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Lim JS, Buckley NA, Cairns R, Schumann J, Schaffer AL, Chitty KM. Substances Detected During Coroner Postmortem Toxicology Analyses in Poisoning- and Nonpoisoning-Related Suicides. JAMA Psychiatry 2023; 80:1121-1130. [PMID: 37494023 PMCID: PMC10372754 DOI: 10.1001/jamapsychiatry.2023.2289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/15/2023] [Indexed: 07/27/2023]
Abstract
Importance Determining the association between drug use and suicide is complicated but can help to inform targeted suicide prevention strategies. Objective To examine the substances prevalent in poisoning- and nonpoisoning-related suicides in Australia. Design, Setting, and Participants This was a multiple-year, cross-sectional study of suicides from July 2013 to October 2019 in Australia with toxicology data available in a national coronial database. The cause of death was classified as poisoning related if any type of poisoning was determined by the coroner to contribute to the cause of death. Prevalence ratios (PRs) were calculated to compare substance detection in poisoning- vs nonpoisoning-related suicides. Data were analyzed from October 2021 to April 2023. Exposures All substances detected in decedents at the time of death according to toxicology reports were recorded. Main Outcome(s) and Measure(s) The most common individual substances and substance classes were identified. From these, blood concentrations of substances of interest were analyzed, and the most commonly occurring combinations of substance classes were listed. Results Toxicology was performed on 13 664 suicide decedents (median [IQR] age, 44 [31-57] years; 10 350 male [76%]). From these, 3397 (25%) were poisoning-related suicides (median [IQR] age, 50 [38-63] years; 2124 male [63%]). The remainder were classified as nonpoisoning-related suicides (median [IQR] age, 42 [29-55] years; 8226 male [80%]). PRs for common medicine classes being detected in poisoning-related suicides compared with nonpoisoning-related suicides were as follows: antidepressants (PR, 1.63; 95% CI, 1.54-1.73), benzodiazepines (PR, 2.01; 95% CI, 1.90-2.13), nonopioid analgesics/anti-inflammatory drugs (PR, 1.88; 95% CI, 1.78-2.00), and opioids (PR, 2.72; 95% CI, 2.58-2.87). Alcohol (as ethanol ≥0.03 g/100 mL) was almost equally prevalent in poisoning- and nonpoisoning-related deaths (PR, 1.07; 95% CI, 1.01-1.14), whereas amphetamines (PR, 0.68; 95% CI, 0.61-0.77) and cannabinoids (PR, 0.67; 95% CI, 0.60-0.74) were detected more often in nonpoisoning-related suicides. Combinations of multiple sedative agents in poisoning-related suicides were common. Conclusions and Relevance Both poisoning- and nonpoisoning-related suicide deaths featured a high prevalence of psychotropic medicines or potential intoxication, which suggests the association of suicide with poor mental health and substance misuse. Findings suggest that substances with a high involvement in poisoning-related suicides should be prescribed cautiously, including antidepressants that are toxic in overdose, sedatives, opioids, and potentially lethal combinations.
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Affiliation(s)
- Jessy S. Lim
- Biomedical Informatics and Digital Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas A. Buckley
- Biomedical Informatics and Digital Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- New South Wales Poisons Information Centre, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Rose Cairns
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- New South Wales Poisons Information Centre, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Jennifer Schumann
- Victorian Institute of Forensic Medicine, Southbank, Melbourne, Victoria, Australia
- Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Andrea L. Schaffer
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Kate M. Chitty
- Biomedical Informatics and Digital Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
- Youth Mental Health, Telethon Kids Institute, Perth, Western Australia, Australia
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Steele ML, Wittenhagen L, Meurk C, Phillips J, Clugston B, Heck P, Waterson E, Heffernan E. Police negotiators and suicide crisis situations: a mixed-methods examination of incident details, characteristics of individuals and precipitating factors. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2023; 31:748-763. [PMID: 39118785 PMCID: PMC11305054 DOI: 10.1080/13218719.2023.2206878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 03/21/2023] [Indexed: 08/10/2024]
Abstract
Police negotiators provide leadership and expertise in the de-escalation and resolution of critical incidents, including responding to individuals exhibiting suicidal behaviour. This study describes the frequency and characteristics of suicide-related negotiation incidents in Queensland, Australia as classified in the Queensland Police Service Negotiator Deployment Database, between 2012 and 2014. Incidents were analysed to understand the individuals involved and precipitating factors including mental health problems and intoxication with alcohol or drugs. Police negotiators were deployed to 156 suicide intervention incidents over a 3-year period, half of which occurred at a residence. The cohort had a median age of 32 years and were predominantly male (82%). Four out of five individuals appeared to have a mental health problem, and at least half were intoxicated due to drugs or alcohol. Findings highlight the importance of strong linkages between police, health and social services and the need for innovative and comprehensive, cross-agency programmes.
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Affiliation(s)
- Megan L. Steele
- Forensic Mental Health Group, Queensland Centre for Mental Health Research, Queensland Health, West Moreton Hospital and Health Service, Wacol, QLD, Australia
- School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - Lisa Wittenhagen
- Forensic Mental Health Group, Queensland Centre for Mental Health Research, Queensland Health, West Moreton Hospital and Health Service, Wacol, QLD, Australia
- School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - Carla Meurk
- Forensic Mental Health Group, Queensland Centre for Mental Health Research, Queensland Health, West Moreton Hospital and Health Service, Wacol, QLD, Australia
- School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - Jane Phillips
- Queensland Forensic Mental Health Service, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Bobbie Clugston
- Forensic Mental Health Group, Queensland Centre for Mental Health Research, Queensland Health, West Moreton Hospital and Health Service, Wacol, QLD, Australia
- School of Public Health, The University of Queensland, Herston, QLD, Australia
- Mental Health Alcohol and Other Drugs Branch, Department of Health, Queensland Health, Brisbane, QLD, Australia
| | - Peter Heck
- Queensland Police Service, QLD, Australia
| | - Elissa Waterson
- Forensic Mental Health Group, Queensland Centre for Mental Health Research, Queensland Health, West Moreton Hospital and Health Service, Wacol, QLD, Australia
- Queensland Forensic Mental Health Service, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Ed Heffernan
- Forensic Mental Health Group, Queensland Centre for Mental Health Research, Queensland Health, West Moreton Hospital and Health Service, Wacol, QLD, Australia
- School of Public Health, The University of Queensland, Herston, QLD, Australia
- Queensland Forensic Mental Health Service, Metro North Hospital and Health Service, Brisbane, QLD, Australia
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Morentin B, Meana JJ, Callado LF. Ethanol and illicit drugs acute use and abuse as risk factors for suicide: A case-control study based on forensic autopsies in the Basque Country, Spain. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023; 16:109-115. [PMID: 37690925 DOI: 10.1016/j.rpsm.2023.02.001] [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: 09/29/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Abuse/dependence and acute use of ethanol and illicit drug are considered risk factors for suicide. The risk is also influenced by demographic conditions and/or psychiatric comorbidity. The aim of the study was to test the association between presence of ethanol, illicit substances and prescribed drugs in suicide decedents and controls. MATERIALS AND METHODS Case-control study of autopsies performed in the Biscay Forensic Pathology Service, Basque Country, Spain from 01/01/2010 to 30/06/2021 in subjects between 15 and 55 years old. Suicide deaths (n=481) with completed autopsy were evaluated. Concurrent natural deaths were chosen as controls (n=330). The risk for suicide according to demographic, toxicological and psychiatric variables was analyzed using logistic regression. RESULTS Ethanol was present in 21% and illicit drugs, mainly cannabis, cocaine and amphetamine, in 27% of suicide deaths. Illicit drugs were more frequent among males. In 63% of suicide cases, prescribed psychotropic drugs were detected. In a multivariate analysis, the main risk factors for suicide were psychiatric diagnosis of illicit drug abuse/dependence (OR=5.56, 95% CI 2.74-11.30) or another mental disease as mood or psychotic disorders (OR=13.05, 95% CI 8.79-19.37). Acute presence of ethanol (OR=4.22, 95% CI 2.52-7.08), recent use of cocaine (OR=2.52, 95% CI 1.05-6.07) and age <35 years (OR=2.50, 95% CI 1.62-3.87) were also associated with suicide deaths. CONCLUSIONS The presence of drugs of abuse in suicide deaths of people ≤55 years old is high. Recent use of ethanol and cocaine is significantly associated with an increased suicide risk. Specific prevention strategies against exposition to substances of abuse should be promoted, especially in psychiatric patients.
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Affiliation(s)
- Benito Morentin
- Basque Institute of Legal Medicine, Bilbao, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain; Department of Medical and Surgical Specialties, University of the Basque Country, UPV/EHU, Leioa, Bizkaia, Spain.
| | - José Javier Meana
- Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain; Department of Pharmacology, University of the Basque Country, UPV/EHU, Leioa, Bizkaia, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Luis Felipe Callado
- Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain; Department of Pharmacology, University of the Basque Country, UPV/EHU, Leioa, Bizkaia, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
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Acute use of alcohol before suicide in Kazakhstan: A population-wide study. J Affect Disord 2023; 321:134-139. [PMID: 36272459 DOI: 10.1016/j.jad.2022.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/27/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Acute use of alcohol is a proximal risk factor for suicidal behavior and suicide attempts. Previous studies have established that alcohol consumption prior to suicide increases the risk of suicide completion. Thus, the current study aims to explore the association between alcohol use and suicide mortality in Kazakhstan. This is the first study to address this association in Kazakhstan. METHODS The main outcome measure was the presence of alcohol in blood of suicide decedents. Logistic regression models were used to test unadjusted and adjusted odds ratios of the risk of suicide involving acute use of alcohol. Regression modeling was used to identify significant predictors of alcohol use among suicide decedents. RESULTS Males (22.5 %) used alcohol more commonly before conducting suicide than females (13.4 %). The odds of alcohol involvement was 2.73 times higher for males compared to females after controlling for age and other covariates. Being a male younger than 45 years old and using suicide methods such as poisoning, immolation, and drowning increased the odds of acute use of alcohol among suicide decedents. LIMITATIONS Data on alcohol use included information only on individuals with a positive alcohol test, and it is unknown how many suicide decedents were not tested for alcohol. CONCLUSIONS Alcohol use is common factor contributing to suicide, particularly among young and middle-aged male adults. Alcohol use is also associated more strongly with certain methods of suicide. Further studies and more detailed data exploring alcohol consumption and suicide risks are needed in countries such as Kazakhstan.
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Abstract
Two years ago, in the early stages of the COVID-19 pandemic, there were widespread and grim predictions of an ensuing suicide epidemic. Not only has this not happened but also by the end of 2021 in the majority of countries and regions with available data, the suicide rates had, if anything, declined. We discuss four reasons why the predictions of suicide models were exaggerated: (1) government intervention reduced the economic and mental costs of lockdowns, (2) the pandemic itself and lockdowns had less of an effect on mental health than assumed, (3) the evidence for a link between economic downturns, distress and suicide is weaker and less consistent than the models assumed and (4) predicting suicide is generally hard. Predictive models have an important place, but their strong modelling assumptions need to acknowledge the inherent high degree of uncertainty which has been further augmented by behavioural responses of pandemic management.
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Affiliation(s)
- Nick Glozier
- Central Clinical School, Faculty of
Medicine and Health, The University of Sydney, Sydney, NSW, Australia,ARC Centre of Excellence for Children
and Families over the Life Course, Indooroopilly, QLD, Australia,Nick Glozier, Central Clinical School,
Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006,
Australia.
| | - Richard Morris
- Central Clinical School, Faculty of
Medicine and Health, The University of Sydney, Sydney, NSW, Australia,ARC Centre of Excellence for Children
and Families over the Life Course, Indooroopilly, QLD, Australia,School of Psychology, Faculty of
Science, The University of Sydney, Sydney, NSW, Australia
| | - Stefanie Schurer
- ARC Centre of Excellence for Children
and Families over the Life Course, Indooroopilly, QLD, Australia,School of Economics, The University of
Sydney, Sydney, NSW, Australia
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Xu P, Sun Y. Risk factors for suicidal attempt in patients with the melancholic subtype of depressive disorder: Implication for nursing care. Medicine (Baltimore) 2022; 101:e29713. [PMID: 35960126 PMCID: PMC9371559 DOI: 10.1097/md.0000000000029713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The incidence of suicide in patients with depressive order is much higher than other population. We aimed to evaluate the current status and risk of suicidal attempt in patients with the melancholic subtype of depressive disorder, to provide evidence for the clinical management and nursing care of depressive disorder. Patients diagnosed as the melancholic subtype of depressive disorder and treated in our hospital from June 1, 2018 to August 31, 2021 were included. The characteristics of included patients were collected and analyzed. Pearson correlation analysis and logistic regression analysis with odd ratio and 95% confidence interval were conducted to analyze the influencing factors of suicidal attempt in patients with the melancholic subtype of depressive disorder. A total of 446 patients with melancholic subtype of depressive disorder were included, the incidence of suicidal attempt was 18.83%. Pearson correlation analysis indicated that gender (R = 0.611), alcohol drinking (R = 0.719), living situation (R = 0.812), number of previous admission to hospital (R = 0.547), sleep disorder (R = 0.612) and frequent depressive episodes (R = 0.559) were all correlated with the suicidal attempt in patients with melancholic subtype of depressive disorder (all P < 0.05). Logistic regression analysis showed that female (OR 3.115, 95%CI 2.493-3.906), alcohol drinking(OR 1.946, 95%CI 1.684-2.763), living alone (OR 2.401, 95%CI 1.915-3.008), number of previous admission to hospital ≥ 3 (OR 2.342, 95%CI 1.601-2.742), sleep disorder (OR 1.821, 95%CI 1.328-2.215) and frequent depressive episodes (OR 3.128, 95%CI 2.421-3.779) were the independent risk factors of suicidal attempt (all P < 0.05). Suicidal attempt is common in the patients with melancholic subtype of depressive disorder, and there are many related risk factors for suicidal attempt in patients with the melancholic subtype of depressive disorder.
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Affiliation(s)
- Pengfei Xu
- Department of Psychiatry, Tianjin Anding Hospital
| | - Ying Sun
- Department of Psychiatry, Tianjin Anding Hospital
- *Correspondence: Ying Sun, No. 13, Liulin Road, Hexi District, Tianjin, China (e-mail: )
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Fitzpatrick SJ, Brew BK, Handley T, Perkins D. Men, suicide, and family and interpersonal violence: A mixed methods exploratory study. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:991-1008. [PMID: 35500037 PMCID: PMC9543582 DOI: 10.1111/1467-9566.13476] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 04/04/2022] [Indexed: 06/14/2023]
Abstract
Research has shown a link between gender, violence, and suicide. This relationship is complex, and few empirical studies have explored suicide and family and interpersonal violence perpetrated by men. Drawing on a coronial dataset of suicide cases and a mixed methods design, this study integrated a quantitative analysis of 155 suicide cases with a qualitative analysis of medico-legal reports from 32 cases. Findings showed different types and patterns of family and intimate partner violence for men who died by suicide. Men used violence in response to conflict, but also to dominate women. Cumulative, interwoven effects of violence, mental illness, alcohol and other drug use, socioeconomic, and psychosocial circumstances were observed in our study population. However, the use of violence and suicidal behaviour was also a deliberate and calculated response by which some men sought to maintain influence or control over women. Health and criminal justice interventions served as short-term responses to violence, mental illness, and suicidal behaviour, but were of limited assistance.
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Affiliation(s)
- Scott J. Fitzpatrick
- Centre for Mental Health ResearchThe Australian National UniversityCanberraAustralia
- Centre for Rural and Remote Mental HealthThe University of NewcastleOrangeAustralia
| | - Bronwyn K. Brew
- National Perinatal Epidemiology and Statistics UnitCentre for Big Data Research in Health and School of Women's and Children's HealthUniversity of New South WalesSydneyAustralia
| | - Tonelle Handley
- Centre for Rural and Remote Mental HealthThe University of NewcastleOrangeAustralia
| | - David Perkins
- Centre for Rural and Remote Mental HealthThe University of NewcastleOrangeAustralia
- Health Research InstituteUniversity of CanberraCanberraAustralia
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A time-series analysis of the association between alcohol and suicide in Australia. Drug Alcohol Depend 2022; 231:109203. [PMID: 34954450 DOI: 10.1016/j.drugalcdep.2021.109203] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION 800,000 people die by suicide every year according to World Health Organisation data. Studies have shown associations between alcohol consumption and suicide, with most demonstrating that alcohol consumption increases suicide risk. However, some studies from high consumption countries show results in the opposite direction. This present study examines the association between per capita (PC) alcohol consumption and same year suicide mortality in Australia, and tests for lag effects, between 1910 and 2017. MATERIALS AND METHODS Age and gender-specific autoregressive integrated moving average (ARIMA) models were used to examine associations between alcohol consumption PC and suicide mortality rates. Associations between unemployment, divorce, barbiturates access, and the Great Depression and World War II, and suicide were examined. RESULTS A 10% increase in PC alcohol consumption was associated with a 5% and 5.1% decrease in overall and male suicide mortality respectively in the same year. However, a 10% increase in PC alcohol consumption was associated with an 5.1% and 5.4% increase in overall and male suicide mortality respectively 12 years later. This association differed among age groups and was significant in the male population only. Unemployment, divorce, the Great Depression and WW2, and barbiturates access were significantly associated with same year suicide mortality. DISCUSSION Contemporaneous alcohol consumption was associated with decreased suicide mortality, but was also associated with an increased risk of suicide 12 years later. Unemployment and barbiturates access were associated with an increased risk of suicide. Interventions and policies that address chronic alcohol consumption and support the unemployed may reduce suicide mortality.
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Fitzpatrick SJ, Handley T, Powell N, Read D, Inder KJ, Perkins D, Brew BK. Suicide in rural Australia: A retrospective study of mental health problems, health-seeking and service utilisation. PLoS One 2021; 16:e0245271. [PMID: 34288909 PMCID: PMC8294514 DOI: 10.1371/journal.pone.0245271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/02/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Suicide rates are higher in rural Australia than in major cities, although the factors contributing to this are not well understood. This study highlights trends in suicide and examines the prevalence of mental health problems and service utilisation of non-Indigenous Australians by geographic remoteness in rural Australia. METHODS A retrospective study of National Coronial Information System data of intentional self-harm deaths in rural New South Wales, Queensland, South Australia and Tasmania for 2010-2015 from the National Coronial Information System. RESULTS There were 3163 closed cases of intentional self-harm deaths by non-Indigenous Australians for the period 2010-2015. The suicide rate of 12.7 deaths per 100,000 persons was 11% higher than the national Australian rate and increased with remoteness. Among people who died by suicide, up to 56% had a diagnosed mental illness, and a further 24% had undiagnosed symptoms. Reported diagnoses of mental illness decreased with remoteness, as did treatment for mental illness, particularly in men. The most reported diagnoses were mood disorders (70%), psychotic disorders (9%) and anxiety disorders (8%). In the six weeks before suicide, 22% of cases had visited any type of health service at least once, and 6% had visited two or more services. Medication alone accounted for 76% of all cases treated. CONCLUSIONS Higher suicide rates in rural areas, which increase with remoteness, may be attributable to decreasing diagnosis and treatment of mental disorders, particularly in men. Less availability of mental health specialists coupled with socio-demographic factors within more remote areas may contribute to lower mental health diagnoses and treatment. Despite an emphasis on improving health-seeking and service accessibility in rural Australia, research is needed to determine factors related to the under-utilisation of services and treatment by specific groups vulnerable to death by suicide.
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Affiliation(s)
- Scott J. Fitzpatrick
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia
| | - Tonelle Handley
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia
| | - Nic Powell
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia
| | - Donna Read
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia
| | - Kerry J. Inder
- School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia
| | - David Perkins
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia
| | - Bronwyn K. Brew
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women and Children’s Health, University of New South Wales, Sydney, Australia
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Hurzeler T, Buckley NA, Noghrehchi F, Malouf P, Page A, Schumann JL, Chitty KM. Alcohol-related suicide across Australia: a geospatial analysis. Aust N Z J Public Health 2021; 45:394-399. [PMID: 34097331 DOI: 10.1111/1753-6405.13122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 03/01/2021] [Accepted: 04/01/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The acute effects of alcohol consumption are a major risk factor for suicide. Positive blood alcohol concentrations are present in almost one-third of all suicides at time of death. These suicides are defined as alcohol-related suicides. This cross-sectional study examines the geospatial distribution/clustering of high proportions of alcohol-related suicides and reports on socioeconomic and demographic risk factors. METHODS National Coronial Information System (NCIS) data were used to calculate proportions of suicides with alcohol present at the time of death for each level 3 statistical areas (SA3) in Australia. A density analysis and hotspot cluster analysis were used to visualise and establish statistically significant clustering of areas with higher (hotspots) and lower (coldspots) proportions. Subsequently, socioeconomic and demographic risk factors for alcohol use and suicide were reported on for hot and cold spots. RESULTS Significant clustering of areas with higher proportions of alcohol-related suicide occurred in northern Western Australia, the Northern Territory and Queensland, as well as inland New South Wales and inland Queensland. Clustering of SA3s with significantly lower proportions occurred in major city and inner regional Sydney and Melbourne. Conclusion and implications for public health: Results from this study identify areas in which prevention strategies should target alcohol use and can be used to inform prevention strategy design. Additionally, hotspots and coldspots identified in this study can be used for further analysis to better understand contextual risk factors for alcohol-related suicide.
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Affiliation(s)
- Tristan Hurzeler
- Faculty of Medicine and Health, Discipline of Pharmacology, Translational Australian Clinical Toxicology Program, The University of Sydney, New South Wales.,Discipline of Addiction Medicine, Central Clinical School, Sydney Medical School, The University of Sydney, New South Wales
| | - Nicholas A Buckley
- Faculty of Medicine and Health, Discipline of Pharmacology, Translational Australian Clinical Toxicology Program, The University of Sydney, New South Wales
| | - Firouzeh Noghrehchi
- Faculty of Medicine and Health, Discipline of Pharmacology, Translational Australian Clinical Toxicology Program, The University of Sydney, New South Wales
| | - Peter Malouf
- Discipline of Indigenous Health and Discipline of Addiction Medicine, Centre of Research Excellence in Indigenous Health and Alcohol, Sydney Medical School, The University of Sydney, New South Wales
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, New South Wales
| | - Jennifer L Schumann
- Victorian Institute of Forensic Medicine, Department of Forensic Medicine, Monash University, Victoria
| | - Kate M Chitty
- Faculty of Medicine and Health, Discipline of Pharmacology, Translational Australian Clinical Toxicology Program, The University of Sydney, New South Wales
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11
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Chitty KM, Schumann JL, Moran LL, Chong DG, Hurzeler TP, Buckley NA. Reporting of alcohol as a contributor to death in Australian national suicide statistics and its relationship to post-mortem alcohol concentrations. Addiction 2021; 116:506-513. [PMID: 32621553 DOI: 10.1111/add.15180] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/10/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
AIM To describe the assignment of International Classification of Disease (ICD)-10 alcohol codes as underlying or contributory causes of death by the Australian Bureau of Statistics during mortality coding for suicides according to the blood alcohol concentration (BAC) detected at autopsy. DESIGN Population-based case-series descriptive analysis. SETTING AND PARTICIPANTS Data for all alcohol-related (Alc+) suicide deaths (aged 15+) in Australia from 2010-2015 (n = 3132) from the National Coronial Information System. MEASUREMENTS Alc+ suicides were categorised as those with a post-mortem BAC ≥0.05 g/100 mL. The outcome variable was whether the case was assigned an ICD-10 alcohol code (F10.0-F10.9, R78.0, T51, X45 and/or X65). We estimated OR for the assignment of codes in Alc+ suicides using BAC as the key predictor. We also examined several covariates that have been implicated in the risk of Alc+ suicides. FINDINGS An ICD-10 alcohol code was assigned during the mortality coding process in 47.6% (n = 1491) of Alc+ suicides. Higher BAC was associated with higher odds of having a code assigned; cases with a BAC over 0.20 g/100 mL over were twice as likely to have an alcohol code assigned (adjusted OR [AOR] = 2.06, 95% CI = 1.59, 2.67) compared with cases with a BAC of 0.050-0.075 g/100 mL. Compared with New South Wales, higher likelihood of code assignment was found in Northern Territory (AOR = 3.85, 95% CI = 2.32, 6.63) and Western Australia (AOR = 2.89, 95% CI = 2.27, 3.68). Compared with 15-24 year olds, 25-44 (AOR = 0.79, 95% CI = 0.63, 0.99) and 65-84 year olds (AOR = 0.63, 95% CI = 0.43, 0.93) were less likely to have a code assigned. CONCLUSIONS An ICD-10 alcohol code was not assigned as an underlying or contributory cause of death in over half of suicides in Australia (2010-2015) with a BAC ≥0.05 g/100 mL. The higher the BAC detected at autopsy, the more likely cases were to be assigned an alcohol code during the mortality coding process.
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Affiliation(s)
- Kate M Chitty
- The University of Sydney Faculty of Medicine and Health, Discipline of Pharmacology, Translational Australian Clinical Toxicology Program, Sydney, NSW, 2006, Australia
| | - Jennifer L Schumann
- Victorian Institute of Forensic Medicine, Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
| | - Lauren L Moran
- Australian Bureau of Statistics, Health and Vital Statistics Section, Brisbane, Queensland, 4000, Australia
| | - Daniel G Chong
- The University of Sydney Faculty of Medicine and Health, Discipline of Pharmacology, Translational Australian Clinical Toxicology Program, Sydney, NSW, 2006, Australia
| | - Tristan P Hurzeler
- The University of Sydney Faculty of Medicine and Health, Discipline of Pharmacology, Translational Australian Clinical Toxicology Program, Sydney, NSW, 2006, Australia
| | - Nicholas A Buckley
- The University of Sydney Faculty of Medicine and Health, Discipline of Pharmacology, Translational Australian Clinical Toxicology Program, Sydney, NSW, 2006, Australia
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