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König D, Gleiss A, Vyssoki B, Harrer C, Trojer A, Groemer M, Weber S, Glahn A, Sommer L, Listabarth S, Wippel A. Suicide risk after discharge from in-patient psychiatric care: A 15-year retrospective cohort study of individual patient data. J Affect Disord 2024; 354:416-423. [PMID: 38479514 DOI: 10.1016/j.jad.2024.03.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 03/05/2024] [Accepted: 03/09/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Suicide rates are known to be increased in patients after discharge from in-patient psychiatric treatment. However, evidence on risk factors for suicide within this patient group are contradictory. Thus, this study aims to investigate suicide after discharge from a sizeable psychiatric care facility to determine associated risk factors. METHODS Data on individual patient level from a 15-year single-centre cohort were linked to data from the national death registry and cumulative incidence rates were calculated applying competing risk models. Independent variables included the patients' sex, age at admission, diagnosis, and length of admission. For each of these factors, subdistribution hazards ratios were calculated using a Fine-Gray model. RESULTS In our sample of 18,425 discharges, when using patients with the diagnosis of substance-use-disorders as a comparator, a significant increase in hazard of post-discharge suicide for male sex (SHR = 1.67;p = 0.037) as well as the discharge diagnoses of affective disorders (SHR = 3.56;p = 0.017) and neurotic stress and somatoform disorders (SHR = 3.73;p = 0.024) were found. Interestingly, the hazard of suicide significantly decreased in more recent discharges (SHR = 0.93;p = 0.006). No statistically significant association of the length of admission with the suicide risk was found (SHR = 0.98;p = 0.834). LIMITATIONS Suicides may have been mis-identified as natural death in the national death register. CONCLUSION Male sex and distinct diagnoses were associated with an increased risk for suicide after discharge from a psychiatric care institution. The markedly increased suicide risk within this patient collective highlights the need for the development of tools to assess suicidal behaviour in this group of patients reliably.
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Affiliation(s)
- Daniel König
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Andreas Gleiss
- Institute of Clinical Biometrics, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
| | - Benjamin Vyssoki
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Christine Harrer
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Armin Trojer
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Magdalena Groemer
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Sabine Weber
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Alexander Glahn
- Department for Psychiatry, Social Psychiatry and Psychotherapy, Medical University of Hannover, Hannover, Germany
| | - Lea Sommer
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Stephan Listabarth
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Andreas Wippel
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
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Leveau CM, Tapia Granados JA. Educational inequalities in suicide in the highly volatile economy of Argentina. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1771-1778. [PMID: 33582827 DOI: 10.1007/s00127-021-02041-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/29/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Little is known about how economic fluctuations affect educational inequalities in mortality in low- or middle-income countries. The objective of this study is to analyze the temporal variations in educational differentials in suicide in four Argentinian provinces. METHODS Data on suicides for ages 25 years and over and three age groups (25-44, 45-64, and 65 +) in four Argentinian provinces during the period 1999-2013 were linked to population data and information on the educational level of the deceased. Regression models were estimated using age, sex, year, province of residence, educational level, and economic character of the year (expansion or recession) as explanatory variables. RESULTS The educational gap in suicide mortality widened since the expansion following the crisis of 1999-2002, and then only decreased in 2005 and 2011. For ages 45-64, the confidence intervals of the suicide rate overlapped each year, and the suicide rate of the middle-high education population exceeded the suicide rate of the low-education population in 2 recession years, 1999 and 2002. Considering the years of economic expansion or recession as a dichotomous variable, at ages 45-64 differences in suicide rates by educational level disappeared during years of recession, while they were present in years of expansion. CONCLUSION Suicides rise during economic downturns but these periods could reduce the educational gaps of suicide mortality by increasing the vulnerability of adults of high educational level to changes in the economy.
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Affiliation(s)
- Carlos M Leveau
- Departamento de Salud Comunitaria, Universidad Nacional de Lanús, Av. 29 de Septiembre 3901, Remedios de Escalada, Argentina.
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.
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Mattei G, Pistoresi B, De Vogli R. Impact of the economic crises on suicide in Italy: the moderating role of active labor market programs. Soc Psychiatry Psychiatr Epidemiol 2019; 54:201-208. [PMID: 30421039 DOI: 10.1007/s00127-018-1625-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 11/02/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To analyze the association between unemployment and suicide in Italy during the years 1990-2014, with a peculiar focus on the great recession (GR) and the role played by social protection as buffering mechanism against the negative effect on health outcomes. METHODS Fixed effects panel regressions were used to assess the association between changes in unemployment rate and suicide rates. Additional models investigated the role of active labor market programs (ALMPs) as possible moderators of the association. Analyses were carried out for both males and females, stratified by age and region. RESULTS The negative time-trend displayed by suicide rate in Italy until 2007 was slowed down by changes in unemployment at the beginning of the GR, when this trend reversed and the rate of suicide started increasing. Male workers aged 25-64 and women aged 55-64 years were affected by both "normal" unemployment rate fluctuations as well as severe economic crises. Women aged 35-44 were only influenced by the latter. Men benefit from ALMPs mainly in Central Italy, while women did not benefit significantly from ALMPs. CONCLUSIONS In Italy, economic downturns were associated with increased suicides mainly among men, while severe economic crises were associated with increased suicides among both men and women. ALMPs showed to be effective in moderating the association between unemployment and suicide among men aged 45-54 only in Central Italy. The overall small effectiveness of such programs may be due to lack of sufficient funding.
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Affiliation(s)
- Giorgio Mattei
- "Marco Biagi" Department of Economics and Marco Biagi Foundation, University of Modena and Reggio Emilia, Via J. Berengario, 51, 41121, Modena, Italy.,Section of Psychiatry, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, via G. Campi, 287, 41125, Modena, Italy
| | - Barbara Pistoresi
- Department of Economics, RECent, Center for Economic Research, University of Modena and Reggio Emila, Viale Berengario 51, 41121, Modena, Italy.
| | - Roberto De Vogli
- Department of Social Psychology and Development and Human Rights Centre, University of Padova, Via Venezia, 12, 35131, Padova, Italy
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Basta M, Vgontzas A, Kastanaki A, Michalodimitrakis M, Kanaki K, Koutra K, Anastasaki M, Simos P. 'Suicide rates in Crete, Greece during the economic crisis: the effect of age, gender, unemployment and mental health service provision'. BMC Psychiatry 2018; 18:356. [PMID: 30384835 PMCID: PMC6211416 DOI: 10.1186/s12888-018-1931-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/17/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Recently, suicides in Greece have drawn national and international interest due to the current economic crisis. According to published reports, suicides in Greece have increased up to 40% and Crete has been highlighted as an area with the sharpest increase. AIM To investigate the suicide mortality rates in Crete between 1999 and 2013 and their association with the economic crisis. METHODS Data on suicides were selected from the Department of Forensic Medicine files of the University of Crete. RESULTS Our analysis showed that (1) Crete, has the highest suicide mortality rate in Greece, however no significant increase was observed between 1999 and 2013, (2) there were opposing trends between men and women, with women showing a decrease whereas men showed an increase in that period, (3) there was a significant increase of suicides in middle-aged men (40-64 yrs) and elderly, although the highest unemployment rates were observed in young men and women, and (4) finally, there was a regional shift of suicides with a significant decrease in Western Crete and a significant increase in Eastern Crete. CONCLUSIONS Although, Crete has the highest suicide mortality rates in Greece, we did not observe an overall increase during the last 15 years, including the period of economic crisis. Furthermore, there was an increase in middle-aged and elderly men, whereas young men and women showed oppositional trends during the years of austerity. This may be related to the culturally different expectations for the two genders, as well as that younger individuals may find refuge to either strong family ties or by immigrating abroad. Finally, the relative increase of suicides in Eastern Crete may be explained by factors, such as the lack of community mental health services in that area.
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Affiliation(s)
- Maria Basta
- grid.412481.aDepartment of Psychiatry, University Hospital of Heraklion, Voutes,Heraklion, 71110 Crete, Greece
| | - Alexandros Vgontzas
- Department of Psychiatry, University Hospital of Heraklion, Voutes,Heraklion, 71110, Crete, Greece.
| | - Anastasia Kastanaki
- 0000 0004 0576 3437grid.8127.cDepartment of Forensic Science, School of Medicine, University of Crete, Voutes, Heraklion, 71003 Crete, Greece
| | - Manolis Michalodimitrakis
- 0000 0004 0576 3437grid.8127.cDepartment of Forensic Science, School of Medicine, University of Crete, Voutes, Heraklion, 71003 Crete, Greece
| | - Katerina Kanaki
- 0000 0004 0576 3437grid.8127.cDepartment of Forensic Science, School of Medicine, University of Crete, Voutes, Heraklion, 71003 Crete, Greece
| | - Katerina Koutra
- 0000 0004 0576 3437grid.8127.cDepartment of Psychology, School of Social Sciences, University of Crete, Gallos, Rethymnon, 74100 Crete, Greece
| | - Maria Anastasaki
- grid.412481.aDepartment of Psychiatry, University Hospital of Heraklion, Voutes,Heraklion, 71110 Crete, Greece
| | - Panagiotis Simos
- grid.412481.aDepartment of Psychiatry, University Hospital of Heraklion, Voutes,Heraklion, 71110 Crete, Greece
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