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Davies M, Horsdal HT, Antonsen S, Sigsgaard T, Fan CC, Thompson WK, Pedersen CB, Sabel CE. The complexities of suicide: a multilevel survival analysis examining individual, familial and neighbourhood determinants of suicide risk using Danish register-based data. Psychol Med 2023; 53:6356-6365. [PMID: 36515183 DOI: 10.1017/s0033291722003701] [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: 12/15/2022]
Abstract
BACKGROUND Suicide risk is complex and nuanced, and how place impacts suicide risk when considered alongside detailed individual risk factors remains uncertain. We aimed to examine suicide risk in Denmark with both individual and neighbourhood level risk factors. METHODS We used Danish register-based data to identify individuals born in Denmark from 1972, with full parental information and psychiatric diagnosis history. We fitted a two-level survival model to estimate individual and neighbourhood determinants on suicide risk. RESULTS We identified 1723 cases of suicide in Denmark during the follow-up period from 1982 to 2015. Suicide risk was explained mainly by individual determinants. Parental comorbidities, particularly maternal schizophrenia [incidence rate ratio (IRR): 2.29, 95% CI 1.56-3.16] and paternal death (2.29, 95% CI 1.31-3.72) partly explained suicide risk when adjusted for all other determinants. The general contextual effect of suicide risk across neighbourhoods showed a median incidence rate ratio (MRR) of 1.13 (1.01-1.28), which was further reduced with full adjustment. Suicide risk increased in neighbourhoods with a higher proportion of manual workers (IRR: 1.08; 1.03-1.14), and decreased with a higher population density (IRR: 0.89; 0.83-0.96). CONCLUSION Suicide risk varies mainly between individuals, with parental comorbidities having the largest effect on suicide risk. Suicide risk was less impacted by neighbourhood, though, albeit to a lesser extent than individual determinants, some characteristics were associated with suicide risk. Suicide prevention policies might consider targeting interventions towards individuals more vulnerable due to particular parental comorbidities, whilst taking into account that some neighbourhood characteristics might exacerbate this risk further.
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Affiliation(s)
- Megan Davies
- Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
- BERTHA Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark
| | - Henriette Thisted Horsdal
- BERTHA Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
| | - Sussie Antonsen
- BERTHA Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
| | - Torben Sigsgaard
- BERTHA Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Chun Chieh Fan
- Department of Radiology, Population Neuroscience and Genetics Lab, University of California San Diego, La Jolla, CA, USA
| | - Wesley K Thompson
- Division of Biostatistics and Department of Radiology, Population Neuroscience and Genetics Lab, University of California San Diego, La Jolla, CA, USA
| | - Carsten Bøcker Pedersen
- BERTHA Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark
| | - Clive E Sabel
- BERTHA Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Health Research Institute, University of Canberra, Canberra, Australia
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Mahinpey N, Pollock NJ, Liu L, Contreras G, Thompson W. Self-harm and rurality in Canada: an analysis of hospitalization data from 2015 to 2019. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1161-1170. [PMID: 37029322 PMCID: PMC10081931 DOI: 10.1007/s00127-023-02463-7] [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: 09/28/2022] [Accepted: 03/08/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE The incidence of self-harm is an important indicator in suicide surveillance and a target outcome for suicide prevention. Self-harm rates vary by geographic location and rurality appears to be a risk factor. The objectives of this study were to estimate rates of self-harm hospitalization in Canada over a 5-year period by sex and age group, and examine relationships between self-harm and rurality. METHODS Hospitalizations related to self-harm were identified in a national dataset (the Discharge Abstract Database) for all patients aged 10 years or older who were discharged from hospital between 2015 and 2019. Self-harm hospitalization rates were calculated and stratified by year, sex, age group, and level of rurality, as measured using the Index of Remoteness. A Poisson regression was fit to estimate rate ratios for the levels of rurality. RESULTS Rates of self-harm hospitalization were higher for females than males across all levels of rurality and increased with each level for both sexes, except for among young males. The widest rural-to-urban disparities were observed for the 10-19 and 20-34-year old age groups. Females aged 10-19 in very remote areas had the highest self-harm hospitalization rate. CONCLUSION The rate of self-harm hospitalization in Canada varied by sex, age group, and level of rurality. Clinical and community-based interventions for self-harm, such as safety planning and increased access to mental health services, should be tailored to the differential risks across geographic contexts.
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Affiliation(s)
- Newsha Mahinpey
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Nathaniel J Pollock
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada.
- School of Arctic and Subarctic Studies, Labrador Campus, Memorial University, Happy Valley-Goose Bay, NL, Canada.
| | - Li Liu
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Gisèle Contreras
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Wendy Thompson
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
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3
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Lee JH, Wheeler DC, Zimmerman EB, Hines AL, Chapman DA. Urban-Rural Disparities in Deaths of Despair: A County-Level Analysis 2004-2016 in the U.S. Am J Prev Med 2023; 64:149-156. [PMID: 38584644 PMCID: PMC10997338 DOI: 10.1016/j.amepre.2022.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction The purpose of this study is to examine nationwide disparities in drug, alcohol, and suicide mortality; evaluate the association between county-level characteristics and these mortality rates; and illustrate spatial patterns of mortality risk to identify areas with elevated risk. Methods The authors applied a Bayesian spatial regression technique to investigate the association between U.S. county-level characteristics and drug, alcohol, and suicide mortality rates for 2004-2016, accounting for spatial correlation that occurs among counties. Results Mortality risks from drug, alcohol, and suicide were positively associated with the degree of rurality, the proportion of vacant housing units, the population with a disability, the unemployed population, the population with low access to grocery stores, and the population with no health insurance. Conversely, risks were negatively associated with Hispanic population, non-Hispanic Black population, and population with a bachelor's degree or higher. Conclusions Spatial disparities in drug, alcohol, and suicide mortality exist at the county level across the U.S. social determinants of health; educational attainment, degree of rurality, ethnicity, disability, unemployment, and health insurance status are important factors associated with these mortality rates. A comprehensive strategy that includes downstream interventions providing equitable access to healthcare services and upstream efforts in addressing socioeconomic conditions is warranted to effectively reduce these mortality burdens.
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Affiliation(s)
- Jong Hyung Lee
- Center on Society and Health, Virginia Commonwealth University, Richmond, Virginia
| | - David C. Wheeler
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Emily B. Zimmerman
- Center on Society and Health, Virginia Commonwealth University, Richmond, Virginia
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Anika L. Hines
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia
| | - Derek A. Chapman
- Center on Society and Health, Virginia Commonwealth University, Richmond, Virginia
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Virginia Commonwealth University, Richmond, Virginia
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4
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Wang G, Jia C, Ma Z, Zhou L. Physical diseases and elderly suicide in rural China: A case-control psychological autopsy study. Aust N Z J Psychiatry 2022; 56:560-568. [PMID: 33726535 DOI: 10.1177/0004867421998804] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Physical diseases are well-established risk factor for suicide, particularly among older adults. However, little is known about the underlying mechanism of the association. This study aimed to describe the prevalence of physical diseases and their influences on the elderly in rural China and to examine the underlying mechanisms of the relationship between physical diseases and suicide. METHODS This matched case-control psychological autopsy study was conducted from June 2014 to September 2015. Consecutive suicide cases (242) among people aged 60 years or above were identified in three Chinese provinces. The suicide cases were 1:1 matched with living comparisons based on age, gender and residential area. Two informants for each participant were interviewed to collect data on their demographic characteristics, the severity index of physical diseases, depressive symptoms, feelings of hopelessness, mental disorders and social support. RESULTS A significant difference was found between suicide cases and living comparisons regarding the prevalence of physical diseases (83.5% vs 66.5%, p < 0.001) and their severity (11.3 ± 6.2 vs 6.7 ± 5.3, p < 0.001). Independent risks of suicide included the following: not currently married (OR = 2.81, 95% CI = [1.04, 7.62]), mental disorders (OR = 7.18, 95% CI = [1.83, 28.13]), depressive symptoms (OR = 1.15, 95% CI = [1.05, 1.26]) and feelings of hopelessness (OR = 1.51, 95% CI = [1.20, 1.90]). The structural equation model indicated that the relationship between the severity index of physical diseases and suicide was mediated by depressive symptoms, feelings of hopelessness and mental disorders. CONCLUSION The severity and number of physical diseases were found to be correlated with suicide among the elderly in rural China, after controlling for demographic characteristics. Physical diseases elevate one's suicide risk by increasing depressive symptoms, feelings of hopelessness and mental disorders. Efforts for suicide prevention should be integrated with strategies to treat physical diseases along with psychological interventions.
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Affiliation(s)
- Guojun Wang
- Shenzhen Graduate School, Peking University, Shenzhen, China.,Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, China
| | - Cunxian Jia
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Zhenyu Ma
- Department of Social Medicine, School of Public Health, Guangxi Medical University, Nanning, China
| | - Liang Zhou
- Department of Social Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
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Schmutte T, Olfson M, Xie M, Marcus SC. Factors Associated With 7-Day Follow-Up Outpatient Mental Healthcare in Older Adults Hospitalized for Suicidal Ideation, Suicide Attempt, and Self-Harm. Am J Geriatr Psychiatry 2022; 30:478-491. [PMID: 34563430 PMCID: PMC10563141 DOI: 10.1016/j.jagp.2021.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Older adults are one of the fastest growing age groups seeking emergency care for suicidal ideation and self-harm. Timely follow-up outpatient mental healthcare is important to suicide prevention, yet little is known about predictors of care continuity following hospital discharge. This study identified patient-, hospital-, and regional-level factors associated with 7-day follow-up outpatient mental healthcare in suicidal older adults. METHODS Retrospective cohort analysis using 2015 Medicare data for adults aged ≥65 years hospitalized for suicidal ideation, suicide attempt, or deliberate self-harm (n = 27,257) linked with the American Hospital Association survey and Area Health Resource File. Rates and adjusted risk ratios stratified by patient, hospital, and regional variables were assessed for 7-day follow-up outpatient mental healthcare. RESULTS Overall, 30.3% of patients received follow-up mental healthcare within 7 days of discharge. However, follow-up rates were higher for patients with any mental healthcare within 30 days prehospitalization (43.7%) compared to patients with no recent mental healthcare (15.7%). Longer length of stay and care in psychiatric hospitals were associated with higher odds of follow-up. For patients with no mental healthcare in the 30 days prehospitalization, discharge from hospitals that were large, system-affiliated, academic medical centers, or provided hospitalist-based care were associated with lower odds of follow-up. Females were more likely to receive 7-day follow-up, whereas non-white patients were less likely to receive follow-up care. CONCLUSION Timely follow-up is influenced by multiple patient, hospital, and community characteristics. Findings highlight the need for quality improvement to promote successful transitions from inpatient to outpatient care.
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Affiliation(s)
- Timothy Schmutte
- Department of Psychiatry, Program for Recovery and Community Health, Yale University, New Haven, Connecticut.
| | - Mark Olfson
- Department of Psychiatry and the New York State Psychiatric Institute, Columbia University, New York, New York
| | - Ming Xie
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven C Marcus
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, Pennsylvania
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Shen YS, Lung SCC, Cui S. Exploring multiple pathways and mediation effects of urban environmental factors for suicide prevention. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 294:118642. [PMID: 34883145 DOI: 10.1016/j.envpol.2021.118642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 11/27/2021] [Accepted: 12/03/2021] [Indexed: 06/13/2023]
Abstract
Public health is threatened by air pollution and high temperature, especially in urban areas and areas impacted by climate change. Well-designed urban forms have co-benefits on promoting human health and mediating atmospheric environment-related threats (e.g., high temperature and air pollution). Previous studies overlooked these mediating effects of urban form on suicide mortality. This study used partial least squares modeling and countywide data in Taiwan to identify the crucial influences and pathways of urban environment, socioeconomic status, and diseases on suicide mortality. The model considered the impact of the characteristics of urban form (i.e., urban development intensity, land mix, and urban sprawl), urban industrial status (i.e., industrial level), urban greening (i.e., green coverage), disease (i.e., important diseases morbidity of human immunodeficiency virus [HIV], cerebrovascular disease [CVD], chronic liver disease and cirrhosis [CLDC], nephritis, nephrotic syndrome and nephrosis [NNSN], malignant tumor [MT]), socioeconomic status (i.e., income level and aging population rate), and the atmospheric environment (i.e., air pollution and high temperature) on suicide mortality. Optimizing land mix and minimizing urban development intensity and urban sprawl have been found to reduce suicide mortality. The mediating effect of urban form on suicide mortality originated from air pollution and high temperature, and mediating air pollution was greater than high temperature. Furthermore, industrial level, important diseases (HIV, CVD, CLDC, NNSN, and MT) morbidity, an aging population rate, air pollution, and high temperature were associated with an increase in suicide mortality, whereas green coverage and income level were associated with a reduction in suicide rates. The findings demonstrate that appropriate urban policy and urban planning may lower suicide mortality, be useful strategies for suicide prevention, and be a foundation for building a healthy city. Moreover, this study provides clarity on the complex relationship of suicide and the urban environment while identifying crucial factors.
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Affiliation(s)
- Yu-Sheng Shen
- Key Lab of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen, China; Xiamen Key Lab of Urban Metabolism, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen, China; University of Chinese Academy of Sciences, Beijing, China
| | - Shih-Chun Candice Lung
- Research Center for Environmental Changes, Academia Sinica, Taipei, Taiwan; Department of Atmospheric Sciences, Taiwan University, Taipei, Taiwan; Institute of Environmental Health, Taiwan University, Taipei, Taiwan
| | - Shenghui Cui
- Key Lab of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen, China; Xiamen Key Lab of Urban Metabolism, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen, China; University of Chinese Academy of Sciences, Beijing, China.
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7
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De Leo D, Giannotti AV. Suicide in late life: A viewpoint. Prev Med 2021; 152:106735. [PMID: 34538377 PMCID: PMC8443431 DOI: 10.1016/j.ypmed.2021.106735] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/06/2021] [Accepted: 07/16/2021] [Indexed: 01/07/2023]
Abstract
Suicide in old age represents a sad public health concern. Despite the global decline in rates of suicide and the general amelioration of quality of life and access to health care for older adults, their rates of suicide remain the highest virtually in every part of the world. With the aging of the world population and the growing number of mononuclear families, the risk of an increase in isolation, loneliness and dependency does not appear ungrounded. The Covid-19 pandemic is claiming the life of many older persons and creating unprecedented conditions of distress, particularly for this segment of the population. This article briefly examines the main characteristics of suicidal behavior in late life, including observations deriving from the spread of the Sars-2 coronavirus and possible strategies for prevention.
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Reccord C, Power N, Hatfield K, Karaivanov Y, Mulay S, Wilson M, Pollock N. Rural-Urban Differences in Suicide Mortality: An Observational Study in Newfoundland and Labrador, Canada: Différences de la Mortalité Par Suicide en Milieu Rural-Urbain: Une Étude Observationnelle à Terre-Neuve et Labrador, Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:918-928. [PMID: 33576277 PMCID: PMC8573702 DOI: 10.1177/0706743721990315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Suicide rates are higher in rural compared to urban areas. Although this pattern appears to be driven by higher rates among men, there is limited evidence about the characteristics of rural people who die by suicide in Canada. The objective of this study was to examine the demographics, manner of death, and social and clinical antecedents of people who died by suicide in rural areas compared to urban areas. METHODS We conducted an observational study of all suicide deaths that occurred among Newfoundland and Labrador residents between 1997 and 2016 using a linked data set derived from a comprehensive review of provincial medical examiner records. We used t tests and χ2 to assess associations between rural/urban status and variables related to demographics, circumstances, and manner of death, as well as social and medical history. Logistic regression was utilized to assess the independent contribution of any variable found to be significant in univariate analysis. RESULTS Rural people who died by suicide accounted for 54.8% of all deaths over a 20-year period. Overall, 81.6% of people who died were male. Compared to urban, rural people who died by suicide were younger, more likely to use firearms or hanging, and had a higher mean blood alcohol content at the time of death (27.69 vs. 22.95 mmol/L). Rural people were also less likely to have had a known history of a prior suicide attempt, psychiatric disorder, alcohol or substance abuse, or chronic pain. DISCUSSION The demographic and clinical differences between rural and urban people who died by suicide underscore the need for suicide prevention approaches that account for place-based differences. A key challenge for suicide prevention in rural communities is to ensure that interventions are developed and implemented in a manner that fits local contexts.
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Affiliation(s)
- Charlene Reccord
- Department of Research, Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Nicole Power
- Department of Research, Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Keeley Hatfield
- Department of Research, Eastern Health, St. John's, Newfoundland and Labrador, Canada.,McMaster University, Hamilton, Ontario, Canada
| | - Yordan Karaivanov
- Medical Services, Labrador Health Centre, Labrador-Grenfell Health, Labrador, Newfoundland and Labrador, Canada.,Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Shree Mulay
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Margo Wilson
- Discipline of Emergency Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.,Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Nathaniel Pollock
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.,School of Public Health, University of Alberta, Edmonton, Canada.,School of Arctic and Subarctic Studies, Labrador Institute, Memorial University, Happy Valley-Goose Bay, NL
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9
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Okubo R, Yoshioka T, Nakaya T, Hanibuchi T, Okano H, Ikezawa S, Tsuno K, Murayama H, Tabuchi T. Urbanization level and neighborhood deprivation, not COVID-19 case numbers by residence area, are associated with severe psychological distress and new-onset suicidal ideation during the COVID-19 pandemic. J Affect Disord 2021; 287:89-95. [PMID: 33774320 PMCID: PMC9754685 DOI: 10.1016/j.jad.2021.03.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent studies indicate an urgent need to take action against mental health issues during the COVID-19 pandemic. However, the association between larger-scale environmental factors such as living conditions and mental health problems during the pandemic is currently unknown. METHODS A nationwide, cross-sectional internet survey was conducted in Japan between August and September 2020 to examine the association between urbanization level and neighborhood deprivation as living conditions and COVID-19 case numbers by prefecture. Prevalence ratios (PRs) for severe psychological distress, suicidal ideation, and new-onset suicidal ideation during the pandemic were adjusted for potential confounders. RESULTS Among 24,819 responses analyzed, the prevalence of mental health problems was 9.2% for severe psychological distress and 3.6% for new-onset suicidal ideation. PRs for severe psychological distress were significantly associated with higher urbanization level (highest PR = 1.30, 95% CI = 1.08-1.56). PRs for new-onset suicidal ideation were significantly associated with higher urbanization level (highest PR = 1.83, 95% CI = 1.37-2.45) and greater neighborhood deprivation (highest PR = 1.35, 95% CI = 1.06-1.72). Severe psychological distress and new-onset suicidal ideation were significantly more prevalent when there was higher urbanization plus lower neighborhood deprivation (PR = 1.34 [1.15-1.56], and 1.57 [1.22-2.03], respectively). CONCLUSION These findings suggest that it is not the number of COVID-19 cases by residence area but higher urbanization level and greater neighborhood deprivation (lower neighborhood-level socioeconomic status) that are associated with severe psychological distress and new-onset suicidal ideation during the pandemic. These findings differ in part from evidence obtained before the pandemic.
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Affiliation(s)
- Ryo Okubo
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Takashi Yoshioka
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan
| | - Tomoki Nakaya
- Graduate School of Environmental Studies, Tohoku University, Sendai, Miyagi, Japan
| | - Tomoya Hanibuchi
- Graduate School of Environmental Studies, Tohoku University, Sendai, Miyagi, Japan
| | - Hiroki Okano
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, Tokyo, Japan
| | - Satoru Ikezawa
- Endowed Institute for Empowering Gifted Minds, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
| | - Kanami Tsuno
- School of Health Innovation, Kanagawa University of Human Services, Kanagawa, Japan
| | - Hiroshi Murayama
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
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10
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Oliffe JL, Kelly MT, Montaner GG, Links PS, Kealy D, Ogrodniczuk JS. Segmenting or Summing the Parts? A Scoping Review of Male Suicide Research in Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:433-445. [PMID: 33719600 PMCID: PMC8107953 DOI: 10.1177/07067437211000631] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Suicide in Canadian men is high and rising. Research consistently indicates increased suicide risk in male subgroups including sexual minority, Indigenous, middle-aged, and military men. The current scoping review addresses the research question: Among male subgroups featured in Canadian suicide research, what are the key findings to inform suicide prevention efforts?. METHOD A scoping review was undertaken in accord with PRISMA-ScR guidelines. Structured searches were conducted in CIHAHL, Medline, PsychInfo, and Web of Science to identify studies reporting suicidality (suicidal ideation, plans and/or attempts) and suicide among men in Canada. Inclusion criteria comprised primary empirical studies featuring Canadian male subgroups published in English from 2009 to 2020 inclusive. RESULTS Sixty-eight articles met the inclusion criteria, highlighting significant rates of male suicidality and/or suicide in 3 categories: (1) health inequities (n = 29); (2) age-specific (n = 30); and (3) occupation (n = 9). The health inequities category included sexual minority men, Indigenous, and other marginalized males (i.e., homeless, immigrant men, and men who use opiates). Age-specific men focused on adolescents and youth, and middle-aged and older males. Active military, veterans, and first responders featured in the occupation category. Studies compared at risk male subgroups to females, general male populations, and/or other marginalized groups in emphasizing mental health disparities and increased suicide risk. Some men's suboptimal connections to existing mental health care services were also highlighted. CONCLUSION While male subgroups who are vulnerable to suicidality and suicide were consistently described, these insights have not translated to tailored upstream suicide prevention services for Canadian boys and men. There may be some important gains through integrating social and mental health care services for marginalized men, implementing school-based masculinity programs for adolescent males, orientating clinicians to the potential for men's mid-life suicide risks (i.e., separation, bereavement, retirement) and lobbying employers to norm help-seeking among activate military, veterans, and first responder males.
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Affiliation(s)
- John L Oliffe
- 70439School of Nursing, University of British Columbia, Vancouver, BC, Canada.,Department of Nursing, The University of Melbourne, Melbourne, Australia
| | - Mary T Kelly
- 70439School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | | | - Paul S Links
- 153002Department of Psychiatry and Behavioural Neurosciences at McMaster University, Hamilton, ON, Canada
| | - David Kealy
- 175098Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - John S Ogrodniczuk
- 175098Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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11
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Kim J, Park MJ. Multilevel Effect of Neighborhood Social Cohesion and Characteristics on Suicidal Ideation Among Korean Older Adults. Community Ment Health J 2021; 57:522-528. [PMID: 32676878 DOI: 10.1007/s10597-020-00678-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 07/04/2020] [Indexed: 11/29/2022]
Abstract
This study examined the effect of neighborhood factors on suicidal ideation of community-dwelling older adults in Korea. To understand the effect of neighborhood factors (neighborhood social cohesion, satisfaction with neighborhood safety, living environment, suicide rate, proportion of social welfare agencies, proportion of social welfare expenses) and individual factors (health, social relationships) on suicidal ideation of older adults, we conducted a multilevel logistic regression analysis. The 2017 Community Health Survey of Korea included data on 67,820 people aged 65 years or older and in 255 neighborhoods. At the individual level, the presence of suicidal ideation was associated with less education attainment, lower family income, not living with a spouse, fewer social networks, fewer social activities, more depressive symptoms, and lower health-related quality of life. At the neighborhood level, lack of social cohesion, a higher suicide rate, and a smaller social welfare budget were significantly effect related to the probability of suicidal ideation.
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Affiliation(s)
- Jin Kim
- Department of Aging and Social Work, Catholic University of Pusan, #57 Oryundae-ro, Geumjeong-gu, Busan, 609-757, South Korea
| | - Mi Jin Park
- Department of Aging and Social Work, Catholic University of Pusan, #57 Oryundae-ro, Geumjeong-gu, Busan, 609-757, South Korea.
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12
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Schmutte T, Olfson M, Xie M, Marcus SC. Self-Harm, Suicidal Ideation, and Attempted Suicide in Older Adults: A National Study of Emergency Department Visits and Follow-Up Care. Am J Geriatr Psychiatry 2020; 28:646-658. [PMID: 31917069 PMCID: PMC7246137 DOI: 10.1016/j.jagp.2019.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/24/2019] [Accepted: 12/04/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Emergency department visits for self-harm and suicidal ideation have increased for US older adults. The purpose of this study was to examine discharge disposition, clinical recognition of mental disorder, and 30-day follow-up mental health outpatient care of older adults treated in emergency departments for suicide attempt (SA), suicidal ideation (SI), or deliberate self-harm (DSH). METHODS Retrospective cohort analysis using 2015 Medicare claims for adults ≥65 years of age with suicide-related emergency encounters (N = 52,383). Demographic, clinical, and service use characteristics from claims were merged with county-level Area Health Resource File data. Rates and adjusted risk ratios were assessed for discharge to the community, mental health diagnosis in the emergency department, and outpatient mental health visits with 30 days after the emergency encounter. RESULTS Encounters for SA (7.8%) and SI (17.2%) were less likely than those for DSH (29.1%) to be discharged to the community. Among community discharges, SA (95.6%) and SI (95.1%) encounters were more likely than DSH (52.3%) encounters to be diagnosed with a mental disorder in the emergency department. Encounters for SA (52.1%) and SI (59.9%) were also more likely than DSH (31.3%) encounters to receive follow-up mental care. CONCLUSIONS Although most older adults treated in EDs for suicide-related reasons are hospitalized, a substantial proportion of patients discharged back to the community do not receive follow-up mental healthcare within 30 days.
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Affiliation(s)
- Timothy Schmutte
- Department of Psychiatry, Program for Recovery and Community Health, Yale University (TS), Westport, CT.
| | - Mark Olfson
- Columbia University, Department of Psychiatry and the New York State Psychiatric Institute
| | - Ming Xie
- University of Pennsylvania, Department of Psychiatry
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13
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Schmutte TJ, Wilkinson ST. Suicide in Older Adults With and Without Known Mental Illness: Results From the National Violent Death Reporting System, 2003-2016. Am J Prev Med 2020; 58:584-590. [PMID: 32001049 PMCID: PMC7089842 DOI: 10.1016/j.amepre.2019.11.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/16/2019] [Accepted: 11/17/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Suicide risk increases with age, and evidence exists for the underdiagnosis and undertreatment of suicide risk in older adults. Recent data suggest that many U.S. adults who die from suicide do not have a known mental health condition. This study compares the characteristics and precipitating circumstances of geriatric suicide decedents with and without known mental illnesses. METHODS This study was a retrospective analysis of suicide deaths for adults aged ≥65 years from the National Violent Death Reporting System, 2003-2016 (n=26,884). ORs compared sociodemographic and clinical characteristics, cause of death, and precipitating circumstances based on coroner/medical examiner and law enforcement reports. Data were collected and analyzed in 2019. RESULTS Most older male (69.1%) and female (50.2%) suicide decedents did not have a known mental illness. A physical health problem was the most prevalent precipitating circumstance but was more common among older adults without known mental illness. Past suicide attempt, disclosure of suicidal intent, depressed mood, and substance use were more common among those with a known mental illness. More than three fourths of suicide decedents did not disclose their suicidal intent. Most suicide deaths involved firearms, which were disproportionately used by decedents without known mental illness (81.6% of male and 44.6% of female decedents) compared with those with known mental illness (70.5% of male and 30.0% of female decedents). CONCLUSIONS Most older adults who die from suicide do not have a known mental health condition. The rapidly growing U.S. geriatric population calls for more effective methods to identify and treat at-risk older adults, particularly those who are male.
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Affiliation(s)
- Timothy J Schmutte
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.
| | - Samuel T Wilkinson
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
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14
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Guo Y, Chau PPH, Chang Q, Woo J, Wong M, Yip PSF. The geography of suicide in older adults in Hong Kong: An ecological study. Int J Geriatr Psychiatry 2020; 35:99-112. [PMID: 31663178 DOI: 10.1002/gps.5225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 09/24/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The geography of suicide has been widely explored among the general population. However, little is known of the geographic variations in suicides among the older adults and their spatial correlates. This study aims to explore the spatial variations in the elderly suicide rates and their correlates in Hong Kong. METHODS Bayesian hierarchical models have been used to estimate smoothed standardized mortality ratios (2006-2015) on suicide in people aged 65 years or older in each geographic unit in Hong Kong. Their associations with the Social Vulnerability Index and the accessibility of eight types of services (ie, recreational services, rehabilitation services, food services, daily necessity services, community services, and transportation services) were further analyzed. RESULTS The results suggested that compared with the simple "inner-city high suicide rate and suburban low" pattern in the Western studies and the "central low suicide rate and peripheral high" pattern in the Asian studies, the spatial variations of elderly suicides in Hong Kong exhibit a much more complicated pattern. In Hong Kong, higher elderly suicide clusters were found in both the lower-density areas located in the New Territories and in some inner-city areas. The spatial variations of suicide in the older adults cannot be explained by the Social Vulnerability Index. Instead, service provision such as recreational services, daily necessity resources, and community centers played a more significant role in affecting suicides in the older adults. CONCLUSIONS Strengthening public services, providing more public spaces and activities, and making good use of the community resources might be key and efficient strategies in elderly suicide prevention in Hong Kong. Key points The spatial variations of elderly suicides in Hong Kong show a much more complicated pattern compared with the simple "inner-city high suicide rate and suburban low" pattern in the Western countries and the "central low suicide rate and peripheral high" pattern in some of the Asian countries. In Hong Kong, suicide rates in the city centers were not higher than the average in the city. Clusters of higher suicide rates were mainly found in the New Territories, which is somewhat disconnected from the city and, in some inner-city neighborhoods, with high-density population. The spatial variations of suicide in the older adults in Hong Kong cannot be explained by the neighborhood Social Vulnerability Index as in the existing literature. Neighborhood service provision such as recreational services, daily necessity resources, and community centers played a significant role in affecting suicides in the older adults in Hong Kong.
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Affiliation(s)
- Yingqi Guo
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, SAR, China.,Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, SAR, China
| | - Patsy P H Chau
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Qingsong Chang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, SAR, China.,School of Sociology and Anthropology, Xiamen University, Xiamen, China
| | - Jean Woo
- Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - Moses Wong
- Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - Paul S F Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, SAR, China.,Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, SAR, China
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15
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Bagheri N, Batterham PJ, Salvador-Carulla L, Chen Y, Page A, Calear AL, Congdon P. Development of the Australian neighborhood social fragmentation index and its association with spatial variation in depression across communities. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1189-1198. [PMID: 30989255 DOI: 10.1007/s00127-019-01712-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 04/09/2019] [Indexed: 01/22/2023]
Abstract
PURPOSE We know little about how community structures influence the risk of common mental illnesses. This study presents a new way to establish links between depression and social fragmentation, thereby identifying pathways to better target mental health services and prevention programs to the right people in the right place. METHOD A principal components analysis (PCA) was conducted to develop the proposed Australian neighborhood social fragmentation index (ANSFI). General practice clinical data were used to identify cases of diagnosed depression. The association between ANSFI and depression was explored using multilevel logistic regression. Spatial hot spots (clusters) of depression prevalence and social fragmentation at the statistical area level 1 (SA1) were examined. RESULTS Two components of social fragmentation emerged, reflecting fragmentation related to family structure and mobility. Individuals treated for depression in primary care were more likely to live in neighborhoods with lower socioeconomic status and with higher social fragmentation related to family structure. A 1-SD increase in social fragmentation was associated with a 16% higher depression prevalence (95% CI 11%, 20%). However, the association attenuated with adjustment for neighborhood socio-economic status. Considerable spatial variation in social fragmentation and depression patterns across communities was observed. CONCLUSIONS Developing a social fragmentation index for the first time in Australia at a small area level generates a new line of knowledge on the impact of community structures on health risks. Findings may extend our understanding of the mechanisms that drive geographical variation in the incidence of common mental disorders and mental health care.
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Affiliation(s)
- Nasser Bagheri
- Centre for Mental Health Research, The Australian National University, Canberra, Australia.
- Visual and Decision Analytics (VIDEA) Lab, Centre for Mental Health Research, Research School of Population Health, Australian National University, Canberra, Australia.
| | - Philip J Batterham
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Yingxi Chen
- Research School of Population Health, The Australian National University, Canberra, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | - Alison L Calear
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Peter Congdon
- School of Geography, Queen Mary University of London, London, UK
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16
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Zandy M, Zhang LR, Kao D, Rajabali F, Turcotte K, Zheng A, Oakey M, Smolina K, Pike I, Rasali D. Area-based socioeconomic disparities in mortality due to unintentional injury and youth suicide in British Columbia, 2009-2013. Health Promot Chronic Dis Prev Can 2019; 39:35-44. [PMID: 30767853 PMCID: PMC6394817 DOI: 10.24095/hpcdp.39.2.01] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The association between health outcomes and socioeconomic status (SES) has been widely documented, and mortality due to unintentional injuries continues to rank among the leading causes of death among British Columbians. This paper quantified the SES-related disparities in the mortality burden of three British Columbia's provincial injury prevention priority areas: falls among seniors, transport injury, and youth suicide. METHODS Mortality data (2009 to 2013) from Vital Statistics and dissemination area or local health area level socioeconomic data from CensusPlus 2011 were linked to examine age-standardized mortality rates (ASMRs) and disparities in ASMRs of unintentional injuries and subtypes including falls among seniors (aged 65+) and transport-related injuries as well as the intentional injury type of youth suicide (aged 15 to 24). Disparities by sex and geography were examined, and relative and absolute disparities were calculated between the least and most privileged areas based on income, education, employment, material deprivation, and social deprivation quintiles. RESULTS Our study highlighted significant sex differences in the mortality burden of falls among seniors, transport injury, and youth suicide with males experiencing significantly higher mortality rates. Notable geographic variations in overall unintentional injury ASMR were also observed across the province. In general, people living in areas with lower income and higher levels of material deprivation had increasingly higher mortality rates compared to their counterparts living in more privileged areas. CONCLUSION The significant differences in unintentional and intentional injury-related mortality outcomes between the sexes and by SES present opportunities for targeted prevention strategies that address the disparities.
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Affiliation(s)
- Moe Zandy
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Li Rita Zhang
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Diana Kao
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Fahra Rajabali
- BC Injury Research and Prevention Unit, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kate Turcotte
- BC Injury Research and Prevention Unit, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alex Zheng
- BC Injury Research and Prevention Unit, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Megan Oakey
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada
- BC Injury Research and Prevention Unit, Vancouver, British Columbia, Canada
| | - Kate Smolina
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Ian Pike
- BC Injury Research and Prevention Unit, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Drona Rasali
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
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Schmutte T, Olfson M, Xie M, Marcus SC. National study of emergency department disposition for high suicide risk geriatric patients. Gen Hosp Psychiatry 2019; 58:67-70. [PMID: 30933688 PMCID: PMC6500465 DOI: 10.1016/j.genhosppsych.2019.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/17/2019] [Accepted: 03/26/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine predictors of hospitalization among older adults at high risk for suicide treated in emergency departments (EDs). METHODS This retrospective cohort analysis used national 2015 Medicare claims for adults ≥65 years with ED visits for suicide ideation or deliberate self-harm (N = 50,472) merged with data from the Area Health Resource File. Rates and adjusted risk ratios (ARR) of hospital admission were assessed. RESULTS A majority of ED episodes resulted in hospital admission (81.9%) with most being admitted to a psychiatric unit (62.8%). Visits for self-harm with suicide ideation were most likely to result in hospitalization (94.7%) compared to suicide ideation alone (84.0%) or self-harm alone (73.1%). Current diagnosis of depression, bipolar, anxiety, cognitive, and personality disorder were associated with hospitalization. Co-occurring mental and substance use disorders were the most predictive mental health condition of admission. Overall, severity of current medical comorbidity was the strongest predictor of hospital admission. CONCLUSIONS Most older adults treated in EDs for suicide ideation or self-harm are hospitalized. Medical morbidity plays a more prominent role than other patient factors in admission status.
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Affiliation(s)
- Timothy Schmutte
- Yale University, Department of Psychiatry, Program for Recovery and Community Health, New Haven, CT, USA.
| | - Mark Olfson
- Columbia University, Department of Psychiatry and the New York State Psychiatric Institute, New York, NY, USA
| | - Ming Xie
- University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
| | - Steven C. Marcus
- University of Pennsylvania, School of Social Policy & Practice, Philadelphia, PA, USA
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Shao Y, Zhu C, Zhang Y, Yu H, Peng H, Jin Y, Shi G, Wang N, Chen Z, Chen Y, Jiang Q. Epidemiology and temporal trend of suicide mortality in the elderly in Jiading, Shanghai, 2003-2013: a descriptive, observational study. BMJ Open 2016; 6:e012227. [PMID: 27543591 PMCID: PMC5013362 DOI: 10.1136/bmjopen-2016-012227] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To investigate and describe the epidemiological characteristics of suicide in the elderly in Jiading, Shanghai, for the period 2003-2013. DESIGN Retrospective, observational, epidemiological study using routinely collected data. SETTING Jiading District, Shanghai. METHODS Suicide data were retrieved from the Shanghai Vital Registry database for the period 2003-2013. Crude and age-standardised mortality rates were calculated for various groups according to sex and age. Joinpoint regression was performed to estimate the percentage change (PC) and annual percentage change (APC) for suicide mortality. RESULT A total of 956 deaths due to suicide occurred among people aged ≥65 years during the study period, accounting for 76.7% (956/1247) of all suicide decedents. Among the 956 people with suicide deaths, 88.7% (848/956) had a history of a psychiatric condition. The age-standardised mortality rates for suicide without and with a psychotic history in people aged ≥65 years were much higher than those for people aged <65 years in both genders. Suicide mortality in the elderly showed a declining trend, with a PC of -51.5% for men and -47.5% for women. The APC was -29.1 in 2003-2005, 4.6 in 2005-2008 and -9.7 in 2008-2013 for aged men, and -12.2 in 2003-2006 and -5.2 in 2006-2013 for aged women, respectively. Women living in Jiading had a higher risk of suicide death than men, especially among the elderly. The mortality rate for suicide increased with age in the elderly, and was more marked for those with a psychiatric history than for those without. CONCLUSIONS Suicide mortality declined in Jiading during the study period 2003-2013 overall, but remained high in the elderly, especially those with a psychiatric history.
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Affiliation(s)
- Yueqin Shao
- Jiading District Center for Disease Control and Prevention, Shanghai, China
| | - Chenghua Zhu
- Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai, China
| | - Yiying Zhang
- Jiading District Center for Disease Control and Prevention, Shanghai, China
| | - Hongjie Yu
- Jiading District Center for Disease Control and Prevention, Shanghai, China
| | - Hui Peng
- Jiading District Center for Disease Control and Prevention, Shanghai, China
| | - Yaqing Jin
- Jiading District Center for Disease Control and Prevention, Shanghai, China
| | - Guozheng Shi
- Jiading District Center for Disease Control and Prevention, Shanghai, China
| | - Na Wang
- Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai, China
| | - Zheng Chen
- Jiading District Center for Disease Control and Prevention, Shanghai, China
| | - Yue Chen
- Faculty of Medicine, School of Epidemiology, Public Health, and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Qingwu Jiang
- Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai, China
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