality effects on serotonin and dopamine function in the human brain. Curr Top Behav Neurosci 2012; 11:149-167. [PMID: 22218931 DOI: 10.1007/7854_2011_174] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
According to current knowledge, disturbances in brain monoamine transmission play a major role in many psychiatric disorders, and many of the radioligands used for investigating these disorders bind to targets within the brain monoamine systems. However, a phylogenetically ancient and prevailing function of monoamines is to mediate the adaptation of organisms and cells to rhythmical changes in light conditions, and to other environmental rhythms, such as changes in temperature, or the availability of energy resources throughout the seasons. The physiological systems mediating these changes are highly conserved throughout species, including humans. Here we review the literature on seasonal changes in binding of monoaminergic ligands in the human brain. Moreover, we argue for the importance of considering possible effects of season when investigating brain monoamines in healthy subjects and subjects with psychiatric disorders.
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Affiliation(s)
- Nicole Praschak-Rieder
- Department of Biological Psychiatry, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria,
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