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Krysinska K, Andriessen K, Bandara P, Reifels L, Flego A, Page A, Schlichthorst M, Pirkis J, Mihalopoulos C, Khanh-Dao Le L. The Cost-Effectiveness of Psychosocial Interventions Following Self-Harm in Australia. CRISIS 2024; 45:118-127. [PMID: 37904498 DOI: 10.1027/0227-5910/a000926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Background: Psychosocial interventions following self-harm in adults, in particular cognitive behavioral therapy (CBT), can be effective in lowering the risk of repeated self-harm. Aims: To evaluate the cost-effectiveness of CBT for reducing repeated self-harm in the Australian context. Method: The current study adopted the accessing cost-effectiveness (ACE) approach using return-on-investment (ROI) analysis. Uncertainty and sensitivity analyses (Sas) tested the robustness of the model outputs to changes in three assumptions: general practitioner referral pathway (SA1), private setting intervention delivery (SA2), and training costs (SA3). Results: The intervention produced cost savings of A$ 46M (95% UI -223.7 to 73.3) and A$ 18.3M (95% UI -86.2 to 24.6), subject to the effect of intervention lasting 2- or 1-year follow-up. The ROI ratio reduced to 5.22 in SA1 (95% UI -10.1 to 27.9), 2.5 in SA2 (95% UI -4.8 to 13.3), and 5.1 in SA3 (95% UI -9.8 to 27.8). Limitations: We assumed that the effectiveness would reduce 50% within 5 years in the base case, and we used Australian data and a partial social perspective. Conclusions: The current study demonstrated cost-effectiveness of CBT for adults who have self-harmed with the return-on-investment ratio of A$ 2.3 to $6.0 for every A$ 1 invested.
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Affiliation(s)
- Karolina Krysinska
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
| | - Karl Andriessen
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
| | - Piumee Bandara
- Translational Health Research Institute, Western Sydney University, NSW, Australia
| | - Lennart Reifels
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
| | - Anna Flego
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, NSW, Australia
| | - Marisa Schlichthorst
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Health Economics Division, Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Long Khanh-Dao Le
- Health Economics Division, Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Kim C, Bai Y, Dusing GJ, Nielsen A, Chum A. The impact of minimum wage increase on suicidal ideation in South Korea: a difference-in-differences analysis using nationally representative panel data. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02646-w. [PMID: 38429540 DOI: 10.1007/s00127-024-02646-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 02/20/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND South Korea had the highest suicide rates in the OECD and one of the largest (16.4%) increases in the minimum wage in 2018. Prior studies have provided evidence that increases in minimum wage reduce suicide rates in the population, but no study examined the effects of the policy change on individual-level suicidal behaviour. METHODS Our study sample was built using the 2015-2019 waves of the Korean Welfare Panel Survey, a population-representative longitudinal survey. The sample consisted of 5146 participants, including those earning above minimum wage (control) and minimum wage earners (treatment) based on their 2018/19 earnings. The outcome of the study was suicidal ideation, which is an important precursor to other suicidal behaviours, and was captured using self-reported measures. We examined the impact of the 2018 minimum wage hike in Korea on suicidal ideation, using a difference-in-differences design. RESULTS The minimum wage increase was associated with a 1.6% points reduction (95% CI: -2.8% to -0.5%) in self-reported suicidal ideation. Stronger policy effects were shown among women and older age groups. CONCLUSIONS Our study demonstrates that public policies employing a population-based approach, such as increasing minimum wages, could serve as an effective intervention to mitigate suicidal ideation among low-income workers.
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Affiliation(s)
- Chungah Kim
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Yihong Bai
- Department of Economics, McMaster University, Hamilton, ON, Canada
- Western University Ontario, London, Canada
| | - Gabriel John Dusing
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Andrew Nielsen
- Canadian Institute for Health Information, Ottawa, ON, Canada
| | - Antony Chum
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada.
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Le LKD, Flego A, Krysinska K, Andriessen K, Bandara P, Page A, Schlichthorst M, Pirkis J, Mihalopoulos C, Carter G, Reifels L. Modelling the cost-effectiveness of brief aftercare interventions following hospital-treated self-harm. BJPsych Open 2023; 9:e139. [PMID: 37525591 PMCID: PMC10486225 DOI: 10.1192/bjo.2023.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 05/31/2023] [Accepted: 06/14/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Prior self-harm represents the most significant risk factor for future self-harm or suicide. AIM To evaluate the cost-effectiveness of a theoretical brief aftercare intervention (involving brief follow-up contact, care coordination and safety planning), following a hospital-treated self-harm episode, for reducing repeated self-harm within the Australian context. METHOD We employed economic modelling techniques to undertake: (a) a return-on-investment analysis, which compared the cost-savings generated by the intervention with the overall cost of implementing the intervention; and (b) a cost-utility analysis, which compared the net costs of the intervention with health outcomes measured in quality-adjusted life years (QALYs). We considered cost offsets associated with hospital admission for self-harm and the cost of suicide over a period of 10 years in the base case analysis. Uncertainty and one-way sensitivity analyses were also conducted. RESULTS The brief aftercare intervention resulted in net cost-savings of AUD$7.5 M (95% uncertainty interval: -56.2 M to 15.1 M) and was associated with a gain of 222 (95% uncertainty interval: 45 to 563) QALYs over a 10-year period. The estimated return-on-investment ratio for the intervention's modelled cost in relation to cost-savings was 1.58 (95% uncertainty interval: -0.17 to 5.33). Eighty-seven per cent of uncertainty iterations showed that the intervention could be considered cost-effective, either through cost-savings or with an acceptable cost-effectiveness ratio of 50 000 per QALY gained. The results remained robust across sensitivity analyses. CONCLUSIONS A theoretical brief aftercare intervention is highly likely to be cost-effective for preventing suicide and self-harm among individuals with a history of self-harm.
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Affiliation(s)
- Long Khanh-Dao Le
- Health Economics Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anna Flego
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Karolina Krysinska
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Karl Andriessen
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Piumee Bandara
- Translational Health Research Institute, Western Sydney University, New South Wales, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, New South Wales, Australia
| | - Marisa Schlichthorst
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Cathrine Mihalopoulos
- Health Economics Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Greg Carter
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Lennart Reifels
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
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Turner BJ, Switzer AC, Welch BE, Legg NK, Gregory MA, Phiri P, Rathod S, Paterson TS. Psychological mediators of the associations between pandemic-related stressors and suicidal ideation across three periods of the COVID-19 pandemic in Canada. J Affect Disord 2023; 324:566-575. [PMID: 36584705 PMCID: PMC9794401 DOI: 10.1016/j.jad.2022.12.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 12/15/2022] [Accepted: 12/18/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND The COVID-19 pandemic's mental health impact is well-established. While early evidence suggested suicide deaths remained stable or declined, suicidal ideation (SI) became more prevalent than before the pandemic. Our study: (1) examined the prevalence and distribution of SI among Canadian adults, (2) compared SI among those with and without pre-existing mental illnesses, and (3) evaluated associations between pandemic-related stressors (i.e., unemployment, insecure employment, loss of income, medical vulnerability, COVID-19 exposure) with SI, and whether such associations were mediated by depression, thwarted belongingness, perceived burdensomeness, or perceived discrimination. METHODS The sample was comprised of data gathered at three timepoints (Wave 1 08/18/2020-10/01/2020, n = 6629; Wave 2 12/21/2020-03/31/2021, n = 5920; Wave 3 09/07/2021-12/07/2021, n = 7354). Quota-based responses from survey research panels which matched the geographic, age, and sex distribution of the Canadian population were supplemented with convenience-sampled responses. RESULTS The prevalence of SI was 4.1 % (Wave 1), 5.3 % (Wave 2), and 5.8 % (Wave 3). Odds of SI were higher for respondents under the age of 35 years and with pre-existing mental illnesses. SI was associated with quarantining due to suspected or confirmed COVID-19 exposure, potential COVID-19 exposure at work, medical vulnerability toward COVID-19, insecure employment or unemployment, and income loss. These associations were mediated by psychological experiences, particularly depression and thwarted belongingness. LIMITATIONS This cross-sectional, observational study cannot establish temporality or causality. CONCLUSION Results highlight groups who may benefit from enhanced screening for depression and suicide risk. Reducing depression and increasing sense of belonging should be prioritized.
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Affiliation(s)
- Brianna J. Turner
- Department of Psychology, University of Victoria, Victoria, BC, Canada,Corresponding author at: Department of Psychology, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2, Canada
| | - Andrew C. Switzer
- Department of Psychology, University of Victoria, Victoria, BC, Canada
| | - Brooke E. Welch
- Department of Psychology, University of Victoria, Victoria, BC, Canada
| | - Nicole K. Legg
- Department of Psychology, University of Victoria, Victoria, BC, Canada
| | | | - Peter Phiri
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, UK,School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Shanaya Rathod
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, UK,Faculty of Science, University of Portsmouth, UK
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Disability weights for castration-resistant prostate cancer: an empirical investigation. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2022; 9:146-154. [PMID: 36628321 PMCID: PMC9668063 DOI: 10.33393/grhta.2022.2431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Health state valuation and diagnostic-therapeutic pathways at the junction between non-metastatic and metastatic castration-resistant prostate cancer (CRPC) are not well documented. We aimed at: (i) estimating the disability weights (DWs) for health states across a continuum of disease from asymptomatic non-metastatic (nmCRPC) to symptomatic metastatic state (mCRPC); (ii) mapping the diagnostic-therapeutic pathway of nmCRPC in Italy. Methods Structured qualitative interviews were performed with clinical experts to gather information on nmCRPC clinical pathway. An online survey was administered to clinical experts to estimate DWs for four CRPC health states defined from interviews and literature review (i.e., nmCRPC, asymptomatic mCRPC, symptomatic mCRPC, mCRPC in progression during or after chemotherapy). Clinicians' preferences for health states were elicited using the Person-Trade-Off (PTO) and Visual Analogue Scale (VAS) methods. DWs associated with each health state, from 0 (best imaginable health state) and 1 (worst imaginable health state), were estimated. Results We found that the management of nmCRPC is heterogeneous across Italian regions and hospitals, especially with respect to diagnostic imaging techniques. DWs for PTO ranged from 0.415 (95% confidence interval [CI] 0.208-0.623) in nmCRPC to 0.740 (95% CI 0.560-0.920) in mCRPC, in progression during or after chemotherapy. DWs for VAS ranged between 0.246 (95% CI 0.131-0.361) in nmCRPC to 0.689 (95% CI 0.583-0.795) in mCRPC, in progression during or after chemotherapy. Conclusions Estimated DWs suggest that delaying transition to a metastatic state might ease the disease burden at both patient and societal levels.
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Zhou J, Zhou J, Feng L, Feng Y, Xiao L, Chen X, Yang J, Wang G. The associations between depressive symptoms, functional impairment, and quality of life, in patients with major depression: undirected and Bayesian network analyses. Psychol Med 2022; 53:1-13. [PMID: 36349712 PMCID: PMC10600944 DOI: 10.1017/s0033291722003385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 09/29/2022] [Accepted: 10/07/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Depressive symptoms, functional impairment, and decreased quality of life (QOL) are three important domains of major depressive disorder (MDD). However, the possible causal relationship between these factors has yet to be elucidated. Moreover, it is not known whether certain symptoms of MDD are more impairing than others. The network approach is a promising solution to these shortfalls. METHODS The baseline data of a multicenter prospective project conducted in 11 governances of China were analyzed. In total, 1385 patients with MDD were included. Depressive symptoms, functioning disability, and QOL were evaluated by the 17-item Hamilton Depression Rating Scale (HAMD-17), the Sheehan Disability Scale (SDS), and the Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF). The network was estimated through the graphical Least Absolute Shrinkage and Selection Operator (LASSO) technique in combination with the directed acyclic graph. RESULTS Three centrality metrics of the graphical LASSO showed that social life dysfunction, QOL, and late insomnia exhibited the highest strength centrality. The network accuracy and stability were estimated to be robust and stable. The Bayesian network indicated that some depressive symptoms were directly associated with QOL, while other depressive symptoms showed an indirect association with QOL mediated by impaired function. Depressed mood was positioned at the highest level in the model and predicted the activation of functional impairment and anxiety. CONCLUSIONS Functional disability mediated the relationship between depressive symptoms and QOL. Family functionality and suicidal symptoms were directly related to QOL. Depressed mood played the predominant role in activating both anxiety symptom and functional impairment.
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Affiliation(s)
- Jia Zhou
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jingjing Zhou
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Lei Feng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yuan Feng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Le Xiao
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xu Chen
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jian Yang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Gang Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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Hedley D, Batterham PJ, Bury SM, Clapperton A, Denney K, Dissanayake C, Fox P, Frazier TW, Gallagher E, Hayward SM, Robinson J, Sahin E, Trollor J, Uljarević M, Stokes MA. The Suicidal Ideation Attributes Scale-Modified (SIDAS-M): Development and preliminary validation of a new scale for the measurement of suicidal ideation in autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 27:1115-1131. [PMID: 36237153 DOI: 10.1177/13623613221131234] [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: 11/15/2022]
Abstract
LAY ABSTRACT Autistic people may be at higher risk of suicidal behavior than people in the general population. Suicidal behavior may include thinking about suicide or attempting to end one's own life by suicide. It is important to identify autistic people who may be thinking about suicide. People who are at risk of suicidal behavior can be identified by asking questions about whether they have been thinking about suicide. A specially designed questionnaire, or screening instrument, can help someone ask the best questions to find out if someone has been thinking about suicide. This information can help to identify supports to be put in place to prevent suicidal behavior, such as a suicide attempt. However, autistic people may interpret questions differently than non-autistic people. It is important to use screening tools that have been designed with, and for autistic people. In this study, we examined the Suicidal Ideation Attributes Scale (SIDAS). The SIDAS is an existing tool that was developed to screen for suicidal thinking in the general population. We modified SIDAS for use with autistic adults. We involved autistic people in the process of modifying SIDAS. We called the modified instrument the SIDAS-M. The results of our study showed SIDAS-M may be useful for screening for suicidal thinking in autistic adults who do not have an intellectual disability.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Jo Robinson
- The University of Melbourne, Australia.,Orygen, Australia
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Alfonso YN, Bishai D, Ivanich JD, O'Keefe VM, Usher J, Aldridge LR, Haroz EE, Goklish N, Barlow A, Cwik M. Suicide Ideation and Depression Quality of Life Ratings in a Reservation-Based Community of Native American Youths and Young Adults. Community Ment Health J 2022; 58:779-787. [PMID: 34455531 PMCID: PMC8933312 DOI: 10.1007/s10597-021-00883-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 08/19/2021] [Indexed: 01/12/2023]
Abstract
Suicide among adolescents is a significant public health concern in the U.S., especially within American Indian and Alaska Native (AIAN) communities. Lack of quality of life (QoL) estimates for both suicide ideation and depression specific to the AIAN population hinders the ability to compare interventions in cost-effectiveness analysis. We surveyed 200 AI youth and young adults from the Fort Apache Indian Reservation to estimate utility weights for experiencing suicide ideation and depression. Our results indicate that, on a scale of 0-100, with higher scores indicating better health, the general community rates both suicide ideation and depression at 15.8 and 25.1, respectively. These weights are statistically significantly different and lower than for other cultures. Culturally specific QoL values will allow the comparison and identification of the most effective and feasible interventions to reduce the suicide burden among tribal communities.
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Affiliation(s)
- Y N Alfonso
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - D Bishai
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - J D Ivanich
- Department of Community and Behavioral Health, Colorado School of Public Health, 13055 East 17th Avenue, Aurora, CO, 80045, USA
| | - V M O'Keefe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - J Usher
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - L R Aldridge
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - E E Haroz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - N Goklish
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - A Barlow
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - M Cwik
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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Charalampous P, Polinder S, Wothge J, von der Lippe E, Haagsma JA. A systematic literature review of disability weights measurement studies: evolution of methodological choices. Arch Public Health 2022; 80:91. [PMID: 35331325 PMCID: PMC8944058 DOI: 10.1186/s13690-022-00860-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/18/2022] [Indexed: 12/13/2022] Open
Abstract
Background The disability weight is an essential factor to estimate the healthy time that is lost due to living with a certain state of illness. A 2014 review showed a considerable variation in methods used to derive disability weights. Since then, several sets of disability weights have been developed. This systematic review aimed to provide an updated and comparative overview of the methodological design choices and surveying techniques that have been used in disability weights measurement studies and how they evolved over time. Methods A literature search was conducted in multiple international databases (early-1990 to mid-2021). Records were screened according to pre-defined eligibility criteria. The quality of the included disability weights measurement studies was assessed using the Checklist for Reporting Valuation Studies (CREATE) instrument. Studies were collated by characteristics and methodological design approaches. Data extraction was performed by one reviewer and discussed with a second. Results Forty-six unique disability weights measurement studies met our eligibility criteria. More than half (n = 27; 59%) of the identified studies assessed disability weights for multiple ill-health outcomes. Thirty studies (65%) described the health states using disease-specific descriptions or a combination of a disease-specific descriptions and generic-preference instruments. The percentage of studies obtaining health preferences from a population-based panel increased from 14% (2004–2011) to 32% (2012–2021). None of the disability weight studies published in the past 10 years used the annual profile approach. Most studies performed panel-meetings to obtain disability weights data. Conclusions Our review reveals that a methodological uniformity between national and GBD disability weights studies increased, especially from 2010 onwards. Over years, more studies used disease-specific health state descriptions in line with those of the GBD study, panel from general populations, and data from web-based surveys and/or household surveys. There is, however, a wide variation in valuation techniques that were used to derive disability weights at national-level and that persisted over time. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00860-z.
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Affiliation(s)
- Periklis Charalampous
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jördis Wothge
- German Environment Agency, Section Noise Abatement of Industrial Plants and Products, Noise Impact, Wörlitzer Pl. 1, 06844, Dessau-Roßlau, Germany
| | - Elena von der Lippe
- Department of Epidemiology and Health Monitorin, Robert Koch Institute, Berlin, Germany
| | - Juanita A Haagsma
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Erevik EK, Landrø H, Mattson ÅL, Kristensen JH, Kaur P, Pallesen S. Problem Gaming and Suicidality: A Systematic Literature Review. Addict Behav Rep 2022; 15:100419. [PMID: 35340768 PMCID: PMC8943245 DOI: 10.1016/j.abrep.2022.100419] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/27/2022] [Accepted: 03/08/2022] [Indexed: 11/24/2022] Open
Abstract
This is the first review on the association between problem gaming and suicidality. 12 studies were identified, all of which found a positive association. Future studies should investigate the causality and mechanisms in the relationship.
Background No studies have so far synthesised the current evidence concerning a possible relationship between problem gaming and suicidality. We therefore conducted a systematic review of the literature. Our objective was to investigate the relationship between problem gaming and suicidality. The review was funded by the Norwegian Competence Center for Gambling and Gaming Research. Methods The review was pre-registered in PROSPERO International prospective register of systematic reviews (CRD42021279774). Searches were conducted in Web of Science, PsycINFO, EMBASE, PubMed and Google Scholar, September 2021. Studies that reported data on the relationship between problem gaming and suicidality, published between 2000 and 2021, and written in any European language were included. Studies investigating internet addiction/problematic internet use and not problem gaming, specifically, and studies investigating mental health in general or mental health outcomes other than suicidality, were excluded. Data from the included studies were extracted independently by two coders who also evaluated for risk of bias using the Newcastle-Ottawa Quality Assessment Scale. The results from each included study were presented in a table. Results A total of 12 cross-sectional studies, with in total 88,732 participants, were included in the review. In total 10 studies investigated the association between problem gaming and suicidal ideation. One of these also investigated the association between problem gaming and suicide attempts. Two studies combined suicidal ideation and suicide attempts into one variable and investigated the association between that variable and problem gaming. In total 11 of the 12 included studies found positive, crude associations between problem gaming and suicidal ideation/attempts. Five studies adjusted for possible confounding variables. Three of these still found significant associations between problem gaming and suicidal ideation, one found a positive but not statistically significant association, and the fifth found an inverse, non-significant association. Discussion The current findings indicate that there is an association between problem gaming and suicidal ideation, and likely between problem gaming and suicide attempts. The most important limitation of the included studies is the lack of longitudinal designs. Future studies should aim to investigate the causality and mechanisms in the relationships using more stringent designs.
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11
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Batterham PJ, Calear AL, Shou Y, Farrer LM, Gulliver A, McCallum SM, Dawel A. Effects of the COVID-19 pandemic on suicidal ideation in a representative Australian population sample-Longitudinal cohort study. J Affect Disord 2022; 300:385-391. [PMID: 34995704 PMCID: PMC8735855 DOI: 10.1016/j.jad.2022.01.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 11/22/2021] [Accepted: 01/02/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The direct and indirect mental health impacts of the COVID-19 pandemic are considerable. However, it is unclear how suicidal ideation was affected in communities during the acute lockdown phase of the pandemic, and over the longer-term. This study provides longitudinal data on the prevalence of, and risk factors for, suicidal ideation in the Australian national population, during the pandemic. METHOD The Australian National COVID-19 Mental Health and Risk Communication Survey assessed a nationally representative sample of Australian adults (N = 1296) fortnightly for 12 weeks from late-March to June 2020 (7 waves), and again in March 2021 (wave 8). Cox proportional hazards models examined demographic and pandemic-related risk factors for suicidal ideation over time. RESULTS Prevalence of suicidal ideation was high but steady at ∼18% across the acute lockdown phase of the pandemic, and 16.2% in March 2021. People who had direct experience with COVID-19 (tested, diagnosed, or contact with someone who was diagnosed) had increased risk for suicidal ideation. Higher pandemic-related work and social impairment, recent adversity, loneliness, and being younger were also associated with increased risk of suicidal ideation over time. CONCLUSION Both the direct and indirect impacts of COVID-19 were associated with increased risk for suicidal ideation over time, although prevalence did not vary over time. The high prevalence of suicidal ideation in our sample flags a critical need for accessible mental health support, and findings provide insights into the factors placing people at risk during the pandemic.
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Affiliation(s)
- Philip J. Batterham
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra Australia,Corresponding author
| | - Alison L. Calear
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra Australia
| | - Yiyun Shou
- Research School of Psychology, The Australian National University, Canberra Australia
| | - Louise M. Farrer
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra Australia
| | - Amelia Gulliver
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra Australia
| | - Sonia M. McCallum
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra Australia
| | - Amy Dawel
- Research School of Psychology, The Australian National University, Canberra Australia
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Use of Ecological Momentary Assessment to Study Suicidal Thoughts and Behavior: a Systematic Review. Curr Psychiatry Rep 2021; 23:41. [PMID: 34003405 DOI: 10.1007/s11920-021-01255-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Ecological momentary assessment (EMA) is a recently introduced approach to patient evaluation that consists of asking patients questions in real time and in their usual habitat. This method seeks to contribute to suicide prevention by providing psychiatrists with detailed information about suicidal thoughts and behavior, how these fluctuate over short periods of time, and the short-term risk factors presented by patients. We conducted a systematic review of published research using EMA to study suicidal thoughts and behavior. RECENT FINDINGS Several systematic reviews of EMA in mental health have been conducted to date, and the literature contains numerous theoretical papers and compilations on EMA and suicide phenomena. To date, however, no systematic reviews have explored the use of this tool to study suicidal thoughts and behavior. We performed a systematic review of five databases (i.e., PubMed, Embase, Scopus, Web of Science, and PsycINFO) to identify studies on EMA and suicidal thoughts and behavior. An initial search revealed 544 articles. Following the study selection process, 35 studies were included in the review. Almost three-quarters of the studies were published in the last 4 years. The studies reviewed concluded that EMA was generally feasible and well accepted. EMA findings correlated well with the results of a retrospective assessment, though tended to over-represent symptom severity. Our review points to important aspects of suicidal thoughts and behavior, such as its wide fluctuation over short periods of time. Negative affect and disturbed sleep, among others, emerged as short-term predictors of suicidal thoughts and behavior. Therefore, EMA is a potentially useful tool in clinical practice, although not without drawbacks, such as participant fatigue with questionnaires and ethical concerns.
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13
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Salagre E, Grande I, Jiménez E, Mezquida G, Cuesta MJ, Llorente C, Amoretti S, Lobo A, González-Pinto A, Carballo JJ, Corripio I, Verdolini N, Castro-Fornieles J, Legido T, Carvalho AF, Vieta E, Bernardo M. Trajectories of suicidal ideation after first-episode psychosis: a growth mixture modeling approach. Acta Psychiatr Scand 2021; 143:418-433. [PMID: 33501646 DOI: 10.1111/acps.13279] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/08/2021] [Accepted: 01/20/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The period immediately after the onset of first-episode psychosis (FEP) may present with high risk for suicidal ideation (SI) and attempts, although this risk may differ among patients. Thus, we aimed to identify trajectories of SI in a 2-years follow-up FEP cohort and to assess baseline predictors and clinical/functional evolution for each trajectory of SI. METHODS We included 334 FEP participants with data on SI. Growth mixture modeling was used to identify trajectories of SI. Putative sociodemographic, clinical, and cognitive predictors of the distinct trajectories were examined using multinomial logistic regression. RESULTS We identified three distinct trajectories: Non-SI trajectory (85.53% sample), Improving SI trajectory (9.58%), and Worsening SI trajectory (6.89%). Multinomial logistic regression model revealed that greater baseline pessimistic thoughts, anhedonia, and worse perceived family environment were associated with higher baseline SI followed by an Improving trajectory. Older age, longer duration of untreated psychosis, and reduced sleep predicted Worsening SI trajectory. Regarding clinical/functional evolution, individuals within the Improving SI trajectory displayed moderate depression at baseline which ameliorated during the study period, while the Worsening SI subgroup exhibited persistent mild depressive symptoms and greater functional impairment at follow-up assessments. CONCLUSION Our findings delineated three distinct trajectories of SI among participants with FEP, one experiencing no SI, another in which SI might depend on acute depressive symptomatology, and a last subset where SI might be associated with mild but persistent clinical and functional impairments. These data provide insights for the early identification and tailored treatment of suicide in this at-risk population.
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Affiliation(s)
- Estela Salagre
- Bipolar and Depressive Disorders Unit, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Iria Grande
- Bipolar and Depressive Disorders Unit, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Esther Jiménez
- Bipolar and Depressive Disorders Unit, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Complejo Hospitalario de Navarra, Instituto de Investigaciones Sanitarias de Navarra (IdiSNa), Pamplona, Spain
| | - Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Instituto de Investigaciones Sanitarias de Navarra (IdiSNa), Pamplona, Spain
| | - Cloe Llorente
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañon, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Sílvia Amoretti
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Madrid, Spain.,August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Antonio Lobo
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - Ana González-Pinto
- Department of Psychiatry, Hospital Universitario de Alava, BIOARABA Health Research Institute, University of the Basque Country, Vitoria, Spain
| | - Juan José Carballo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañon, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Iluminada Corripio
- Department of Psychiatry, Biomedical Research Institute Sant Pau (IIB-SANT PAU), Hospital Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Norma Verdolini
- Bipolar and Depressive Disorders Unit, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, Clinic Institute of Neurosciences, Hospital Clínic de Barcelona, 2017SGR881, CIBERSAM, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Teresa Legido
- Neuroscience Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, the Centre for Addiction and Mental Health, Toronto, ON, Canada.,The IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Miquel Bernardo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Madrid, Spain.,August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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López-Steinmetz LC, Godoy JC, Fong SB, López-Steinmetz RL. Factors Increasing Suicidal Risk in Young Argentinean College Students With and Without Suicide Attempt History. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00517-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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15
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Mulholland H, McIntyre JC, Haines-Delmont A, Whittington R, Comerford T, Corcoran R. Investigation to identify individual socioeconomic and health determinants of suicidal ideation using responses to a cross-sectional, community-based public health survey. BMJ Open 2021; 11:e035252. [PMID: 33542033 PMCID: PMC7868260 DOI: 10.1136/bmjopen-2019-035252] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To address a gap in knowledge by simultaneously assessing a broad spectrum of individual socioeconomic and potential health determinants of suicidal ideation (SI) using validated measures in a large UK representative community sample. DESIGN In this cross-sectional design, participants were recruited via random area probability sampling to participate in a comprehensive public health survey. The questionnaire examined demographic, health and socioeconomic factors. Logistic regression analysis was employed to identify predictors of SI. SETTING Community setting from high (n=20) and low (n=8) deprivation neighbourhoods across the North West of England, UK. PARTICIPANTS 4319 people were recruited between August 2015 and January 2016. There were 809 participants from low-deprivation neighbourhoods and 3510 from high-deprivation neighbourhoods. The sample comprised 1854 (43%) men and 2465 (57%) women. PRIMARY OUTCOME MEASURES SI was the dependent variable which was assessed using item 9 of the Patient Health Questionnaire-9 instrument. RESULTS 454 (11%) participants reported having SI within the last 2 weeks. Model 1 (excluding mental health variables) identified younger age, black and minority ethnic (BME) background, lower housing quality and current smoker status as key predictors of SI. Higher self-esteem, empathy and neighbourhood belonging, alcohol abstinence and having arthritis were protective against SI. Model 2 (including mental health variables) found depression and having cancer as key health predictors for SI, while identifying as lesbian, gay, bisexual, transgender or queer (LGBTQ) and BME were significant demographic predictors. Alcohol abstinence, having arthritis and higher empathy levels were protective against SI. CONCLUSIONS This study suggests that it could be useful to increase community support and sense of belonging using a public health approach for vulnerable groups (e.g. those with cancer) and peer support for people who identify as LGBTQ and/or BME. Also, interventions aimed at increasing empathic functioning may prove effective for reducing SI.
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Affiliation(s)
- Helen Mulholland
- Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Jason C McIntyre
- Natural Sciences and Psychology, Liverpool John Moores University, Liverpool, Merseyside, UK
| | - Alina Haines-Delmont
- Department of Nursing, Manchester Metropolitan University, Manchester, Greater Manchester, UK
| | - Richard Whittington
- Brøset Centre for Research and Education in Forensic Psychiatry, St. Olav's Hospital and Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Terence Comerford
- National Institute for Health Research Applied Research Collaboration North West Coast (NIHR ARC NWC), University of Liverpool, Liverpool, UK
| | - Rhiannon Corcoran
- Primary Care and Mental Health, University of Liverpool, Liverpool, UK
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16
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Rohr JC, Rufino KA, Alfano CA, Patriquin MA. Sleep disturbance in patients in an inpatient hospital mediates relationship between PTSD and suicidal ideation. J Psychiatr Res 2021; 133:174-180. [PMID: 33348251 DOI: 10.1016/j.jpsychires.2020.12.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/12/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
A common reason for admission to inpatient psychiatric units is suicidal ideation. Growing evidence of the link between sleep disturbance and suicidal ideation brings an interest in greater clarity of the pathways; this paper focused on post-traumatic stress disorder (PTSD), which carries increased risk for both sleep disturbance and suicidal ideation, as well as sex differences in those pathways. Patients were 2822 inpatients studied at admission to an inpatient psychiatric hospital and mediation analyses were used to examine pathways of interest. There was an indirect effect of PTSD on suicidal ideation through sleep disturbances for the entire sample and for men and women separately. The effect for men was larger than that for women, suggesting a stronger effect for sleep disturbance in the relationship for men. For women only, the direct effect between PTSD and suicidal ideation remained significant after mediation. Sleep disturbance plays an important role in the relationship between PTSD and suicidal ideation. Early identification of sleep disturbance in inpatients and targeted focus of sleep in conjunction with resolving trauma-related symptoms may help reduce suicidal ideation. This may be especially true of men; the indirect effect was smaller for women, suggesting that sleep disturbance should be addressed in conjunction with other PTSD symptoms likely leading to suicidal ideation.
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Affiliation(s)
- Jessica C Rohr
- The Menninger Clinic, 12301 S. Main St., Houston TX 77035, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Houston TX 77030, USA.
| | - Katrina A Rufino
- The Menninger Clinic, 12301 S. Main St., Houston TX 77035, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Houston TX 77030, USA; The University of Houston Downtown, 1 Main St., Houston TX 77002, USA
| | - Candice A Alfano
- Sleep and Anxiety Center of Houston, University of Houston, 4505 Cullen Blvd., Houston TX 77204, USA
| | - Michelle A Patriquin
- The Menninger Clinic, 12301 S. Main St., Houston TX 77035, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Houston TX 77030, USA; Michaeld E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd, Houston, TX, 77030, USA
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17
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Kang HJ, Kim JW, Lee JY, Kim SW, Shin IS, Hong YJ, Ahn Y, Jeong MH, Kim JM. Time-Specific Associations of Tumor Necrosis Factor-α Levels and Polymorphisms (-850 C/T or -308 G/A) With Suicidal Ideation in Acute Coronary Syndrome Patients. Front Psychiatry 2021; 12:739823. [PMID: 34630187 PMCID: PMC8496737 DOI: 10.3389/fpsyt.2021.739823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/17/2021] [Indexed: 01/02/2023] Open
Abstract
Background: Considering the association of inflammation with suicide and acute coronary syndrome (ACS), we investigated the individual and interactive effects of serum tumor necrosis factor-alpha (sTNFα) levels and two polymorphisms (-850 C/T and -308 G/A) on suicidal ideation (SI) after ACS. Methods: The SI status using items on the Montgomery-Åsberg Depression Rating Scale (MADRS), related covariates including sociodemographic and clinical characteristics, sTNFα levels, and tumor necrosis factor-alpha (TNF-α) polymorphisms were evaluated in 969 patients within 2 weeks after ACS. Of the patients, 711 were evaluated 1 year later for SI. Multivariate logistic regression models were used to calculate individual and interactive associations after adjusting for the covariates. Results: Higher (vs. lower) sTNFα levels and the -850 C/T or T/T (vs. C/C) polymorphism were significantly associated with SI 2 weeks after ACS, while only higher sTNFα levels were significantly associated with SI after 1 year. Significant interactive effects were detected between sTNFα (higher) levels and the -850 C/T (C/C or C/T) polymorphism on SI 2 weeks after ACS and between the two (-850 CC or CT and -308 G/A or AA) polymorphisms on SI 1 year after ACS. Conclusions: The sTNFα level and two polymorphisms (-850C/T and -308 G/A), separately or in combination, could be time-specific biomarkers for SI in ACS. Focused interventions for ACS patients at risk of SI might reduce the suicidal burden in patients with ACS.
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Affiliation(s)
- Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Il-Seon Shin
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Medical School, Gwangju, South Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Medical School, Gwangju, South Korea
| | - Myung-Ho Jeong
- Department of Cardiology, Chonnam National University Medical School, Gwangju, South Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
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18
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Mellesdal L, Kroken R, Lutro O, Wentzel-Larsen T, Kjelby E, Oedegaard K, Jørgensen H, Mehlum L. Self-harm induced somatic admission after discharge from psychiatric hospital – a prospective cohort study. Eur Psychiatry 2020; 29:246-52. [DOI: 10.1016/j.eurpsy.2013.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 06/04/2013] [Accepted: 06/30/2013] [Indexed: 11/29/2022] Open
Abstract
AbstractBackground:Few studies have examined rate and predictors of self-harm in discharged psychiatric patients.Aims:To investigate the rate, coding, timing, predictors and characteristics of self-harm induced somatic admission after discharge from psychiatric acute admission.Method:Cohort study of 2827 unselected patients consecutively admitted to a psychiatric acute ward during three years. Mean observation period was 2.3 years. Combined register linkage and manual data examination. Cox regression was used to investigate covariates for time to somatic admission due to self-harm, with covariates changing during follow-up entered time dependently.Results:During the observation period, 10.5% of the patients had 792 somatic self-harm admissions. Strongest risk factors were psychiatric admission due to non-suicidal self-harm, suicide attempt and suicide ideation. The risk was increased throughout the first year of follow-up, during readmission, with increasing outpatient consultations and in patients diagnosed with recurrent depression, personality disorders, substance use disorders and anxiety/stress-related disorders. Only 49% of the somatic self-harm admissions were given hospital self-harm diagnosis.Conclusions:Self-harm induced somatic admissions were highly prevalent during the first year after discharge from acute psychiatric admission. Underdiagnosing of self-harm in relation to somatic self-harm admissions may cause incorrect follow-up treatments and unreliable register data.
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Lebenbaum M, Cheng J, de Oliveira C, Kurdyak P, Zaheer J, Hancock-Howard R, Coyte PC. Evaluating the Cost Effectiveness of a Suicide Prevention Campaign Implemented in Ontario, Canada. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:189-201. [PMID: 31535350 DOI: 10.1007/s40258-019-00511-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Although suicide-prevention campaigns have been implemented in numerous countries, Canada has yet to implement a strategy nationally. This is the first study to examine the cost utility of the implementation of a multidimensional suicide-prevention program that combines several interventions over a 50-year time horizon. METHODS We used Markov modeling to capture the dynamic changes to health status and estimate the incremental cost per quality-adjusted life-year gained over a 50-year period for Ontario residents for a suicide-prevention strategy compared to no intervention. The strategy consisted of a package of interventions geared towards preventing suicide including a public health awareness campaign, increased identification of individuals at risk, increased training of primary-care physicians, and increased treatment post-suicide attempt. Four health states were captured by the Markov model: (1) alive and no recent suicide attempt; (2) suicide attempt; (3) death by suicide; (4) death (other than suicide). Analyses were from a societal perspective where all costs, irrespective of payer, were included. We used a probabilistic analysis to test the robustness of the model results to both variation and uncertainty in model parameters. RESULTS Over the 50-year period, the suicide-prevention campaign had an incremental cost-effectiveness ratio (ICER) of $18,853 (values are in Canadian dollars) per QALY gained. In all one-way sensitivity analyses, the ICER remained under $50,000/QALY. In the probabilistic analysis, there was a probability of 94.8% that the campaign was cost effective at a willingness-to-pay of $50,000/QALY (95% confidence interval of ICER probabilistic distribution: 2650-62,375). Among the current population, the intervention was predicted to result in the prevention of 4454 suicides after 50 years (1033 by year 10; 2803 by year 25). A healthcare payer perspective sensitivity analysis showed an ICER of $21,096.14/QALY. INTERPRETATION These findings demonstrate that a suicide-prevention campaign in Ontario is very likely a cost-effective intervention to reduce the incidence of suicide and suggest suicide-prevention campaigns are likely to be cost effective for some other Canadian provinces and potentially other countries.
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Affiliation(s)
- Michael Lebenbaum
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada.
| | - Joyce Cheng
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada.
- Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON, Canada.
| | - Claire de Oliveira
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada
- Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - Paul Kurdyak
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada
- ICES, Toronto, ON, Canada
- Health Outcomes and Performance Evaluation, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Juveria Zaheer
- Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Rebecca Hancock-Howard
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada
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van Spijker BAJ, Batterham PJ, Calear AL, Wong QJJ, Werner-Seidler A, Christensen H. Self-reported disability and quality of life in an online Australian community sample with suicidal thoughts. J Affect Disord 2020; 263:707-714. [PMID: 31787424 DOI: 10.1016/j.jad.2019.11.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 05/22/2019] [Accepted: 11/10/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Limited research has been conducted to quantify the level of disability and health related quality of life (HRQoL) associated with suicidal thoughts and behaviour. The aims of the current study were to (1) describe levels of disability and HRQoL in an Australian sample of adults with suicidal ideation, (2) examine the effect of zero, one, or more than one previous suicide attempt on disability and HRQoL, and (3) describe the demographic and clinical characteristics associated with disability and HRQoL. METHOD Data for the current study is drawn from the baseline assessment of the Healthy Thinking trial that evaluated the effectiveness of an online self-help program for suicidal thoughts in an Australian adult community sample (n = 418). Measures of disability, quality of life, clinical symptoms, suicidality and demographic variables were included. RESULTS The mean disability score for the overall sample was 19.2 (SD = =8.9), while the mean perceived physical health score was 40.7 (SD = =6.5) and the mean perceived mental health score was 36.1 (SD = =5.9). Higher levels of disability and lower levels of perceived physical health were associated with multiple suicide attempts compared to one or no history of suicide attempt. LIMITATIONS Limitations included the limited generalisability of results, the use of self-report to assess suicide attempts, and the use of cross-sectional data. CONCLUSION Suicidal thoughts and behaviours are associated with high levels disability and low levels of perceived physical and mental health. Early intervention programs are needed to reduce the high levels of burden associated with suicidality.
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Affiliation(s)
- Bregje A J van Spijker
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Alison L Calear
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia.
| | - Quincy J J Wong
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia; School of Social Sciences and Psychology, Western Sydney University, Sydney, NSW, Australia
| | | | - Helen Christensen
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
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21
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Obegi JH. Is suicidality a mental disorder? Applying DSM-5 guidelines for new diagnoses. DEATH STUDIES 2019; 45:638-650. [PMID: 31588867 DOI: 10.1080/07481187.2019.1671546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Suicidality-specific diagnoses have been proposed recently, but suicidologists are only just beginning to evaluate their merits. To advance this discussion, I introduce the term suicidal syndrome to describe the underlying entity, present a rationale for why a formal diagnosis is necessary, define the major features of the syndrome, and show how the syndrome could meet the requirements for new diagnostic candidates used in the development of the DSM-5. Against this backdrop, I examine common objections to a suicidality-specific diagnosis. Finally, I discuss several challenges with the creation of new diagnostic entities as they apply to suicidal syndrome.
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Affiliation(s)
- Joseph H Obegi
- California Department of Corrections and Rehabilitation, California Medical Facility, Vacaville, California, USA
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Bomyea J, Stout DM, Simmons AN. Attenuated prefrontal and temporal neural activity during working memory as a potential biomarker of suicidal ideation in veterans with PTSD. J Affect Disord 2019; 257:607-614. [PMID: 31349177 DOI: 10.1016/j.jad.2019.07.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 04/05/2019] [Accepted: 07/04/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Suicide is a significant health concern among veterans, and suicidal ideation is a common and functionally debilitating condition that frequently precedes suicidal behavior. Characterizing neurobiological substrates associated with suicidal ideation in veterans may inform evaluation of risk for this population. Associations between suicidal ideation and functional abnormalities in prefrontal, temporal, and striatal regions supporting cognitive task performance have been documented in individuals with mood and psychotic disorders, suggesting a potential role for neurocognitive vulnerabilities in this condition. To date, however, relatively little research has explored neural correlates of suicidal ideation, particularly among individuals with posttraumatic stress disorder (PTSD). METHODS Twenty three combat veterans diagnosed with PTSD completed an adapted Reading Span (Rspan) working memory task during functional magnetic resonance imaging (fMRI). Participants were classified based on presence of current SI. We evaluated differences between these groups on neural activation in response to interference-based working memory demands within the task. Primary analyses were conducted using a voxel-wise between-group t-test. RESULTS Task-based activations were observed in regions including the cingulate, middle frontal, parietal, and occipital cortex, striatum, and cerebellum. Relative to individuals without SI, individuals with SI demonstrated less activation in a large region spanning the lateral prefrontal cortex and cingulate cortex, as well as the inferior temporal cortex, in response to interference demands. CONCLUSIONS Results are consistent with models proposing that prefrontal neural substrates involved in cognitive regulation are implicated in suicidal ideation. Involvement of temporal functioning may also exist based on current findings. Future research is needed to understand whether disturbances in prefrontal regulatory control reflect a specific profile subtype with distinct neural correlates, and how such neural patterns may be used to improve detection and treatment personalization.
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Affiliation(s)
- J Bomyea
- VA San Diego Healthcare System Center of Excellence for Stress and Mental Health, University of California, San Diego, United States.
| | - D M Stout
- VA San Diego Healthcare System Center of Excellence for Stress and Mental Health, University of California, San Diego, United States
| | - A N Simmons
- VA San Diego Healthcare System Center of Excellence for Stress and Mental Health, University of California, San Diego, United States
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Quinlivan L, Steeg S, Elvidge J, Nowland R, Davies L, Hawton K, Gunnell D, Kapur N. Risk assessment scales to predict risk of hospital treated repeat self-harm: A cost-effectiveness modelling analysis. J Affect Disord 2019; 249:208-215. [PMID: 30772749 DOI: 10.1016/j.jad.2019.02.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/16/2019] [Accepted: 02/11/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Risk scales are used widely for assessing individuals presenting to Emergency Departments (EDs) following self-harm. There is growing evidence that risk scales have limited clinical utility in identifying episodes at highest risk of repeat self-harm. However, their cost-effectiveness in terms of treatment allocation and subsequent repeat self-harm is unknown. We aimed to examine the cost-effectiveness of five risk scales (SAD PERSONS Scale, Modified SAD PERSONS Scale, ReACT Self-Harm Rule, Manchester Self-Harm Rule, Barratt Impulsivity Scale) and single item clinician and patient ratings of risk. METHOD Quality-Adjusted Life Years were estimated for each episode. The five risk scales and the patient rating were compared to the clinician rating. Incremental cost-effectiveness ratios (ICERs) were estimated for each scale, using a range of ICER thresholds. Sensitivity analysis explored different model assumptions. RESULTS The formal scales were less cost-effective than the clinician and patient ratings across a range of ICER thresholds (£0-£30,000). The five scales were also less cost-effective than the clinician rating in most alternative scenario analyses. However, the clinician rating would be likely to result in unnecessary treatment costs for over half of patients identified as high risk. LIMITATIONS Our primary model depended on the assumption that high-intensity care reduced patients' risk of further self-harm. CONCLUSION The use of formal assessment tools for managing self-harm presentations to EDs did not appear to be cost-effective. While the judgement of a mental health clinician was found to be slightly more cost-effective, it still resulted in incorrect allocation of costs and missed treatment opportunities.
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Affiliation(s)
- Leah Quinlivan
- NIHR Greater Manchester Patient Safety Translational Research Centre, United Kingdom; Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building Oxford Road, Manchester M13 9PL, United Kingdom.
| | - Sarah Steeg
- Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building Oxford Road, Manchester M13 9PL, United Kingdom.
| | - Jamie Elvidge
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, United Kingdom
| | - Rebecca Nowland
- Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building Oxford Road, Manchester M13 9PL, United Kingdom
| | - Linda Davies
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, United Kingdom
| | - Keith Hawton
- Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford, United Kingdom
| | - David Gunnell
- School of Social and Community Medicine, University of Bristol, United Kingdom; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, United Kingdom
| | - Nav Kapur
- NIHR Greater Manchester Patient Safety Translational Research Centre, United Kingdom; Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building Oxford Road, Manchester M13 9PL, United Kingdom; Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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Fereidouni Z, Behnammoghadam M, Jahanfar A, Dehghan A. The Effect of Eye Movement Desensitization and Reprocessing (EMDR) on the severity of suicidal thoughts in patients with major depressive disorder: a randomized controlled trial. Neuropsychiatr Dis Treat 2019; 15:2459-2466. [PMID: 31695382 PMCID: PMC6717728 DOI: 10.2147/ndt.s210757] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/12/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Depression is a major risk factor for suicide and more than 90% of people who attempt suicide suffer from depression. The present study aimed to investigate the effect of eye movement desensitization and reprocessing (EMDR) therapy on the severity of suicidal thoughts in patients with major depressive disorder. STUDY DESIGN Randomized Clinical Trial. METHODS This clinical trial was performed on 70 people with major depressive disorder who exhibited suicidal thoughts. The patients were selected via convenience sampling and were randomly divided into control (n=35) and experimental (n=35) groups. EMDR was performed individually in the experimental group for 45-90 min, 3 days per week, on alternate days, for 3 weeks (9 sessions in total), whereas the controls group received routine treatment without intervention. Both groups completed the Beck Scale for Suicide Ideation (BSSI) at pre- and post-test. The obtained data were analyzed with descriptive and inferential statistics using SPSS 22 (α=0.05). RESULTS Mean BSSI score for the experimental group was reduced significantly at post-test (11.11±4.15) compared to pre-test (26.48±5.74) (p<0.001). Although the control group's mean BSSI score was also reduced at post-test (24.93±4.42) compared to pre-test (26.68±5.05), this difference was not statistically significant (p>0.05). CONCLUSION EMDR therapy has been shown in this study to reduce the severity of suicidal feelings. Therefore, it can be recommended as an alternative treatment method for reducing the severity of suicidal thoughts in patients with major depressive disorder.
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Affiliation(s)
- Zhila Fereidouni
- Department of Medical Surgical Nursing, Nursing School, Fasa University of Medical Sciences, Fasa, Iran
| | | | - Abdolhadi Jahanfar
- Department of Medical Surgical Nursing, Nursing School, Fasa University of Medical Sciences, Fasa, Iran
| | - Azizallah Dehghan
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
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Efstathiou V, Papadopoulou A, Christodoulou C, Gournellis R, Michopoulos I, Ferentinos P, Papageorgiou C, Douzenis A. The Relationship between Hopelessness and Clinical Characteristics of Hospitalized Patients with Recent Suicide Attempt. Issues Ment Health Nurs 2018; 39:876-882. [PMID: 30252555 DOI: 10.1080/01612840.2018.1491656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study aimed to assess hopelessness in 170 hospitalized individuals with recent suicide attempt and examine its association with patients' characteristics, with a view to improving awareness in health professionals and especially nurses, who are among the first to take care of these patients. Participants completed Beck Hopelessness Scale and Beck Depression Inventory. More than half (51.18%) experienced moderate-to-severe hopelessness. A multiple linear regression analysis showed that age, attempted suicide method, past suicide attempt, and psychiatric diagnosis contributed statistically significantly to hopelessness prediction. Hopelessness assessment could efficiently help health professionals to minimize both inpatient suicide and suicidal acts after discharge.
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Affiliation(s)
- Vasiliki Efstathiou
- a Second Department of Psychiatry , National and Kapodistrian University of Athens, Medical School "Attikon" University General Hospital , Athens , Greece
| | - Athanasia Papadopoulou
- a Second Department of Psychiatry , National and Kapodistrian University of Athens, Medical School "Attikon" University General Hospital , Athens , Greece
| | - Christos Christodoulou
- a Second Department of Psychiatry , National and Kapodistrian University of Athens, Medical School "Attikon" University General Hospital , Athens , Greece
| | - Rossetos Gournellis
- a Second Department of Psychiatry , National and Kapodistrian University of Athens, Medical School "Attikon" University General Hospital , Athens , Greece
| | - Ioannis Michopoulos
- a Second Department of Psychiatry , National and Kapodistrian University of Athens, Medical School "Attikon" University General Hospital , Athens , Greece
| | - Panagiotis Ferentinos
- a Second Department of Psychiatry , National and Kapodistrian University of Athens, Medical School "Attikon" University General Hospital , Athens , Greece
| | - Charalabos Papageorgiou
- b First Department of Psychiatry , National and Kapodistrian University of Athens, Medical School, "Eginition" Hospital , Athens , Greece
| | - Athanassios Douzenis
- a Second Department of Psychiatry , National and Kapodistrian University of Athens, Medical School "Attikon" University General Hospital , Athens , Greece
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Kang HJ, Bae KY, Kim SW, Shin IS, Hong YJ, Ahn Y, Jeong MH, Yoon JS, Kim JM. BDNF Methylation and Suicidal Ideation in Patients with Acute Coronary Syndrome. Psychiatry Investig 2018; 15:1094-1097. [PMID: 30380818 PMCID: PMC6259000 DOI: 10.30773/pi.2018.09.20] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/20/2018] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Patients with acute coronary syndrome (ACS) are at an increased risk of suicide. It is well known that epigenetic mechanisms may explain the pathophysiology of suicidal behavior including suicidal ideation (SI), but no study has explored these mechanisms in ACS populations. METHODS In total, 969 patients were initially recruited within 2 weeks of the acute coronary event and, 711 patients were successfully followed up 1 year after ACS. SI was evaluated using the relevant items on the Montgomery-Åsberg Depression Rating Scale and covariates potentially affecting SI were estimated. RESULTS Brain-derived neurotrophic factor (BDNF) hypermethylation was associated with SI in both the acute and chronic phases of ACS, although the association was not statistically significant in the acute phase after applying Bonferroni's correction. CONCLUSION These results suggested that BDNF hypermethylation may have played a role in an epigenetic predisposition for SI in ACS patients, particularly during the chronic phase.
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Affiliation(s)
- Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Kyung-Yeol Bae
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Il-Seon Shin
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jin-Sang Yoon
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
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Iorfino F, Davenport TA, Ospina-Pinillos L, Hermens DF, Cross S, Burns J, Hickie IB. Using New and Emerging Technologies to Identify and Respond to Suicidality Among Help-Seeking Young People: A Cross-Sectional Study. J Med Internet Res 2017; 19:e247. [PMID: 28701290 PMCID: PMC5529742 DOI: 10.2196/jmir.7897] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 05/26/2017] [Accepted: 05/26/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Suicidal thoughts are common among young people presenting to face-to-face and online mental health services. The early detection and rapid response to these suicidal thoughts and other suicidal behaviors is a priority for suicide prevention and early intervention efforts internationally. Establishing how best to use new and emerging technologies to facilitate person-centered systematic assessment and early intervention for suicidality is crucial to these efforts. OBJECTIVE The aim of this study was to examine the use of a suicidality escalation protocol to respond to suicidality among help-seeking young people. METHODS A total of 232 young people in the age range of 16-25 years were recruited from either a primary mental health care service or online in the community. Each young person used the Synergy Online System and completed an initial clinical assessment online before their face-to-face or online clinical appointment. A suicidality escalation protocol was used to identify and respond to current and previous suicidal thoughts and behaviors. RESULTS A total of 153 young people (66%, 153/232) reported some degree of suicidality and were provided with a real-time alert online. Further levels of escalation (email or phone contact and clinical review) were initiated for the 35 young people (15%, 35/232) reporting high suicidality. Higher levels of psychological distress (P<.001) and a current alcohol or substance use problem (P=.02) predicted any level of suicidality compared with no suicidality. Furthermore, predictors of high suicidality compared with low suicidality were higher levels of psychological distress (P=.01), psychosis-like symptoms in the last 12 months (P=.01), a previous mental health problem (P=.01), and a history of suicide planning or attempts (P=.001). CONCLUSIONS This study demonstrates the use of new and emerging technologies to facilitate the systematic assessment and detection of help-seeking young people presenting with suicidality. This protocol empowered the young person by suggesting pathways to care that were based on their current needs. The protocol also enabled an appropriate and timely response from service providers for young people reporting high suicidality that was associated with additional comorbid issues, including psychosis-like symptoms, and a history of suicide plans and attempts.
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Affiliation(s)
- Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | | | | | - Daniel F Hermens
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Shane Cross
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Jane Burns
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
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28
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Steckling N, Devleesschauwer B, Winkelnkemper J, Fischer F, Ericson B, Krämer A, Hornberg C, Fuller R, Plass D, Bose-O'Reilly S. Disability Weights for Chronic Mercury Intoxication Resulting from Gold Mining Activities: Results from an Online Pairwise Comparisons Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14010057. [PMID: 28075395 PMCID: PMC5295308 DOI: 10.3390/ijerph14010057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/15/2016] [Accepted: 01/03/2017] [Indexed: 10/26/2022]
Abstract
In artisanal small-scale gold mining, mercury is used for gold-extraction, putting miners and nearby residents at risk of chronic metallic mercury vapor intoxication (CMMVI). Burden of disease (BoD) analyses allow the estimation of the public health relevance of CMMVI, but until now there have been no specific CMMVI disability weights (DWs). The objective is to derive DWs for moderate and severe CMMVI. Disease-specific and generic health state descriptions of 18 diseases were used in a pairwise comparison survey. Mercury and BoD experts were invited to participate in an online survey. Data were analyzed using probit regression. Local regression was used to make the DWs comparable to the Global Burden of Disease (GBD) study. Alternative survey (visual analogue scale) and data analyses approaches (linear interpolation) were evaluated in scenario analyses. A total of 105 participants completed the questionnaire. DWs for moderate and severe CMMVI were 0.368 (0.261-0.484) and 0.588 (0.193-0.907), respectively. Scenario analyses resulted in higher mean values. The results are limited by the sample size, group of interviewees, questionnaire extent, and lack of generally accepted health state descriptions. DWs were derived to improve the data basis of mercury-related BoD estimates, providing useful information for policy-making. Integration of the results into the GBD DWs enhances comparability.
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Affiliation(s)
- Nadine Steckling
- Unit Paediatric Environmental Epidemiology, WHO Collaborating Centre for Occupational Health, Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich, Ziemssenstr. 1, Munich 80336, Germany.
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Center I, Hall in Tyrol 6060, Austria.
- Department of Environment & Health, School of Public Health, Bielefeld University, Universitätsstr. 25, Bielefeld 33615, Germany.
| | - Brecht Devleesschauwer
- Department of Public Health and Surveillance, Scientific Institute of Public Health (WIV-ISP), Rue Juliette Wytsmanstraat 14, Brussels 1050, Belgium.
| | - Julia Winkelnkemper
- Department of Public Health Medicine, School of Public Health, Bielefeld University, Universitätsstr. 25, Bielefeld 33615, Germany.
| | - Florian Fischer
- Department of Public Health Medicine, School of Public Health, Bielefeld University, Universitätsstr. 25, Bielefeld 33615, Germany.
| | - Bret Ericson
- Pure Earth, Formerly Blacksmith Institute, 475 Riverside Drive, Suite 860, New York, NY 10115, USA.
| | - Alexander Krämer
- Department of Public Health Medicine, School of Public Health, Bielefeld University, Universitätsstr. 25, Bielefeld 33615, Germany.
| | - Claudia Hornberg
- Department of Environment & Health, School of Public Health, Bielefeld University, Universitätsstr. 25, Bielefeld 33615, Germany.
| | - Richard Fuller
- Pure Earth, Formerly Blacksmith Institute, 475 Riverside Drive, Suite 860, New York, NY 10115, USA.
| | - Dietrich Plass
- Section Exposure Assessment and Environmental Health Indicators, German Environment Agency, Corrensplatz 1, Berlin 14195, Germany.
| | - Stephan Bose-O'Reilly
- Unit Paediatric Environmental Epidemiology, WHO Collaborating Centre for Occupational Health, Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich, Ziemssenstr. 1, Munich 80336, Germany.
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Center I, Hall in Tyrol 6060, Austria.
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The impact of suicidality on health-related quality of life: A latent growth curve analysis of community-based data. J Affect Disord 2016; 203:14-21. [PMID: 27285722 DOI: 10.1016/j.jad.2016.05.067] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/10/2016] [Accepted: 05/28/2016] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The subjective burden of suicidality on mental and physical health-related quality of life (HRQoL) remains to be examined. Eight-year trajectories of mental and physical components of HRQoL were compared for suicidal and non-suicidal participants at baseline. The effect of poor mental and/or physical HRQoL on subsequent suicidality was also investigated. METHOD Randomly-selected community data (W1=7485; W2=6715; W3=6133) were analysed with multivariate latent growth curve (LGC) and logistic regression models. RESULTS Adjusted LGC modelling identified that baseline ideation was associated with poorer mental, but better physical HRQoL at baseline (b=-3.93, 95% CI=-4.75 to -3.12; b=1.38, 95% CI=0.53-2.23, respectively). However, ideation was associated with a declining physical HRQoL trajectory over 8 subsequent years (b=-0.88, 95% CI=-1.42 to -0.35). Poorer mental HRQoL was associated with higher odds of ideation onset (OR=0.98, 95% CI=0.96-0.99). LIMITATIONS Frequency of data collection was four-yearly, while suicidality was reported for the previous 12-months; analyses did not control for physical health problems at baseline, baseline depression may have influenced physical QoL; suicidality was assessed with binary measures; and, prior analyses of attrition over time showed those with poorer health were less likely to continue participating in the study. CONCLUSIONS Suicidality has differential longitudinal effects on mental and physical HRQoL. Findings emphasise the considerable subjective HRQoL burden upon suicidal individuals. HRQoL may be useful to compare relative social and economical impacts.
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Assadi R, Afshari R. Suicidal Attempt With Intentional Poisoning Seems a Comorbid Illness With an Increased Burden. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS & ADDICTION 2016; 5:e24380. [PMID: 27162760 PMCID: PMC4859999 DOI: 10.5812/ijhrba.24380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/21/2015] [Accepted: 04/08/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND In measuring health utilities, the primary reason for selecting patients as a source for valuations is that they directly experience the impact of the disease. OBJECTIVES Accordingly, the aim of this study was to examine the variation in generic utility measures with respect to acute poisonings by including a comparison between those subjects who had high intention and low intention to commit suicide. PATIENTS AND METHODS We evaluated the responses of patients who had attempted suicide and were admitted to a toxicology ward. We used multiple methods, including TTO, VAS, and EQ-5D. RESULTS We reviewed the collected questionnaires of one hundred patients admitted to the medical toxicology ward of Emam Reza teaching hospital in Mashhad, Iran. Our results show that the mental state after an incomplete suicide attempt can present either a real desire for suicide or a desire for attention from relatives and rejection of life problems. CONCLUSIONS This study demonstrates that the mental states associated with specific diseases should not be ignored in evaluating health states. Although there are benefits to relying on expert panels and the general population in evaluating various health states, attention to the particular health states of the patients (taking into account their associated mental well-being) should also be utilized.
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Affiliation(s)
- Reza Assadi
- Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Reza Afshari
- Addiction Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
- BC Disease Control Center, Vancouver, Canada
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Asadi R, Afshari R, Dadpour B. The measurement of disability weights for 18 prevalent acute poisoning conditions. Hum Exp Toxicol 2015; 35:1033-40. [PMID: 26655638 DOI: 10.1177/0960327115617229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Disability weights (DWs) are used in disease burden studies, with the calculation of the weight of the disability as years lived with disability versus years of lost life accounting for mortalities. Currently, there is a single DW score available for poisoning, which is considered to be a single health state. This makes it difficult to evaluate the differing burdens of poisonings involving various substances/conditions in comparison with other health states in countries with different patterns of substance abuse. The aim of this study is therefore to estimate the DWs of 18 common poisonings based on the expert elicitation method. METHODS A panel of 10 medical clinicians who were familiar with the clinical aspects of different poisonings estimated the DWs of 50 health states by interpolating them on a calibrated Visual Analogue Scale. The DWs of some poisonings, such as alcohol, cannabis and heroin, had been estimated in previous studies and so were used to determine the external consistency of our panel. As a matter of routine, the DWs could vary on a scale between 0 (best health state) and 1 (worst health state). RESULTS Statistical analysis showed that both the internal (Cronbach's α = 0.912) and external consistency of the panel were acceptable. The DWs for the different poisonings were estimated along a range from 0.830 for severe aluminium phosphide to 0.022 for mild benzodiazepine. CONCLUSIONS Different poisonings should be weighted differently since they vary widely. Unfortunately, they are currently all weighted the same.
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Affiliation(s)
- R Asadi
- Medical Toxicology Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | - R Afshari
- Addiction Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran BC Disease Control Center, Vancouver, Canada
| | - B Dadpour
- Addiction Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
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Gooding P, Tarrier N, Dunn G, Shaw J, Awenat Y, Ulph F, Pratt D. Effect of hopelessness on the links between psychiatric symptoms and suicidality in a vulnerable population at risk of suicide. Psychiatry Res 2015; 230:464-71. [PMID: 26429147 DOI: 10.1016/j.psychres.2015.09.037] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 06/30/2015] [Accepted: 09/23/2015] [Indexed: 10/23/2022]
Abstract
The aim of this study was to examine the impact of two risk factors working together on a measure of suicide probability in a highly vulnerable group who were male prisoners identified as being at risk of self harm. The first risk factor was psychiatric symptoms, including general psychiatric symptoms and symptoms of personality disorder. The second risk factor was psychological precursors of suicidal thoughts and behaviours which were defeat, entrapment, and hopelessness. Sixty-five male prisoners from a high secure prison in NW England, UK, were recruited, all of whom were considered at risk of suicide by prison staff. General psychiatric symptoms and symptoms of personality disorders predicted the probability of suicide. Hopelessness amplified the strength of the positive relationship between general psychiatric symptoms and suicide probability. These amplification effects acted most strongly on suicidal ideation as opposed to negative self evaluations or hostility. In contrast, defeat, entrapment and hopelessness did not affect the relationship between personality disorders and suicide probability. Clinical assessments of highly vulnerable individuals, as exemplified by prisoners, should include measures of a range of general psychiatric symptoms, together with measures of psychological components, in particular perceptions of hopelessness.
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Affiliation(s)
- Patricia Gooding
- School of Psychological Sciences, University of Manchester, Manchester, UK; Manchester Health Science Centre (MAHSC), Manchester, UK.
| | - Nicholas Tarrier
- School of Psychological Sciences, University of Manchester, Manchester, UK; Department of Psychology, Institute of Psychiatry, King's College, London, UK
| | - Graham Dunn
- Institute of Population Health, University of Manchester, Manchester, UK; Manchester Health Science Centre (MAHSC), Manchester, UK
| | - Jennifer Shaw
- Manchester Health Science Centre (MAHSC), Manchester, UK; Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Yvonne Awenat
- School of Psychological Sciences, University of Manchester, Manchester, UK; Manchester Health Science Centre (MAHSC), Manchester, UK
| | - Fiona Ulph
- School of Psychological Sciences, University of Manchester, Manchester, UK; Manchester Health Science Centre (MAHSC), Manchester, UK
| | - Daniel Pratt
- School of Psychological Sciences, University of Manchester, Manchester, UK; Manchester Health Science Centre (MAHSC), Manchester, UK; Manchester Mental Health and Social Care NHS Trust, Manchester, UK
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Steckling N, Plass D, Bose-O'Reilly S, Kobal AB, Krämer A, Hornberg C. Disease profile and health-related quality of life (HRQoL) using the EuroQol (EQ-5D + C) questionnaire for chronic metallic mercury vapor intoxication. Health Qual Life Outcomes 2015; 13:196. [PMID: 26654565 PMCID: PMC4675011 DOI: 10.1186/s12955-015-0388-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 11/24/2015] [Indexed: 01/27/2023] Open
Abstract
Background Toxic mercury is still being used today for example by workers mining gold, resulting in diverse health symptoms in users and individuals in proximity. A considerable burden of disease (BoD) can be assumed, while previous analyses were limited by data scarcity. Besides limited epidemiological data, neither data about the health-related quality of life (HRQoL) nor about the disease severity (disability weight, DW) is available. The aim of the project was to develop disease profiles of chronic metallic mercury vapor intoxication (CMMVI) by including the HRQoL to improve the data basis for BoD analyses of gold miners exposed to mercury. Methods Disease profiles comprising the disease label [a], differentiation into disease stages [b], description of the cause of exposure [c], a list of common symptoms [d], and an assessment of the HRQoL [e] were developed using expert elicitation and literature search. The HRQoL was assessed by experts using the five EuroQol dimensions accompanied by the cognition add-on questionnaire (EQ-5D + C). Results The ten sources used for the analyses (interview transcript, presentation, and eight literature reviews) identified more than 250 terms describing 85 distinguishable health effects of CMMVI. The analysis revealed 29 common symptoms that were frequently mentioned. Moderate and severe CMMVI cases differ regarding their symptoms and/or symptom severity and HRQoL, resulting in the EQ-5D + C-3L codes 121222 and 233333, respectively. Conclusions The profiles should be used to facilitate the ascertainment of CMMVI cases, to compare the HRQoL with other diseases, to derive DWs for improving BoD estimates, and to foster discussions about how to reduce the associated burden. Electronic supplementary material The online version of this article (doi:10.1186/s12955-015-0388-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nadine Steckling
- WHO Collaborating Centre for Occupational Health, Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Workgroup Paediatric Environmental Epidemiology, University Hospital Munich, Ziemssenstr. 1, D-80336, Munich, Germany. .,School of Public Health, Department of Environment & Health, Bielefeld University, Universitätsstraße, 25, D-33615, Bielefeld, Germany.
| | - Dietrich Plass
- Federal Environment Agency, Section Exposure Assessment and Environmental Health Indicators, Corrensplatz 1, D-14195, Berlin, Germany.
| | - Stephan Bose-O'Reilly
- WHO Collaborating Centre for Occupational Health, Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Workgroup Paediatric Environmental Epidemiology, University Hospital Munich, Ziemssenstr. 1, D-80336, Munich, Germany. .,Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health and Health Technology Assessment, Eduard Wallnoefer Center I, UMIT (The Health & Life Sciences University), A-6060, Hall i.T., Austria.
| | | | - Alexander Krämer
- School of Public Health, Department of Public Health Medicine, Bielefeld University, Universitätsstraße 25, D-33615, Bielefeld, Germany.
| | - Claudia Hornberg
- School of Public Health, Department of Environment & Health, Bielefeld University, Universitätsstraße, 25, D-33615, Bielefeld, Germany.
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de Beurs DP, Bosmans JE, de Groot MH, de Keijser J, van Duijn E, de Winter RFP, Kerkhof AJFM. Training mental health professionals in suicide practice guideline adherence: Cost-effectiveness analysis alongside a randomized controlled trial. J Affect Disord 2015; 186:203-10. [PMID: 26247913 DOI: 10.1016/j.jad.2015.07.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 07/13/2015] [Accepted: 07/23/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is a lack of information on the cost-effectiveness of suicide prevention interventions. The current study examines the cost-effectiveness of a multifaceted structured intervention aiming to improve adherence to the national suicide practice guideline in comparison with usual implementation. METHODS In the intervention condition, professionals of psychiatric departments were trained using an e-learning supported Train-the-Trainer program. Newly admitted suicidal patients were assessed as soon as their department was trained and at 3 months follow-up. The primary outcome was improvement in suicide ideation. Missing cost and effect data were imputed using multiple imputation. Cost-effectiveness planes were plotted, and cost-effectiveness acceptability curves were estimated. RESULTS For the total group of suicidal patients (n=566), no effect of the intervention on suicide ideation or costs was found. For a subgroup of depressed suicidal patients (n=154, intervention=75, control=79), mean level of suicide ideation decreased with 2.7 extra points in the intervention condition, but this was not statistically significant. For this subgroup, the intervention may be considered cost-effective in comparison with usual implementation if society is willing to pay≥€ 6100 per unit of effect on the suicide ideation scale extra. LIMITATIONS Considering the cost outcomes, we had almost no cases that were complete, and heavily relied on statistical techniques to impute the missing data. Also, diagnoses were not derived from structured clinical interviews. CONCLUSIONS We presented the first randomized trial (trial registration: The Netherlands Trial Register (NTR3092 www.trialregister.nl)) on cost-effectiveness of a suicide practice guideline implementation in mental health care. The intervention might be considered cost-effective for depressed suicidal patients if society is willing to make substantial investments.
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Affiliation(s)
- Derek P de Beurs
- Department of Clinical Psychology and the EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands; The Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Nethterlands.
| | - Judith E Bosmans
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
| | - Marieke H de Groot
- Department of Clinical Psychology and the EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
| | - Jos de Keijser
- GGZ Foundation for Mental Health Care Friesland and Groningen University, Groningen, The Netherlands
| | - Erik van Duijn
- GGZ Foundation for Mental Health Care Delfland, The Netherlands
| | - Remco F P de Winter
- Department of Clinical Psychology and the EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands; GGZ Foundation for Mental Health Care, Parnassia Group, The Netherlands
| | - Ad J F M Kerkhof
- Department of Clinical Psychology and the EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
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Eylem O, van Straten A, Bhui K, Kerkhof AJFM. Protocol: Reducing suicidal ideation among Turkish migrants in the Netherlands and in the UK: effectiveness of an online intervention. Int Rev Psychiatry 2015; 27:72-81. [PMID: 25747026 DOI: 10.3109/09540261.2014.996121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The Turkish community living in Europe has an increased risk for suicidal ideation and attempted suicide. Online self-help may be an effective way of engagement with this community. This study will evaluate the effectiveness of a culturally adapted, guided, cognitive behavioural therapy-based online self-help intervention targeting suicidal ideation for Turkish adults living in the Netherlands and in the UK. METHODS AND DESIGN This study will be performed in two phases. First, the Dutch online intervention will be adapted to Turkish culture. The second phase will be a randomized controlled trial with two conditions: experimental and waiting-list control. Ethical approval has been granted for the trials in London and Amsterdam. The experimental group will obtain direct access to the intervention, which will take 6 weeks to complete. Participants in the waiting-list condition will obtain access to the modules after 6 weeks. Participants in both conditions will be assessed at baseline, post-test and 3 months post-test follow-up. The primary outcome measure is reduction in frequency and intensity of suicidal thoughts. Secondary outcome measures are self-harm, attempted suicide, suicide ideation attributes, depression, hopelessness, anxiety, quality of life, worrying and satisfaction with the treatment.
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Affiliation(s)
- Ozlem Eylem
- Department of Clinical Psychology, VU University , Amsterdam , the Netherlands
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Haagsma JA, Polinder S, Cassini A, Colzani E, Havelaar AH. Review of disability weight studies: comparison of methodological choices and values. Popul Health Metr 2014; 12:20. [PMID: 26019690 PMCID: PMC4445691 DOI: 10.1186/s12963-014-0020-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 07/20/2014] [Indexed: 10/29/2022] Open
Abstract
INTRODUCTION The disability-adjusted life year (DALY) is widely used to assess the burden of different health problems and risk factors. The disability weight, a value anchored between 0 (perfect health) and 1 (equivalent to death), is necessary to estimate the disability component (years lived with disability, YLDs) of the DALY. After publication of the ground-breaking Global Burden of Disease (GBD) 1996, alternative sets of disability weights have been developed over the past 16 years, each using different approaches with regards to the panel, health state description, and valuation methods. The objective of this study was to review all studies that developed disability weights and to critically assess the methodological design choices (health state and time description, panel composition, and valuation method). Furthermore, disability weights of eight specific conditions were compared. METHODS Disability weights studies (1990¿2012) in international peer-reviewed journals and grey literature were identified with main inclusion criteria being that the study assessed DALY disability weights for several conditions or a specific group of illnesses. Studies were collated by design and methods and evaluation of results. RESULTS Twenty-two studies met the inclusion criteria of our review. There is considerable variation in methods used to derive disability weights, although most studies used a disease-specific description of the health state, a panel that consisted of medical experts, and nonpreference-based valuation method to assess the values for the majority of the disability weights. Comparisons of disability weights across 15 specific disease and injury groups showed that the subdivision of a disease into separate health states (stages) differed markedly across studies. Additionally, weights for similar health states differed, particularly in the case of mild diseases, for which the disability weight differed by a factor of two or more. CONCLUSIONS In terms of comparability of the resulting YLDs, the global use of the same set of disability weights has advantages, though practical constraints and intercultural differences should be taken into account into such a set.
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Affiliation(s)
- Juanita A Haagsma
- Department of Public Health, Erasmus Medical Center, Rotterdam, 3000 CA, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus Medical Center, Rotterdam, 3000 CA, The Netherlands
| | - Alessandro Cassini
- Office of the Chief Scientist, European Centre for Disease Prevention and Control, Stockholm, SE-171 83, Sweden
| | - Edoardo Colzani
- Office of the Chief Scientist, European Centre for Disease Prevention and Control, Stockholm, SE-171 83, Sweden
| | - Arie H Havelaar
- National Institute for Public Health and the Environment, Laboratory for Zoonoses and Environmental Microbiology, Bilthoven, 3720 BA, The Netherlands ; Utrecht University, Institute for Risk Assessment Sciences, Utrecht, 3508 TD, the Netherlands
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van Spijker BAJ, Batterham PJ, Calear AL, Farrer L, Christensen H, Reynolds J, Kerkhof AJFM. The suicidal ideation attributes scale (SIDAS): Community-based validation study of a new scale for the measurement of suicidal ideation. Suicide Life Threat Behav 2014; 44:408-19. [PMID: 24612048 DOI: 10.1111/sltb.12084] [Citation(s) in RCA: 228] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 10/02/2013] [Indexed: 10/25/2022]
Abstract
While suicide prevention efforts are increasingly being delivered using technology, no scales have been developed specifically for web-based use. The Suicidal Ideation Attributes Scale (SIDAS) was developed and validated as a brief, web-based measure for severity of suicidal ideation, using an online survey of Australian adults (n = 1,352). The SIDAS demonstrated high internal consistency and good convergent validity. Frequency and controllability of thoughts were more strongly associated with suicide plans and attempts than other attributes assessed. Scores ≥ 21 indicated high risk of suicide behavior. The SIDAS appears to be a valid web-based measure for severity of suicidal ideation.
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Affiliation(s)
- Bregje A J van Spijker
- Centre for Mental Health Research, The Australian National University, Canberra, Australia; Black Dog Institute, University of New South Wales, Sydney, Australia
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Christensen H, Calear AL, Van Spijker B, Gosling J, Petrie K, Donker T, Fenton K. Psychosocial interventions for suicidal ideation, plans, and attempts: a database of randomised controlled trials. BMC Psychiatry 2014; 14:86. [PMID: 24661473 PMCID: PMC3987830 DOI: 10.1186/1471-244x-14-86] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 03/10/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Research in suicide prevention using psychosocial interventions is rapidly advancing. However, randomised controlled trials are published across a range of medical, psychological and sociology journals, and it can be difficult to locate a full set of research studies. In this paper, we present a database of randomised controlled outcome studies on psychosocial interventions targeting suicidal behaviour. The database is updated annually and can be accessed by contacting the corresponding author. DESCRIPTION A comprehensive literature search of the major bibliographical databases (PsycINFO; PubMed; Cochrane Central Register of Controlled Trials) was conducted for articles published between 1800 to July 30 2013, and examined reference lists of previous relevant reviews and included papers to locate additional references. Studies were included if they featured a randomised controlled design in which the effects of a psychosocial intervention were compared to a control condition (no intervention, attention placebo, wait-list, treatment-as-usual [TAU]), another psychosocial intervention or a pharmacological intervention. In total, 12,250 abstracts were identified. Of these, 131 studies met eligibility criteria and were included. Each paper was then coded into categories of participant characteristics (age, gender, formal diagnosis, primary reason for recruitment); details of the intervention (recruitment setting, content, intervention setting, administering individual, delivery type, delivery format, delivery frequency, delivery length); and study characteristics (control and experimental conditions, primary outcome/s, secondary outcome/s, follow-up period). One paper has been published from the database using studies collected and coded prior to 2012. CONCLUSION The database and listing of 131 studies is available for use by suicide prevention researchers. It provides a strong starting point for systematic reviews and meta-analyses of treatments and interventions. It will be updated yearly by researchers funded through the Australian National Health and Medical Research Council Centre for Research Excellence for Suicide Prevention (CRESP), located at the Black Dog Institute, Australia. This database adds to the evidence base of best-practice psychosocial interventions for suicidal behaviour and prevention.
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Affiliation(s)
- Helen Christensen
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, Sydney, New South Wales 2031, Australia.
| | - Alison L Calear
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Bregje Van Spijker
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - John Gosling
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Katherine Petrie
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, Sydney, New South Wales 2031, Australia
| | - Tara Donker
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, Sydney, New South Wales 2031, Australia,Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands,EMGO Institute for Health and Care Research, VU University Amsterdam and VU University Medical Center, Amsterdam, The Netherlands
| | - Katherine Fenton
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
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Abstract
BACKGROUND This study aimed to assess the prevalence, incidence, and persistence of suicidal ideation (SI), and to investigate the psychosocial factors associated with these. METHODS A total of 1,204 community dwelling elderly adults aged 65 years or older were evaluated at baseline, 909 (75%) of whom were followed two years later. The presence of SI was identified using the questions from the community version of the Geriatric Mental State (GMS) diagnostic schedule (GMS B3) at both baseline and follow-up interviews. Baseline measures included demographic status, years of education, rural/urban residence, accommodation, past and current occupation, monthly income, marital status, stressful life events, social support deficits, number of physical illnesses, severity of pain, physical activity, disability, depressive symptoms, anxiety, insomnia, cognitive function, alcohol consumption, and smoking. RESULTS Baseline SI prevalence, follow-up incidence (SI rate at follow-up of 805 elderly subjects who did not have SI at baseline), and persistence (SI rate at follow-up of 104 elderly subjects who had SI at baseline) were 11.5%, 9.6%, and 36.5%, respectively. Baseline SI was independently associated with no current employment, lower monthly income, stressful life events, more severe pain, presence of disability, depressive symptoms, and smoking. Incident SI was independently predicted by baseline unmarried status, social support deficit, severe pain, presence of depressive symptoms, and smoking. Persistent SI was independently predicted by baseline stressful life events and depressive symptoms. CONCLUSIONS Depressive symptoms were independently associated with prevalent, incident, and persistent SI, but other predictors varied according to incidence and persistence outcomes.
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Batterham PJ, Calear AL, Mackinnon AJ, Christensen H. The association between suicidal ideation and increased mortality from natural causes. J Affect Disord 2013; 150:855-60. [PMID: 23618327 DOI: 10.1016/j.jad.2013.03.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 02/04/2013] [Accepted: 03/24/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Despite strong evidence for increased suicide mortality among individuals experiencing thoughts of suicide, the effect of suicidal ideation on increased natural mortality has not been evaluated. The present study aimed to assess whether there is excess mortality from all natural causes or from specific natural causes that is attributable to suicidal ideation. Adjustments were made for a range of demographic, mental health and physical health measures to examine evidence for specific mechanisms of the relationship. METHOD A community-based Australian cohort of 861 older adults was followed for up to 17 years. Vital status and cause of death were ascertained from a national death registry. RESULTS After adjusting for demographics, physical health and mental health, presence of suicidal ideation was associated with a 23% increase in the risk of mortality from natural causes (p=0.034). The increased mortality was largely attributable to heart disease deaths (hazard ratio=1.43, p=0.041). LIMITATIONS There was a limited number of deaths from respiratory disease or stroke, and modest rates of suicidal ideation in the cohort. Assessment of suicidal ideation was brief, while adjustment for mental health symptoms relied on non-diagnostic measures. CONCLUSIONS Although the relationship between suicidal ideation and mortality from natural causes was partly explained by physical and mental health status, thoughts of suicide independently accounted for an increased risk of mortality. Further research should examine whether this relationship is mediated by poorer health behaviours among individuals experiencing thoughts of suicide.
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Affiliation(s)
- Philip J Batterham
- Centre for Mental Health Research, The Australian National University, Canberra, Australian Capital Territory, Australia.
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Pil L, Pauwels K, Muijzers E, Portzky G, Annemans L. Cost-effectiveness of a helpline for suicide prevention. J Telemed Telecare 2013; 19:273-81. [PMID: 24163237 DOI: 10.1177/1357633x13495487] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We evaluated the cost-effectiveness and budget impact of a suicide helpline in Belgium, consisting of a telephone- and a chat service. An age- and gender-dependent Markov model with a ten-year time horizon and a one-year cycle length was developed, assuming a societal perspective, to predict cumulative costs and quality-adjusted life-years (QALYs) in the helpline users. The model included six transition states: the initial state (at risk), first attempt, re-attempt, follow-up, suicide and death from other causes. Data on the effect of the helpline and costs associated with model states were obtained from the literature. One-way and probabilistic sensitivity analyses were performed to capture uncertainty. In addition, the budget impact of the helpline was analysed. Over ten years, the telephone- as well as the chat service could avoid about 36% of suicides and attempts in this high-risk population. In males, 0.063 QALYs (95% confidence interval, CI 0.030-0.097) and 0.035 QALYs (95%CI -0.026-0.096) were gained by users of the telephone- and chat service respectively. The corresponding values for females were 0.019 QALYs (95%CI -0.015-0.052) and a QALY-neutral result of -0.005 (95%CI -0.071-0.062). There were net societal savings of respectively €2382 (95%CI 1953-2859) and €2282 (95%CI 1855-2758) in male users; €2171 (95%CI 1735-2664) and €2458 (95%CI 1945-3025) in female users. At the population level, an investment of €218,899 saved €1,452,022 for the public health service (national health insurance), mainly due to the telephone service. The analysis predicted that both means of telemedicine for suicide prevention in Flanders are cost-saving, and have a modest effect on QALYs.
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Affiliation(s)
- Lore Pil
- * Department of Public Health, Ghent University, Ghent, Belgium
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Salomon JA, Vos T, Hogan DR, Gagnon M, Naghavi M, Mokdad A, Begum N, Shah R, Karyana M, Kosen S, Farje MR, Moncada G, Dutta A, Sazawal S, Dyer A, Seiler J, Aboyans V, Baker L, Baxter A, Benjamin EJ, Bhalla K, Bin Abdulhak A, Blyth F, Bourne R, Braithwaite T, Brooks P, Brugha TS, Bryan-Hancock C, Buchbinder R, Burney P, Calabria B, Chen H, Chugh SS, Cooley R, Criqui MH, Cross M, Dabhadkar KC, Dahodwala N, Davis A, Degenhardt L, Díaz-Torné C, Dorsey ER, Driscoll T, Edmond K, Elbaz A, Ezzati M, Feigin V, Ferri CP, Flaxman AD, Flood L, Fransen M, Fuse K, Gabbe BJ, Gillum RF, Haagsma J, Harrison JE, Havmoeller R, Hay RJ, Hel-Baqui A, Hoek HW, Hoffman H, Hogeland E, Hoy D, Jarvis D, Karthikeyan G, Knowlton LM, Lathlean T, Leasher JL, Lim SS, Lipshultz SE, Lopez AD, Lozano R, Lyons R, Malekzadeh R, Marcenes W, March L, Margolis DJ, McGill N, McGrath J, Mensah GA, Meyer AC, Michaud C, Moran A, Mori R, Murdoch ME, Naldi L, Newton CR, Norman R, Omer SB, Osborne R, Pearce N, Perez-Ruiz F, Perico N, Pesudovs K, Phillips D, Pourmalek F, Prince M, Rehm JT, Remuzzi G, Richardson K, Room R, Saha S, Sampson U, Sanchez-Riera L, Segui-Gomez M, Shahraz S, Shibuya K, Singh D, Sliwa K, Smith E, Soerjomataram I, Steiner T, Stolk WA, Stovner LJ, Sudfeld C, Taylor HR, Tleyjeh IM, van der Werf MJ, Watson WL, Weatherall DJ, Weintraub R, Weisskopf MG, Whiteford H, Wilkinson JD, Woolf AD, Zheng ZJ, Murray CJL, Jonas JB. Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010. Lancet 2012; 380:2129-43. [PMID: 23245605 PMCID: PMC10782811 DOI: 10.1016/s0140-6736(12)61680-8] [Citation(s) in RCA: 884] [Impact Index Per Article: 73.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Measurement of the global burden of disease with disability-adjusted life-years (DALYs) requires disability weights that quantify health losses for all non-fatal consequences of disease and injury. There has been extensive debate about a range of conceptual and methodological issues concerning the definition and measurement of these weights. Our primary objective was a comprehensive re-estimation of disability weights for the Global Burden of Disease Study 2010 through a large-scale empirical investigation in which judgments about health losses associated with many causes of disease and injury were elicited from the general public in diverse communities through a new, standardised approach. METHODS We surveyed respondents in two ways: household surveys of adults aged 18 years or older (face-to-face interviews in Bangladesh, Indonesia, Peru, and Tanzania; telephone interviews in the USA) between Oct 28, 2009, and June 23, 2010; and an open-access web-based survey between July 26, 2010, and May 16, 2011. The surveys used paired comparison questions, in which respondents considered two hypothetical individuals with different, randomly selected health states and indicated which person they regarded as healthier. The web survey added questions about population health equivalence, which compared the overall health benefits of different life-saving or disease-prevention programmes. We analysed paired comparison responses with probit regression analysis on all 220 unique states in the study. We used results from the population health equivalence responses to anchor the results from the paired comparisons on the disability weight scale from 0 (implying no loss of health) to 1 (implying a health loss equivalent to death). Additionally, we compared new disability weights with those used in WHO's most recent update of the Global Burden of Disease Study for 2004. FINDINGS 13,902 individuals participated in household surveys and 16,328 in the web survey. Analysis of paired comparison responses indicated a high degree of consistency across surveys: correlations between individual survey results and results from analysis of the pooled dataset were 0·9 or higher in all surveys except in Bangladesh (r=0·75). Most of the 220 disability weights were located on the mild end of the severity scale, with 58 (26%) having weights below 0·05. Five (11%) states had weights below 0·01, such as mild anaemia, mild hearing or vision loss, and secondary infertility. The health states with the highest disability weights were acute schizophrenia (0·76) and severe multiple sclerosis (0·71). We identified a broad pattern of agreement between the old and new weights (r=0·70), particularly in the moderate-to-severe range. However, in the mild range below 0·2, many states had significantly lower weights in our study than previously. INTERPRETATION This study represents the most extensive empirical effort as yet to measure disability weights. By contrast with the popular hypothesis that disability assessments vary widely across samples with different cultural environments, we have reported strong evidence of highly consistent results. FUNDING Bill & Melinda Gates Foundation.
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van Spijker BAJ, Majo MC, Smit F, van Straten A, Kerkhof AJFM. Reducing suicidal ideation: cost-effectiveness analysis of a randomized controlled trial of unguided web-based self-help. J Med Internet Res 2012; 14:e141. [PMID: 23103835 PMCID: PMC3517339 DOI: 10.2196/jmir.1966] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 05/08/2012] [Accepted: 05/24/2012] [Indexed: 12/16/2022] Open
Abstract
Background Suicidal ideation is highly prevalent, but often remains untreated. The Internet can be used to provide accessible interventions. Objective To evaluate the cost-effectiveness of an online, unguided, self-help intervention for reducing suicidal ideation. Methods A total of 236 adults with mild to moderate suicidal thoughts, defined as scores between 1-26 on the Beck Scale for Suicide Ideation (BSS), were recruited in the general population and randomized to the intervention (n = 116) or to a waitlist, information-only, control group (n = 120). The intervention aimed to decrease the frequency and intensity of suicidal ideation and consisted of 6 modules based on cognitive behavioral techniques. Participants in both groups had unrestricted access to care as usual. Assessments took place at baseline and 6 weeks later (post-test). All questionnaires were self-report and administered via the Internet. Treatment response was defined as a clinically significant decrease in suicidal ideation on the BSS. Total per-participant costs encompassed costs of health service uptake, participants’ out-of-pocket expenses, costs stemming from production losses, and intervention costs. These were expressed in Euros (€) for the reference year 2009. Results At post-test, treatment response was 35.3% and 20.8% in the experimental and control conditions, respectively. The incremental effectiveness was 0.35 − 0.21 = 0.15 (SE 0.06, P = .01). The annualized incremental costs were −€5039 per participant. Therefore, the mean incremental cost-effectiveness ratio (ICER) was estimated to be −€5039/0.15 = −€34,727 after rounding (US −$41,325) for an additional treatment response, indicating annual cost savings per treatment responder. Conclusions This is the first trial to indicate that online self-help to reduce suicidal ideation is feasible, effective, and cost saving. Limitations included reliance on self-report and a short timeframe (6 weeks). Therefore, replication with a longer follow-up period is recommended.
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Affiliation(s)
- Bregje A J van Spijker
- Department of Clinical Psychology and the EMGO+ Institute for Health and Care Research, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, Netherlands.
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Kerkhof A. Calculating the Burden of Disease of Suicide, Attempted Suicide, and Suicide Ideation by Estimating Disability Weights. CRISIS 2012; 33:63-5. [DOI: 10.1027/0227-5910/a000161] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ad Kerkhof
- Professor of Clinical Psychology, Psychopathology, and Suicide Prevention, Vrije Universiteit Amsterdam, The Netherlands
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