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Lee H, Lee E. Latent groups from multidimensional factors and effects on suicidal ideation in older adults. BJPsych Open 2024; 10:e103. [PMID: 38712624 PMCID: PMC11094448 DOI: 10.1192/bjo.2024.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/21/2024] [Accepted: 03/23/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Suicide is a serious social problem among older adults. However, little is known about how multidimensional factors affect suicide of older adults. AIMS We classify the multidimensional suicidal risk types of older adults based on their characteristics and identify differences in suicidal ideation. METHOD Data were obtained via a nationwide online survey targeting 612 older adults over the age of 55 years. A latent profile analysis identified three profiles, one of which represented the optimal situation for these adults. RESULTS We identified three distinct multidimensional suicidal risk types in older adults: high-risk predicament (24.5%), moderate-risk predicament (57.7%) and abundant internal/external resources (17.8%). In particular, depression, a major risk factor for suicide, was found together with self-neglect in each group. Multiple regression analysis showed that older adults in the moderate-risk predicament and high-risk predicament groups were more likely to have suicidal ideation than those in the abundant internal/external resources group. CONCLUSIONS Our findings suggest that co-occurrence of depression and self-neglect represents a suicide risk pattern in high-risk older individuals. Therefore, local communities need to urgently screen and provide interventions for such older adults and strengthen their capacity for multidimensional aspects of life to prevent suicide in the long term.
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Affiliation(s)
- Hyun Lee
- Department of Social Welfare, Mokwon University, Daejeon, South Korea
| | - Eunjin Lee
- The Center for Social Welfare Research, Yonsei University, Seoul, South Korea
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Davila-Cervantes CA, Luna-Contreras M. Suicide attempts in the adult Mexican population: an analysis of sociodemographic characteristics and associated factors. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2024; 27:e240014. [PMID: 38511824 PMCID: PMC10946288 DOI: 10.1590/1980-549720240014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE Suicide is the culmination of a process or continuum known as suicidal behavior that proceeds from ideation and planning to attempt. The objective was to estimate the prevalence of suicide attempts in the adult Mexican population and to analyze their main associated factors. METHODS We conducted an observational, cross-sectional, and descriptive study with information from the National Health and Nutrition Survey (2018). Self-reported lifetime suicide attempt was used in the analysis. We analyzed depression, obesity, tobacco smoking, and alcohol consumption as suicide attempt-associated factors using a multivariate logistic regression model. RESULTS The prevalence of adult suicide attempt was 2.0% (95%CI 1.8-2.2) and it was higher among women (2.4%; 95%CI 2.2-2.8) and young people (2.9%; 95%CI 2.4-3.4). Low education (OR=1.6; 95%CI 1.2-2.2), being single (OR=1.3; 95%CI 1.0-1.6), having obesity (OR=1.4; 95%CI 1.1-1.8), consumption of alcohol (OR=2.4; 95%CI 1.7-3.4) or tobacco smoking (OR=1.8; 95%CI 1.4-2.4), and having strong symptoms of depression (OR=10.1; 95%CI 6.2-16.3) were associated with a higher prevalence of suicide attempts. CONCLUSION These results help better understand suicidal behavior in Mexico and identify the factors that increase the likelihood of suicide attempts, which is essential to help reduce suicide mortality. This research is crucial for developing early interventions and prevention programs aimed at reducing suicide's public health burden.
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Cliffe C, Cusick M, Vellupillai S, Shear M, Downs J, Epstein S, Pathak J, Dutta R. A multisite comparison using electronic health records and natural language processing to identify the association between suicidality and hospital readmission amongst patients with eating disorders. Int J Eat Disord 2023; 56:1581-1592. [PMID: 37194359 PMCID: PMC10524005 DOI: 10.1002/eat.23980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 04/21/2023] [Accepted: 04/21/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVES To describe and compare the association between suicidality and subsequent readmission for patients hospitalized for eating disorder treatment, within 2 years of discharge, at two large academic medical centers in two different countries. METHODS Over an 8-year study window from January 2009 to March 2017, we identified all inpatient eating disorder admissions at Weill Cornell Medicine, New York, USA (WCM) and South London and Maudsley Foundation NHS Trust, London, UK (SLaM). To establish each patient's-suicidality profile, we applied two natural language processing (NLP) algorithms, independently developed at the two institutions, and detected suicidality in clinical notes documented in the first week of admission. We calculated the odds ratios (OR) for any subsequent readmission within 2 years postdischarge and determined whether this was to another eating disorder unit, other psychiatric unit, a general medical hospital admission or emergency room attendance. RESULTS We identified 1126 and 420 eating disorder inpatient admissions at WCM and SLaM, respectively. In the WCM cohort, evidence of above average suicidality during the first week of admission was significantly associated with an increased risk of noneating disorder-related psychiatric readmission (OR 3.48 95% CI = 2.03-5.99, p-value < .001), but a similar pattern was not observed in the SLaM cohort (OR 1.34, 95% CI = 0.75-2.37, p = .32), there was no significant increase in risk of admission. In both cohorts, personality disorder increased the risk of any psychiatric readmission within 2 years. DISCUSSION Patterns of increased risk of psychiatric readmission from above average suicidality detected via NLP during inpatient eating disorder admissions differed in our two patient cohorts. However, comorbid diagnoses such as personality disorder increased the risk of any psychiatric readmission across both cohorts. PUBLIC SIGNIFICANCE Suicidality amongst is eating disorders is an extremely common presentation and it is important we further our understanding of identifying those most at risk. This research also provides a novel study design, comparing two NLP algorithms on electronic health record data based in the United States and United Kingdom on eating disorder inpatients. Studies researching both UK and US mental health patients are sparse therefore this study provides novel data.
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Affiliation(s)
- Charlotte Cliffe
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London & Maudsley Foundation NHS Trust, London, UK
| | - Marika Cusick
- Division of Population Health Sciences, Cornell University, New York, New York, USA
- Department of Health Policy, Stanford School of Medicine, Stanford, CA, USA
| | - Sumithra Vellupillai
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matthew Shear
- Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA
- Psychiatry, New York Presbyterian Hospital, White Plains, New York, USA
| | - Johnny Downs
- South London & Maudsley Foundation NHS Trust, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Sophie Epstein
- South London & Maudsley Foundation NHS Trust, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Jyotishman Pathak
- Division of Population Health Sciences, Cornell University, New York, New York, USA
| | - Rina Dutta
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London & Maudsley Foundation NHS Trust, London, UK
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Strasser M, Halms T, Rüther T, Hasan A, Gertzen M. Lethal Lust: Suicidal Behavior and Chemsex-A Narrative Review of the Literature. Brain Sci 2023; 13:brainsci13020174. [PMID: 36831717 PMCID: PMC9954759 DOI: 10.3390/brainsci13020174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/06/2023] [Accepted: 01/13/2023] [Indexed: 01/22/2023] Open
Abstract
Chemsex is described as the use of certain drugs-commonly methamphetamine, gamma-butyrolactone (GBL)/gammahydroxybutyrate (GHB), and mephedrone-before or during planned sexual activity primarily among men who have sex with men (MSM). Evidence shows that MSM who engage in chemsex are at increased risk of physical harm, such as sexually transmittable infections (STIs), and are more likely to experience mental health symptoms. To further assess this, we reviewed the recent literature to evaluate whether the psychological impact of chemsex behavior includes suicidal ideation and suicidal attempts. Pubmed/MEDLINE was searched for articles reporting suicidal ideation and behavior among chemsex users with the terms "chemsex", "sexualized drug use", "suicide", and "mental health". Twelve articles (three case reports and nine cross-sectional studies) were included in the final narrative review. Overall, we retrieved mixed results regarding the relationship between chemsex practice and suicidality outcomes. Considering the inhomogeneous nature of the studies, the findings indicate that suicidality could be an issue of concern among MSM in general but among chemsex users in particular. Possible risk factors for suicidality among chemsex participants may include adversities experienced due to one's sexual orientation and an increased risk for HIV and other STI infections and the resulting negative impact on mental well-being. These aspects warrant further investigations.
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Affiliation(s)
- Martina Strasser
- Psychiatry and Psychotherapy, Faculty of Medicine, University of Augsburg, Geschwister-Schönert-Str. 1, 86156 Augsburg, Germany
| | - Theresa Halms
- Psychiatry and Psychotherapy, Faculty of Medicine, University of Augsburg, Geschwister-Schönert-Str. 1, 86156 Augsburg, Germany
| | - Tobias Rüther
- Department of Psychiatry, Ludwig-Maximilians-University Hospital Munich, 80336 Munich, Germany
| | - Alkomiet Hasan
- Psychiatry and Psychotherapy, Faculty of Medicine, University of Augsburg, Geschwister-Schönert-Str. 1, 86156 Augsburg, Germany
| | - Marcus Gertzen
- Psychiatry and Psychotherapy, Faculty of Medicine, University of Augsburg, Geschwister-Schönert-Str. 1, 86156 Augsburg, Germany
- Correspondence:
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Manouchehri A, Marznaki ZH, Atim LM, Mohammadian amiri M, Kaggwa MM. The relationship between causes of suicidal attempts in Iran and individual and social variables: a retrospective study. BMC Psychiatry 2022; 22:780. [PMID: 36503535 PMCID: PMC9743690 DOI: 10.1186/s12888-022-04449-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Determine the prevalence of suicide attempts and the relationships between the different causes of attempts with sociodemographic and clinical characteristics among individuals in Iran. METHODS A retrospective review of data about suicide attempts from poisoning care centers in Babol city between 2017 and 2021. Multinomial regression analysis (with mental illness being the reference variable) was used to determine the factors associated with the different causes of suicide attempts (addiction, romantic relationship problems, and economic problems). RESULTS The overall prevalence of completed suicide in the population sampled was 10.8% (95% confidence interval 9.5-12.1) (244/2,263). Relative to mental disorder, given that other variables in the model are held constant the following were associated with suicide attempts. A previous history of suicide attempts was associated with increasing the relative risk ratio of attempting suicide while having no positive history of smoking was associated with reducing the relative risk ratio of a suicidal attempt. However, the use of multiple drugs to attempt suicide was associated with an increased relative risk ratio of attempting suicide with romantic relationship problems and addiction as causes of suicide attempts. The first year of data collection (2017) and the female gender were both associated with an increased relative risk ratio of having a suicide attempt due to romantic relationships and economic problems. A family history of suicide was associated with an increased relative risk ratio of suicide attempts due to romantic relationship problems. However, using Pesticides-aluminum phosphide and detergent and javel water to attempt reduced the relative risk ratio of attempting due to romantic relationship problems. Age, self-employment, middle income, and married were associated with an increased relative risk ratio of suicide attempts among individuals due to addiction. However, staying longer at the emergency department was associated with a reduced relative risk ratio of having had a suicide attempt due to addiction. CONCLUSIONS This study highlights the interplay between romantic hardships, addiction, economic hardships as reasons for suicide attempts and various sociable variables in a population in Northern Iran. The most associated reason for suicide attempts was romantic relationship hardships. Therefore, interventions such as sessions on conflict resolution, boundary setting, and management of grieving would greatly benefit this society and reduce the rate of suicide, especially among individuals with a history of suicide attempts.
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Affiliation(s)
- Aliasghar Manouchehri
- grid.411495.c0000 0004 0421 4102Department of Internal Medicine, Shahid Beheshti Hospital Babol University of Medical Sciences, Babol, Iran
| | | | - Letizia Maria Atim
- African Centre for Suicide Prevention and Research, Mbarara, Uganda ,grid.33440.300000 0001 0232 6272Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mehdi Mohammadian amiri
- grid.411495.c0000 0004 0421 4102Department of Emergency Medicine, School of Medicine, Babol University of Medical Sciences, Mazandaran, Iran
| | - Mark Mohan Kaggwa
- African Centre for Suicide Prevention and Research, Mbarara, Uganda ,grid.33440.300000 0001 0232 6272Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda ,grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Sciences, McMaster University, Hamilton, Ontario Canada
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Ishii R, Ohyama T, Endo H. Moderating effect of financial literacy on the relationship between socioeconomic status and depression. JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 2022. [DOI: 10.1080/15555240.2022.2147940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Ryo Ishii
- Department of School Education, Nara University of Education, Nara, Japan
| | - Takuya Ohyama
- Digital Transformation Business Development Division, UNIADEX Ltd, Tokyo, Japan
| | - Hideki Endo
- Faculty of Economics, Nihon Fukushi University, Tokai, Japan
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Stagg AL, Hatch S, Fear NT, Dorrington S, Madan I, Stevelink SAM. Long-term health conditions in UK working-age adults: a cross-sectional analysis of associations with demographic, socioeconomic, psychosocial and health-related factors in an inner-city population. BMJ Open 2022; 12:e062115. [PMID: 36385039 PMCID: PMC9670944 DOI: 10.1136/bmjopen-2022-062115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To study the overall disease prevalence, and associations between demographic, socioeconomic, psychosocial, and health-related factors, and self-reporting one or more long-term health conditions (LTCs) in a working-age inner-city population. DESIGN Cross-sectional household-based survey with a follow-up timepoint. SETTING South-East London Community Health survey data. PARTICIPANTS 893 adults aged 16-64 years living in Lambeth and Southwark, London. OUTCOME MEASURES Prevalence estimates of individual and multiple LTCs. Multinomial logistic regression was used to analyse the association of demographic, socioeconomic, psychosocial and health-related indicators with having one and multiple LTCs at two timepoints. RESULTS More than one third of participants reported at least one LTC, with the most prevalent being musculoskeletal conditions and asthma. The prevalence of one LTC at both timepoints was 20.6% and 21.4%, and of multimorbidity was 14.0% and 16.4%. At both timepoints, the 35-44 age group showed the largest increase in prevalence of one LTC compared with the preceding age group (16-34). After adjusting for age and gender, small social networks and a larger number of stressful life events were associated with increased risk of having both one and multiple LTCs. The risk of multimorbidity was greater than for initial LTCs for small social networks (3.8 (95% CI: 1.8 to 7.8) compared with 2.0 (95% CI: 1.0 to 3.9)), and three to five stressful life events (3.0 (95% CI: 1.7 to 5.3) compared with 1.5 (95% CI 1.0 to 2.2)). CONCLUSIONS In this study, the prevalence of multimorbidity increased more than the prevalence of one LTC between the two timepoints, indicating a progression of the overall disease prevalence over time. The 35-44 age group showed the greatest increase in the number of initial LTCs which support health-promotion interventions targeting younger age groups. Focusing on increasing social support networks and treating the psychological impact of stressful life events may also be of benefit.
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Affiliation(s)
- Anne L Stagg
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- Department of Occupational Health, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Stephani Hatch
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Nicola T Fear
- Academic Department of Military Mental Health, King's College London, London, UK
- King's Centre for Military Health Research, King's College, London, UK
| | - Sarah Dorrington
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Ira Madan
- Department of Occupational Health, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Sharon A M Stevelink
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- King's Centre for Military Health Research, King's College, London, UK
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Ba’yah Abdul Kadir N, Griffiths MD. Psychosocial Risk Factors for Depression Among Married Muslim Mothers in Malaysia. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-020-00452-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Castillejos MC, Huertas P, Martín P, Moreno Küstner B. Prevalence of Suicidality in the European General Population: A Systematic Review and Meta-Analysis. Arch Suicide Res 2021; 25:810-828. [PMID: 32620069 DOI: 10.1080/13811118.2020.1765928] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis of the prevalence and variability in suicidality in the general adult population of Europe between 2008 and 2017. METHODS Studies containing original data on suicidality were identified in five electronic databases. Point, 12-month and lifetime prevalences were calculated for various types of suicidality. Pooled prevalence rates were calculated using a random effects model. Subgroup analysis and multivariate meta-regression were also performed. RESULTS We identified 24 papers containing original data, which provided 97 prevalence rates for suicidality. The pooled point prevalence rate was 3.96% (2.37-5.56), pooled 12-month prevalence 2.9% (1.49-4.32), and pooled lifetime prevalence 5.55% (4.31-6.79). The subgroup analysis showed that lifetime prevalence figures for wishing to be dead and suicidal ideation were higher in areas with a population of less than 3,849 inhabitants and in Eastern Europe. Finally, the multivariate meta-regression showed differences with respect to the period and type of suicidality, lower and upper age thresholds, population size, and study area. CONCLUSION Our data showed that approximately 21% of European individuals have wished to be dead at some point during their lifetime. Studies like this are necessary to highlight the need for efforts to prevent and intervene in suicidality.
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McClelland H, Evans JJ, O'Connor RC. Exploring the role of loneliness in relation to self-injurious thoughts and behaviour in the context of the integrated motivational-volitional model. J Psychiatr Res 2021; 141:309-317. [PMID: 34304034 DOI: 10.1016/j.jpsychires.2021.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/02/2021] [Accepted: 07/13/2021] [Indexed: 01/10/2023]
Abstract
Suicide is a worldwide public health concern claiming approximately 800,000 lives around the world every year. The impact of loneliness on mental and physical wellbeing has received increasing attention in recent years, however its role in the emergence of self-injurious thoughts and behaviours is unclear. The current study explored loneliness in relation to other psychological variables associated with self-injurious thoughts and behaviour. Data were collected from UK residents (n = 400, aged 18-76 years) via an online survey accessible between September 2018 and April 2019. Univariate multinomial logistic regression analyses identified that loneliness independently distinguished between participants with no history of self-injurious thoughts or behaviours, those with a history of self-injurious thoughts only, and those with a history of self-injurious behaviours. When other key variables were controlled for, loneliness distinguished between controls and those with a self-injurious thoughts or behaviours history. However, loneliness did not distinguish between people with self-injurious thoughts only and those with a history of self-injurious behaviours. To understand how loneliness might contribute towards the emergence of self-injury, analysis exploring the extent to which loneliness moderates established risk factors (e.g., defeat, entrapment) was conducted. The results suggest that loneliness moderates both the relationship between defeat and entrapment, and between entrapment and self-injurious thoughts. Future work exploring these associations prospectively would advance understanding of the role of loneliness in suicide risk and inform the development of clinical and community-based suicide prevention interventions.
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Affiliation(s)
- Heather McClelland
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, United Kingdom.
| | - Jonathan J Evans
- Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Rory C O'Connor
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
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Outcomes of community-based suicide prevention program in primary health care of Iran. Int J Ment Health Syst 2021; 15:67. [PMID: 34348779 PMCID: PMC8336287 DOI: 10.1186/s13033-021-00492-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/27/2021] [Indexed: 01/20/2023] Open
Abstract
Background Suicidal management and prevention in communities, especially in its first stages, is an effective intervention for the health systems. However, in numerous societies most cases go undetected. Primary Health Care (PHC) is an effective place for the management of Suicide Prevention Programs (SPP). In Malekan County, a health community assessment found suicide as the most important health problem. A regional SPP was performed for suicide prevention during 2014–2017. Methods This study was carried out in six steps: (1) Establishing a research team, (2) Improving a registry for suicidal behaviors (SBs), (3) Identifying local determinants of SBs, (4) Training healthcare providers, (5) Follow-up and monitoring of SBs, and (6) Public awareness campaigns. Our ultimate goal was to lower the rates of suicide, and suicide attempt (SA) by 15 and 20 %, respectively. Multiple logistic regression was used to estimate the adjusted odds ratios and the 95% confidence intervals. Results A total of 821 SAs and 32 suicides were identified. The gender distribution for suicides was 70% males whereas SAs were 64% among females. The majority of suicides occurred in spring 18 (56.25%) while summer was the most common season among SAs 288 (35.8%). Almost 62 and 75% of suicides and SAs have used hanging and poisoning methods, respectively. Hanging increased suicide risk significantly (OR: 8.5, 95% CI 2.9–76.99). During the study, 93 life-skill and parenting education sessions were held. The incidence rates of suicide and SA decreased from 11.22, and 203 per 100,000 in 2013 to 2.63, and 157 in 2017, respectively. Similarly, the re-attempt to SAs ratio decreased from 12% to 2013 to 6.7% in 2017. Moreover, more than 8% of SBs were collected from adjacent Counties. Conclusions At the study end, suicide, SA, and re-attempt were lowered by 75%, 22%, and 42%, respectively. The practical framework that achieved in this study could be used as a basis for developing future SPPs and suicide researches in the Iranian context. Furthermore, the various socio-economic and socio-cultural challenges highlight the need to consider a wide range of contextual factors when developing an SPP.
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Fakhari A, Farahbakhsh M, Esmaeili ED, Azizi H. A longitudinal study of suicide and suicide attempt in northwest of Iran: incidence, predictors, and socioeconomic status and the role of sociocultural status. BMC Public Health 2021; 21:1486. [PMID: 34330239 PMCID: PMC8323272 DOI: 10.1186/s12889-021-11527-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/21/2021] [Indexed: 12/12/2022] Open
Abstract
Background A detailed community-level understanding of socioeconomic status (SES) and sociocultural status (SCS) of suicides and suicide attempters (SAs) in a prospective design could have significant implications for policymakers at the local prevention and treatment levels. The effect of SCS and SES on SAs is poorly understood and investigated in Iran. The present study aimed to investigate the incidence, trend, and role of SES and SCS on suicide and SAs. Methods A longitudinal study was conducted based on the registry for SAs in Malekan County, Iran, from 2015 to 2018. Demographic characteristics, SES, SCS, incidence rates, and predictors of suicidal behaviors were measured via structured instruments. Simple and multiple logistic regressions were used to estimate crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Results A total of 853 SAs (32 suicides and 821 attempts) were identified during the study. Trend analysis revealed that the suicide rate significantly decreased from 2014 (10.28) to 2018 (1.75) per 100,000. In the final multiple variable models, age (26–40), male sex, unemployment, antisocial activities, history of SA, hanging method, and season (spring) increased the suicide risk while religious commitment had protective effects on suicide. Conclusions Our findings indicated that demographic characteristics, low SES, and SCS are associated with suicide. In this county, trend of suicide and SA were decreased from 2014 to 2018. This study findings highlight the need to consider a wide range of contextual variables, socio-demographic, SES, and SCS in suicide prevention strategies. Improving inter-sectoral collaborations and policymakers’ attitudes are imperative for SA reduction.
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Affiliation(s)
- Ali Fakhari
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.,Medical Education Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mostafa Farahbakhsh
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Hosein Azizi
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran. .,Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran. .,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Pitkänen J, Bijlsma MJ, Remes H, Aaltonen M, Martikainen P. The effect of low childhood income on self-harm in young adulthood: Mediation by adolescent mental health, behavioural factors and school performance. SSM Popul Health 2021; 13:100756. [PMID: 33681447 PMCID: PMC7910518 DOI: 10.1016/j.ssmph.2021.100756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 11/26/2022] Open
Abstract
Low childhood income is an established risk factor of self-harm in adolescence and young adulthood, and childhood income is additionally associated with various correlates of self-harm. How these correlates, such as psychiatric disorders, substance abuse, violent behaviour and school problems, mediate the effect of childhood income on self-harm, is less understood. The purpose of the current paper is to examine this mediation. The study is based on administrative register data on all Finnish children born in 1990–1995. An analytical sample of 384,121 children is followed from age 8 to 22. We apply the parametric g-formula to study the effect of childhood income on the risk of self-harm in young adulthood. Adolescent psychiatric disorders, substance abuse, prior self-harm, violent criminality and victimization, out-of-home placements, not being in education, employment or training and school performance are considered as potential mediators. We control for confounding factors related to childhood family characteristics. As a hypothetical intervention, we moved those in the lowest childhood income quintile to the second-lowest quintile, which resulted in a 7% reduction in hospital-presenting self-harm in young adulthood among those targeted by the intervention (2% reduction in the total population). 67% of the effect was mediated through the chosen mediators. The results indicate that increases in childhood material resources could protect from self-harm in young adulthood. Moreover, the large proportion of mediation suggests that targeted interventions for high-risk adolescents may be beneficial. To our knowledge, this is the first paper to use the parametric g-formula to study youth self-harm. Future applications are encouraged as the method offers several further opportunities for analysing the complex life course pathways to self-harm. We study mediation in the association between low childhood income and self-harm. Effects of a hypothetical intervention are examined. Most of the effect of low childhood income on the risk of self-harm is indirect. Distinct pathways are identified. The parametric g-formula offers further avenues for self-harm research.
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Affiliation(s)
- Joonas Pitkänen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, FIN-00014, Helsinki, Finland.,International Max Planck Research School for Population, Health and Data Science, Max Planck Institute for Demographic Research, Rostock, Germany
| | | | - Hanna Remes
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, FIN-00014, Helsinki, Finland
| | - Mikko Aaltonen
- Institute of Criminology and Legal Policy, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.,Law School. University of Eastern Finland, Joensuu, Finland
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, FIN-00014, Helsinki, Finland.,Max Planck Institute for Demographic Research, Rostock, Germany.,Department of Public Health Sciences, Stockholm University, Sweden
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14
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Polling C, Woodhead C, Harwood H, Hotopf M, Hatch SL. "There Is So Much More for Us to Lose If We Were to Kill Ourselves": Understanding Paradoxically Low Rates of Self-Harm in a Socioeconomically Disadvantaged Community in London. QUALITATIVE HEALTH RESEARCH 2021; 31:122-136. [PMID: 32930046 PMCID: PMC7750675 DOI: 10.1177/1049732320957628] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
London has unexpectedly low overall rates of self-harm in public health data and contains highly deprived areas with these paradoxically low rates. Qualitative data were collected via interviews and focus groups with 26 individuals living and working in one such area. Using the Stress Process Model, we explore why this ethnically diverse community, which is exposed to multiple, chronic stressors, might nonetheless appear to have low rates of self-harm. Participants described significant impacts of stressors on the mental health of people locally. These were partly buffered by social resources related to community solidarity and a culture of self-reliance. However, identifying oneself as mentally ill through being known to have self-harmed was seen as highly risky, diminishing a person's social status and exposing them to additional stressors from the community and services. Consequently, people tended to hide distress, respond with behaviors less linked to mental illness, and avoid mental health services.
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Affiliation(s)
- Catherine Polling
- Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, United
Kingdom
- South London and Maudsley NHS
Foundation Trust, London, United Kingdom
| | - Charlotte Woodhead
- Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, United
Kingdom
| | - Hannah Harwood
- Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, United
Kingdom
| | - Matthew Hotopf
- Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, United
Kingdom
- South London and Maudsley NHS
Foundation Trust, London, United Kingdom
| | - Stephani L. Hatch
- Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, United
Kingdom
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15
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Cripps RL, Hayes JF, Pitman AL, Osborn DPJ, Werbeloff N. Characteristics and risk of repeat suicidal ideation and self-harm in patients who present to emergency departments with suicidal ideation or self-harm: A prospective cohort study. J Affect Disord 2020; 273:358-363. [PMID: 32560929 DOI: 10.1016/j.jad.2020.03.130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 02/10/2020] [Accepted: 03/29/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Characteristics and outcomes of patients presenting to Emergency Departments (EDs) have been under-examined. This paper describes the characteristics and risk of repeat suicidality amongst patients presenting to EDs with (1) suicidal ideation and (2) self-harm, compared to (3) controls in mental health crisis. METHODS The Clinical Record Interactive Search tool identified 2211 patients who presented to three London EDs with suicidal ideation or self-harm, and 1108 control patients. All patients received a full psychosocial assessment. Chi-squared tests examined group characteristics. Cox regression models assessed the risk of re-presentation with suicidal ideation or self-harm within one year. RESULTS There were a higher proportion of females and individuals under the age of 25 in the self-harm group. Patients presenting with suicidal ideation or self-harm were more likely to be white, live in more deprived areas, and less likely to receive a psychiatric diagnosis within one year compared to controls. Risk of repeat suicidality within one year was 3-4 times higher in those with baseline suicidal ideation (adjusted HR = 3.66, 95% CI 2.44-5.48) or self-harm (HR = 3.53 95% CI 2.47-5.04) compared to controls. LIMITATIONS To be included patients needed to have a full psychosocial assessment. Incomplete records meant 21.4% of the sample was excluded. This will have introduced bias which might confound observed associations. CONCLUSION Individuals presenting with either suicidal ideation or self-harm have similar risk for re-presentation within one year. Both groups would benefit from personalised risk management plans and active follow-up to reduce the risk of repeat suicidal behaviour.
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Affiliation(s)
- Rachel L Cripps
- Division of Psychiatry, University College London, United Kingdom
| | - Joseph F Hayes
- Division of Psychiatry, University College London, UK and Camden and Islington NHS Foundation Trust, United Kingdom
| | - Alexandra L Pitman
- Division of Psychiatry, University College London, UK and Camden and Islington NHS Foundation Trust, United Kingdom
| | - David P J Osborn
- Division of Psychiatry, University College London, UK and Camden and Islington NHS Foundation Trust, United Kingdom
| | - Nomi Werbeloff
- School of Social Work, Bar Ilan University, Ramat Gan, Israel.
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16
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Carrasco-Barrios MT, Huertas P, Martín P, Martín C, Castillejos MC, Petkari E, Moreno-Küstner B. Determinants of Suicidality in the European General Population: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4115. [PMID: 32526975 PMCID: PMC7312422 DOI: 10.3390/ijerph17114115] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 12/11/2022]
Abstract
Close to one million people commit suicide each year, with suicidal attempts being the main risk factor for suicide. The aim of this systematic review and meta-analysis is to achieve a greater understanding of suicidality in the general population of Europe by studying associated factors and their statistical significance with suicidality, as well as the effect of the temporal moment in which suicidality is observed in a relationship. A search strategy was carried out in electronic databases: Proquest's Psychology Database, Scopus, PsycINFO, Medline and Embase. Odds ratios (ORs), publication bias, influential studies on heterogeneity and analysis moderators were calculated. Twenty-six studies were included after meeting the inclusion criteria. Factors statistically associated with suicidality are female gender, age over 65 years, unemployment, low social support, adulthood adversity, childhood adversity, family history of mental disorder, any affective disorder, major depression, anxiety/stress/somatoform disorders, tobacco and substance use, any mental disorder and body mass index. As a limitation, a high heterogeneity between studies was found. Factors associated with suicidality in the general population are relevant for understanding the suicidal phenomenon.
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Affiliation(s)
- María Teresa Carrasco-Barrios
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, 29010 Malaga, Spain; (M.T.C.-B.); (P.M.); (M.C.C.); (B.M.-K.)
| | - Paloma Huertas
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, 29010 Malaga, Spain; (M.T.C.-B.); (P.M.); (M.C.C.); (B.M.-K.)
| | - Paloma Martín
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, 29010 Malaga, Spain; (M.T.C.-B.); (P.M.); (M.C.C.); (B.M.-K.)
| | - Carlos Martín
- Primary Care Center of Marquesado, Área Nordeste de Granada, 18512 Granada, Spain;
| | - Mª Carmen Castillejos
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, 29010 Malaga, Spain; (M.T.C.-B.); (P.M.); (M.C.C.); (B.M.-K.)
| | - Eleni Petkari
- Social and Behavioural Sciences, European University Cyprus 6th Diogenous st., Nicosia 2063, Cyprus;
| | - Berta Moreno-Küstner
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, 29010 Malaga, Spain; (M.T.C.-B.); (P.M.); (M.C.C.); (B.M.-K.)
- Biomedical Research Institute of Malaga (IBIMA), 29010 Málaga, Spain
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17
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Huertas P, Moreno-Küstner B, Gutiérrez B, Cervilla JA. Prevalence and correlates of suicidality in Andalusia (Spain): Results of the epidemiological study PISMA-ep. J Affect Disord 2020; 266:503-511. [PMID: 32056919 DOI: 10.1016/j.jad.2020.01.115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/06/2019] [Accepted: 01/20/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Suicidality is an important public health problem. Hence, the aims of this study are to report prevalence rates and correlates of suicidality in Andalusia (Southern Spain). METHODS This is a cross-sectional household survey conducted on a representative sample of adults living in Andalusia. 4507 subjects were interviewed using the Mini International Neuropsychiatric Interview (MINI) to assess suicidality and standardized instruments were employed to evaluate associated variables. A multivariate logistic regression analysis was used to explore independent associations with suicidality. RESULTS Current prevalence of suicidality was 6.4%, 4.4% showed death wish, 1.4% had ideas of self-harm, 2.4% had suicidal thoughts, 1.1% had a suicidal plan, 0.6% had attempted suicide during the month prior to the interview, and, lastly, 2.6% reported to have had any sort of suicide attempt during his/her previous life. Independent factors associated with suicidality were being female, older age, not having a stable couple, lower levels of social support, having had physical childhood abuse experience, having experienced an increasing number of stressful life events, higher neuroticism scores, having a family history of mental disorder and nicotine or drugs dependence. LIMITATIONS The instrument employed to measure suicidality is a screening tool rather than a more in-depth diagnostic measure. We have not included all potential correlates of suicidality. This is a cross-sectional study which cannot establish causal relationships between exposures and outcomes. CONCLUSIONS This is the first epidemiological study in Andalusia on suicidality offering important results of clinical interest for suicide prevention.
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Affiliation(s)
- Paloma Huertas
- Departament of Personality, Assessment and Psychological Treatment, University of Málaga, Group GAP, Málaga, Spain
| | - Berta Moreno-Küstner
- Departament of Personality, Assessment and Psychological Treatment, University of Málaga, IBIMA, Group GAP, Málaga, Spain.
| | | | - Jorge A Cervilla
- Department of Psychiatry, University of Granada, Granada, Spain; San Cecilio University Hospital, Granada, Spain
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18
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Abstract
Globally, suicide is a major public health problem among homeless people. Suicidal ideation and attempt are remarkably higher among homeless people as compared to the general population and they are linked with greater risk of complete suicide. However, no systematic review and meta-analysis has been conducted to report the consolidated magnitude of suicidal ideation and attempt among homeless people. We searched PubMed, Embase, and Scopus to identify pertinent studies on suicidal ideation and attempt among homeless people. A meta-analysis of the studies was conducted using a random effect model. We also conducted a sensitivity analysis and Cochran's Q- and the I2 test was employed to evaluate heterogeneity. Publication bias was assessed by Egger's test and visual inspection of the symmetry in funnel plots. In total, 20 eligible studies with 27,497 homeless people matched the inclusion criteria. Nineteen studies assessed suicidal attempt and thirteen studies assessed suicidal ideation among homeless people. The pooled current and lifetime prevalence of suicidal ideation was 17.83% (95% CI;10.73-28.14) and 41.60% (95% CI; 28.55-55.95), respectively whereas the pooled current and lifetime prevalence of suicidal attempt was 9.16% (95% CI;4.10-19.20) and 28.80% (95% CI; 21.66-37.18), respectively. We found a considerable heterogeneity between the studies, but we found no significant publication bias. The current review revealed a remarkably higher magnitude of suicidal ideation and attempt among homeless people as compared to the estimated prevalence in the general population. The concerned stakeholders need to give attention to address this problem emphasizing more on prevention and treatment strategies as well as utilizing holistic approaches to address the potential predictors of suicide among homeless people including physical, mental, and substance use problems.
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19
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Polling C, Bakolis I, Hotopf M, Hatch SL. Differences in hospital admissions practices following self-harm and their influence on population-level comparisons of self-harm rates in South London: an observational study. BMJ Open 2019; 9:e032906. [PMID: 31628133 PMCID: PMC6803107 DOI: 10.1136/bmjopen-2019-032906] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To compare the proportions of emergency department (ED) attendances following self-harm that result in admission between hospitals, examine whether differences are explained by severity of harm and examine the impact on spatial variation in self-harm rates of using ED attendance data versus admissions data. SETTING A dataset of ED attendances and admissions with self-harm to four hospitals in South East London, 2009-2016 was created using linked electronic patient record data and administrative Hospital Episode Statistics. DESIGN Proportions admitted following ED attendance and length of stay were compared. Variation and spatial patterning of age and sex standardised, spatially smoothed, self-harm rates by small area using attendance and admission data were compared and the association with distance travelled to hospital tested. RESULTS There were 20 750 ED attendances with self-harm, 7614 (37%) resulted in admission. Proportion admitted varied substantially between hospitals with a risk ratio of 2.45 (95% CI 2.30 to 2.61) comparing most and least likely to admit. This was not altered by adjustment for patient demographics, deprivation and type of self-harm. Hospitals which admitted more had a higher proportion of admissions lasting less than 24 hours (54% of all admissions at highest admitting hospital vs 35% at lowest). A previously demonstrated pattern of lower rates of self-harm admission closer to the city centre was reduced when ED attendance rates were used to represent self-harm. This was not altered when distance travelled to hospital was adjusted for. CONCLUSIONS Hospitals vary substantially in likelihood of admission after ED presentation with self-harm and this is likely due to the differences in hospital practices rather than in the patient population or severity of self-harm seen. Public health policy that directs resources based on self-harm admissions data could exacerbate existing health inequalities in inner-city areas where these data may underestimate rates relative to other areas.
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Affiliation(s)
- C Polling
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Ioannis Bakolis
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Matthew Hotopf
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Stephani L Hatch
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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20
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Polling C, Bakolis I, Hotopf M, Hatch SL. Spatial patterning of self-harm rates within urban areas. Soc Psychiatry Psychiatr Epidemiol 2019; 54:69-79. [PMID: 30259055 PMCID: PMC6336929 DOI: 10.1007/s00127-018-1601-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 09/18/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Urban areas are usually found to have higher rates of self-harm, with deprivation the strongest predictor at area-level. We use a disease mapping approach to examine how self-harm is patterned within an urban area and its associations with deprivation, urbanness and ethnicity. METHODS Data from clinical records on individuals admitted for self-harm for 725 small areas in South East London were included. Bayesian hierarchical models explored the spatio-temporal patterns of self-harm admission rates and potential associations with proximity to city centre, population density, percentage greenspace and non-white ethnic-minority populations. All models were adjusted for area-level deprivation, social fragmentation and hospital of admission. RESULTS There were 8327 first admissions for self-harm during the study period. Self-harm admission rates varied fourfold across the study area, with lower rates close to the city centre [adjusted standardised admission ratio, closest versus furthest quartile 0.71(95% CrI 0.54-0.96)]. Deprivation was associated with self-harm but partially masked rather than explained the spatial pattern, which strengthened after adjustment. After adjustment for deprivation, hospital of admission and social fragmentation, greenspace, population density and ethnicity were not associated with self-harm rates. CONCLUSION Proximity to the city centre was associated with lower rates of self-harm, but the usual operationalisations of urbanness, population density and greenspace, were not. Deprivation did not explain the spatial patterning, nor did ethnicity. While nationally self-harm rates are higher in urban and deprived areas, this cannot be extrapolated to mean that within cities the inner-city is the highest risk area nor that risk will be principally patterned according to deprivation.
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Affiliation(s)
- Catherine Polling
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ioannis Bakolis
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Stephani L. Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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21
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Lund EM, Nadorff MR, Thomas KB, Galbraith K. Examining the Contributions of Disability to Suicidality in the Context of Depression Symptoms and Other Sociodemographic Factors. OMEGA-JOURNAL OF DEATH AND DYING 2018; 81:298-318. [PMID: 29665740 DOI: 10.1177/0030222818768609] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We examined the contribution of disability status to suicidality when accounting for depression and sociodemographic risk factors in 438 American adults, 82 (18.7%) of whom identified as having disabilities. Participants with disabilities had significantly higher depression scores and were more likely to be unemployed and unpartnered, all of which were also associated with increased suicidality. However, disability remained a significant predictor of suicidality even when depression and sociodemographic risk factors were accounted for in a linear regression. Other significant predictors of suicidality in this regression were female gender, depression symptoms, and family and friend suicide history; identifying as a member of a religion was a significant protective factor against suicidality. Our findings suggest that the contribution of disability to suicidality goes beyond that which can be explained by increased depression symptoms and sociodemographic vulnerability.
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Affiliation(s)
- Emily M Lund
- St. Cloud State University, MN, USA.,Utah State University, Logan, UT, USA
| | - Michael R Nadorff
- Mississippi State University, Starkville, MS, USA.,Baylor College of Medicine, Houston, TX, USA
| | - Katie B Thomas
- Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA
| | - Kate Galbraith
- Utah State Office of Rehabilitation, Salt Lake City, UT, USA
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22
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Ki M, Seong Sohn E, An B, Lim J. Differentiation of direct and indirect socioeconomic effects on suicide attempts in South Korea. Medicine (Baltimore) 2017; 96:e9331. [PMID: 29390510 PMCID: PMC5758212 DOI: 10.1097/md.0000000000009331] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Despite the wide recognition of the inverse association between socioeconomic position (SEP) and suicidal behaviors, its underlying process and potential mediators are little known. This study investigated the pathway from SEP to suicide attempts with attention to potential mediators.From the Korean Health and Nutrition Examination Survey 2007-2013, which is a nationwide cross-sectional survey of the health and nutritional status, a total of 34,565 participants (≥30 years) were included in the analysis. To unfold the pathways linking SEP to suicide attempts, the direct and indirect effects of 3 SEP measures (educational attainment, household income, and occupational group) and 3 mediators (physical illness, mental health problems, and problematic drinking) were differentiated using structured equation model (SEM).Most of direct and indirect effects of educational attainment, household income, and occupational group on suicide attempts were significant; Nonemployment status had the largest total (β = 0.291, P < .01) and direct effects (β = 0.212, P < .01), while educational attainment had the largest indirect effect (β = -0.124, P < .01). Educational attainment was mainly mediated by physical illness and problem drinking, whereas household income and occupational group were mainly mediated by anxious or depressed mood and problem drinking. Physical illness played a major role in explaining suicide attempts, compared to mental health problem and problem drinking.Overall, experience of socioeconomic disadvantage increased suicide attempts independently of mental and physical problems. An extension of suicide prevention program is required for comprehensively targeting people with general problems such as physical illness and low SEP, complemented to narrowly targeting high risk group with, such as mental health problem.
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Affiliation(s)
- Myung Ki
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
| | | | - Byungduck An
- Department of Psychology and Philosophy, PaiChai University
| | - Jiseun Lim
- Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, Korea
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23
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Govender K, Cowden RG, Oppong Asante K, George G, Reardon C. Validation of the child and youth resilience measure among South African adolescents. PLoS One 2017; 12:e0185815. [PMID: 28982195 PMCID: PMC5628872 DOI: 10.1371/journal.pone.0185815] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 09/20/2017] [Indexed: 01/13/2023] Open
Abstract
Resilience is a dynamic, interactive process between resources that contribute to safeguarding a person and the adversities they experience. Within this promotional framework of resilience, this study sought to validate the Child and Youth Resilience Measure (CYRM-28) among a sample of South African adolescents (N = 1854). Confirmatory factor analysis supported a superior level of fit for a 24-item, three-factor model (i.e., individual/social, familial, and community/spiritual). Internal consistency and test-retest reliability estimates at a 12-month interval (N = 648) supported the reliability of the scales. Higher scores on the scales were associated with feeling more connected at school, greater parental monitoring perceptions, and lower sexual risk, confirming the convergent and criterion validity of the instrument. Partial discriminative power was evidenced based on selected scale distinctions according to age and sex groupings. Collectively, the findings suggest the 24-item CYRM is a valid and reliable self-report measure to assess the availability of resources associated with resilience in South African youth.
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Affiliation(s)
- Kaymarlin Govender
- Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Richard G. Cowden
- Institute of Psychology and Wellbeing, School of Psychosocial Behavioral Sciences, North-West University, Potchefstroom, North West, South Africa
- * E-mail:
| | - Kwaku Oppong Asante
- Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Gavin George
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Candice Reardon
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
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24
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Choi SB, Lee W, Yoon JH, Won JU, Kim DW. Risk factors of suicide attempt among people with suicidal ideation in South Korea: a cross-sectional study. BMC Public Health 2017; 17:579. [PMID: 28619107 PMCID: PMC5472995 DOI: 10.1186/s12889-017-4491-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 06/07/2017] [Indexed: 11/16/2022] Open
Abstract
Background Suicide is a serious public health concern worldwide, and the fourth leading cause of death in Korea. Few studies have focused on risk factors for suicide attempt among people with suicidal ideation. The aim of the present study was to investigate the risk factors and develop prediction models for suicide attempt among people with suicidal ideation in the Korean population. Method This study included 1567 men and 3726 women aged 20 years and older who had suicidal ideation from the Korea National Health and Nutrition Examination Survey from 2007 to 2012. Among them, 106 men and 188 women attempted suicide. Multivariate logistic regression analysis with backward stepwise elimination was performed to find risk factors for suicide attempt. Sub-group analysis, dividing participants into under 50 and at least 50 years old was also performed. Results Among people with suicidal ideation, age, education, cancer, and depressive disorder were selected as risk factors for suicide attempt in men. Age, education, national basic livelihood security, daily activity limitation, depressive disorder, stress, smoking, and regular exercise were selected in women. Area under curves of our prediction models in men and women were 0.728 and 0.716, respectively. Conclusions It is important to pay attention to populations with suicidal ideation and the risk factors mentioned above. Prediction models using the determined risk factors could be useful to detect high-risk groups early for suicide attempt among people with suicidal ideation. It is necessary to develop specific action plans for these high-risk groups to prevent suicide. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4491-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Soo Beom Choi
- Department of Medical Engineering, Yonsei University College of Medicine, CPO Box, Seoul, 8044, South Korea.,Graduate Program in Biomedical Engineering, Yonsei University, Seoul, South Korea
| | - Wanhyung Lee
- The Institute for Occupational Health, Yonsei University College of Medicine, Seoul, South Korea.,Graduate School of Public Health, Yonsei University College of Medicine, Seoul, South Korea.,Incheon Worker's Health Center, Incheon, South Korea
| | - Jin-Ha Yoon
- The Institute for Occupational Health, Yonsei University College of Medicine, Seoul, South Korea.,Graduate School of Public Health, Yonsei University College of Medicine, Seoul, South Korea.,Incheon Worker's Health Center, Incheon, South Korea
| | - Jong-Uk Won
- The Institute for Occupational Health, Yonsei University College of Medicine, Seoul, South Korea.,Graduate School of Public Health, Yonsei University College of Medicine, Seoul, South Korea.,Incheon Worker's Health Center, Incheon, South Korea
| | - Deok Won Kim
- Department of Medical Engineering, Yonsei University College of Medicine, CPO Box, Seoul, 8044, South Korea. .,Graduate Program in Biomedical Engineering, Yonsei University, Seoul, South Korea.
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25
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A comparative analysis of suicide attempts in left-behind children and non-left-behind children in rural China. PLoS One 2017; 12:e0178743. [PMID: 28594874 PMCID: PMC5464573 DOI: 10.1371/journal.pone.0178743] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 05/18/2017] [Indexed: 11/19/2022] Open
Abstract
To estimate the prevalence of suicide attempts and explore the shared and unique factors influencing suicide risk in left-behind children (LBC) and non-left-behind children (NLBC) in rural China, this study collected data using a multi-stage cluster random sampling method from 13,952 children including 6,034 LBC and 7,918 NLBC. Sociodemographic characteristics, suicide attempts, neglect and physical abuse, negative life events, and loneliness were measured by self-reported questionnaires. Data were analyzed using logistic regression models. Gender and mother's education level were unique influential factors for NLBC while family structure type was a unique influential factor for LBC. The study provides two novel findings regarding NLBC specifically: 1. Children with optimal family socioeconomic status are more likely to report suicide attempts (odds ratio OR = 1)than are those in the general children population, OR 0.52 (95% CI: 0.39-0.70), and 2. Children with higher mother's education level are subject to higher suicide rates in high school, OR 1.67 (95% CI: 1.13-2.46), and post-secondary education, OR 2.14 (95% CI: 1.37-3.37). The unique characteristics of LBC and NLBC in China suggest that investigating risk factors and determining the factors that might be targeted in intervention programs are urgently needed currently.
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26
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Kinyanda E, Nakasujja N, Levin J, Birabwa H, Mpango R, Grosskurth H, Seedat S, Patel V. Major depressive disorder and suicidality in early HIV infection and its association with risk factors and negative outcomes as seen in semi-urban and rural Uganda. J Affect Disord 2017; 212:117-127. [PMID: 28160684 DOI: 10.1016/j.jad.2017.01.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 08/31/2016] [Accepted: 01/23/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION There is a paucity of research into the psychiatric problems associated with early stage HIV clinical disease in sub-Saharan Africa. METHODS A cross sectional study was undertaken among 899 adult ART naïve persons in early stage HIV clinical disease (participants with CD4≥250 and who were at WHO clinical Stage I or II) attending a semi-urban and a rural clinic in Uganda. RESULTS The prevalence of major depressive disorder in this study was 14.0% [95% CI 11.7-6.3%] while that of 'moderate to high risk for suicidality' was 2.8% [95% CI 1.7%; 3.9%]. Multivariable analyses found that factors in the socio-demographic, vulnerability/protective and stress (only for major depressive disorder) domains were significantly associated with both major depressive disorder and 'moderate to high risk for suicidality'. Major depressive disorder but not 'moderate to high risk for suicidality' was significantly associated with impaired psychosocial functioning, greater utilisation of health services and non-adherence to septrin/dasone. Neither major depressive disorder nor 'moderate to high risk for suicidality' was associated with CD4 counts, risky sexual behaviour nor with non-utilisation of condoms. LIMITATIONS The bidirectional nature of some of the relationships between the investigated psychiatric problems, risk factors and outcomes in this cross sectional study makes it difficult to elucidate the actual direction of causality. CONCLUSION Early stage HIV clinical disease is associated with considerable major depressive disorder and 'moderate to high risk for suicidality'. Therefore there is a need to integrate mental health into HIV interventions that target early stage HIV disease.
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Affiliation(s)
- Eugene Kinyanda
- Mental Health Project, MRC/UVRI Uganda Research Unit on AIDS/ MRC-DFID African Leadership Award, Entebbe, Uganda; Department of Psychiatry, Makerere College of Health Sciences, Kampala, Uganda; London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Noeline Nakasujja
- Department of Psychiatry, Makerere College of Health Sciences, Kampala, Uganda.
| | - Jonathan Levin
- Statistical Section, MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Harriet Birabwa
- Butabika National Psychiatric Referral Hospital, Kampala, Uganda.
| | - Richard Mpango
- Mental Health Project, MRC/UVRI Uganda Research Unit on AIDS/ MRC-DFID African Leadership Award, Entebbe, Uganda
| | - Heiner Grosskurth
- London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | | | - Vikram Patel
- London School of Hygiene and Tropical Medicine, London, United Kingdom; Senior Wellcome Trust Fellowship, London, United Kingdom.
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27
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Stanford S, Jones MP, Loxton DJ. Understanding women who self-harm: Predictors and long-term outcomes in a longitudinal community sample. Aust N Z J Psychiatry 2017; 51:151-160. [PMID: 26921278 DOI: 10.1177/0004867416633298] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE There is growing awareness of the range of psychosocial, lifestyle, and sociodemographic factors related to self-harm, however this research is often limited by using cross-sectional or convenience samples. And while we generally assume that young adults who self-harm experience poorer long-term outcomes, longitudinal research is needed. This paper builds on prior research using a large, representative, longitudinal sample. METHODS 5765 Australian women completed 5 surveys (age 18-23 to 31-36). Six-month self-harm was measured by self-report. We had two aims: firstly to predict future self-harm, separately for women with and without prior self-harm. Secondly, to identify outcomes 3 and 6 years following self-harm. RESULTS Six-month self-harm prevalence was 2.5%. Predictors among women without recent self-harm included depression, dieting behaviours, number of male sexual partners, and abuse. Among women with recent or current self-harm, predictors were number of dieting behaviours, tiredness of life, and stress. Women who self-harmed reported poorer outcomes, namely greater difficulties in relationships at 3- and 6-year follow-up. CONCLUSIONS Longitudinal risk factors for self-harm differed depending on prior self-harm status, and included depression, dieting behaviours, tiredness of life and stress. These factors may serve as warning signs for new or continued self-harm. This study offers new insight into long-term outcomes up to six years after self-harm, particularly with relationships.
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Affiliation(s)
- Sarah Stanford
- 1 Faculty of Human Sciences, Department of Psychology, Macquarie University, North Ryde, NSW, Australia
| | - Michael P Jones
- 1 Faculty of Human Sciences, Department of Psychology, Macquarie University, North Ryde, NSW, Australia
| | - Deborah J Loxton
- 2 Faculty of Health and Medicine (Public Health), University of Newcastle, Newcastle, NSW, Australia
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28
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Kim M, Oh GJ, Lee YH. Gender-Specific Factors Associated with Suicide Attempts among the Community-Dwelling General Population with Suicidal Ideation: the 2013 Korean Community Health Survey. J Korean Med Sci 2016; 31:2010-2019. [PMID: 27822943 PMCID: PMC5102868 DOI: 10.3346/jkms.2016.31.12.2010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/23/2016] [Indexed: 11/21/2022] Open
Abstract
We identified traditional risk factors and investigated poorly understood risk factors for suicide attempts according to gender in a large Korean population. We analyzed the data from 6,768 males and 12,475 females with suicidal ideation obtained from the nationwide 2013 Korean Community Health Survey. The dependent variable was suicide attempts within the past year. There was a significant trend towards an increase in suicide attempts with decreasing age in both genders. Compared with those who were married, suicide attempts were significantly higher among those who were widowed, divorced, or separated for males (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.34-3.20), but lower for females (OR, 0.66; 95% CI, 0.45-0.98). Current smoking and depression were significant risk factor for suicide attempts in males and females. However, monthly household income, myocardial infarction, and osteoporosis were significantly associated with suicide attempts only in males, whereas education level, recipient of National Basic Livelihood Security, family contact, leisure activity, and drinking frequency were significantly associated only in females. These findings indicate that gender difference should be considered in the assessment, prevention, and management of future suicide attempts by community policy-makers and clinicians.
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Affiliation(s)
- Mina Kim
- Department of Nursing, Graduate School, Chonnam National University, Gwangju, Korea
- Department of Counseling Psychology, Graduate School of Dongshin University, Naju, Korea
| | - Gyung Jae Oh
- Department of Preventive Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
- Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Young Hoon Lee
- Department of Preventive Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
- Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea.
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29
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Schofield P, Das-Munshi J, Bécares L, Morgan C, Bhavsar V, Hotopf M, Hatch SL. Minority status and mental distress: a comparison of group density effects. Psychol Med 2016; 46:3051-3059. [PMID: 27523979 PMCID: PMC5080664 DOI: 10.1017/s0033291716001835] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND It has been observed that mental disorders, such as psychosis, are more common for people in some ethnic groups in areas where their ethnic group is less common. We set out to test whether this ethnic density effect reflects minority status in general, by looking at three situations where individual characteristics differ from what is usual in a locality. METHOD Using data from the South East London Community Health study (n = 1698) we investigated associations between minority status (defined by: ethnicity, household status and occupational social class) and risk of psychotic experiences, common mental disorders and parasuicide. We used a multilevel logistic model to examine cross-level interactions between minority status at individual and neighbourhood levels. RESULTS Being Black in an area where this was less common (10%) was associated with higher odds of psychotic experiences [odds ratio (OR) 1.34 95% confidence interval (CI) 1.07-1.67], and attempted suicide (OR 1.84 95% CI 1.19-2.85). Living alone where this was less usual (10% less) was associated with increased odds of psychotic experiences (OR 2.18 95% CI 0.91-5.26), while being in a disadvantaged social class where this was less usual (10% less) was associated with increased odds of attempted suicide (OR 1.33 95% CI 1.03-1.71). We found no evidence for an association with common mental disorders. CONCLUSIONS The relationship between minority status and mental distress was most apparent when defined in terms of broad ethnic group but was also observed for individual household status and occupational social class.
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Affiliation(s)
- P. Schofield
- Institute of Psychiatry, Psychology &
Neuroscience, King’s College London, UK
| | - J. Das-Munshi
- Institute of Psychiatry, Psychology &
Neuroscience, King’s College London, UK
| | - L. Bécares
- The University of Manchester,
Manchester, UK
| | - C. Morgan
- Institute of Psychiatry, Psychology &
Neuroscience, King’s College London, UK
| | - V. Bhavsar
- Institute of Psychiatry, Psychology &
Neuroscience, King’s College London, UK
| | - M. Hotopf
- Institute of Psychiatry, Psychology &
Neuroscience, King’s College London, UK
| | - S. L. Hatch
- Institute of Psychiatry, Psychology &
Neuroscience, King’s College London, UK
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30
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Lopez-Morinigo JD, Ayesa-Arriola R, Torres-Romano B, Fernandes AC, Shetty H, Broadbent M, Dominguez-Ballesteros ME, Stewart R, David AS, Dutta R. Risk assessment and suicide by patients with schizophrenia in secondary mental healthcare: a case-control study. BMJ Open 2016; 6:e011929. [PMID: 27678536 PMCID: PMC5051464 DOI: 10.1136/bmjopen-2016-011929] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 07/09/2016] [Accepted: 07/11/2016] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To investigate the role of risk assessment in predicting suicide in patients with schizophrenia spectrum disorders (SSDs) receiving secondary mental healthcare. We postulated that risk assessment plays a limited role in predicting suicide in these patients. DESIGN Retrospective case-control study. SETTING Anonymised electronic mental health record data from the South London and Maudsley National Health Service (NHS) Foundation Trust (SLaM) (London, UK) linked with national mortality data. PARTICIPANTS In 242 227 SLaM service users up to 31 December 2013, 635 suicides were identified. 96 (15.1%) had a SSD diagnosis. Those who died before 1 January 2007 (n=25) were removed from the analyses. Thus, 71 participants with SSD who died from suicide over the study period (cases) were compared with 355 controls. MAIN OUTCOME MEASURE Risk of suicide in relation to risk assessment ratings. RESULTS Cases were younger at first contact with services (mean±SD 34.5±12.6 vs 39.2±15.2) and with a higher preponderance of males (OR=2.07, 95% CI 1.18 to 3.65, p=0.01) than controls. Also, suicide occurred within 10 days after last contact with services in half of cases, with the most common suicide methods being hanging (14) and jumping (13). Cases were more likely to have the following 'risk assessment' items previously recorded: suicidal history (OR=4.42, 95% CI 2.01 to 9.65, p<0.001), use of violent method (OR=3.37, 95% CI 1.47 to 7.74, p=0.01), suicidal ideation (OR=3.57, 95% CI 1.40 to 9.07, p=0.01) and recent hospital discharge (OR=2.71, 95% CI 1.17 to 6.28, p=0.04). Multiple regression models predicted only 21.5% of the suicide outcome variance. CONCLUSIONS Predicting suicide in schizophrenia is highly challenging due to the high prevalence of risk factors within this diagnostic group irrespective of outcome, including suicide. Nevertheless, older age at first contact with mental health services and lack of suicidal history and suicidal ideation are useful protective markers indicative of those less likely to end their own lives.
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Affiliation(s)
- Javier-David Lopez-Morinigo
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Rosa Ayesa-Arriola
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IFIMAV, School of Medicine, University of Cantabria, Santander, Spain
| | | | - Andrea C Fernandes
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Hitesh Shetty
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Matthew Broadbent
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | | | - Robert Stewart
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Anthony S David
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Rina Dutta
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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31
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Sampasa-Kanyinga H, Hamilton HA. Does socioeconomic status moderate the relationships between school connectedness with psychological distress, suicidal ideation and attempts in adolescents? Prev Med 2016; 87:11-17. [PMID: 26876628 DOI: 10.1016/j.ypmed.2016.02.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 02/01/2016] [Accepted: 02/02/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Research has indicated that school connectedness acts as a buffer against depressive symptoms and suicidality. However, little is known about the role of socioeconomic status (SES) on these links. The present study examined the moderating role of subjective SES and parental education on the relationships between school connectedness and psychological distress, suicidal ideation and suicide attempts. METHODS Data were gathered from 4955 participants within the 2013 cycle of the Ontario Students Drug Use and Health Survey, a province-wide repeated school-based survey of students in grade 7 to 12 across Ontario, Canada. RESULTS Results indicated that higher subjective SES is associated with high levels of school connectedness. Subjective SES is also a significant moderator of the association between school connectedness and psychological distress, but not between school connectedness and suicidal ideation or attempts. At low subjective SES, there was no difference in risk of psychological distress between students with high and low levels of school connectedness. However, at higher subjective SES, students with high levels of school connectedness have lower odds of psychological distress than those with low levels of school connectedness. The associations between school connectedness and each of the mental health outcomes did not significantly vary with parental education. CONCLUSIONS These findings suggest that the beneficial effects of school connectedness on mental health problems may be more strongly related to adolescents' status beliefs rather than parental education. Future research is needed to better understand the mechanism through which subjective SES and school connectedness influence psychological distress.
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Affiliation(s)
| | - Hayley A Hamilton
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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32
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Raude J, Fressard L, Gautier A, Pulcini C, Peretti-Watel P, Verger P. Opening the 'Vaccine Hesitancy' black box: how trust in institutions affects French GPs' vaccination practices. Expert Rev Vaccines 2016; 15:937-48. [PMID: 27140417 DOI: 10.1080/14760584.2016.1184092] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND In recent years, vaccine hesitancy among health professionals has emerged as an important issue on public health agendas. However, we do not yet know very much about whether, and if so how, trust in institutions affects their practices. METHODS A path analysis model explaining the influence of trust on GPs' vaccine hesitancy was applied to a cross-sectional survey of 1,582 French GPs performed in 2014. We hypothesized that distrust in public health institutions influences GPs' concerns about the safety of various vaccines, their perceptions about the importance of vaccination, their self-efficacy in the doctor-patient relationship, and ultimately their vaccination recommendations to patients. RESULTS GPs' trust in institutions was found to be significantly associated with lower vaccine hesitancy, an association mediated to a large extent by the vaccine's perceived safety (β = 0.09, P < 0.01) and the importance of vaccination (β = 0.46, P < 0.001). CONCLUSION These results suggest that restoration of high vaccination coverage may require the re-establishment of a significant degree of trust in the public health system among health professionals.
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Affiliation(s)
- Jocelyn Raude
- a IRD French Institute of Research for Development, EHESP French School of Public Health, UMR_D 190 'Emergence des Pathologies Virales' , Aix Marseille University , Marseille , France.,b UMR PIMIT, INSERM 1187, CNRS 9192, IRD 249. Plateforme Technologique CYROI , Université de La Réunion , Réunion , France
| | - Lisa Fressard
- c UMR912 'Economics and Social Sciences Applied to Health & Analysis of Medical Information' (SESSTIM) , INSERM , Marseille , France.,d UMR_S912, IRD, 13006, Aix Marseille University , Marseille , France.,e ORS PACA, Southeastern Health Regional Observatory , Marseille , France
| | - Arnaud Gautier
- f French Public Health Agency, Direction de la prévention - promotion de la santé , Saint-Maurice , France
| | - Céline Pulcini
- g Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC , Nancy , France.,h CHU de Nancy, Service de Maladies Infectieuses , Nancy cedex , France
| | - Patrick Peretti-Watel
- c UMR912 'Economics and Social Sciences Applied to Health & Analysis of Medical Information' (SESSTIM) , INSERM , Marseille , France.,d UMR_S912, IRD, 13006, Aix Marseille University , Marseille , France.,e ORS PACA, Southeastern Health Regional Observatory , Marseille , France
| | - Pierre Verger
- c UMR912 'Economics and Social Sciences Applied to Health & Analysis of Medical Information' (SESSTIM) , INSERM , Marseille , France.,d UMR_S912, IRD, 13006, Aix Marseille University , Marseille , France.,e ORS PACA, Southeastern Health Regional Observatory , Marseille , France
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33
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Weng SC, Chang JC, Yeh MK, Wang SM, Chen YH. Factors influencing attempted and completed suicide in postnatal women: A population-based study in Taiwan. Sci Rep 2016; 6:25770. [PMID: 27173845 PMCID: PMC4865942 DOI: 10.1038/srep25770] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 04/22/2016] [Indexed: 11/27/2022] Open
Abstract
The aims of study were to investigate risk factors associated with attempted and completed suicide. This nested case–control study was conducted using the medical and death data of nearly all pregnant women for the period 2002–2012 in Taiwan. A total of 139 cases of attempted suicide and 95 cases of completed suicide were identified; for each case, 10 controls were randomly selected and matched to the cases according to age and year of delivery. A conditional logistic regression model was used. The mean attempted and completed suicide rates were 9.91 and 6.86 per 100,000 women with live births, respectively. Never having married and postpartum depression also increased the risk of attempted suicide (OR = 2.06; 95% CI = 1.09–3.88 and OR = 2.51; 95% CI = 1.10–5.75, respectively) and completed suicide (OR = 20.27; 95% CI = 8.99–45.73 and OR = 21.72; 95% CI = 8.08–58.37, respectively). Other factors for attempted suicide included being widowed or divorced, and having a caesarean delivery or suicide history. Other factors for completed suicide included lower education level, low infant birth weight, and diagnosis of anxiety or mood disorder. These results suggest that people should appropriately assess potential risk factors and provide assistance for postnatal women to reduce the occurrence of suicide events.
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Affiliation(s)
- Shu-Chuan Weng
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Jung-Chen Chang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Kung Yeh
- School of Pharmacy, Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan
| | - Shun-Mu Wang
- Department of Public Health, China Medical University, Taichung, Taiwan.,Department of Health Services Administration, China Medical University, Taichung, Taiwan.,Department of Health Care Administration, Oriental Institute of Technology, New Taipei, Taiwan
| | - Yi-Hua Chen
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
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34
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Law BMF, Shek DTL. A 6-year Longitudinal Study of Self-harm and Suicidal Behaviors among Chinese Adolescents in Hong Kong. J Pediatr Adolesc Gynecol 2016; 29:S38-48. [PMID: 26461529 DOI: 10.1016/j.jpag.2015.10.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE To examine the trajectories of self-harm and suicidal behaviors among Chinese adolescents in Hong Kong and to investigate the related predictors, including gender, family nonintactness, economic disadvantage, positive youth development, and family functioning. DESIGN We used quantitative data from a large sample of adolescent participants. Participants initially joined this study when they were in grade 7 (wave 1), and they were followed from grade 8 (wave 2) to grade 12 (wave 6). SETTING, PARTICIPANTS, AND INTERVENTIONS The participants consisted of 2023 grade 12 students from 28 secondary schools in Hong Kong. A multistage cluster random sampling method was adopted. MAIN OUTCOME MEASURES Self-harm and suicidal behaviors. RESULTS The trajectories of self-harm and suicidal behaviors in general declined from grade 7 to grade 12. Regarding the effect of gender, whereas adolescent girls showed a higher prevalence for self-harm and suicidal behaviors at baseline and other waves, adolescent boys showed a pronounced decline in self-harm rates. Adolescents from nonintact families were more likely to self-harm or engage in suicidal behaviors at wave 6. Economic disadvantage at wave 4 predicted higher suicidal behavior among adolescents but not self-harm at wave 6. Regarding positive youth development, several protective factors that include cognitive-behavioral competencies, prosocial attributes, general positive youth development qualities, and positive identity could help reduce self-harm and suicidal behaviors at different time points. Regarding the role of family functioning, more family conflicts predicted higher suicidality in adolescence (self-harm and suicidal behaviors), and family communication affected self-harming behaviors at wave 6. CONCLUSION The trajectories of self-harm and suicidal behaviors decline from early to late adolescence among Chinese adolescents. Positive youth development and constructive family functioning are critical to help reduce suicidal behaviors. Regarding increased risk, more attention should be paid to adolescent girls and adolescents from nonintact and economic disadvantaged families.
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Affiliation(s)
- Ben M F Law
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, P.R. China.
| | - Daniel T L Shek
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, P.R. China; Centre for Innovative Programmes for Adolescents and Families, The Hong Kong Polytechnic University, Hong Kong, P.R. China; School of Social Development, East China Normal University, Shanghai, P.R. China; Kiang Wu Nursing College of Macau, Macau, P.R. China; Division of Adolescent Medicine, Department of Pediatrics, Kentucky Children's Hospital, University of Kentucky College of Medicine, Lexington, Kentucky
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35
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Townsend E, Ness J, Waters K, Kapur N, Turnbull P, Cooper J, Bergen H, Hawton K. Self-harm and life problems: findings from the Multicentre Study of Self-harm in England. Soc Psychiatry Psychiatr Epidemiol 2016; 51:183-92. [PMID: 26499114 DOI: 10.1007/s00127-015-1136-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 10/13/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE Self-harm is a major clinical problem and is strongly linked to suicide. It is important to understand the problems faced by those who self-harm to design effective clinical services and suicide prevention strategies. We investigated the life problems experienced by patients presenting to general hospitals for self-harm. METHODS Data for 2000-2010 from the Multicentre Study of Self-harm in England were used to investigate life problems associated with self-harm and their relationship to patient and clinical characteristics, including age, gender, repeat self-harm and employment status. RESULTS Of 24,598 patients (36,431 assessed episodes), 57% were female and with a mean age of 33.1 years (SD 14.0 years), 92.6% were identified as having at least one contributing life problem. The most frequently reported problems at first episode of self-harm within the study period were relationship difficulties (especially with partners). Mental health issues and problems with alcohol were also very common (especially in those aged 35-54 years, and those who repeated self-harm). Those who repeated self-harm were more likely to report problems with housing, mental health and dealing with the consequences of abuse. CONCLUSIONS Self-harm usually occurs in the context of multiple life problems. Clinical services for self-harm patients should have access to appropriate care for provision of help for relationship difficulties and problems concerning alcohol and mental health issues. Individualised clinical support (e.g. psychological therapy, interventions for alcohol problems and relationship counselling) for self-harm patients facing these life problems may play a crucial role in suicide prevention.
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Affiliation(s)
- Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, University Park, Nottingham, NG72RD, UK.
| | - Jennifer Ness
- Centre for Self-Harm and Suicide Prevention Research, Research and Development Centre, Derbyshire Healthcare NHS Foundation Trust, Kingsway, Derby, DE22 3LZ, UK
| | - Keith Waters
- Centre for Self-Harm and Suicide Prevention Research, Research and Development Centre, Derbyshire Healthcare NHS Foundation Trust, Kingsway, Derby, DE22 3LZ, UK
| | - Navneet Kapur
- Centre for Suicide Prevention, University of Manchester, Centre for Mental Health and Safety, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Pauline Turnbull
- Centre for Suicide Prevention, University of Manchester, Centre for Mental Health and Safety, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Jayne Cooper
- Centre for Suicide Prevention, University of Manchester, Centre for Mental Health and Safety, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Helen Bergen
- Centre for Suicide Research, University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Keith Hawton
- Centre for Suicide Research, University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
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Abstract
AIMS This review will focus on the rates, clinical characteristics, risk factors and methods of self-harm and suicide in different ethnic groups in the United Kingdom, providing an update synthesis of recent literature. METHODS Studies that met the inclusion criteria between 2003 and 2013 were reviewed using the following databases: MEDLINE, PsycINFO, EMBASE and CINAHL. The methodological quality of each study was then assessed using a structured scoring system. RESULTS A total of 2,362 articles were retrieved, 10 of which matched the inclusion criteria were reviewed. Significant differences were found in the rates of self-harm between ethnic groups with Asian males being least likely to self-harm and Black females being most likely to self-harm. Also, Black and South Asian people were less likely to repeat self-harm. Factors that may help protect or predispose individuals to self-harm or attempt suicide (such as religion, mental health and coping styles) also differ between ethnic groups. CONCLUSIONS There are clear ethnic differences in self-harm and suicide, which may be affected by factors such as cultural pressures and prevalence of mental illness. An awareness of these differences is vital to help prevent further attempts of self-harm and suicide. Further research into differences between ethnic and cultural groups and self-harm continues to be important.
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Affiliation(s)
- Ali Al-Sharifi
- Department of Psychiatry, College of Medical and Dental Sciences, The University of Birmingham, Birmingham, UK
| | - Carl R Krynicki
- Department of Psychiatry, College of Medical and Dental Sciences, The University of Birmingham, Birmingham, UK
| | - Rachel Upthegrove
- Department of Psychiatry, College of Medical and Dental Sciences, The University of Birmingham, Birmingham, UK Birmingham Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
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Hardt J, Bernert S, Matschinger H, Angermeier MC, Vilagut G, Bruffaerts R, de Girolamo G, de Graaf R, Haro JM, Kovess V, Alonso J. Suicidality and its relationship with depression, alcohol disorders and childhood experiences of violence: results from the ESEMeD study. J Affect Disord 2015; 175:168-74. [PMID: 25618003 DOI: 10.1016/j.jad.2014.12.044] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 12/16/2014] [Accepted: 12/16/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Suicidality constitutes a major health concern in many countries. The aim of the present paper was to analyse 10 of its risk factors and their interdependence. METHODS Data on suicidality, mental disorders and experience of childhood violence was collected from 8796 respondents in the European Study of the Epidemiology of Mental Disorders (ESEMeD). The CIDI was used to assess mental disorders. Individuals were randomly divided into two subgroups. In one, a Graphical Markov model to predict suicidality was constructed, in the second, predictors were cross-validated. RESULTS Lifetime suicidality was predicted mainly by lifetime depression and early experiences of violence, with a pseudo R-square of 12.8%. In addition, alcohol disorders predicted suicidality, but played a minor role compared with the other risk factors in this sample. CONCLUSION In addition to depression, early experience of violence constitutes an important risk factor of suicidality. LIMITATIONS This is a cross-sectional and retrospective study assessing risk factors for suicidality, not for suicide itself.
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Affiliation(s)
- J Hardt
- Medizinische Psychologie und Medizinische Soziologie, Klinik für Psycho-somatische Medizin und Psychotherapie, Universitätsmedizin Mainz, Germany.
| | - S Bernert
- Institute of Medical Sociology, Department of Rehabilitation Research, Charité - University Medicine Berlin
| | - H Matschinger
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig
| | - M C Angermeier
- Center for Public Mental Health, Gösing am Wagram, Austria; Department of Public Health, University of Cagliari, Italy
| | - G Vilagut
- Health Services Research Unit, IMIM- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
| | - R Bruffaerts
- Department of Psychiatry, University Hospital Gasthuisberg; Leuven, Belgium
| | - G de Girolamo
- IRCCS St John of God Fatebenefratelli, Via Pilastroni, 4, 25125, Brescia, Italy
| | - R de Graaf
- Netherlands Institute of Mental Health and Addiction (Trimbos-Instituut), Utrecht, Nl; Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - J M Haro
- CIBER en Salud Mental (CIBERSAM), Spain
| | - V Kovess
- EA4069, Paris Descartes University, Ecole des Hautes Etudes en Santé Publique (EHESP), Paris, France
| | - J Alonso
- Health Services Research Unit, IMIM- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
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CAO XIAOLAN, ZHONG BAOLIANG, XIANG YUTAO, UNGVARI GABORS, LAI KELLYYC, CHIU HELENFK, CAINE ERICD. Prevalence of suicidal ideation and suicide attempts in the general population of China: A meta-analysis. Int J Psychiatry Med 2015; 49:296-308. [PMID: 26060259 PMCID: PMC4536918 DOI: 10.1177/0091217415589306] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this meta-analysis is to estimate the pooled prevalence of suicidal ideation and suicide attempts in the general population of Mainland China. METHODS A systematic literature search was conducted via the following databases: PubMed, PsycINFO, MEDLINE, China Journals Full-Text Databases, Chongqing VIP database for Chinese Technical Periodicals, and Wan Fang Data. Statistical analysis used the Comprehensive Meta-Analysis program. RESULTS Eight studies met the inclusion criteria for the analysis; five reported on the prevalence of suicidal ideation and seven on that of suicide attempts. The estimated lifetime prevalence figures of suicidal ideation and suicide attempts were 3.9% (95% confidence interval: 2.5%-6.0%) and 0.8% (95% confidence interval: 0.7%-0.9%), respectively. The estimated female-male ratio for lifetime prevalence of suicidal ideation and suicide attempts was 1.7 and 2.2, respectively. Only the difference of suicide attempts between the two genders was statistically significant. CONCLUSION This was the first meta-analysis of the prevalence of suicidal ideation and suicide attempts in the general population of Mainland China. The pooled lifetime prevalence of both suicidal ideation and suicide attempts are relatively low; however, caution is required when assessing these self-report data. Women had a modestly higher prevalence for suicide attempts than men. The frequency for suicidal ideation and suicide attempts in urban regions was similar to those in rural areas.
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Affiliation(s)
- XIAO-LAN CAO
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China,Shenzhen Kangning Hospital, Shenzhen, Guangdong province, China
| | - BAO-LIANG ZHONG
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - YU-TAO XIANG
- Faculty of Health Sciences, University of Macau, Macao SAR, China,Address correspondence to: Dr. Yu-Tao Xiang, 3/F, Building E12, Faculty of Health Sciences, University of Macau, Avenida da Universidade, Taipa, Macau SAR, China. Fax: +853-2288-2314; Phone: +853-8822-4223;
| | - GABOR S. UNGVARI
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia,The University of Notre Dame Australia / Marian Centre, Perth, Australia
| | - KELLY Y. C. LAI
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - HELEN F. K. CHIU
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - ERIC D. CAINE
- Injury Control Research Center for Suicide Prevention, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
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Critères de soins psychiatriques sans consentement. Revue de littérature et synthèse des différentes recommandations. Presse Med 2014; 43:1195-205. [DOI: 10.1016/j.lpm.2014.02.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 01/24/2014] [Accepted: 02/05/2014] [Indexed: 11/23/2022] Open
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40
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Lopez-Morinigo JD, Fernandes AC, Chang CK, Hayes RD, Broadbent M, Stewart R, David AS, Dutta R. Suicide completion in secondary mental healthcare: a comparison study between schizophrenia spectrum disorders and all other diagnoses. BMC Psychiatry 2014; 14:213. [PMID: 25085220 PMCID: PMC4149212 DOI: 10.1186/s12888-014-0213-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 07/18/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide completion is a tragic outcome in secondary mental healthcare. However, the extent to which demographic and clinical characteristics, suicide method and service use-related factors vary across psychiatric diagnoses remains poorly understood, particularly regarding differences between 'schizophrenia spectrum disorders (SSD)' and 'all other diagnoses', which may have implications for suicide prevention in high risk groups. METHODS 308 patients who died by suicide over 2007-2011 were identified from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre Case Register. Demographic, clinical, services use-related factors, 'full risk assessment' ratings and the Health of the Nation Outcome Scale (HONOS) scores were compared across psychiatric diagnoses. Specifically, differences between patients with and without SSD were investigated. RESULTS Patients with SSD ended their lives at a younger age, were more frequently of Black ethnicity and had higher levels of social deprivation than other diagnoses. Also, these patients were more likely to have HONOS and 'risk assessment' completed. However, patients who had no SSD scored significantly higher on 'self-injury' and 'depression' HONOS items and they were more likely to have the following 'risk assessment' items: 'suicidal ideation', 'hopelessness', 'feeling no control of life', 'impulsivity' and 'significant loss'. Of note, 'disengagement' was more common in patients with SSD, although they had been seen by the staff closer to the time of suicide than in all-other diagnoses. Whilst 'hanging' was the most common suicide method amongst patients with non-SSD, most service users with a SSD diagnosis used 'jumping' (from heights or in front of a vehicle). CONCLUSIONS Suicide completion characteristics varied between SSD and other diagnoses in patients receiving secondary mental healthcare. In particular, although clinicians tend to more frequently recognize suicide risk as a focus of concern in patients who have SSD, who are therefore more likely to have a detailed risk assessment documented; 'known' suicide risk factors appear to be more relevant in patients with non-SSD. Hence, the classic suicide prevention model might be of little use for SSD.
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Affiliation(s)
- Javier-David Lopez-Morinigo
- Department of Psychosis Studies, King’s College London, Institute of Psychiatry, De Crespigny Park, PO Box 68, London, SE5 8AF UK
| | - Andrea C Fernandes
- Department of Psychological Medicine, King’s College London, Institute of Psychiatry, London, UK
| | - Chin-Kuo Chang
- Department of Psychological Medicine, King’s College London, Institute of Psychiatry, London, UK
| | - Richard D Hayes
- Department of Psychological Medicine, King’s College London, Institute of Psychiatry, London, UK
| | - Matthew Broadbent
- Department of Psychological Medicine, King’s College London, Institute of Psychiatry, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, King’s College London, Institute of Psychiatry, London, UK
| | - Anthony S David
- Department of Psychosis Studies, King’s College London, Institute of Psychiatry, De Crespigny Park, PO Box 68, London, SE5 8AF UK
| | - Rina Dutta
- Department of Psychological Medicine, King’s College London, Institute of Psychiatry, London, UK
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Solmi F, Hatch SL, Hotopf M, Treasure J, Micali N. Prevalence and correlates of disordered eating in a general population sample: the South East London Community Health (SELCoH) study. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1335-46. [PMID: 24441522 PMCID: PMC4108843 DOI: 10.1007/s00127-014-0822-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 01/05/2014] [Indexed: 10/27/2022]
Abstract
PURPOSE Disordered eating has been shown to be more prevalent than full eating disorders diagnoses. However, research on its prevalence, socio-demographic, psychological correlates, and patterns of service use in multi-ethnic samples is still limited. This paper explores these associations in a South London-based (UK) sample. METHODS The South East London Community Health (SELCoH) study is a general population survey (N = 1,698) of individuals aged 16+. Disordered eating was defined as ≥2 positive answers at the SCOFF questionnaire. Crude and adjusted logistic and multinomial logistic regression models were fit to investigate associations between socio-demographic characteristics, disordered eating, psychiatric comorbidity, and service use. RESULTS A total of 164 (10 %) participants reported disordered eating and the majority were from ethnic minorities. In adjusted models, Asian ethnicity was associated with purging, loss of control eating and preoccupation with food. Individuals with disordered eating had higher odds of screening positive for post-traumatic stress disorder and personality disorders and of having anxiety/mood disorders, suicidal ideation/attempts, hazardous levels of drinking, and used drugs in the previous year. Only 36 % of individuals with disordered eating had sought professional help in the previous 12 months mostly through their general practitioner (27.4 %), followed by psychotherapists (12.8 %) and mental health specialists (5.5 %). CONCLUSION This study found a high prevalence of disordered eating, especially amongst ethnic minorities, and associations with a number of psychiatric conditions. Overall few participants accessed specialist services. These findings suggest that both disordered eating manifestations amongst ethnic minorities and access to care need better investigation.
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Affiliation(s)
- F. Solmi
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College London, 30 Guilford Street, WC1N 1EH, London, UK
| | - S. L. Hatch
- Psychological Medicine, Institute of Psychiatry, King’s College London, London, UK
| | - M. Hotopf
- Psychological Medicine, Institute of Psychiatry, King’s College London, London, UK
| | - J. Treasure
- Eating Disorders Department, Institute of Psychiatry, King’s College London, London, UK
| | - N. Micali
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College London, 30 Guilford Street, WC1N 1EH, London, UK
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