1
|
Nan J, Grennan G, Ravichandran S, Ramanathan D, Mishra J. Neural activity during inhibitory control predicts suicidal ideation with machine learning. NPP-DIGITAL PSYCHIATRY AND NEUROSCIENCE 2024; 2:10. [PMID: 38988507 PMCID: PMC11230903 DOI: 10.1038/s44277-024-00012-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/04/2024] [Accepted: 06/04/2024] [Indexed: 07/12/2024]
Abstract
Suicide is a leading cause of death in the US and worldwide. Current strategies for preventing suicide are often focused on the identification and treatment of risk factors, especially suicidal ideation (SI). Hence, developing data-driven biomarkers of SI may be key for suicide prevention and intervention. Prior attempts at biomarker-based prediction models for SI have primarily used expensive neuroimaging technologies, yet clinically scalable and affordable biomarkers remain elusive. Here, we investigated the classification of SI using machine learning (ML) on a dataset of 76 subjects with and without SI(+/-) (n = 38 each), who completed a neuro-cognitive assessment session synchronized with electroencephalography (EEG). SI+/- groups were matched for age, sex, and mental health symptoms of depression and anxiety. EEG was recorded at rest and while subjects engaged in four cognitive tasks of inhibitory control, interference processing, working memory, and emotion bias. We parsed EEG signals in physiologically relevant theta (4-8 Hz), alpha (8-13 Hz), and beta (13-30 Hz) frequencies and performed cortical source imaging on the neural signals. These data served as SI predictors in ML models. The best ML model was obtained for beta band power during the inhibitory control (IC) task, demonstrating high sensitivity (89%), specificity (98%). Shapley explainer plots further showed top neural predictors as feedback-related power in the visual and posterior default mode networks and response-related power in the ventral attention, fronto-parietal, and sensory-motor networks. We further tested the external validity of the model in an independent clinically depressed sample (n = 35, 12 SI+) that engaged in an adaptive test version of the IC task, demonstrating 50% sensitivity and 61% specificity in this sample. Overall, the study suggests a promising, scalable EEG-based biomarker approach to predict SI that may serve as a target for risk identification and intervention.
Collapse
Affiliation(s)
- Jason Nan
- Neural Engineering and Translation Labs, University of California, San Diego, La Jolla, CA USA
- Department of Bioengineering, University of California, San Diego, La Jolla, CA USA
| | - Gillian Grennan
- Neural Engineering and Translation Labs, University of California, San Diego, La Jolla, CA USA
| | - Soumya Ravichandran
- Neural Engineering and Translation Labs, University of California, San Diego, La Jolla, CA USA
| | - Dhakshin Ramanathan
- Neural Engineering and Translation Labs, University of California, San Diego, La Jolla, CA USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA USA
- Department of Mental Health, VA San Diego Medical Center, San Diego, CA USA
- Center of Excellence for Stress and Mental Health, VA San Diego Medical Center, San Diego, CA USA
| | - Jyoti Mishra
- Neural Engineering and Translation Labs, University of California, San Diego, La Jolla, CA USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA USA
- Center of Excellence for Stress and Mental Health, VA San Diego Medical Center, San Diego, CA USA
| |
Collapse
|
2
|
Guo Z, Han X, Kong T, Wu Y, Kang Y, Liu Y, Wang F. The mediation effects of nightmares and depression between insomnia and suicidal ideation in young adults. Sci Rep 2024; 14:9577. [PMID: 38670978 PMCID: PMC11052998 DOI: 10.1038/s41598-024-58774-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Suicide is prevalent among young adults, and epidemiological studies indicate that insomnia, nightmares, and depression are significantly associated with a high incidence of suicidal ideation (SI). However, the causal relationship between these factors and SI remains unclear. Therefore, the purpose of this study was to examine the association between nightmares and depression and insomnia and SI in young adults, as well as to develop a mediation model to investigate the causal relationship between insomnia, nightmare, depression, and SI. We assessed insomnia, nightmares, depression, and SI in 546 young adults using the Insomnia Severity Scale (ISI), Disturbing Dream and Nightmare Severity Scale (DDNSI), Depression Study Scale (CESD-20), and Columbia-Suicide Severity Rating Scale (C-SSRS). Using the Bootstrap method, the mediation effects of nightmares and depression between insomnia and SI were calculated. The results demonstrated that nightmares and depression fully mediated the relationship between insomnia and SI, including the chain-mediation of insomnia and SI between nightmare and depression with an effect value of 0.02, 95% CI 0.01-0.04, and depression as a mediator between insomnia and SI with an effect value of 0.22, 95% CI 0.15-0.29. This study found that depression and nightmares may be risk and predictive factors between insomnia and SI, which implies that the assessment and treatment of depression and the simple or linked effect of nightmares play crucial roles in preventing SI in young adults.
Collapse
Affiliation(s)
- Zixuan Guo
- Medical Neurobiology Lab, Inner Mongolia Medical University, Huhhot, 010110, China
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing, 100096, China
| | - Xiaoli Han
- Clinical Nutrition Department, Friendship Hospital of Urumqi, Urumqi, 830049, China
| | - Tiantian Kong
- Xinjiang Key Laboratory of Neurological Disorder Research, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi, 830063, China
| | - Yan Wu
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing, 100096, China
| | - Yimin Kang
- Medical Neurobiology Lab, Inner Mongolia Medical University, Huhhot, 010110, China.
| | - Yanlong Liu
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325035, China.
| | - Fan Wang
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing, 100096, China.
- Xinjiang Key Laboratory of Neurological Disorder Research, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi, 830063, China.
| |
Collapse
|
3
|
Akinyemi O, Ogundare T, Oladunjoye AF, Nasef KE, Lipscombe C, Akinbote JA, Bezold M. Factors associated with suicide/self-inflicted injuries among women aged 18-65 years in the United States: A 13-year retrospective analysis of the National Inpatient Sample database. PLoS One 2023; 18:e0287141. [PMID: 37788271 PMCID: PMC10547191 DOI: 10.1371/journal.pone.0287141] [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: 01/31/2023] [Accepted: 05/30/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Suicide is a significant cause of mortality in the United States, accounting for 14.5 deaths/100,000. Although there are data on gender disparity in suicide/self-inflicted injury rates in the United States, few studies have examined the factors associated with suicide/self-inflicted injury in females. OBJECTIVE To determine factors associated with suicide/self-inflicted injuries among women aged 18-65 years in the United States. METHODS Hospitalizations for suicide or self-inflicted injuries were identified using the National Inpatient Sample database from 2003-2015 using sample weights to generate national estimates. Independent predictors of suicide/self-inflicted injuries were identified using multivariable regression models. Interaction term analysis to identify the interaction between race/ethnicity and income were conducted. RESULTS There were 1,031,693 adult women hospitalizations in the U.S. with a primary diagnosis of suicide/self-inflicted injury in the study period. The highest suicide/self-inflicted injury risk was among women aged 31-45years (OR = 1.23, CI = 1.19-1.27, p < 0.05). Blacks in the highest income strata had a 20% increase in the odds of suicide/self-inflicted injury compared to Whites in the lowest socioeconomic strata (OR = 1.20, CI = 1.05-1.37, p <0.05). Intimate partner violence increased suicide/self-inflicted injury risk 6-fold (OR = 5.77, CI = 5.01-6.65, p < 0.05). CONCLUSION Suicide risk is among women aged 31-45 years, higher earning Black women, intimate partner violence victims, uninsured, and current smokers. Interventions and policies that reduce smoking, prevents intimate partner violence, addresses racial discrimination and bias, and provides universal health coverage are needed to prevent excess mortality from suicide deaths.
Collapse
Affiliation(s)
- Oluwasegun Akinyemi
- Clive O Callender Department of Surgery, Howard University, Washington, D.C., United States of America
| | - Temitope Ogundare
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States of America
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States of America
| | - Adeolu Funsho Oladunjoye
- Department of Obstetrics and Gynecology, Howard University, Washington, D.C., United States of America
| | - Kindha Elleissy Nasef
- Department of Obstetrics and Gynecology, Howard University, Washington, D.C., United States of America
| | - Christina Lipscombe
- Department of Obstetrics and Gynecology, Howard University, Washington, D.C., United States of America
| | - John Akinshola Akinbote
- Department of Obstetrics and Gynecology, Howard University, Washington, D.C., United States of America
| | - Maureen Bezold
- Department of Health Sciences and Social Work, Western Illinois University, Macomb, Illinois, United States of America
| |
Collapse
|
4
|
Perry SW, Rainey JC, Allison S, Bastiampillai T, Wong ML, Licinio J, Sharfstein SS, Wilcox HC. Achieving health equity in US suicides: a narrative review and commentary. BMC Public Health 2022; 22:1360. [PMID: 35840968 PMCID: PMC9284959 DOI: 10.1186/s12889-022-13596-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 06/07/2022] [Indexed: 11/16/2022] Open
Abstract
Suicide rates in the United States (US) reached a peak in 2018 and declined in 2019 and 2020, with substantial and often growing disparities by age, sex, race/ethnicity, geography, veteran status, sexual minority status, socioeconomic status, and method employed (means disparity). In this narrative review and commentary, we highlight these many disparities in US suicide deaths, then examine the possible causes and potential solutions, with the overarching goal of reducing suicide death disparities to achieve health equity. The data implicate untreated, undertreated, or unidentified depression or other mental illness, and access to firearms, as two modifiable risk factors for suicide across all groups. The data also reveal firearm suicides increasing sharply and linearly with increasing county rurality, while suicide rates by falls (e.g., from tall structures) decrease linearly by increasing rurality, and suicide rates by other means remain fairly constant regardless of relative county urbanization. In addition, for all geographies, gun suicides are significantly higher in males than females, and highest in ages 51–85 + years old for both sexes. Of all US suicides from 1999–2019, 55% of male suicides and 29% of female suicides were by gun in metropolitan (metro) areas, versus 65% (Male) and 42% (Female) suicides by gun in non-metro areas. Guns accounted for 89% of suicides in non-metro males aged 71–85 + years old. Guns (i.e., employment of more lethal means) are also thought to be a major reason why males have, on average, 2–4 times higher suicide rates than women, despite having only 1/4—1/2 as many suicide attempts as women. Overall the literature and data strongly implicate firearm access as a risk factor for suicide across all populations, and even more so for male, rural, and older populations. To achieve the most significant results in suicide prevention across all groups, we need 1) more emphasis on policies and universal programs to reduce suicidal behaviors, and 2) enhanced population-based strategies for ameliorating the two most prominent modifiable targets for suicide prevention: depression and firearms.
Collapse
Affiliation(s)
- Seth W Perry
- Department of Psychiatry and Behavioral Sciences, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA. .,Department of Neuroscience & Physiology, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA. .,Department of Neurosurgery, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA. .,Department of Public Health and Preventive Medicine, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA.
| | - Jacob C Rainey
- Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Stephen Allison
- Department of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Tarun Bastiampillai
- Department of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Mind and Brain Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.,Department of Psychiatry, Monash University, Clayton, Australia
| | - Ma-Li Wong
- Department of Psychiatry and Behavioral Sciences, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA.,Department of Neuroscience & Physiology, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA.,Department of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Julio Licinio
- Department of Psychiatry and Behavioral Sciences, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA.,Department of Neuroscience & Physiology, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA.,Department of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Department of Medicine, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA.,Department of Pharmacology, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA
| | - Steven S Sharfstein
- Sheppard Pratt Health System, Baltimore, MD, USA.,Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Holly C Wilcox
- Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| |
Collapse
|
5
|
Recent Suicidal Ideation and Behavior in the General Population: The Role of Depression, Posttraumatic Stress, and Reactive Avoidance. J Nerv Ment Dis 2019; 207:320-325. [PMID: 30958420 DOI: 10.1097/nmd.0000000000000976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The multivariate relationship between suicidality and three potential etiologic variables (depression, posttraumatic stress, and reactive avoidance) was examined in a stratified sample of 679 individuals from the general population. Lifetime exposure to a trauma or another very upsetting event was prevalent among those reporting suicidal behavior in the previous 6 months (58%) and those reporting recent suicidal ideation alone (40%), relative to those with no recent suicidal thoughts or behaviors (26%). Canonical correlation analysis indicated two independent sources of variance: the first loading on both suicidal ideation and behavior, predicted by depression, posttraumatic stress, and reactive avoidance, and the second indicating a unique relationship between suicidal behavior and reactive avoidance alone. Results indicate that the etiology of suicidality is likely multidimensional, and point to a significant variant of suicidal behavior that is unrelated to depression or posttraumatic stress, but may reflect emotional dysregulation and subsequent distress reduction behaviors.
Collapse
|
6
|
Assari S. Blacks' Diminished Return of Education Attainment on Subjective Health; Mediating Effect of Income. Brain Sci 2018; 8:E176. [PMID: 30213135 PMCID: PMC6162786 DOI: 10.3390/brainsci8090176] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/05/2018] [Accepted: 08/10/2018] [Indexed: 01/28/2023] Open
Abstract
Background: Minorities' Diminished Return (MDR) can be defined as smaller health gains from socioeconomic status (SES) indicators, such as education attainment among ethnic minorities compared to the majority group. The current study tested whether income explains why Black and White adults differ in the association between education attainment and self-rated health (SRH). Methods: With a cross-sectional design, this study used data from Cycle 5 of the Health Information National Trends Survey (HINTS), 2017. With a nationally representative sample, the HINTS study generates results that are generalizable to US adults. This study included 2277 adults who were either non-Hispanic White (n = 1868; 82%) or non-Hispanic Black (n = 409; 18%). The independent variable was education attainment. The dependent variable was SRH, measured using a standard single item. Age, gender, and health insurance status were covariates. Ethnicity was the focal moderator. Income was the mediator. A structural equation model (SEM) was applied for data analysis. Results: Overall, higher education attainment was associated with better SRH, net of covariates. However, a significant interaction between ethnicity and education attainment suggested a smaller SRH gain from education for Blacks compared to Whites. This interaction could be explained by Black⁻White differences in income. Conclusion: Our study results suggests that labor market preferences may explain smaller effects of education attainment on SRH for Blacks relative to Whites. Given this finding and other studies documenting MDR, policies should reduce labor market discrimination, increasing job opportunities and reducing the racial pay gap for Blacks. Programs should help Blacks compete for prestigious and high-paying jobs.
Collapse
Affiliation(s)
- Shervin Assari
- Center for Research on Ethnicity, Culture, and Health (CRECH), School of Public Health, University of Michigan, Ann Arbor, MI 48104, USA.
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd.; Ann Arbor, MI 48109-2700, USA.
| |
Collapse
|
7
|
Assari S, Lapeyrouse LM, Neighbors HW. Income and Self-Rated Mental Health: Diminished Returns for High Income Black Americans. Behav Sci (Basel) 2018; 8:E50. [PMID: 29772799 PMCID: PMC5981244 DOI: 10.3390/bs8050050] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/11/2018] [Accepted: 05/13/2018] [Indexed: 01/16/2023] Open
Abstract
Background: The minorities' diminished return theory suggests that socioeconomic position (SEP) generates smaller health gains for racial/ethnic minorities compared to Whites. The current study was a Black⁻White comparison of the association between household income and self-rated mental health (SRMH). Methods: This cross-sectional study used data from the 2017 State of the State Survey (SOSS). With representative sampling, the SOSS generates results that are generalizable to the state of Michigan. This study included 881 adults, (n = 92) Black and (n = 782) White. The independent variable was household income. The dependent variable was SRMH, measured using a single item. Age, gender, and participation in the labor force were covariates. Race/ethnicity was the focal moderator. Logistic regression models were used for data analysis. Results: Overall, higher household income was associated with better SRMH, net of covariates. An interaction was found between race/ethnicity and household income on SRMH, suggesting a smaller, or nonexistent, protective effect for Blacks compared to Whites. In race/ethnicity-stratified models, higher household income was associated with better SRMH for Whites but not Blacks. Conclusion: Supporting the minorities' diminished return theory, our study documents differential effects for income on SRHM for Blacks and Whites, where Whites but not Blacks appear to benefit from their income. Given this, researchers and policy makers are cautioned against making assumptions that racial groups benefit equally from similar economic resources.
Collapse
Affiliation(s)
- Shervin Assari
- Center for Research on Ethnicity, Culture, and Health (CRECH), School of Public Health, University of Michigan, Ann Arbor, MI 48104, USA.
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd.; Ann Arbor, MI 48109-2700, USA.
| | - Lisa M Lapeyrouse
- Department of Public Health and Health Sciences, University of Michigan, Flint, MI 48502, USA.
| | - Harold W Neighbors
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI 48502, USA.
| |
Collapse
|
8
|
Cheah YK, Azahadi M, Phang SN, Abd Manaf NH. Sociodemographic, lifestyle and health determinants of suicidal behaviour in Malaysia. Psychiatry Res 2018; 261:319-324. [PMID: 29331849 DOI: 10.1016/j.psychres.2017.12.086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 10/12/2017] [Accepted: 12/31/2017] [Indexed: 11/17/2022]
Abstract
Suicide has become a serious matter in both developed and developing countries. The objective of the present study is to examine the factors affecting suicidal behaviour among adults in Malaysia. A nationally representative data which consists of 10,141 respondents is used for analysis. A trivariate probit model is utilised to identify the probability of having suicide ideation, suicide plan and suicide attempt. Results of the regression analysis show that to ensure unbiased estimates, a trivariate probit model should be used instead of three separate probit models. The determining factors of suicidal behaviour are income, age, gender, ethnicity, education, marital status, self-rated health and being diagnosed with diabetes and hypercholesterolemia. The likelihood of adopting suicidal behaviour is lower among higher income earners and older individuals. Being male and married significantly reduce the propensity to engage in suicidal behaviour. Of all the ethnic groups, Indian/others displays the highest likelihood of adopting suicidal behaviour. There is a positive relationship between poor health condition and suicide. Policies targeted at individuals who are likely to adopt suicidal behaviour may be effective in lowering the prevalence of suicide.
Collapse
Affiliation(s)
- Yong Kang Cheah
- School of Economics, Finance and Banking, College of Business, Universiti Utara Malaysia, 06010 UUM, Sintok, Kedah, Malaysia.
| | - Mohd Azahadi
- Centre for Burden of Disease Research, Institute for Public Health, Ministry of Health Malaysia, Malaysia
| | - Siew Nooi Phang
- School of Government, College of Law, Government and International Studies, Universiti Utara Malaysia, Malaysia
| | - Noor Hazilah Abd Manaf
- Department of Business Administration, Faculty of Economics and Management Sciences, International Islamic University Malaysia, Malaysia
| |
Collapse
|
9
|
Yuma-Guerrero P, Orsi R, Lee PT, Cubbin C. A systematic review of socioeconomic status measurement in 13 years of U.S. injury research. JOURNAL OF SAFETY RESEARCH 2018; 64:55-72. [PMID: 29636170 PMCID: PMC10372816 DOI: 10.1016/j.jsr.2017.12.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/09/2017] [Accepted: 12/05/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The purpose of this review was to assess the impact of socioeconomic status (SES) on injury and to evaluate how U.S. injury researchers have measured SES over the past 13years in observational research studies. DESIGN & METHODS This systematic review included 119 US injury studies indexed in PubMed between January 1, 2002 and August 31, 2015 that used one or more individual and/or area-level measures of SES as independent variables. Study findings were compared to the results of a previous review published in 2002. RESULTS Findings indicate SES remains an important predictor of injury. SES was inversely related to injury in 78 (66%) of the studies; inverse relationships were more consistently found in studies of fatal injury (77.4%) than in studies of non-fatal injury (58%). Approximately two-thirds of the studies (n=73, 61%) measured SES along a gradient and 59% used more than one measure of SES (n=70). Studies that used a gradient measure of SES and/or more than one measure of SES identified significant relationships more often. These findings were essentially equivalent to those of a similar 2002 review (Cubbin & Smith, 2002). CONCLUSIONS There remains a need to improve measurement of SES in injury research. Public health training programs should include best practices for measurement of SES, which include: measuring SES along a gradient, selecting SES indicators based on the injury mechanism, using the smallest geographic region possible for area-level measures, using multiple indicators when possible, and using both individual and area-level measures as both contribute independently to injury risk. Area-level indicators of SES are not accurate estimates of individual-level SES. PRACTICAL APPLICATIONS Injury researchers should measure SES along a gradient and incorporate individual and area-level SES measures that are appropriate to the injury outcome under study.
Collapse
Affiliation(s)
- Paula Yuma-Guerrero
- Colorado State University, College of Health and Human Sciences, School of Social Work, 127 Education, 1586 Campus Delivery, Fort Collins, CO 80523-1586, United States.
| | - Rebecca Orsi
- Colorado State University, College of Health and Human Sciences, School of Social Work, 127 Education, 1586 Campus Delivery, Fort Collins, CO 80523-1586, United States
| | - Ping-Tzu Lee
- Colorado State University, College of Health and Human Sciences, School of Social Work, 127 Education, 1586 Campus Delivery, Fort Collins, CO 80523-1586, United States
| | - Catherine Cubbin
- The University of Texas at Austin, School of Social Work, Austin, TX, United States
| |
Collapse
|
10
|
Hung GCL, Kwok CL, Yip PSF, Gunnell D, Chen YY. Predicting suicide in older adults - a community-based cohort study in Taipei City, Taiwan. J Affect Disord 2015; 172:165-70. [PMID: 25451412 DOI: 10.1016/j.jad.2014.09.037] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 09/14/2014] [Accepted: 09/20/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Older adults worldwide are at a greater risk of suicide than other age groups. There is a scarcity of prospective studies exploring risk factors for suicide in older people and their discriminative ability to identify future suicide. METHODS We examined a prospective cohort of senior Taipei City residents between 2005 and 2009 (N=101,764). Cox proportional hazards regression analysis was used to determine significant risk factors and to construct a predictive score. The accuracy of the derived score in the prediction was tested by Receiver Operating Characteristic analysis. RESULTS Male sex (Hazard Ratio [HR]=3.41, p<0.001), lower education (HR=3.31, p<0.001) and lower income (HR=2.52, p=0.01) were associated with an increased risk of suicide, as well as depressed mood (HR=1.44, p=0.02; per unit increase in a 4-point scale) and insomnia (HR=1.30, p=0.03; per unit increase in a 4-point scale). The derived prediction score yielded a sensitivity of 0.63 a specificity of 0.73 and an area under curve of 0.73. Removing depressed mood from the prediction model did not significantly alter suicide predictability (P=0.11). LIMITATIONS The dataset examined did not contain information regarding to important risk factors such as substance misuse and prescribed medications and the measures of mental health were relatively limited. CONCLUSION Prediction of suicide based on factors recorded in a routine health screen of elderly people was unsatisfactory; the strongest predictors were factors that cannot be easily altered. Further understanding of how the socioeconomic condition of seniors contributes to suicide may provide valuable insights for intervention targeting this growing population-at-risk.
Collapse
Affiliation(s)
| | - Chi-Leung Kwok
- Hong Kong Jockey Club Center for Suicide Research and Prevention, University of Hong Kong, Hong Kong; Department of Social Work and Social Administration, University of Hong Kong, Hong Kong
| | - Paul S F Yip
- Hong Kong Jockey Club Center for Suicide Research and Prevention, University of Hong Kong, Hong Kong; Department of Social Work and Social Administration, University of Hong Kong, Hong Kong
| | - David Gunnell
- School of Social and Community Medicine, University of Bristol, UK
| | - Ying-Yeh Chen
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Institute of Public Health and Department of Public Health, National Yang-Ming University, Taipei, Taiwan.
| |
Collapse
|
11
|
Naidoo SS, Gathiram P, Schlebusch L. Effectiveness of a Buddy intervention support programme for suicidal behaviour in a primary care setting. S Afr Fam Pract (2004) 2015. [DOI: 10.1080/20786190.2014.980159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
12
|
Walker RL, Salami TK, Carter SE, Flowers K. Perceived racism and suicide ideation: mediating role of depression but moderating role of religiosity among African American adults. Suicide Life Threat Behav 2014; 44:548-59. [PMID: 24690042 DOI: 10.1111/sltb.12089] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 11/21/2013] [Indexed: 11/29/2022]
Abstract
Suicide is a public health problem for African Americans who are young and of working age. The purpose of this study was to examine mediated and moderated effects of perceived racism on suicide ideation in a community sample of 236 African American men and women. Measures of suicide ideation, depression symptoms, intrinsic/extrinsic religiosity, and perceived racism were administered. Perceived racial discrimination was directly and indirectly associated with suicide ideation. For participants who reported low levels of extrinsic religiosity, the mediated effect of perceived racism (via depression symptoms) was significant. These findings provide some insight into suicide vulnerability for specific subgroups of African Americans.
Collapse
Affiliation(s)
- Rheeda L Walker
- Dept. of Psychology, University of Houston, Houston, TX, USA
| | | | | | | |
Collapse
|
13
|
Risk of suicidal ideation in diabetes varies by diabetes regimen, diabetes duration, and HbA1c level. J Psychosom Res 2014; 76:275-9. [PMID: 24630176 DOI: 10.1016/j.jpsychores.2014.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 02/05/2014] [Accepted: 02/09/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate patient subgroups based on the clinical characteristics of diabetes to evaluate risk factors for suicidal ideation using a large population-based sample in South Korea. METHODS Data from the Fifth Korea National Health and Nutrition Examination Survey, a cross-sectional, nationally representative survey, were analyzed. The participants were 9159 subjects aged ≥40years. We defined patients with diabetes based on self-reported physician-diagnosed diabetes. We evaluated clinical risk factors for suicidal ideation according to diabetes regimen, diabetes duration, and glycated hemoglobin (HbA1c) level compared with no diabetes. Given the complex sample design and unequal weights, we analyzed weighted percentages and used survey logistic regression. RESULTS Diabetes per se was not associated with suicidal ideation. However, suicidal ideation was significantly more prevalent among patients who had injected insulin, had a duration of diabetes ≥5years and had HbA1c levels ≥6.5 compared with those without diabetes. Depressive symptoms were the most prominent predictor of suicidal ideation. CONCLUSIONS Insulin therapy, diabetes of long duration, and unsatisfactory glycemic control were identified as risk factors for suicidal ideation; thus, patients with these characteristics warrant special attention. Our findings suggest the need to integrate efforts to manage emotional distress into diabetes care.
Collapse
|
14
|
Shojaei A, Moradi S, Alaeddini F, Khodadoost M, Barzegar A, Khademi A. Association between suicide method, and gender, age, and education level in Iran over 2006-2010. Asia Pac Psychiatry 2014; 6:18-22. [PMID: 24038892 DOI: 10.1111/appy.12097] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 07/16/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We aimed to evaluate the relationship between suicide method, and gender, age, and level of education in a nationwide study in Iran over the period from 2006 to 2010. METHODS Data on completed suicide cases referred to all forensic medicine centers throughout the country that were approved by an autopsy test were collected using data collection forms, which were filled out by the family members in interview sessions. Then, statistical analyses were performed using analysis of variance and chi-square tests, as well as logistic regression analysis. RESULTS Hanging is more popular among men (62.9% versus 27.7%), while self-burning is preferable for women (39% versus 7%) (P < 0.0001). Younger individuals more frequently adopt a highly violent method, firearms (mean age of 27.1), while older persons more often use hanging and poisoning (mean ages of 32.4 and 32.1, respectively) (P < 0.0001). Hanging and self-burning are more frequently used by persons with lower levels of education, whereas poisoning is more popular with more educated individuals (P < 0.0001). DISCUSSION All of the studied variables, that is, gender, age, education level, are critical risk factors of adopting different suicide methods in an Iranian population. Future work is necessary to explore the psychopathology adopting different suicide methods in the Iranian population.
Collapse
Affiliation(s)
- Ahmad Shojaei
- Baqiyatallah Medical Sciences University, Tehran, Iran
| | | | | | | | | | | |
Collapse
|
15
|
Lee HY, Hahm MI, Park EC. Differential association of socio-economic status with gender- and age-defined suicidal ideation among adult and elderly individuals in South Korea. Psychiatry Res 2013; 210:323-8. [PMID: 23769392 DOI: 10.1016/j.psychres.2013.05.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 01/18/2013] [Accepted: 05/08/2013] [Indexed: 10/26/2022]
Abstract
South Korea has the highest suicide rate among countries in the Organisation for Economic Co-operation and Development (OECD), with a rising trend that contrasts with the trend in most other OECD countries. This study assessed differential associations of socio-demographic factors with suicidal ideation in South Korea. We used five waves of data from the 2010 Korea National Health and Nutrition Examination Survey. Study subjects included 5803 men and women aged >25 years. We analysed weighted percentages with consideration of the complex survey sample design and unequal weights. Surveylogistic regressions were applied. Protective effects against suicidal ideation were found for higher household income, higher educational attainment, and being married. Functional limitations and depressive symptoms were risk factors for suicidal ideation. However, these significant factors may exert different effects on vulnerability for suicidal ideation among different genders and age groups. Thus, household income was mainly protective for women and subjects aged 25-44 years, and educational attainment was protective for individuals aged >65 years. Our findings suggest the need for extended social protection policies for the less privileged population and special strategies for different groups.
Collapse
Affiliation(s)
- Hoo-Yeon Lee
- Department of Social Medicine, College of Medicine, Dankook University, 201, Manghyang-ro, Dongnam-gu, Cheonan-si, Choongnam 330-714, South Korea
| | | | | |
Collapse
|
16
|
Fuller-Thomson E, Baker TM, Brennenstuhl S. Evidence supporting an independent association between childhood physical abuse and lifetime suicidal ideation. Suicide Life Threat Behav 2012; 42:279-91. [PMID: 22494105 DOI: 10.1111/j.1943-278x.2012.00089.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A regionally representative Canadian sample was used to investigate the gender-specific relationship between childhood physical abuse and lifetime suicidal ideation. The prevalence of suicidal ideation was about five times higher in abused men and women compared with their nonabused counterparts. After controlling for five clusters of potentially confounding factors (adverse childhood conditions, socioeconomic factors, health behaviors, psychosocial stressors/chronic illnesses, and mental health), childhood physical abuse was significantly associated with suicidal ideation (OR(adjusted) women = 4.48, 95% CI = 3.32-6.04; men = 3.57, 95% CI = 2.08-6.14). These findings suggest childhood physical abuse is independently associated with suicidal ideation and highlight the importance of providing preventative treatment to childhood abuse survivors.
Collapse
Affiliation(s)
- Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work & Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada M5S 1A1.
| | | | | |
Collapse
|
17
|
Toprak S, Cetin I, Guven T, Can G, Demircan C. Self-harm, suicidal ideation and suicide attempts among college students. Psychiatry Res 2011; 187:140-4. [PMID: 21040980 DOI: 10.1016/j.psychres.2010.09.009] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 09/18/2010] [Accepted: 09/26/2010] [Indexed: 11/18/2022]
Abstract
Self-harm, suicidal ideation, and suicide attempts are well represented behaviours in the general population of both developed and developing countries. These behaviours are indicative of underlying risk factors that show a strong interdependent correlation. In this study we attempted to define correlates for and prevalence of self-harm, suicidal ideation, and suicide attempts among Turkish college students. This 2006 study included 636 students from two Turkish state universities. Our results showed that the lifetime prevalence of self-harm was 15.4%, the prevalence of suicidal ideation was 11.4%, and the prevalence of suicide attempts was 7.1%. We uncovered correlates for self-harm, including low income, unsatisfying familial relationships, smoking, and alcohol, inhalant, and tranquilizer abuse. Tranquilizer abuse shared a dual role as a correlate for suicide ideation and as a means to attempt suicide. Additionally, we found that drug abusers and adolescents who practise self-harm presented the highest suicide risk.
Collapse
Affiliation(s)
- Sadik Toprak
- Forensic Medicine Department, Zonguldak Karaelmas University, 67600 Zonguldak, Turkey.
| | | | | | | | | |
Collapse
|
18
|
Roy A, Roy M, Janal M. Suicide attempts and ideation in African-American type 1 diabetic patients. Psychiatry Res 2010; 179:53-6. [PMID: 20630602 DOI: 10.1016/j.psychres.2010.06.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 05/28/2010] [Accepted: 06/03/2010] [Indexed: 11/29/2022]
Abstract
In order to examine suicidality and its correlates in type 1 diabetics 412 African-American type 1 diabetics and 404 African-American controls underwent a semi-structured interview that asked if they had ever attempted suicide. Patients completed the Childhood Trauma Questionnaire (CTQ), Hostility and Direction of Hostility Questionnaire (HDHQ), and Beck Depression Inventory (BDI). Diabetics and controls were compared for their rate of suicide attempt. Diabetic patients who had or had never attempted suicide were compared on socio-demographic and clinical data. It was found that diabetics were 3 to 4 times more likely to attempt suicide than controls (13.3% vs 3.5%, respectively, P<0.001). Diabetic attempters were significantly more likely to be female, depressed and hostile, and to report a history of childhood trauma, smoking, alcohol abuse, and drug abuse than diabetic non-attempters. Multivariate analyses showed that female sex, severity of childhood abuse, history of alcohol abuse, and depression were significantly and independently associated with having attempted suicide. These results suggest that African-Americans with type 1 diabetes have a raised risk of attempting suicide. Suicide risk in diabetics appears to be multifactorial and includes gender, developmental, personality, psychiatric, and substance abuse determinants.
Collapse
Affiliation(s)
- Alec Roy
- Psychiatry Service, New Jersey VA Health Care System, East Orange, NJ 070818, USA.
| | | | | |
Collapse
|