1
|
Zartaloudi AE. Adolescent suicide: a major mental health issue in pediatric care. Minerva Pediatr (Torino) 2024; 76:660-678. [PMID: 37947773 DOI: 10.23736/s2724-5276.23.06682-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Adolescent suicide is a major public health problem, as suicide is one of the leading causes of death for adolescents. Predicting and preventing suicide represent very difficult challenges for clinicians. Youth suicide might be prevented by identifying risk factors for adolescent suicidal behavior. Diagnostic assessment involves identification of multiple factors including gender differences, psychopathology, comorbidity, interpersonal problems, family discord, family psychopathology, accessibility of lethal suicide methods, exposure to suicide, previous attempt, social support, life stressors, and protective factors. The literature clearly indicates a need for suicide awareness and prevention programs and for early identification of adolescents at risk for suicidal behaviors. However, many health care professionals who have frequent contact with adolescents are not sufficiently trained in suicide evaluation techniques and approaches to adolescents with suicidal behavior. Pediatricians and other health professionals involved in adolescents' care need more in-depth information about the characteristics and the warning signs for suicide.
Collapse
|
2
|
Geith S, Lumpe M, Schurr J, Schmoll S, Rabe C, Ott A, Stich R, Rentrop M, Eyer F, Zellner T. Clinical course and demographic insights into suicide by self-poisoning: patterns of substance use and socio-economic factors. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02750-x. [PMID: 39317728 DOI: 10.1007/s00127-024-02750-x] [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: 04/04/2024] [Accepted: 08/15/2024] [Indexed: 09/26/2024]
Abstract
PURPOSE To analyze whether sociodemographic characteristics influence the substance choice and preclinical and clinical course of suicidal poisoning. METHODS This was a retrospective single-center study in patients hospitalized due to suicidal poisoning and who received at least one psychiatric exploration during their inpatient stay. Patients' sociodemographic, anamnestic, preclinical, and clinical parameters were analyzed with respect to sex and age. RESULTS 1090 patients were included, 727 (67%) were females, median age was 39 years (min-max: 13-91) with 603 (55%) aged 18-44 years. 595 patients (54.8%) ingested a single substance for self-poisoning, 609 (59.5%) used their own long-term medication. Comparing to males, females preferred antidepressants (n = 223, 30.7%, vs n = 85, 23.4%; p = 0.013) and benzodiazepines (n = 202, 27.8%, vs n = 65, 17.9%; p < 0.001); males more often used cardiovascular drugs (n = 33, 9.1%, vs n = 34, 4.7%; p = 0.005) and carbon monoxide (n = 18, 5.0%, vs n = 2, 0.3%; p < 0.001). Use of Z-drugs (n = 1, 1.7%, to n = 37, 33.3%; p < 0.001) and benzodiazepines (n = 4, 6.9%, to n = 33, 29.7%; p = 0.003) increased with age (< 18 to > 64 years), while use of non-opioid analgesics (n = 23, 39.7%, to n = 20, 18.0%; p < 0.001) decreased. Average dose of substance in patients > 64 years was 12.9 ± 18.4 times higher than recommended maximum daily dose (compared to 8.7 ± 15.2 higher in those aged < 18 years; p < 0.001). Males more often required intensive care (n = 150, 41.3%, vs n = 205 females, 28.2%; p < 0.001). CONCLUSION These results underline the complexity of (para-)suicidal poisonings and identify potential measures for their prevention, such as restricting access and better oversight over the use of certain substances.
Collapse
Affiliation(s)
- Stefanie Geith
- Department of Clinical Toxicology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Maja Lumpe
- Department of Clinical Toxicology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Johannes Schurr
- Department of Clinical Toxicology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sabrina Schmoll
- Department of Clinical Toxicology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christian Rabe
- Department of Clinical Toxicology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | | | - Raphael Stich
- Department of Clinical Toxicology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Michael Rentrop
- Clinic and Policlinic for Psychiatry and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- kbo-Inn-Salzach Clinic, Wasserburg am Inn, Germany
| | - Florian Eyer
- Department of Clinical Toxicology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Tobias Zellner
- Department of Clinical Toxicology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| |
Collapse
|
3
|
Inoue K, Apbassova M, Seksenbayev N, Toleuov E, Akkuzinova K, Karimova Z, Moldagaliyev T, Ospanova N, Apbassova S, Chaizhunusova N, Shabdarbayeva D, Dyussupov A, Takeshita H, Kawano N. The relationship between a comprehensive index of prosperity and suicide rates in former Soviet countries, including a comparison with European and Asian countries: Discussion from a new perspective. Leg Med (Tokyo) 2024; 69:102460. [PMID: 38739974 DOI: 10.1016/j.legalmed.2024.102460] [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: 08/12/2023] [Revised: 05/05/2024] [Accepted: 05/09/2024] [Indexed: 05/16/2024]
Abstract
Investigations of suicide in countries of the former Soviet Union, which broke into 15 different countries in the early 1990s, require examinations of a combination of economic, social, and health factors. It is important to address these factors individually and to examine the various composite indicators for each. Moreover, it would be worthwhile to explore the potential applicability of a comprehensive worldwide index. We analyzed data from nine of the former Soviet countries for which both the annual suicide rate and the Global Competitiveness Index (GCI) were available for the years 2006-2017. We determined the precise relationships between the suicide rate and the GCI during this period in these nine countries as well as in nine countries with high suicide rates in Europe and Asia. The results indicated the following: (i) In six of the nine former Soviet countries with complete data, the suicide rate showed a relationship with the GCI. Notably, this relationship was inverse in all but one country. (ii) Among the nine European and Asian countries with high suicide rates, three exhibited a correlation between the suicide rate and the GCI. Measures to prevent suicide should be devised especially in countries of the former Soviet Union through collaboration among multiple fields and organizations, as necessary, with particular attention paid to countries with worse or worsening GCI values.
Collapse
Affiliation(s)
- Ken Inoue
- Research and Education Faculty, Medical Sciences Cluster, Health Service Center, Kochi University, Kochi, Japan; The Center for Peace, Hiroshima University, Hiroshima, Japan.
| | - Madina Apbassova
- Department of Pathological Anatomy and Forensic Medicine, Semey Medical University, Semey, Kazakhstan
| | | | - Elaman Toleuov
- Department of Psychiatry and Narcology, Semey Medical University, Semey, Kazakhstan
| | - Kamila Akkuzinova
- Department of Psychiatry and Narcology, Semey Medical University, Semey, Kazakhstan
| | - Zhanna Karimova
- Department of Psychiatry and Narcology, Semey Medical University, Semey, Kazakhstan
| | - Timur Moldagaliyev
- Department of Psychiatry and Narcology, Semey Medical University, Semey, Kazakhstan
| | - Nargul Ospanova
- Department of Psychiatry and Narcology, Semey Medical University, Semey, Kazakhstan
| | - Saulesh Apbassova
- Department of Pathological Anatomy and Forensic Medicine, Semey Medical University, Semey, Kazakhstan
| | | | - Dariya Shabdarbayeva
- Department of Pathological Anatomy and Forensic Medicine, Semey Medical University, Semey, Kazakhstan
| | - Altay Dyussupov
- Chairman of the Board-Rector, Semey Medical University, Semey, Kazakhstan
| | - Haruo Takeshita
- Department of Legal Medicine, Faculty of Medicine, Shimane University, Shimane, Japan
| | - Noriyuki Kawano
- The Center for Peace, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
4
|
Bergström T, Seikkula J, Gaily-Luoma S, Miettunen J, Kurtti M. A 5-Year Suicide Rate of Adolescents Who Enrolled to an Open Dialogue-Based Services: A Nationwide Longitudinal Register-Based Comparison. Community Ment Health J 2023; 59:1043-1050. [PMID: 36917299 PMCID: PMC10290011 DOI: 10.1007/s10597-023-01106-0] [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: 10/16/2022] [Accepted: 02/23/2023] [Indexed: 03/16/2023]
Abstract
In the Open Dialogue (OD) based psychiatric services adolescent patients receive less medication and are more often treated within an outpatient setting as compared to standard services. An evaluation of the possible risks of implementing OD are required. The aim of this longitudinal register-based study was to evaluate how treatment under OD is associated with the probability of suicide as compared standard psychiatric care. Study included all 13- to 20-year-old adolescents who enrolled to a psychiatric service in Finland in 2003-2013. The OD-group included adolescents whose treatment commenced in the Western Lapland area (n = 2107), this being the only region where OD covered all psychiatric services. The comparison group (CG) included rest of Finland (n = 121,658). Information was gathered from onset of treatment to the end of the 5-year follow-up or death. In a multivariate Cox regression there were no statistically significant differences in 5-year suicide hazard ratios between OD and CG.
Collapse
Affiliation(s)
- Tomi Bergström
- Department of Psychology, University of Jyväskylä, Jyvaskyla, Finland.
- Department of Psychiatry, Wellbeing service county of Lapland, Kemi, Finland.
| | - Jaakko Seikkula
- Department of Psychology, University of Jyväskylä, Jyvaskyla, Finland
- Faculty of Health and Sport, University of Agder, Kristiansand, Norway
| | - Selma Gaily-Luoma
- Department of Psychology, University of Jyväskylä, Jyvaskyla, Finland
| | - Jouko Miettunen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Mia Kurtti
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| |
Collapse
|
5
|
Son JY, Han JH, Kim SC, Choi WS, Hong HJ. Korean adolescent suicide and search volume for "self-injury" on internet search engines. Front Psychiatry 2023; 14:1186754. [PMID: 37346904 PMCID: PMC10279855 DOI: 10.3389/fpsyt.2023.1186754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/17/2023] [Indexed: 06/23/2023] Open
Abstract
Introduction Many adolescents with suicidal ideation receive support through the Internet. However, they also find ways to attempt suicide or strengthen their suicidal ideation through this medium. This study analyzed the association between the search volume of suicide-related terms and the number of suicides among Korean adolescents. We also analyzed the correlations between the search volumes of suicide-related terms. Methods We selected seven words (suicide, self-injury, depression, academic score, school violence, outcasts, and family trouble) related to adolescent suicide. A dataset was constructed by combining data from the most commonly used search engine in Korea (Naver Datalab) and the daily number of adolescent suicides in school settings (n = 347) from January 1, 2016 to December 31, 2018, collected from the Ministry of Education. Poisson regression and Pearson correlation analyses were performed. Results Significant associations were found between suicide attempts and search term volumes, which differed according to sex and time interval. Among the search terms, "self-injury" was most strongly associated with suicide, and this association was significant at all time intervals (daily, weekly, and monthly) in female adolescents and in the total population. Further, the association was strongest in the daily suicide data. More search term volumes were related to suicide in the daily and weekly data than in the monthly data. There were positive correlations between "suicide," "self-injury," and "depression" search volumes. Conclusion Further studies with larger sample sizes, more search terms, and analysis of time intervals between suicide-related term search and suicide death are required. These studies can contribute to the establishment of an online suicide prevention system to detect suicide risk in adolescents and provide interventions.
Collapse
Affiliation(s)
- Jin Yeong Son
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Jun Hee Han
- Department of Psychiatry, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Republic of Korea
| | - Seung Chan Kim
- Department of Biostatistics, Clinical Trial Center, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Won-Seok Choi
- Department of Psychiatry, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun Ju Hong
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
- Hallym University Suicide and School Mental Health Institute, Anyang, Republic of Korea
| |
Collapse
|
6
|
Lee YJ, Lee HA, Kim KA, Baik M, Paik JW, Seol J, Lee SM, Lee EJ, Lee H, Lim M, Jun JY, Ki SW, Jeon HJ, Kwon SJ, Lee HY. Standardized Suicide Prevention Program for Gatekeeper Intervention of North Korean Defectors in South Korea. Psychiatry Investig 2023; 20:452-460. [PMID: 37253471 DOI: 10.30773/pi.2023.0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/29/2023] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE North Korean defectors (NKDs) have experienced substantial difficulties during the migration and settlement in South Korea. They have a high prevalence of depression, post-traumatic stress disorder, and suicidal behaviors. The high prevalence of mental disorders among NKDs can lead to a high suicide rate. However, there are no suicide prevention programs for NKDs. This study aims to customize a suicide prevention program with content suitable for NKDs' particular circumstances. METHODS A multidisciplinary research team developed this program based on domestic and international gatekeeper training programs for suicide prevention and articles related to suicide prevention. RESULTS We developed a multi-part gatekeeper training program, "Suicide CARE for NKDs." In the "Introduction," trainees learn about the need for the program and its importance. In "Careful observation," trainees learn to recognize linguistic, behavioral, and situational signals of suicide risk. In "Active listening," trainees learn how to ask about suicidal thoughts and to listen empathetically. In "Risk evaluation and expert referral," trainees learn to evaluate suicide risk and to connect NKDs with institutes or services. CONCLUSION We expect this program to become useful for training gatekeepers to prevent suicide among NKD. A future follow-up study is needed to confirm the efficacy of the program.
Collapse
Affiliation(s)
- Yeon Jung Lee
- Department of Psychiatry, Soonchunhyang University Seoul Hospital, Soonchunhyang University, College of Medicine, Seoul, Republic of Korea
| | - Hyeon-Ah Lee
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Soonchunhyang University, College of Medicine, Cheonan, Republic of Korea
| | - Kyong Ah Kim
- Department of Psychology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Myungjae Baik
- Department of Psychiatry, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jong-Woo Paik
- Department of Psychiatry, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jinmi Seol
- Workplace Mental Health Institute, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
| | - Sang Min Lee
- Department of Psychiatry, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Eun-Jin Lee
- Department of Social Welfare, Suwon Science College, Hwaseong, Republic of Korea
| | - Haewoo Lee
- Department of Psychiatry, Seoul Medical Center, Seoul, Republic of Korea
| | - Meerae Lim
- Workplace Mental Health Institute, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
| | - Jin Yong Jun
- Department of Psychiatry, National Center for Mental Health, Seoul, Republic of Korea
| | - Seon Wan Ki
- Department of Psychiatry and Behavioral Neurosciences, Catholic Kwandong University International St. Mary's Hospital, Incheon, Republic of Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sun Jung Kwon
- Republic of Korea Air Force, Daejeon, Republic of Korea
| | - Hwa-Young Lee
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Soonchunhyang University, College of Medicine, Cheonan, Republic of Korea
| |
Collapse
|
7
|
Choi WS, Han J, Hong HJ. Association Between Internet Searches Related to Suicide/Self-Harm and Adolescent Suicide Death in South Korea, 2016–2020: Data Analysis Study (Preprint). J Med Internet Res 2023; 25:e46254. [PMID: 37079349 PMCID: PMC10160929 DOI: 10.2196/46254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Previous studies have investigated the association between suicide and internet search volumes of terms related to suicide or self-harm. However, the results varied by people's age, period, and country, and no study has exclusively investigated suicide or self-harm rates among adolescents. OBJECTIVE This study aims to determine the association between the internet search volumes of terms related to suicide/self-harm and the number of suicides among South Korean adolescents. We investigated gender differences in this association and the time lag between the internet search volumes of the terms and the connected suicide deaths. METHODS We selected 26 search terms related to suicide and self-harm among South Korean adolescents, and the search volumes of these terms for adolescents aged 13-18 years were obtained from the leading internet search engine in South Korea (Naver Datalab). A data set was constructed by combining data from Naver Datalab and the number of suicide deaths of adolescents on a daily basis from January 1, 2016, to December 31, 2020. Spearman rank correlation and multivariate Poisson regression analyses were performed to identify the association between the search volumes of the terms and the suicide deaths during that period. The time lag between suicide death and the increasing trend in the search volumes of the related terms was estimated from the cross-correlation coefficients. RESULTS Significant correlations were observed within the search volumes of the 26 terms related to suicide/self-harm. The internet search volumes of several terms were associated with the number of suicide deaths among South Korean adolescents, and this association differed by gender. The search volume for "dropout" showed a statistically significant correlation with the number of suicides in all adolescent population groups. The correlation between the internet search volume for "dropout" and the connected suicide deaths was the strongest for a time lag of 0 days. In females, self-harm and academic score showed significant associations with suicide deaths, but academic score showed a negative correlation, and the time lags with the strongest correlations were 0 and -11 days, respectively. In the total population, self-harm and suicide method were associated with the number of suicides, and the time lags with the strongest correlations were +7 and 0 days, respectively. CONCLUSIONS This study identifies a correlation between suicides and internet search volumes related to suicide/self-harm among South Korean adolescents, but the relatively weak correlation (incidence rate ratio 0.990-1.068) should be interpreted with caution.
Collapse
Affiliation(s)
- Won-Seok Choi
- Department of Psychiatry, Yeouido St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Junhee Han
- Department of Statistics, Hallym University, Chunchon, Republic of Korea
| | - Hyun Ju Hong
- Department of Psychiatry, Hallym University Sacred Heart Hospital, College of Medicine, Hallym Univerisity, Anyang, Republic of Korea
| |
Collapse
|
8
|
Moller CI, Davey CG, Badcock PB, Wrobel AL, Cao A, Murrihy S, Sharmin S, Cotton SM. Correlates of suicidality in young people with depressive disorders: A systematic review. Aust N Z J Psychiatry 2022; 56:910-948. [PMID: 35362327 DOI: 10.1177/00048674221086498] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Depression is one of the most prevalent and disabling mental health conditions among young people worldwide. The health and economic burdens associated with depressive illness are substantial. Suicide and depression are closely intertwined, yet a diagnosis of depression itself lacks predictive specificity for suicidal behaviour. To better inform suicide prevention and early intervention strategies for young people, improved identification of modifiable intervention targets is needed. The objective of this review was to identify clinical, psychosocial and biological correlates of suicidality in young people diagnosed with a broad range of unipolar and bipolar depressive disorders. METHOD Systematic searches were conducted across MEDLINE, Embase and PsycINFO to identify studies of young people aged 15-25 years diagnosed with unipolar or bipolar depressive disorders. An assessment of suicidality was required for inclusion. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 and Synthesis Without Meta-analysis guidelines. RESULTS We integrated findings from 71 studies including approximately 24,670 young people with clinically diagnosed depression. We identified 26 clinical, psychosocial and biological correlates of suicidality. Depression characteristics (type and severity), psychiatric comorbidity (particularly anxiety and substance use disorders) and neurological characteristics emerged as having the most evidence for being associated with suicidal outcomes. Our ability to pool data and conduct meaningful quantitative synthesis was hampered by substantial heterogeneity across studies and incomplete reporting; thus, meta-analysis was not possible. CONCLUSION Findings of this review reinforce the notion that suicidality is a complex phenomenon arising from the interplay of multiple contributing factors. Our findings question the utility of considering a diagnosis of depression as a specific risk factor for suicidality in young people. Suicidality itself is transdiagnostic; adoption of a transdiagnostic approach to investigating its aetiology and treatment is perhaps warranted. Future research investigating specific symptoms, or symptom networks, might help to further our understanding of suicidality among young people experiencing mental illness.
Collapse
Affiliation(s)
- Carl I Moller
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, The University of Melbourne, Parkville, VIC, Australia
| | - Christopher G Davey
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, The University of Melbourne, Parkville, VIC, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Paul B Badcock
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, The University of Melbourne, Parkville, VIC, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Anna L Wrobel
- Orygen, The University of Melbourne, Parkville, VIC, Australia
- IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Alice Cao
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Sean Murrihy
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, The University of Melbourne, Parkville, VIC, Australia
| | - Sonia Sharmin
- Department of Occupational Therapy, Social Work and Social Policy, La Trobe University, Bundoora, VIC, Australia
- Research and Evaluation, Take Two, Berry Street, Eaglemont, VIC, Australia
- Department of Public Health, Torrens University Australia, Melbourne, VIC, Australia
| | - Sue M Cotton
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, The University of Melbourne, Parkville, VIC, Australia
| |
Collapse
|
9
|
Jopling E, LeMoult J, Kerns CM, Nugent S, Eslami A. Potential lethality of suicide attempts in youth. Eur Child Adolesc Psychiatry 2022; 31:919-927. [PMID: 33523314 DOI: 10.1007/s00787-021-01724-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
Rates of suicide in youth have increased over the last 50 years, yet our ability to predict suicidal behaviours has not significantly improved during this time. Examining predictors of suicide attempt lethality can enhance our understanding of suicidality in youth, yet research has focused on actual medical lethality (the actual danger to life resulting from a suicide attempt) rather than potential lethality (the potential for death that is associated with a suicide attempt). Thus, the aim of the present study was twofold: first, we quantified the percentage of youth for whom the severity of suicide attempt was misclassified by considering only actual lethality; second, we tested whether key variables that predict the actual lethality of suicide attempts also predict the potential lethality of suicide attempts in youth. We examined these questions in a sample of children and adolescents admitted to a psychiatric inpatient unit following a suicide attempt. Over 70% of youth who made serious suicide attempts would have been misclassified by assessments relying on only actual lethality. Although several variables relevant to the construct of actual lethality significantly predicted potential lethality (e.g., male sex, substance use disorder), others did not. In addition, we found that the subset of youth who would have been misclassified as low risk based on actual lethality had a disproportionately high need for healthcare resources due to future hospital admissions. The present study provides evidence to suggest that considering potential lethality may lead to improved detection and prediction of suicide risk in youth, and in doing so supports recent calls to broaden considerations of the lethality associated with suicide attempts.
Collapse
Affiliation(s)
- E Jopling
- Department of Psychology, University of British Columbia, Vancouver, Canada.
| | - J LeMoult
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - C M Kerns
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - S Nugent
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - A Eslami
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| |
Collapse
|
10
|
Pitkänen J, Remes H, Aaltonen M, Martikainen P. Socioeconomic differences in psychiatric treatment before and after self-harm: an observational study of 4,280 adolescents and young adults. BMC Psychiatry 2022; 22:14. [PMID: 34986806 PMCID: PMC8728977 DOI: 10.1186/s12888-021-03654-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/13/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Individuals in higher socioeconomic positions tend to utilise more mental health care, especially specialist services, than those in lower positions. Whether these disparities in treatment exist among adolescents and young adults who self-harm is currently unknown. METHODS The study is based on Finnish administrative register data on all individuals born 1986-1994. Adolescents and young adults with an episode of self-harm treated in specialised healthcare at ages 16-21 in 2002-2015 (n=4280, 64% female) were identified and followed 2 years before and after the episode. Probabilities of specialised psychiatric inpatient admissions and outpatient visits and purchases of psychotropic medication at different time points relative to self-harm were estimated using generalised estimation equations, multinomial models and cumulative averages. Socioeconomic differences were assessed based on parental education, controlling for income. RESULTS An educational gradient in specialised treatment and prescription medication was observed, with the highest probabilities of treatment among the adolescents and young adults with the highest educated parents and lowest probabilities among those whose parents had basic education. These differences emerged mostly after self-harm. The probability to not receive any treatment, either in specialised healthcare or psychotropic medication, was highest among youth whose parents had a basic level of education (before self-harm 0.39, 95% CI 0.34-0.43, and after 0.29, 95% CI 0.25-0.33 after) and lowest among youth with higher tertiary educated parents (before self-harm: 0.22, 95% CI 0.18-0.26, and after 0.18, 95% CI 0.14-0.22). The largest differences were observed in inpatient care. CONCLUSIONS The results suggest that specialised psychiatric care and psychotropic medication use are common among youth who self-harm, but a considerable proportion have no prior or subsequent specialised treatment. The children of parents with lower levels of education are likely to benefit from additional support in initiating and adhering to treatment after an episode of self-harm. Further research on the mechanisms underlying the educational gradient in psychiatric treatment is needed.
Collapse
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, Rostock, Germany.
| | - Hanna Remes
- grid.7737.40000 0004 0410 2071Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, FIN-00014 Helsinki, Finland
| | - Mikko Aaltonen
- grid.7737.40000 0004 0410 2071Institute of Criminology and Legal Policy, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland ,grid.9668.10000 0001 0726 2490Law School, University of Eastern Finland, Joensuu, Finland
| | - Pekka Martikainen
- grid.7737.40000 0004 0410 2071Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, FIN-00014 Helsinki, Finland ,grid.419511.90000 0001 2033 8007Max Planck Institute for Demographic Research, Rostock, Germany ,grid.10548.380000 0004 1936 9377Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| |
Collapse
|
11
|
Junuzovic M, Lind KMT, Jakobsson U. Child suicides in Sweden, 2000-2018. Eur J Pediatr 2022; 181:599-607. [PMID: 34476611 PMCID: PMC8821491 DOI: 10.1007/s00431-021-04240-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/14/2021] [Accepted: 08/17/2021] [Indexed: 11/27/2022]
Abstract
Although child mortality is decreasing in Sweden, an increase in suicide rates has been previously observed among children and adolescents collectively. To increase knowledge about trends, demographics, and means in child suicides, data including all child (< 18 years) suicides in Sweden in 2000 through 2018 were retrieved from the Swedish National Board of Forensic Medicine. In all, a total of 416 child suicides were found in a 19-year period, accounting for an annual suicide rate of 1.1/100,000 child population. The number of suicides increased with 2.2% by each successive year during the study period (p < 0.001). The mean age in both sexes was 16 years; boys accounted for 55% and girls for 45% of all study cases. The majority of the children who died by suicide (96%) were teenagers (13-17 years old) and suicides in children younger than 10 years were uncommon. Suicide methods were 59% hanging, 20% lying/jumping in front of a moving object, 8% jumping from a height, 7% firearm injury, 4% poisoning, and 2% other methods. Sex differences were significant (p < 0.001) only for firearms being preferably used by boys. The vast majority of firearms used were licensed long-barreled weapons.Conclusion: The number of child suicides in Sweden is relatively low but increasing. Most of the children used a violent and highly lethal method. Prevention of premature mortality is an urgent concern with an emphasis on resolutely reducing the availability of suicide means. What is Known: • Suicide is a significant cause of death globally among children, bringing tragic consequences for young individuals, their family, and the entire society. • Suicide rates and distribution of suicide methods in children differ between countries and settings, but studies of time trends are scarce. What is New: • Increasing number of minors' suicides and the predominance of violent methods emphasize the importance of prevention strategies tailored for a child population. • Even in a setting of very restrictive firearm laws, firearm suicides in children must not be overlooked.
Collapse
Affiliation(s)
- Mensura Junuzovic
- Department of Community Medicine and Rehabilitation, Forensic Medicine, Umeå University, PO Box 7616, 907 12, Umeå, Sweden. .,Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Clinical Research Centre, Lund University, Jan Waldenströms gata 35, 214 28, Malmö, Sweden.
| | - Kaja Maria Toporska Lind
- grid.411843.b0000 0004 0623 9987Department of Pediatrics, Skåne University Hospital Lund, Entrégatan 7, SE-222 42, Lund, Sweden
| | - Ulf Jakobsson
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Clinical Research Centre, Lund University, Jan Waldenströms gata 35, 214 28 Malmö, Sweden
| |
Collapse
|
12
|
Crespo KC, Rios AMFM, Martini M, Barcellos C, De Borba Telles LE, Magalhães PVS. Characteristics of suicides of young people in Porto Alegre, Southern Brazil, from 2010 to 2016. Forensic Sci Med Pathol 2021; 17:596-601. [PMID: 34739713 DOI: 10.1007/s12024-021-00403-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to describe demographic, toxicological, criminal, and medicolegal characteristics of suicides of young people aged up to 24 years examined by the Porto Alegre Medicolegal Office, from 2010 to 2016. This cross-sectional study collected data from the Porto Alegre Medicolegal Office and the Rio Grande do Sul State Police Department. The information was obtained from death certificates, toxicological analyses and police reports. Rates were calculated according to sex and age range (under 15 years old, 15 to 19 years old, and 20 to 24 years old) for comparing local with national data. There were 143 people who died by suicide in the period, 120 males and 23 females. Hanging was the most frequently used method, but in the range of 10 to 14 years old, firearm use was the predominant method. Fifty percent of male victims and 30% of female victims had some criminal history. Suicide rates in the study groups generally followed national trends. The relative frequency of suicide by firearm in this study diverged from international findings, as it was relatively more frequent in children under 15 years old and less frequent in older ranges. If confirmed, the finding draws attention to access to firearms in this age range. In older age ranges, adolescents and young adults were frequently involved in the criminal system. This finding may be useful for planning interventions involving both mental health education and screening for problems that may be associated with criminal involvement.
Collapse
Affiliation(s)
- Kleber Cardoso Crespo
- Clinical Research Center, Universidade Federal Do Rio Grande Do Sul, Hospital de Clínicas de Porto Alegre, Graduate Program in Psychiatry and Behavioral Sciences, Porto Alegre, Rio Grande do Sul, Brasil
| | - Angelita Maria Ferreira Machado Rios
- Clinical Research Center, Universidade Federal Do Rio Grande Do Sul, Hospital de Clínicas de Porto Alegre, Graduate Program in Psychiatry and Behavioral Sciences, Porto Alegre, Rio Grande do Sul, Brasil.,Departamento Médico Legal de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brasil
| | - Murilo Martini
- Clinical Research Center, Universidade Federal Do Rio Grande Do Sul, Hospital de Clínicas de Porto Alegre, Graduate Program in Psychiatry and Behavioral Sciences, Porto Alegre, Rio Grande do Sul, Brasil
| | - Camila Barcellos
- Clinical Research Center, Universidade Federal Do Rio Grande Do Sul, Hospital de Clínicas de Porto Alegre, Graduate Program in Psychiatry and Behavioral Sciences, Porto Alegre, Rio Grande do Sul, Brasil
| | - Lisieux Elaine De Borba Telles
- Clinical Research Center, Universidade Federal Do Rio Grande Do Sul, Hospital de Clínicas de Porto Alegre, Graduate Program in Psychiatry and Behavioral Sciences, Porto Alegre, Rio Grande do Sul, Brasil
| | - Pedro V S Magalhães
- Clinical Research Center, Universidade Federal Do Rio Grande Do Sul, Hospital de Clínicas de Porto Alegre, Graduate Program in Psychiatry and Behavioral Sciences, Porto Alegre, Rio Grande do Sul, Brasil.
| |
Collapse
|
13
|
Lee YJ, Lee JY, Kim M. Parental Factors Related to Adolescent Girls' Suicide Attempts: A Cross-Sectional Study from 2015 to 2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158122. [PMID: 34360417 PMCID: PMC8345805 DOI: 10.3390/ijerph18158122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022]
Abstract
Adolescent suicide is a serious global health concern. Although familial transmission of suicidal behaviors has been identified in previous research, the effects of parental gender remain unknown. This study identified the influence of parental suicidal behaviors on suicide attempts among adolescent girls. We collected data through a cross-sectional, nationwide, population-based survey in South Korea and evaluated data from 890 adolescent girls (aged 12–18 years) who had attempted suicide and their parents. Hierarchical logistic regression was used to analyze the risk factors related to suicide attempts among adolescent girls. The final model indicated that mothers’ suicidal plans and attempts (OR = 6.39, OR = 12.38, respectively) were important risk factors for suicide attempts in adolescent girls. Future studies should identify specific methods for effective prevention and treatment through path analysis of the related factors affecting suicidal behavior of adolescents according to their parents’ gender.
Collapse
Affiliation(s)
- Yeon-Jung Lee
- Department of Psychiatry, Soonchunhyang University Seoul Hospital, College of Medicine, Soonchunhyang University, Seoul 04401, Korea;
- Correspondence: ; Tel.: +82-2-709-9081
| | - Jin-Young Lee
- Department of Applied Statistics, Chung-Ang University, Seoul 06911, Korea;
| | - Minjae Kim
- Department of Psychiatry, Soonchunhyang University Seoul Hospital, College of Medicine, Soonchunhyang University, Seoul 04401, Korea;
| |
Collapse
|
14
|
Forte A, Vichi M, Ghirini S, Orri M, Pompili M. Trends and ecological results in suicides among Italian youth aged 10-25 years: A nationwide register study. J Affect Disord 2021; 282:165-172. [PMID: 33418363 DOI: 10.1016/j.jad.2020.12.142] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/15/2020] [Accepted: 12/24/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Documenting current trends and sources of variation in youth suicide rates is critical to inform prevention strategies. We aimed to document suicide mortality trends among Italian youth from 1981 to 2016 and to describe age-, gender- and urbanization-specific suicide rates. METHODS We used official mortality data for the period 1981-2016 for adolescents and young adults aged 10-25 years. We estimated standardized all-cause and suicide mortality rates per 100,000 individuals and used joinpoint regression analyses to determine annual mortality trends and significant changes in rate trends. Analyses were reported according to gender, age group (10-17 and 18-25 years), urbanization and suicide method. RESULTS From 1981 to 2016, 1,752 suicides were identified among youth aged 10-17 years (boy/girl ratio of 5.80 in 2016) and 9,897 suicides among youth aged 18-25 years (boy/girl ratio of 3.97 in 2016). Overall suicide rates remained stable for boys and showed a small decrease for girls. Suicide was most common in rural areas for boys and in metropolitan areas for girls. We observed a significant decrease in the use of firearms and poisoning; the most common suicide method was hanging for boys and falls for girls. LIMITATIONS We did not control for regional-level sociodemographic, economic and health care system characteristics. CONCLUSIONS Youth suicides were either stable (for boys) or slightly declining (for girls). We found differences according to urban versus rural areas, suggesting the need for a broader view of the phenomenon. Factors influencing these trends and gender differences in the geographical areas are important in delivering suicide prevention strategies.
Collapse
Affiliation(s)
- Alberto Forte
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy; Department of Psychiatry and Substance Abuse, ASL Roma 5, Rome, Italy
| | - Monica Vichi
- Statistical Service, Istituto Superiore di Sanità, Rome, Italy, Via Giano della Bella 34, 00161 Rome, Italy, National Institute of Health (ISS).
| | - Silvia Ghirini
- National Center on Addictions and Doping, Istituto Superiore di Sanità, Rome, Italy
| | - Massimiliano Orri
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Canada; Bordeaux Population Health Research Centre, Inserm U1219, Université de Bordeaux, Bordeaux, France
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| |
Collapse
|
15
|
Lee D, Jung S, Park S, Lee K, Kweon YS, Lee EJ, Yoon KH, Cho H, Jung H, Kim AR, Shin BR, Hong HJ. Youth Suicide in Korea Across the Educational Stages. CRISIS 2019; 41:187-195. [PMID: 31512944 DOI: 10.1027/0227-5910/a000624] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Youth suicides have diverse characteristics according to the young people's developmental stages. Warning signs and communication of suicidal intent can be vague among early adolescents, while mental health problems may be more evidently related to suicidal ideation in older adolescents. Understanding the developmental characteristics of youth suicide is necessary for effective suicide prevention. Aims: We explored the differences between children and adolescents who died by suicide and the characteristics of these young people as observed by their school teachers. Method: We analyzed teachers' mandatory postmortem reports of suicides among 308 Korean students. We compared: suicide-related information including personal, familial, and school factors; stressful life events; and participation in interventions among elementary, middle, and high school students who died by suicide. We also assessed the distribution of student suicides per month. Results: Suicide among elementary school students increased during school vacations, and suicide among middle and high school students increased during the school semester. According to the teachers' reports, elementary school students who died by suicide were more extroverted and had better academic achievements than their high school peers, and had significantly lower levels of substance/tobacco use. Elementary school students who died by suicide showed significantly less academic stress and use of external professional help than did other groups. Limitations: Because this research is based on mandatory teacher reports, the subjective opinions of teachers may have affected the reliability of the data. Suicide by out-of-school youth was not included. Conclusion: School-based suicide prevention should be implemented in accordance with young people's developmental characteristics.
Collapse
Affiliation(s)
- Dayoung Lee
- Suicide and School Mental Health Institute, Hallym University, Anyang, South Korea
| | - Song Jung
- Suicide and School Mental Health Institute, Hallym University, Anyang, South Korea
| | - Seongjun Park
- Suicide and School Mental Health Institute, Hallym University, Anyang, South Korea
| | - KangWoo Lee
- Suicide and School Mental Health Institute, Hallym University, Anyang, South Korea
| | - Yong-Sil Kweon
- Suicide and School Mental Health Institute, Hallym University, Anyang, South Korea.,Department of Psychiatry, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, South Korea
| | - Eun-Jin Lee
- Social Welfare Department, Suwon Science College, Hwaseong, South Korea
| | - Kyung Hee Yoon
- Suicide and School Mental Health Institute, Hallym University, Anyang, South Korea
| | - Hannah Cho
- Psychological Consultation for Children, Sookmyung Women's University, Graduate School of Child Welfare & Studies, Seoul, South Korea
| | - Hyeji Jung
- Suicide and School Mental Health Institute, Hallym University, Anyang, South Korea
| | - Ah Reum Kim
- Suicide and School Mental Health Institute, Hallym University, Anyang, South Korea
| | - Bo-Ram Shin
- Suicide and School Mental Health Institute, Hallym University, Anyang, South Korea
| | - Hyun Ju Hong
- Suicide and School Mental Health Institute, Hallym University, Anyang, South Korea.,Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, South Korea
| |
Collapse
|
16
|
|
17
|
Jung S, Lee D, Park S, Lee K, Kweon YS, Lee EJ, Yoon KH, Cho H, Jung H, Kim AR, Shin BR, Hong HJ. Gender differences in Korean adolescents who died by suicide based on teacher reports. Child Adolesc Psychiatry Ment Health 2019; 13:12. [PMID: 30899325 PMCID: PMC6410496 DOI: 10.1186/s13034-019-0274-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 02/27/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND We investigated the characteristics of adolescents who committed suicide in South Korea, and how these characteristics differed by gender. METHOD Data from middle and high school students who committed suicide between 2014 and 2016 were analyzed. We evaluated differences in suicide method and place, personal characteristics, and school life characteristics by gender using the Chi square test and t test. RESULTS Jumping from a high place was the most common suicide method for both male and female students. A significantly greater proportion of female adolescents had experienced depressive symptoms, previous self-injury, previous suicide attempts, and had problems with school attendance and peers. Additionally, they were more likely to be classified as high risk according to a school-based mental health screening test and to utilize professional mental health treatment services. CONCLUSION Our results demonstrate that adolescents who committed suicide exhibited gender differences in personal characteristics and school life. These characteristics might aid in the development of adolescent suicide policies and intervention programs.
Collapse
Affiliation(s)
- Song Jung
- 0000000404154154grid.488421.3Hallym University Suicide and School Mental Health Institute, Hallym University Sacred Heart Hospital, 176-14, Gwanpyeong-ro, Dongan-gu, Anyang-si, Gyeonggi-do South Korea
| | - Dayoung Lee
- 0000000404154154grid.488421.3Department of Psychiatry, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do South Korea ,0000000404154154grid.488421.3Hallym University Suicide and School Mental Health Institute, Hallym University Sacred Heart Hospital, 176-14, Gwanpyeong-ro, Dongan-gu, Anyang-si, Gyeonggi-do South Korea
| | - Sungjun Park
- 0000000404154154grid.488421.3Hallym University Suicide and School Mental Health Institute, Hallym University Sacred Heart Hospital, 176-14, Gwanpyeong-ro, Dongan-gu, Anyang-si, Gyeonggi-do South Korea
| | - Kangwoo Lee
- 0000000404154154grid.488421.3Hallym University Suicide and School Mental Health Institute, Hallym University Sacred Heart Hospital, 176-14, Gwanpyeong-ro, Dongan-gu, Anyang-si, Gyeonggi-do South Korea
| | - Yong-Sil Kweon
- 0000000404154154grid.488421.3Hallym University Suicide and School Mental Health Institute, Hallym University Sacred Heart Hospital, 176-14, Gwanpyeong-ro, Dongan-gu, Anyang-si, Gyeonggi-do South Korea ,0000 0004 0470 4224grid.411947.eDepartment of Psychiatry, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Eun-Jin Lee
- 0000 0004 1782 7098grid.496559.2Department of Social Welfare, Suwon Science College, 288, Seja-ro, Jeongnam-myeon, Hwaseong-si, Gyeonggi-do South Korea
| | - Kyung Hee Yoon
- 0000000404154154grid.488421.3Hallym University Suicide and School Mental Health Institute, Hallym University Sacred Heart Hospital, 176-14, Gwanpyeong-ro, Dongan-gu, Anyang-si, Gyeonggi-do South Korea
| | - Hannah Cho
- 0000 0001 0729 3748grid.412670.6Department of Child Welfare and Studies, Sookmyung Women’s University, 100 Cheongpa-ro 47-gil, Yongsan-gu, Seoul, South Korea
| | - Hyeji Jung
- 0000 0004 0532 7395grid.412977.eDepartment of Social Studies Education, Incheon National University, Songdo-dong, 119 Academy-ro, Yeonsu-gu, Incheon, South Korea
| | - Ah Reum Kim
- 0000000404154154grid.488421.3Hallym University Suicide and School Mental Health Institute, Hallym University Sacred Heart Hospital, 176-14, Gwanpyeong-ro, Dongan-gu, Anyang-si, Gyeonggi-do South Korea
| | - Bo-Ram Shin
- 0000000404154154grid.488421.3Hallym University Suicide and School Mental Health Institute, Hallym University Sacred Heart Hospital, 176-14, Gwanpyeong-ro, Dongan-gu, Anyang-si, Gyeonggi-do South Korea
| | - Hyun Ju Hong
- 0000000404154154grid.488421.3Department of Psychiatry, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do South Korea ,0000000404154154grid.488421.3Hallym University Suicide and School Mental Health Institute, Hallym University Sacred Heart Hospital, 176-14, Gwanpyeong-ro, Dongan-gu, Anyang-si, Gyeonggi-do South Korea
| |
Collapse
|
18
|
Keeshin BR, Gray D, Zhang C, Presson AP, Coon H. Youth Suicide Deaths: Investigation of Clinical Predictors in a Statewide Sample. Suicide Life Threat Behav 2018; 48:601-612. [PMID: 28833472 DOI: 10.1111/sltb.12386] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 05/17/2017] [Indexed: 11/29/2022]
Abstract
Death by suicide is a significant cause of mortality among youth. However, there is limited information on the demographic and clinical factors associated with youth suicide deaths. The objective of this study was to link large statewide databases to describe demographic, clinical, and cause of death characteristics among youth who died by suicide. We examined 1,218 decedents under age 26 who died by suicie between 2000 and 2014. Eighteen died before age 12, 53 died between ages 12 and 14, 292 died between ages 15 and 18, and 855 died between ages 19 and 25. Most were male (83%), and firearm was most common cause of death; 28% previously attempted suicide, 31% had a mental health diagnosis, and 17% were prescribed psychotropic medication. Younger children died by hanging/smothering (89% of all 7- to 11-year olds), and overdose/poisoning increased progressively with age. Adolescents had a higher proportion of females than young adults (23% vs. 14%, p = .002). Combining data from the medical examiner and large hospital systems allows examination of youth suicide from a developmental perspective. Differences between age groups included gender, method, diagnosed mental illness, and diagnosis of attention deficit hyperactivity disorder. These data point to missed opportunities for effective interventions for specific developmental stages.
Collapse
Affiliation(s)
- Brooks R Keeshin
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Doug Gray
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA.,Mental Illness Research, Education and Clinical Center, Veterans Integrated Service Network 19, George E. Whalen Department of Veteran Affairs Medical Center, Salt Lake City, UT, USA
| | - Chong Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Angela P Presson
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Hilary Coon
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
19
|
Griffin E, McMahon E, McNicholas F, Corcoran P, Perry IJ, Arensman E. Increasing rates of self-harm among children, adolescents and young adults: a 10-year national registry study 2007-2016. Soc Psychiatry Psychiatr Epidemiol 2018; 53:663-671. [PMID: 29721594 DOI: 10.1007/s00127-018-1522-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/25/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Rates of hospital-treated self-harm are highest among young people. The current study examined trends in rates of self-harm among young people in Ireland over a 10-year period, as well as trends in self-harm methods. METHODS Data from the National Self-Harm Registry Ireland on presentations to hospital emergency departments (EDs) following self-harm by those aged 10-24 years during the period 2007-2016 were included. We calculated annual self-harm rates per 100,000 by age, gender and method of self-harm. Poisson regression models were used to examine trends in rates of self-harm. RESULTS The average person-based rate of self-harm among 10-24-year-olds was 318 per 100,000. Peak rates were observed among 15-19-year-old females (564 per 100,000) and 20-24-year-old males (448 per 100,000). Between 2007 and 2016, rates of self-harm increased by 22%, with increases most pronounced for females and those aged 10-14 years. There were marked increases in specific methods of self-harm, including those associated with high lethality. CONCLUSIONS The findings indicate that the age of onset of self-harm is decreasing. Increasing rates of self-harm, along with increases in highly lethal methods, indicate that targeted interventions in key transition stages for young people are warranted.
Collapse
Affiliation(s)
- Eve Griffin
- National Suicide Research Foundation, 4.28 Western Gateway Building, University College Cork, Cork, Ireland.
| | - Elaine McMahon
- National Suicide Research Foundation, 4.28 Western Gateway Building, University College Cork, Cork, Ireland
| | - Fiona McNicholas
- Department of Child and Adolescent Psychiatry, Our Lady's Children's Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland.,Lucena Clinic, Rathgar, Dublin 6, Ireland
| | - Paul Corcoran
- National Suicide Research Foundation, 4.28 Western Gateway Building, University College Cork, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
| | - Ivan J Perry
- School of Public Health, University College Cork, Cork, Ireland
| | - Ella Arensman
- National Suicide Research Foundation, 4.28 Western Gateway Building, University College Cork, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
| |
Collapse
|
20
|
Roh BR, Jung EH, Hong HJ. A Comparative Study of Suicide Rates among 10-19-Year-Olds in 29 OECD Countries. Psychiatry Investig 2018; 15:376-383. [PMID: 29486551 PMCID: PMC5912485 DOI: 10.30773/pi.2017.08.02] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 08/02/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study had two main objectives: to compare current suicide rates in OECD countries among 10-19-year-olds and to identify patterns of suicide rates based on age, gender and time. Furthermore we investigated the main dimensions that contributed to the variation in child and adolescent suicide rates across countries. METHODS We combined the WHO mortality data and the population data released by OECD to calculate the suicide rates in 29 OECD countries. A self-organizing map (SOM), k-means clustering analysis, and multi-dimensional scaling were used to classify countries based on similarities in suicide rate structure and to identify the important dimensions accounting for differences among groups. RESULTS We identified significant differences in suicide rates depending on age, sex, country, and time period. Late adolescence and male gender were universal risk factors for suicide, and we observed a general trend of declining suicide rates in OECD countries. The SOM analysis yielded eight types of countries. Most countries showed gender gaps in suicide rates of similar magnitudes; however, there were outliers in which the gender gap was particularly large or small. CONCLUSION Significant variation exists with respect to suicide rates and their associated gender gaps in OECD countries.
Collapse
Affiliation(s)
- Beop-Rae Roh
- Hallym University Suicide and School Mental Health Institute, Anyang, Republic of Korea
| | - Eun Hee Jung
- Mental Health and Communal Society Research Center, Kwangwoon University, Seoul, Republic of Korea
| | - Hyun Ju Hong
- Hallym University Suicide and School Mental Health Institute, Anyang, Republic of Korea.,Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| |
Collapse
|
21
|
Stenbacka M, Samuelsson M, Nordström P, Jokinen J. Suicide Risk in Young Men and Women After Substance Intoxication. Arch Suicide Res 2018; 22:254-262. [PMID: 28541758 DOI: 10.1080/13811118.2017.1319311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study investigates suicide and overdoses in 1,119 consecutive patients (64% women), 15 to 34 years of age, presenting at the emergency department after self-poisoning from1994 to 2000 and followed regarding death to 2006. Regression and Kaplan-Meier survival analyses were performed for suicide and other causes of death. The patients had about a 60 times higher risk (SMR = 61.95) of death due to suicide and 26 times higher (SMR = 26.47) for all-cause mortality. Men had a nearly 2 times higher risk for suicide than women and half of the suicides occurred during the first 2 years after admission. Poisoning was the most common suicide method and early prevention of self-poisoning is crucial to reducing future deaths.
Collapse
|
22
|
Tong Y, Phillips MR, Yin Y. Prevalence of psychiatric diagnoses in individuals who die by suicide or attempt suicide in China based on independent structured diagnostic interviews with different informants. J Psychiatr Res 2018; 98:30-38. [PMID: 29274530 DOI: 10.1016/j.jpsychires.2017.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/25/2017] [Accepted: 12/04/2017] [Indexed: 11/16/2022]
Abstract
Many individuals who die by suicide or attempt suicide have no pre-existing psychiatric record. In these cases determination of the presence of mental illness at the time of the suicidal act depends on diagnostic interviews with different informants, but the reliability of such interviews is unknown. To address this issue, the current study from northern China conducted independent diagnostic interviews (by different psychiatrists) with a co-resident family member and another associate of 151 suicide decedents, with 120 individuals who attempted suicide, and with two proxy informants for each suicide attempter. In the suicide decedent group, 56% of interviews with family members and 50% with other associates resulted in one or more psychiatric diagnosis; the concordance (kappa) of these two respondents for the presence of any current psychiatric disorder, any mood disorder and any other psychiatric disorder were 0.35, 0.32 and 0.41, respectively. In the suicide attempt group, 47% of interviewers with suicide attempters, 31% with family members, and 15% with other associates resulted in a psychiatric diagnosis; the concordance for any current psychiatric disorder, any mood disorder and any other psychiatric disorder between the interview with the suicide attempter and the combined result of the two separate proxy informant interviews were 0.31, 0.34 and 0.39, respectively. We conclude that the concordance of the presence and type of psychiatric diagnosis of individuals with suicidal behavior based on independent structured interviews by psychiatrists with different informants is low to fair and that using multiple informants will increase the identification of psychiatric disorders.
Collapse
Affiliation(s)
- Yongsheng Tong
- Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, China; WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China; Peking University Huilongguan Clinical Medical School, China
| | - Michael R Phillips
- WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China; Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, China.
| | - Yi Yin
- Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, China; WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| |
Collapse
|
23
|
Gyllenberg D, Marttila M, Sund R, Jokiranta-Olkoniemi E, Sourander A, Gissler M, Ristikari T. Temporal changes in the incidence of treated psychiatric and neurodevelopmental disorders during adolescence: an analysis of two national Finnish birth cohorts. Lancet Psychiatry 2018; 5:227-236. [PMID: 29398636 DOI: 10.1016/s2215-0366(18)30038-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Comprehensive overviews of the temporal changes in treated psychiatric and neurodevelopmental disorders during adolescence are scarce. We reviewed data from two national cohorts, 10 years apart, to establish the change in use of specialised services for psychiatric and neurodevelopmental diagnoses in Finland. METHODS We compared the nationwide register-based incidence of psychiatric and neurodevelopmental diagnoses between the 12th birthday and 18th birthday of adolescents born in Finland in 1987 and 1997. Adolescents who emigrated or died before their 12th birthday and those with missing covariate data were excluded, as were those who, when aged 11 years, had lived in a municipality belonging to a hospital district with obviously incomplete data reports during any follow-up years in our study. Our primary outcomes were time to incident specialised service use for any psychiatric or neurodevelopmental disorder and for 17 specific diagnostic classes. We also investigated whether adolescents who died by suicide had accessed specialised services before their deaths. FINDINGS The cumulative incidence of psychiatric or neurodevelopmental disorders increased from 9·8 in the 1987 cohort to 14·9 in the 1997 cohort (difference 5·2 percentage points [95% CI 4·8-5·5]) among girls, and from 6·2 in the 1987 cohort to 8·8 in the 1997 (2·6 percentage points [2·4-2·9]) among boys. The hazard ratio for the overall relative increase in neurodevelopment and psychiatric disorders in the 1997 cohort compared with the 1987 cohort was 1·6 (95% CI 1·5-1·8) among girls and 1·5 (1·4-1·6) among boys. Of the studied diagnostic classes, we noted significant (ie, p<0·001) relative increases for ten of 17 diagnoses among girls and 11 among boys. Of the adolescents who died by suicide before age 18, only five of 16 in the 1987 cohort and two of 12 in the 1997 cohort had used specialised services in the 6 months before their death. INTERPRETATION The large absolute rise in service use for psychiatric or neurodevelopmental disorders points to the need to deliver effective treatment to a rapidly increased patient population, whereas the relative increase in specific diagnoses should inform clinical practice. Despite increasing service use, identification of adolescents at risk of suicide remains a major public health priority. FUNDING Academy of Finland, Brain and Behavior Research Foundation, Finnish Medical Foundation.
Collapse
Affiliation(s)
- David Gyllenberg
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland; Welfare Department, National Institute for Health and Welfare, Helsinki, Finland
| | - Mikko Marttila
- Welfare Department, National Institute for Health and Welfare, Helsinki, Finland
| | - Reijo Sund
- Centre for Research Methods, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | | | - André Sourander
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland; Department of Child Psychiatry, Turku University Central Hospital, Turku, Finland
| | - Mika Gissler
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland; Information Services Department, National Institute for Health and Welfare, Helsinki, Finland; Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
| | - Tiina Ristikari
- Welfare Department, National Institute for Health and Welfare, Helsinki, Finland
| |
Collapse
|
24
|
Puuskari V, Aalto-Setälä T, Komulainen E, Marttunen M. Suicidal ideation, suicide attempts, and psychological distress among intoxicated adolescents in the pediatric emergency department. Nord J Psychiatry 2018; 72:137-144. [PMID: 29126365 DOI: 10.1080/08039488.2017.1400099] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Studies have emphasized screening for psychiatric disorders, especially suicide risk in emergency departments. Psychiatric disorders and experimentation with alcohol increase in adolescence and intoxications among patients challenge the staff in emergency departments. AIMS This study examined the degree of suicidal ideation (SI) and suicidal behavior in adolescents, and the extent to which they differed from non-suicidal patients in terms of alcohol use, psychological distress, self-esteem, and perceived social support. METHODS The study comprised 120 adolescents, a mean age of 14.2 years. Of them 60% were females. We collected data on the clinical characteristics and assessed the patient's psychiatric status using self-report scales and analyzed blood samples for alcohol. A consulting psychiatrist interviewed each patient before discharge to evaluate potential SI or suicide attempt (SA) using structured and semi-structured scales. RESULTS Of the 120 patients 20% had SI or had made a SA. High psychological distress in girls, low blood alcohol levels (BALs), as well as low scores on self-esteem, on social support and on familial support were associated with patients with SI/SA. Logistic regression showed that the most significant variables with suicidal patients included low BAL and low self-esteem and high alcohol consumption. Psychological distress had a direct and mediational role in the suicidal patients. CONCLUSIONS Adolescents referred to the pediatric emergency department with intoxication displaying high psychological distress and low self-esteem represent a high-risk group of teens. In this group, careful assessment of mental health status, screening for suicidal ideation, and SAs seems warranted.
Collapse
Affiliation(s)
- Varpu Puuskari
- a Adolescent Psychiatry , Helsinki University Hospital, University of Helsinki , Helsinki , Finland
| | - Terhi Aalto-Setälä
- b The Social Insurance Institute , Helsinki , Finland.,c Mental Health Unit , National Institute for Health and Welfare , Helsinki , Finland
| | - Erkki Komulainen
- d Department of Behavioural Sciences , University of Helsinki , Helsinki , Finland
| | - Mauri Marttunen
- a Adolescent Psychiatry , Helsinki University Hospital, University of Helsinki , Helsinki , Finland.,c Mental Health Unit , National Institute for Health and Welfare , Helsinki , Finland
| |
Collapse
|
25
|
Abstract
OBJECTIVE Economic recessions and severe weather events are often associated with increased suicide rates. The Global Dairy Crisis 2015/2016 led to an economic downturn in the New Zealand dairy farming industry and, coupled with droughts in some regions and floods in others, raised fears about increased suicide rates among farmers. However, little was known about suicides in the farming sector. This study reviews characteristics of recent farm-related suicides in New Zealand and assesses the extent to which financial stresses contributed to the deaths. METHODS Data were abstracted from coroners' records for a consecutive series of 185 people in farm- and agriculture-related occupations who died by suicide between 2007 and 2015 and for whom coronial inquiries had been completed. RESULTS Farm suicides were heterogeneous: six distinct risk profiles were identified. Financial stresses made negligible contributions to farm suicides. Overall, risk factors for farm suicides differed little from risk factors for suicide in the general population. However, suicide risk in farmers was exacerbated by ready access to firearms: almost 40% of farm suicides involved firearms, compared to 8% in the general population over the same time. Among farm suicides, young male farm labourers predominated, rather than farm owners or managers. For many young men, relationship losses, acute alcohol intoxication and ready access to a firearm formed a common constellation of risk factors. CONCLUSIONS While coroners' records are variable and do not record specific information about financial stresses and weather events, it was clear that these issues made a negligible contribution to farm suicides. A range of rural suicide prevention initiatives are needed to address various farm suicide risk profiles. In particular, young male labourers often had no contact with health services prior to death, suggesting that rural suicide prevention efforts need to be positioned within community, farming and sports organisations, as well as health and social service providers.
Collapse
Affiliation(s)
- Annette L Beautrais
- Department of Health Sciences, University of Canterbury, Christchurch, New Zealand
| |
Collapse
|
26
|
Stene-Larsen K, Reneflot A. Contact with primary and mental health care prior to suicide: A systematic review of the literature from 2000 to 2017. Scand J Public Health 2017; 47:9-17. [DOI: 10.1177/1403494817746274] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: To examine rates of contact with primary and mental health care prior to suicide in men and women and across a range of age categories. Method: The authors performed a systematic review of 44 studies from 2000 to 2017 of which 36 reported rates on contact with primary health care and 14 reported on contact with mental health care prior to suicide. Results: Contact with primary health care was highest in the year prior to suicide with an average contact rate of 80%. At one month, the average rate was 44%. The lifetime contact rate for mental health care was 57%, and 31% in the final 12 months. In general, women and those over 50 years of age had the highest rates of contact with health care prior to suicide. Conclusions: Contact with primary health care prior to suicide is common even in the final month before death. The findings presented in this study highlight the importance of placing suicide prevention strategies and interventions within the primary health care setting.
Collapse
Affiliation(s)
- Kim Stene-Larsen
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, Norway
| | - Anne Reneflot
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, Norway
| |
Collapse
|
27
|
Rahikainen AL, Majaharju S, Haukka J, Palo JU, Sajantila A. Serotonergic 5HTTLPR/rs25531 s-allele homozygosity associates with violent suicides in male citalopram users. Am J Med Genet B Neuropsychiatr Genet 2017; 174:691-700. [PMID: 28608626 DOI: 10.1002/ajmg.b.32553] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 04/13/2017] [Accepted: 05/05/2017] [Indexed: 12/27/2022]
Abstract
Depressive disorders are involved as a background factor in over 50% of suicide cases. The most widely used antidepressants today are serotonin selective reuptake inhibitors (SSRIs). However, not all users benefit from SSRI medication. Although the overall number of suicides in Finland have decreased notably during the last decade, the annual rate is still relatively high, particularly in male population. In this study, we tested the hypothesis that the genetic variants associated with decreased citalopram efficiency, 5HTTLPR/rs25531, and increased impulsive behavior, MAOA-uVNTR and HTR2B Q20*, are more frequent among citalopram users committing suicide than among the citalopram users in general. Also the effect of alcohol was evaluated. The study population comprised 349 suicide victims (184 males and 165 females). Based on the suicide method used, cases were divided into two groups; violent (88 males and 49 females) and non-violent (96 males and 116 females). The control group (284; 159 males and 125 females) consisted of citalopram users who died of causes other than suicide. We found that male citalopram users with low functioning s/s genotype of 5HTTLPR/rs25531 were in increased risk to commit violent suicide (OR 2.50, 95%CI 1.15-5.42, p = 0.020). Surprisingly, high blood alcohol concentration was observed to be a risk factor only in non-violent suicides (both males and females), but not in violent ones. No association between suicides and MAOA-uVNTR and HTR2B Q20*, which have been previously connected to violent and impulsive behavior, was detected.
Collapse
Affiliation(s)
| | - Salla Majaharju
- Metropolia University of Applied Sciences, Metropolia, Helsinki, Finland
| | - Jari Haukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Jukka U Palo
- Department of Forensic Medicine, University of Helsinki, Helsinki, Finland.,Forensic Genetics Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Antti Sajantila
- Department of Forensic Medicine, University of Helsinki, Helsinki, Finland
| |
Collapse
|
28
|
Suicide in children and adolescents: a Tunisian perspective from 2009 to 2015. Forensic Sci Med Pathol 2017; 13:417-425. [PMID: 28879455 DOI: 10.1007/s12024-017-9909-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2017] [Indexed: 10/18/2022]
Abstract
This study presents the characteristics of child and adolescent suicides which occurred in Kairouan, Tunisia. Data were collected from autopsy records of the Forensic Department of the University Hospital Ibn El Jazzar of Kairouan. General characteristics of suicides among children and adolescents (under the age of 18) between 2009 and 2015 were retrospectively reviewed. A total of 49 cases, with a female predominance (61.2%) and a mean age of 15.4 ± 2.1, were registered. Most of the victims were from rural areas (93.1%). In most cases, suicide occurred in the victim's home or the surrounding area (73.4%). The identified precipitating factors were family problems in 55.1%, and school issues in 12.2%. The most common suicide method was hanging (69.38%) for both genders, followed by self-immolation for males and poisoning for females, the majority using pesticides. This study offers useful information to understand the risk factors in Tunisian child and adolescent suicides and provides a basis for the development of urgently needed preventive strategies.
Collapse
|
29
|
Association of Self-reported Impulsivity to Nonsuicidal Self-Injury, Suicidality, and Mortality in Adolescent Psychiatric Inpatients. J Nerv Ment Dis 2017; 205:340-345. [PMID: 28141633 DOI: 10.1097/nmd.0000000000000655] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examines the association of self-reported impulsivity to nonsuicidal self-injury, suicidal ideation, suicide attempts, and completed suicides in a clinical sample of 508 Finnish adolescents (aged 12-17) treated in psychiatric inpatient care between April 2001 and March 2006. The Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime interview was used to gather information on psychiatric disorders, impulsivity, and suicidality of the adolescents. Mortality data were obtained from the national cause of death register. In adolescent girls, impulsivity was significantly associated with suicidal ideation and attempts and completed suicides in adolescent boys. Of adolescent boys with impulsivity, 10.4% had died by suicide during the follow-up time. For preventive purposes, health care professionals are encouraged asked adolescents targeted questions about impulsivity and to consider the associated risk of suicidality identified in this study.
Collapse
|
30
|
Ballard ED, Cwik M, Van Eck K, Goldstein M, Alfes C, Wilson ME, Virden JM, Horowitz LM, Wilcox HC. Identification of At-Risk Youth by Suicide Screening in a Pediatric Emergency Department. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2017; 18:174-182. [PMID: 27678381 PMCID: PMC5247314 DOI: 10.1007/s11121-016-0717-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The pediatric emergency department (ED) is a critical location for the identification of children and adolescents at risk for suicide. Screening instruments that can be easily incorporated into clinical practice in EDs to identify and intervene with patients at increased suicide risk is a promising suicide prevention strategy and patient safety objective. This study is a retrospective review of the implementation of a brief suicide screen for pediatric psychiatric ED patients as standard of care. The Ask Suicide Screening Questions (ASQ) was implemented in an urban pediatric ED for patients with psychiatric presenting complaints. Nursing compliance rates, identification of at-risk patients, and sensitivity for repeated ED visits were evaluated using medical records from 970 patients. The ASQ was implemented with a compliance rate of 79 %. Fifty-three percent of the patients who screened positive (237/448) did not present to the ED with suicide-related complaints. These identified patients were more likely to be male, African American, and have externalizing behavior diagnoses. The ASQ demonstrated a sensitivity of 93 % and specificity of 43 % to predict return ED visits with suicide-related presenting complaints within 6 months of the index visit. Brief suicide screening instruments can be incorporated into standard of care in pediatric ED settings. Such screens can identify patients who do not directly report suicide-related presenting complaints at triage and who may be at particular risk for future suicidal behavior. Results have the potential to inform suicide prevention strategies in pediatric EDs.
Collapse
Affiliation(s)
- Elizabeth D Ballard
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Building 10, CRC Room 7-3345, MSC 1282, Bethesda, MD, 20892, USA.
| | - Mary Cwik
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn Van Eck
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mitchell Goldstein
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Clarissa Alfes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary Ellen Wilson
- Pediatric Emergency Department, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jane M Virden
- Pediatric Emergency Department, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Lisa M Horowitz
- Office of the Clinical Director, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Holly C Wilcox
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
31
|
Lindemann C, Langner I, Banaschewski T, Garbe E, Mikolajczyk RT. The Risk of Hospitalizations with Injury Diagnoses in a Matched Cohort of Children and Adolescents with and without Attention Deficit/Hyperactivity Disorder in Germany: A Database Study. Front Pediatr 2017; 5:220. [PMID: 29114538 PMCID: PMC5660679 DOI: 10.3389/fped.2017.00220] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 09/28/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Attention deficit/hyperactivity disorder (ADHD) is a common neuropsychiatric disorder in children and adolescents worldwide, and children with ADHD have elevated risk of injuries. Our aim was to assess the risk of hospitalizations with injury diagnoses and their various subtypes in children and adolescents with newly diagnosed ADHD compared to those without ADHD, as well as to study sex effects on this risk in the setting of the German health care system. METHODS The German Pharmacoepidemiological Research Database, in which 20 million insured from four statutory health insurances in Germany are included, was used to set up a matched cohort study of 3- to 17-year-old children and adolescents with and without ADHD. We calculated age-specific incidence rates and used Cox regression to obtain hazard ratios (HRs) for hospitalizations with injury diagnoses. We used the injury mortality diagnosis matrix for classification of injuries. RESULTS The matched cohort comprised a total of 75,300 children. The age-specific incidence rates for hospitalization with injury diagnosis for males with ADHD displayed a u-shaped form with highest incidences in the in the age groups 3-6 years [26.2 per 1,000 person-years; 95% confidence interval (CI) 20.5-33.0] and 18-21 years (28.6; 22.4-36.0). Girls with ADHD were less affected in younger age-groups, but the incidence rate for 18-21 year olds was similar to boys with ADHD (26.4; 17.4-38.4). The adjusted HR for children with ADHD was 1.40 (95% CI 1.30-1.49) compared to non-affected children. With respect to nature of injury, ADHD was associated with hospitalization with injury diagnoses of the internal organs, open wounds, and contusions but not with other injuries. With respect to body regions, children with ADHD were more prone to hospitalizations with injuries of the abdomen, traumatic brain injuries, other head injuries, and system-wide injuries such as poisoning and intoxication. No significant associations were seen for the other body regions. Differences between sexes were only seen for system-wide injuries. CONCLUSION Children and adolescents with ADHD are at an increased risk for hospitalizations with diagnoses of injuries compared to non-affected children. Despite differences in health-care systems, the risk increase is at a similar level in Germany as in other countries.
Collapse
Affiliation(s)
- Christina Lindemann
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Medical School Hannover, Hannover, Germany
| | - Ingo Langner
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | - Edeltraut Garbe
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Core Scientific Area 'Health Sciences' at the University of Bremen, Bremen, Germany
| | - Rafael T Mikolajczyk
- Medical School Hannover, Hannover, Germany.,ESME - Epidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection Research, Braunschweig, Germany.,Institute for Medical Epidemiology, Biometrics and Computer Science, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| |
Collapse
|
32
|
Feigelman W, Joiner T, Rosen Z, Silva C, Mueller AS. Contrasts Between Young Males Dying by Suicide, Those Dying From Other Causes and Those Still Living: Observations From the National Longitudinal Survey of Adolescent to Adult Health. Arch Suicide Res 2016; 20:389-401. [PMID: 26752537 PMCID: PMC7064059 DOI: 10.1080/13811118.2015.1104270] [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] [Indexed: 10/22/2022]
Abstract
UNLABELLED Utilizing Add Health longitudinal data, we compared 21 male suicide casualties to 10,101 living respondents identifying suicide correlates. METHOD 21 suicide decedents completed surveys in 1994/1995 (Wave 1) and 11 completed at Wave 3; responses were compared with Chi-square and oneway ANOVA tests. RESULTS Suicide decedents were prone to higher delinquency and fighting at Wave 1, but not at Wave 3. At Wave 1 suicide decedents remained undistinguished from living respondents in depression, self-esteem, and drug uses. Yet, after Wave 3, the 11 respondents dying by suicide showed significantly higher depression, drug use and lower self-esteem. CONCLUSION Delinquency trends can readily understood, but more complex causes are needed to account for unexpected changes in self-esteem, depression and drug uses.
Collapse
|
33
|
Rukundo GZ, Mishara B, Kinyanda E. Psychological correlates of suicidality in HIV/AIDS in semi-urban south-western Uganda. Trop Doct 2016; 46:211-215. [PMID: 26738768 DOI: 10.1177/0049475515623110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is a paucity of data on the prevalence of suicidality in HIV/AIDS, and associated psychological factors in sub-Saharan Africa, shown to be high in Uganda. Yet, the region accounts for over 70% of the world HIV burden. Our study used a cross-sectional survey of 226 HIV-positive (HIV+) adults and adolescents (aged 15-17 years) in Mbarara, Uganda. The relationship between suicidality and depressed mood, anxiety symptoms, state anger, self-esteem, trait anger and hopelessness was examined; anger was the predominant factor in suicidality, suggesting that anger management could potentially lower the prevalence of suicidality.
Collapse
Affiliation(s)
- Godfrey Zari Rukundo
- Senior Lecturer of Psychiatry, Department of Psychiatry, Mbarara University of Science and Technology, Uganda
| | - Brian Mishara
- Professor of Psychology, Centre for Research and Intervention on Suicide and Euthanasia, Université du Québec à Montréal, Canada
| | - Eugene Kinyanda
- Associate Professor of Psychiatry, Uganda Medical Research Council, Entebbe and Department of Psychiatry, Makerere College of Health Sciences, Uganda
| |
Collapse
|
34
|
Calle P, Hautekiet A, François H, Sundahl N, Cornelis C, Calle S, Damen J, Vanbrabant P, De Turck B, De Graeve K, Mpotos N, De Paepe P. Alcohol-related emergency department admissions among adolescents in the Ghent and Sint-Niklaas areas. Acta Clin Belg 2015; 70:345-9. [PMID: 25984783 DOI: 10.1179/2295333715y.0000000031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Alcohol abuse is a major health concern. The aim of this retrospective study was to analyse the alcohol-related emergency department (ED) admissions among adolescents in all hospitals of distinct areas during a 1-year period. In each hospital, all ED patients with a blood alcohol concentration (BAC) of at least 0.5 g/l were surveyed in a standardised way. Of the 3918 included patients, only 146 (3.7%) were < 18 years. The male-to-female ratio was 1.5:1. There was a strong preponderance of weekend and night time admissions. Most of the patients were transported by ambulance (77% of 138 patients with information on this item). The main reason for ED admittance was depressed level of consciousness (64%), trauma (12%), vomiting and/or abdominal pain (12%), agitation or aggression (4%), syncope (4%) and psychological problems (4%). The context of the alcohol intoxication was related to some kind of festivity in 85%, mental problems in 14% and chronic abuse in 1%. Median BAC values (and range) were 2.08 g/l (0.73-3.70 g/l) for boys and 1.51 g/l (0.73-2.90 g/l) for girls. Most patients (87%) could be discharged home within 24 hours. Our study confirms that problematic alcohol use leading to ED admissions starts in adolescence. Although the numbers of cases below 18 years are low when compared to adults, the phenomenon is alarming as it is associated with substantial health problems. Therefore, Belgium urgently needs a global national alcohol plan, with youngsters being one of the target groups.
Collapse
Affiliation(s)
- P Calle
- Emergency Department, Maria Middelares General Hospital , Ghent, Belgium
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Park S. Brief report: Sex differences in suicide rates and suicide methods among adolescents in South Korea, Japan, Finland, and the US. J Adolesc 2015; 40:74-7. [DOI: 10.1016/j.adolescence.2015.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 12/08/2014] [Accepted: 01/21/2015] [Indexed: 10/24/2022]
|