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Tralla L, Gustavsson S, Söderberg C, Jönsson AK, Kugelberg FC. Fatal Intoxications with Zopiclone-A Cause for Concern? Drug Saf 2024; 47:687-697. [PMID: 38536627 PMCID: PMC11182790 DOI: 10.1007/s40264-024-01424-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 06/18/2024]
Abstract
INTRODUCTION Zopiclone, a controlled substance prescribed for insomnia, has become a common toxicological finding in forensic autopsy cases. This study investigated the role and extent of zopiclone use in fatal intoxications in Sweden. METHODS All forensic autopsy cases positive for zopiclone in femoral blood during 2012-2020 were selected. Among these cases, fatalities caused by intoxication according to the cause of death certificates issued by the forensic pathologist were identified. Intoxications where zopiclone contributed to the cause of death were included in the study. The Swedish Prescribed Drug Register was utilized to examine whether the included cases were prescribed zopiclone or not. RESULTS In total 7320 fatal intoxications underwent a forensic autopsy during the study period, 573 of them were caused by zopiclone. Among the zopiclone fatalities, 87% (n = 494) had a prescription for zopiclone, and 8% (n = 43) were monointoxications. Most fatalities, 62% (n = 354) were suicides, and zopiclone was involved in about 17% (n = 354) of all intoxication suicides in Sweden. Women were significantly (p < 0.01) overrepresented in suicides with zopiclone, comprising 56% (n = 291) of fatalities. The median age was 55 years among zopiclone intoxications compared with 44 years amongst all fatal intoxications. CONCLUSION This study demonstrates that the toxicity of zopiclone can be lethal both in combination with other substances and on its own. Most individuals dying in fatal zopiclone intoxications were prescribed zopiclone, which potentially indicates that a more restrictive prescribing rate could prevent future intoxication deaths, especially when caring for patients with an increased suicide risk.
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Affiliation(s)
- Lova Tralla
- Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
| | - Sara Gustavsson
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
| | - Carl Söderberg
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
| | - Anna K Jönsson
- Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
| | - Fredrik C Kugelberg
- Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.
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Huang Q, Ma XQ, Chen HF. Lithium Exposure and Risk of Major Neurocognitive Disorders: A Systematic Review and Meta-analysis. J Clin Psychopharmacol 2024; 44:418-423. [PMID: 38743015 DOI: 10.1097/jcp.0000000000001863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND Published studies on the association between lithium use and the decreased risk of major neurocognitive disorders (MNCDs) have shown disparities in their conclusions. We aimed to provide updated evidence of this association. METHODS A comprehensive literature search was performed in PubMed, EMBASE, and Cochrane Library from inception until August 31, 2023. All the observational studies evaluating the association between lithium use and MNCD risk were eligible for inclusion. Pooled odds ratios (ORs) and 95% prediction intervals were computed using random-effects models. RESULTS Eight studies with 377,060 subjects were included in the analysis. In the general population on the association between lithium use versus nonuse and dementia, the OR was 0.94 (95% confidence interval [CI] = 0.77-1.24). Further analysis also demonstrated that lithium use was not associated with an increased risk of Alzheimer's disease (OR = 0.69, 95% CI: 0.31-1.65). When the analysis was restricted to individuals with bipolar disorder to reduce the confounding by clinical indication, lithium exposure was also not associated with a decreased risk of MNCD (OR = 0.9, 95% CI = 0.71-1.15). CONCLUSION The results of this systematic review and meta-analysis do not support a significant association between lithium use and the risk of MNCD.
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Affiliation(s)
- Qing Huang
- From the Hubin Street Community Healthcare Center, Hangzhou, Zhejiang, China
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Levi-Belz Y, Shoval-Zuckerman Y, Blank C, Groweiss Y, Neria Y. The moderating role of belongingness in the contribution of depression to suicide ideation following the October 7, 2023, terrorist attack in Israel: A nationwide prospective study. J Affect Disord 2024; 356:292-299. [PMID: 38615841 DOI: 10.1016/j.jad.2024.04.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION With >1300 civilians murdered, the terrorist attack of October 7 is one of the deadliest terrorist attacks in modern history. Previous research documented a sharp increase in depression in the aftermath of the attacks and the military conflict that followed. In this national prospective cohort study, we examined to what extent perceived belongingness (PB) moderates the association between depression and suicide ideation (SI) in the wake of the October 7th terrorist attack. METHODS A representative sample of 710 Israeli adults (of them, 362 females, 51.1 %), Jews (557, 79.9 %), and Arabs (153, 20.1 %), aged 18-85 (M = 41.01, SD = 13.72) completed questionnaires assessing depression, current SI, and perceived belongingness at two timepoints: T1 (in August 2023) and T2 (in November 2023). RESULTS Perceived belongingness at T1 predicted SI at T2 beyond demographic and trauma-related characteristics. Importantly, we found a significant interaction in which a PB at T1 moderated the link between depression and current SI at T2. Specifically, the level of depression at T2 contributed to current SI-T2 more strongly for individuals with low PB levels than for individuals with high PB levels. DISCUSSION Our study highlights the impact of PB on SI following the October 7th terrorist attack. Clinicians treating individuals coping with depression should attend to their patients' sense of belongingness, as low PB comprises a significant risk factor for current SI. Moreover, community and national initiatives that could increase levels of PB among the citizens may help to diminish suicide risk in the aftermath of the attack.
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Affiliation(s)
- Yossi Levi-Belz
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel; Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel.
| | | | - Carmel Blank
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel; Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel
| | - Yoav Groweiss
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - Yuval Neria
- Department of Psychiatry and New York State Psychiatric Institute, Columbia University Irving Medical Center, NY, USA
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Liu G, Tong Y, Li J, Sun X, Chen L, Zheng X, Zhang X, Lv J, Wang J, Wei B, Wei J, Cheng R, Wang Z. Burnout, moral injury, and suicidal/self-harm ideation among healthcare professionals in Mainland China: Insights from an online survey during the COVID-19 pandemic. Int J Psychiatry Med 2024; 59:487-502. [PMID: 38047438 DOI: 10.1177/00912174231219041] [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: 12/05/2023]
Abstract
OBJECTIVE This survey explored the relationships between burnout, moral injury, and suicidal/self-harm ideation among Chinese health professionals in mainland China. METHODS Health professionals were surveyed online using the Maslach Burnout Inventory-Human Services Survey for Medical Personnel, Patient Health Questionnaire-9, and the Moral Injury Symptom Scale-Health Professional version. RESULTS A total of 6,146 health professionals participated in the study. The average age of participants was 34.9 ± 8.5 years, and suicidal/self-harm ideation was present in 2,338 participants (38.0%). The prevalence of suicidal/self-harm ideation was more common among those with severe burnout (vs. mild burnout), particularly in the dimensions of emotional exhaustion, depersonalization, and decreased personal accomplishment. The prevalence of suicidal/self-harm ideation among those with significant moral injury symptoms was higher than in those without moral injury. Unconditional logistic regression analysis demonstrated that those with moderate or severe emotional exhaustion, moderate or severe reduced sense of professional accomplishment, and moderate or severe depersonalization were at increased risk of suicidal/self-harm ideation.Structural equation modelling demonstrated that burnout significantly mediated the relationship between moral injury and suicidal/self-harm ideation. The proportion of mediation (PM) by burnout was 43.0%. CONCLUSIONS This study found that burnout and moral injury were significant predictors of suicidal/self-harm ideation among health professionals in China. Both moral injury and burnout had positive and direct effects on suicidal/self-harm ideation, and burnout mediated the relationship between moral injury and suicidal/self-harm ideation. Interventions to address moral injury and subsequent burnout in Chinese healthcare workers may enhance the mental health of these healthcare professionals and increase the quality of care that they provide.
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Affiliation(s)
- Guangtian Liu
- Department of Infectious Disease, The No.4 Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Yan Tong
- Department of Social Medicine, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Jinghong Li
- Department of Social Medicine, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Xiaoya Sun
- Department of Clinical Psychology, Futian Center for Chronic Disease Control, Shenzhen, China
| | - Linlin Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan, China
| | - Xiwei Zheng
- Department of Respiratory and Critical Care, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Xinhui Zhang
- Department of Infectious Disease, The No.4 Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Jufen Lv
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan, China
| | - Jinyan Wang
- Department of Rehabilitation and Nursing, Ningxia Vocational and Technical College for Minorities, Wuzhong, China
| | - Bingfen Wei
- Department of Rehabilitation and Nursing, Ningxia Vocational and Technical College for Minorities, Wuzhong, China
| | - Jianhua Wei
- Department of Infectious Disease, The No.4 Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Ruixia Cheng
- Department of Infectious Disease, The No.4 Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Zhizhong Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan, China
- Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical University, Dongguan, China
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Krishnamoorthy S, Mathieu S, Armstrong G, Ross V, Francis J, Reifels L, Kõlves K. Implementation of Complex Suicide Prevention Interventions: Insights into Barriers, Facilitators and Lessons Learned. Arch Suicide Res 2024:1-24. [PMID: 38900080 DOI: 10.1080/13811118.2024.2368127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
INTRODUCTION Effective suicide prevention interventions are infrequently translated into practice and policy. One way to bridge this gap is to understand the influence of theoretical determinants on intervention delivery, adoption, and sustainment and lessons learned. This study aimed to examine barriers, facilitators and lessons learned from implementing complex suicide prevention interventions across the world. METHODS AND MATERIALS This study was a secondary analysis of a systematic review of complex suicide prevention interventions, following updated PRISMA guidelines. English published records and grey literature between 1990 and 2022 were searched on PubMed, CINAHL, PsycINFO, ProQuest, SCOPUS and CENTRAL. Related reports were organized into clusters. Data was extracted from clusters of reports on interventions and were mapped using the updated Consolidated Framework for Implementation Research. RESULTS The most frequently-reported barriers were reported within the intervention setting and were related to the perceived appropriateness of interventions within settings; shared norms, beliefs; and maintaining formal and informal networks and connections. The most frequently reported facilitators concerned individuals' motivation, capability/capacity, and felt need. Lessons learned focused on the importance of tailoring the intervention, responding to contextual needs and the importance of community engagement throughout the process. CONCLUSION This study emphasizes the importance of documenting and analyzing important influences on implementation. The complex interplay between the contextual determinants and implementation is discussed. These findings contribute to a better understanding of barriers and facilitators salient for implementation of complex suicide prevention interventions.
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Qu D, Zhu A, Chen R. Addressing the gender paradox: Effective suicide prevention strategies for women. Cell Rep Med 2024; 5:101613. [PMID: 38897169 PMCID: PMC11228777 DOI: 10.1016/j.xcrm.2024.101613] [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: 04/09/2024] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024]
Abstract
The gender paradox in suicide research refers to the phenomenon that while males report higher suicide mortality, females suffer more from suicidal thoughts, leading to higher suicidal risks. This paradox may lead to the misconception that female suicides do not require as much attention. Therefore, there is an urgent need for researchers to shift their perspectives from the current male-centric approach to more inclusive knowledge for female suicidality. Following this, the current commentary emphasizes the importance of identifying and addressing the crucial but overlooked psychosocial factors underlying female suicidality. In addition, the ecological framework is employed as a guiding tool for exploring the intricate interplay of biological, psychological, societal, and cultural factors that are associated with female suicidality, thereby allowing researchers and stakeholders to develop more effective prevention and intervention strategies tailored to women's needs. Overall, this commentary calls for more refined and equitable approaches to suicide prevention that address the needs of individuals for all gender identities.
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Affiliation(s)
- Diyang Qu
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute for Healthy China, Tsinghua University, Beijing, China
| | - Anni Zhu
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute for Healthy China, Tsinghua University, Beijing, China
| | - Runsen Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute for Healthy China, Tsinghua University, Beijing, China.
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Lopes EITC, Cavalcanti-Ribeiro P, Palhano-Fontes F, Gonçalves KTDC, Nunes EA, Lima NBDM, Santos NC, Brito AJCD, de Araujo DB, Galvão-Coelho NL. Rapid and long-lasting effects of subcutaneous esketamine on suicidality: An open-label study in patients with treatment-resistant depression. J Psychiatr Res 2024; 176:254-258. [PMID: 38901389 DOI: 10.1016/j.jpsychires.2024.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 05/23/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024]
Abstract
Therapeutics for suicide management is limited, taking weeks to work. This open-label clinical trial with 18 treatment-resistant depressive patients tested subcutaneous esketamine (8 weekly sessions) for suicidality. We noted a rapid and enduring effect of subcutaneous esketamine, lasting from one week to six months post-treatment, assessed by the Beck Inventory for Suicidality (BSI). There was an immediate drop in suicidality, 24 h following the initial dose, which persisted for seven days throughout the eight-week dosing period. Additionally, this study is the first to examine a six-month follow-up after multiple administrations of subcutaneous esketamine, finding consistently lower levels of suicidality throughout this duration. Conversely, suicidality also was measured along the 8-weeks of treatment by a psychiatrist using the Montgomery-Asberg Depression Rating Scale (MADRS), which showed significant reduction only after two treatment sessions expanding until the last session. Moreover, notably, 61% of patients achieved remission on suicidality (MADRS). These results suggest that weekly subcutaneous esketamine injections offer a cost-effective approach that induces a rapid and sustained response to anti-suicide treatment. This sets the stage for further, more controlled studies to corroborate our initial observations regarding the effects of SC esketamine on suicidality. Registered trial at: https://ensaiosclinicos.gov.br/rg/RBR-1072m6nv.
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Affiliation(s)
| | - Patrícia Cavalcanti-Ribeiro
- Laboratory of Hormone Measurement, Department of Physiology and Behavior, Federal University of Rio Grande do Norte, Natal, RN, Brazil; Postgraduate Program in Psychobiology and Department of Physiology and Behavior, Federal University of Rio Grande do Norte, Natal- RN, Brazil; Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | | | - Kaike Thiê da Costa Gonçalves
- Laboratory of Hormone Measurement, Department of Physiology and Behavior, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Emerson Arcoverde Nunes
- Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal, RN, Brazil; Department of Clinical Medicine, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Nicole Bezerra de Medeiros Lima
- Laboratory of Hormone Measurement, Department of Physiology and Behavior, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Nestor Caetano Santos
- Laboratory of Hormone Measurement, Department of Physiology and Behavior, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | | | | | - Nicole Leite Galvão-Coelho
- Laboratory of Hormone Measurement, Department of Physiology and Behavior, Federal University of Rio Grande do Norte, Natal, RN, Brazil; Postgraduate Program in Psychobiology and Department of Physiology and Behavior, Federal University of Rio Grande do Norte, Natal- RN, Brazil; Western Sydney University, NICM Health Research Institute, Westmead, NSW, Australia; National Science and Technology Institute for Translational Medicine (INCT-TM), Brazil.
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Tandon R. Suicide prevention: A public health imperative Asian Journal of Psychiatry Collection 2018-2024. Asian J Psychiatr 2024; 96:104094. [PMID: 38789362 DOI: 10.1016/j.ajp.2024.104094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Affiliation(s)
- Rajiv Tandon
- Department of Psychiatry, WMU Homer Stryker School of Medicine, Kalamazoo, MI, USA.
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Xiao Y, Bi K, Yip PSF, Cerel J, Brown TT, Peng Y, Pathak J, Mann JJ. Decoding Suicide Decedent Profiles and Signs of Suicidal Intent Using Latent Class Analysis. JAMA Psychiatry 2024; 81:595-605. [PMID: 38506817 PMCID: PMC10955339 DOI: 10.1001/jamapsychiatry.2024.0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/07/2024] [Indexed: 03/21/2024]
Abstract
Importance Suicide rates in the US increased by 35.6% from 2001 to 2021. Given that most individuals die on their first attempt, earlier detection and intervention are crucial. Understanding modifiable risk factors is key to effective prevention strategies. Objective To identify distinct suicide profiles or classes, associated signs of suicidal intent, and patterns of modifiable risks for targeted prevention efforts. Design, Setting, and Participants This cross-sectional study used data from the 2003-2020 National Violent Death Reporting System Restricted Access Database for 306 800 suicide decedents. Statistical analysis was performed from July 2022 to June 2023. Exposures Suicide decedent profiles were determined using latent class analyses of available data on suicide circumstances, toxicology, and methods. Main Outcomes and Measures Disclosure of recent intent, suicide note presence, and known psychotropic usage. Results Among 306 800 suicide decedents (mean [SD] age, 46.3 [18.4] years; 239 627 males [78.1%] and 67 108 females [21.9%]), 5 profiles or classes were identified. The largest class, class 4 (97 175 [31.7%]), predominantly faced physical health challenges, followed by polysubstance problems in class 5 (58 803 [19.2%]), and crisis, alcohol-related, and intimate partner problems in class 3 (55 367 [18.0%]), mental health problems (class 2, 53 928 [17.6%]), and comorbid mental health and substance use disorders (class 1, 41 527 [13.5%]). Class 4 had the lowest rates of disclosing suicidal intent (13 952 [14.4%]) and leaving a suicide note (24 351 [25.1%]). Adjusting for covariates, compared with class 1, class 4 had the highest odds of not disclosing suicide intent (odds ratio [OR], 2.58; 95% CI, 2.51-2.66) and not leaving a suicide note (OR, 1.45; 95% CI, 1.41-1.49). Class 4 also had the lowest rates of all known psychiatric illnesses and psychotropic medications among all suicide profiles. Class 4 had more older adults (23 794 were aged 55-70 years [24.5%]; 20 100 aged ≥71 years [20.7%]), veterans (22 220 [22.9%]), widows (8633 [8.9%]), individuals with less than high school education (15 690 [16.1%]), and rural residents (23 966 [24.7%]). Conclusions and Relevance This study identified 5 distinct suicide profiles, highlighting a need for tailored prevention strategies. Improving the detection and treatment of coexisting mental health conditions, substance and alcohol use disorders, and physical illnesses is paramount. The implementation of means restriction strategies plays a vital role in reducing suicide risks across most of the profiles, reinforcing the need for a multifaceted approach to suicide prevention.
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Affiliation(s)
- Yunyu Xiao
- Department of Population Health Sciences, Weill Cornell Medicine/NewYork-Presbyterian, New York
| | - Kaiwen Bi
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Paul Siu-Fai Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong
| | - Julie Cerel
- College of Social Work, University of Kentucky, Lexington
| | | | - Yifan Peng
- Department of Population Health Sciences, Weill Cornell Medicine/NewYork-Presbyterian, New York
| | - Jyotishman Pathak
- Department of Population Health Sciences, Weill Cornell Medicine/NewYork-Presbyterian, New York
| | - J. John Mann
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, New York
- Department of Radiology, Columbia University Irving Medical Center, Columbia University, New York, New York
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York
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Edwards AC, Abrahamsson L, Crump C, Sundquist J, Sundquist K, Kendler KS. Alcohol use disorder and risk of specific methods of suicide death in a national cohort. Acta Psychiatr Scand 2024; 149:479-490. [PMID: 38556255 PMCID: PMC11065572 DOI: 10.1111/acps.13683] [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: 01/25/2024] [Revised: 03/13/2024] [Accepted: 03/17/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Alcohol use disorder (AUD) is among the strongest correlates of suicide death, but it is unclear whether AUD status is differentially associated with risk of suicide by particular methods. METHODS The authors used competing risks models to evaluate the association between AUD status and risk of suicide by poisoning, suffocation, drowning, firearm, instruments, jumping, or other means in a large Swedish cohort born 1932-1995 (total N = 6,581,827; 48.8% female). Data were derived from Swedish national registers, including the Cause of Death Register and a range of medical registers. RESULTS After adjusting for sociodemographic factors and familial liability to suicidal behavior, AUD was positively associated with risk of suicide for each method evaluated (cumulative incidence differences: 0.006-1.040 for females, 0.046-0.680 for males), except the association with firearm suicide in females. AUD was most strongly associated with risk of suicide by poisoning. Sex differences in the effects of AUD and family liability were observed for some, but not all, methods. Furthermore, high familial liability for suicidal behavior exacerbated AUD's impact on risk for suicide by poisoning (both sexes) and suffocation and jumping (males only), while the inverse interaction was observed for firearm suicide (males only). CONCLUSIONS AUD increases risk of suicide by all methods examined and is particularly potent with respect to risk of suicide by poisoning. Differences in risk related to sex and familial liability to suicidal behavior underscore AUD's nuanced role in suicide risk. Future research should investigate targeted means restriction effectiveness among persons with AUD.
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Affiliation(s)
- Alexis C. Edwards
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, US
| | - Linda Abrahamsson
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Casey Crump
- Departments of Family and Community Medicine and of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center, Houston, TX, US
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | | | - Kenneth S. Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, US
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Werdin S, Wyss K. Advancing suicide prevention in Germany, Austria and Switzerland: a qualitative study. Front Public Health 2024; 12:1378481. [PMID: 38873323 PMCID: PMC11173583 DOI: 10.3389/fpubh.2024.1378481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/10/2024] [Indexed: 06/15/2024] Open
Abstract
Introduction Suicide is a significant public health problem, impacting individuals, families and communities worldwide. Effective suicide prevention requires a comprehensive approach with diverse integrated interventions and collaboration across sectors, stakeholders and professions. This study aims to identify challenges, gaps and success factors in current suicide prevention efforts in Germany, Austria and Switzerland, providing specific recommendations for advancement. Methods We conducted online, semi-structured interviews with 36 suicide prevention experts from Germany, Austria and Switzerland, incorporating perspectives from policy, science and practice. Interviews were conducted between September 2022 and February 2023, audio-recorded, transcribed verbatim and analyzed using the Framework method. Results Despite progress in national strategies and coordinated efforts for suicide prevention, challenges such as resource scarcity, stigma and structural issues in psychiatric and psychotherapeutic care persist. The interviewees identified several areas for advancement, including developing targeted prevention measures for men and older people, strengthening collaboration across sectors, stakeholders and professions, and increasing the involvement of individuals with lived experience. While the COVID-19 pandemic has exacerbated challenges in psychiatric and psychotherapeutic care, it has concurrently strengthened interest in suicide prevention among policymakers and the media. Discussion National suicide prevention strategies play a crucial role in setting priorities, raising public awareness, and guiding action. However, since most suicide prevention efforts are still predominantly health sector-driven, a more comprehensive approach is needed to promote the involvement of all relevant actors and address suicidality as a collective societal responsibility. Tailoring prevention programs for risk groups like older people and men is important, as these populations show high suicide rates and face a lack of targeted interventions. Our study underscores the importance to continuously monitor, refine and strengthen collaborative and evidence-based suicide prevention efforts.
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Affiliation(s)
- Sophia Werdin
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Kaspar Wyss
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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Liu Q, Qu Z, Dong H, Qi Y, Wu J, Zhang W, Wang X, Wang Z, Fang Y, Wang J. Trends in cancer-related suicide in the United States: a population-based epidemiology study spanning 40 years of data. Transl Psychiatry 2024; 14:213. [PMID: 38802377 PMCID: PMC11130301 DOI: 10.1038/s41398-024-02917-9] [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: 08/29/2023] [Revised: 03/31/2024] [Accepted: 05/07/2024] [Indexed: 05/29/2024] Open
Abstract
Large cohort studies examining trends in cancer-related suicide are lacking. We analyzed data from the Surveillance, Epidemiology, and End Results (SEER) database, encompassing a total of 4,870,410 patients diagnosed with cancer from 1975 to 2017 in the United States. Joinpoint regression was used to estimate the annual percent change (APC) and average annual percentage change (AAPC) of age-adjusted rates of suicide. In the past 40 years, we revealed a gradual increase in cancer-related suicide rates from 1975 to 1989, followed by a gradual decrease from 1989 to 2013, and a marked decrease from 2013 to 2017. These trends suggested the potential impact of advancements in psychosocial care for patients with cancer in contributing to the observed decrease in suicide rates.
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Affiliation(s)
- Qiang Liu
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zheng Qu
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Hao Dong
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yihang Qi
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
- Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Juan Wu
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Wenxiang Zhang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xiangyu Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zhongzhao Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Yi Fang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Jing Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Gabilondo A, Gonzalez-Pinto A, Garcia J, Del Valle D, Morentin B, Iruin A. Analysis of health services use and clinical profiles in the year prior to suicide between 2010 and 2018: An opportunity to improve its prevention. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2024:S2950-2853(24)00031-0. [PMID: 38768759 DOI: 10.1016/j.sjpmh.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 05/07/2024] [Accepted: 05/15/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Suicide is the first cause of external death in Spain. International studies show frequent and varied health contacts in the months prior to suicide. There are hardly any studies on that phenomenon in this country. OBJECTIVE To analyze health care use in the year prior to suicide between 2010 and 2018 in the Basque Country, as well as pharmacological prescriptions and psychiatric diagnoses received. METHODS Retrospective descriptive study with all suicides registered by the Basque Institute of Legal Medicine (BILM) between 2010 and 2018. The records of the BILM and the Basque Health Service (Osakidetza) were cross-checked. RESULTS 1526 suicides were analyzed. 74% had health contacts in the previous year. The use was higher in women (p<0.05) and in older ages (p<0001). Primary care was the most used specialty (58.8% the previous year and 7.1% the previous week), followed by Hospital Emergencies (50.3% and 10.2%) and Outpatient Medical Specialties (49% and 11.6%), especially Radiology. Outpatient psychiatry only contacted 29.6% that year, although it had the highest average number of visits (15.1 SD22.6). The most frequent diagnostic category among psychiatric patients was F30-39 (26.7%), with differences between sexes and ages. 49.7% received psychotropic drugs. CONCLUSIONS The results are aligned with international evidence, which they also extend, and reinforce the need to extend prevention beyond psychiatric services. It seems advisable to increase proactivity in the search for risk by sensitizing and training different professional profiles, but also to work from non-health settings to improve assistance to highly vulnerable profiles (young men) with low health links.
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Affiliation(s)
- Andrea Gabilondo
- Outpatient Mental Health Network of Gipuzkoa, Basque Health System (Osakidetza), San Sebastián, Spain; Biodonostia Health Research Institute, Basque Health System (Osakidetza), San Sebastián, Spain; CiberSam, Network Centre for Biomedical Research in Mental Health, Spain.
| | - Ana Gonzalez-Pinto
- CiberSam, Network Centre for Biomedical Research in Mental Health, Spain; University Hospital of Araba, Basque Health System (Osakidetza), Vitoria-Gasteiz, Spain; Bioaraba Health Research Institute, Basque Health System (Osakidetza), Vitoria-Gasteiz, Spain
| | - Jon Garcia
- Outpatient Mental Health Network of Bizkaia, Basque Health System (Osakidetza), Bilbao, Spain; Biocruces Health Research Institute, Basque Health System (Osakidetza), Bilbao, Spain
| | - David Del Valle
- Basque Institute of Legal Medicine, San Sebastián, Bilbao, Vitoria-Gasteiz, Spain
| | - Benito Morentin
- Basque Institute of Legal Medicine, San Sebastián, Bilbao, Vitoria-Gasteiz, Spain
| | - Alvaro Iruin
- Outpatient Mental Health Network of Gipuzkoa, Basque Health System (Osakidetza), San Sebastián, Spain; Biodonostia Health Research Institute, Basque Health System (Osakidetza), San Sebastián, Spain
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Kohlbeck SA, Schramm AT, Monroe T, Kant J, McLeod E, deRoon-Cassini TA, Hargarten SW. Implementation of a countywide adult suicide review commission: Development, lessons learned, and recommendations. Suicide Life Threat Behav 2024. [PMID: 38700425 DOI: 10.1111/sltb.13089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/12/2024] [Accepted: 04/20/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION Fatality review is a public health approach designed to inform efforts to prevent fatalities of a certain kind (e.g., suicide, homicide) or in a specific setting or population (e.g., hospitals, youth). Despite extensive literature on fatality review generally, the literature on suicide review teams specifically is scant. The aim of this paper is to: describe the implementation of a local adult suicide review commission, detail examples of initial outcomes and recommendations developed by the commission, and provide recommendations and/or best practices for how to develop and implement an adult suicide review team. METHODS We utilize framing questions from the American Association of Suicidology's psychological autopsy framework. By using these guiding questions in the discussion, members are invited to explore not only the stressors that may have more immediately preceded the suicide event itself, but to situate those stressors in the context of the individual's life course. RESULTS Several recommendations proposed by our commission have resulted in tangible outcomes and are detailed using Haddon's Matrix as a guiding prevention planning tool. IMPLICATIONS We have highlighted the need to move beyond looking at individual-level help-seeking to focus on structural/systemic issues that result in stress or create unsafe environments for at-risk individuals.
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Affiliation(s)
- Sara A Kohlbeck
- Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Andrew T Schramm
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Tricia Monroe
- Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jacey Kant
- Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Emilie McLeod
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Terri A deRoon-Cassini
- Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Stephen W Hargarten
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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15
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Amendola S, Plöderl M, Hengartner MP. Suicide Rates and Prescription of Antidepressants. CRISIS 2024; 45:225-233. [PMID: 38353035 DOI: 10.1027/0227-5910/a000941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Background: Previous ecological studies reported that increasing antidepressant prescriptions were associated with decreasing suicide rates. Aim: To determine whether antidepressant prescription prevalence is negatively associated with suicide rates (i.e., as antidepressant prescribing increases, suicide rates decrease) between 1999 and 2020. Method: The study protocol was pre-registered on the Open Science Framework (https://osf.io/978sk/). Publicly available data from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiological Research (CDC WONDER) and Medical Expenditure Panel Survey (MEPS) were used. Results: Overall, both the antidepressant prescription prevalence and the suicide rate were increasing from 1990 to 2020 in the United States. Positive trends for both outcomes were also evident when analyses were stratified according to sex and/or race/ethnicity. Pearson's correlation analyses consistently found positive associations between antidepressant prescription prevalence and suicide rates. Limitations: Trends and their associations were examined at the population level. The results cannot clarify the causal nature of the association observed. Conclusion: The results of our analysis consistently demonstrated positive trends for both antidepressant prescription prevalence and suicide rates over time as well as positive associations between them. These findings update those from previous studies and are at odds with the notion that, at a population level, more antidepressant prescriptions would lead to lower suicide rates. However, it needs to be acknowledged that ecological studies provide insufficient evidence to infer causality.
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Affiliation(s)
- Simone Amendola
- Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Martin Plöderl
- Department of Inpatient Psychotherapy and Crisis Intervention, University Clinic for Psychiatry, Psychotherapy, and Psychosomatics, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Michael P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
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Emslie GJ. Editorial: Novel Approaches to the Treatment of Suicidality and Depression in Youth. J Am Acad Child Adolesc Psychiatry 2024; 63:500-501. [PMID: 37422104 DOI: 10.1016/j.jaac.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/29/2023] [Indexed: 07/10/2023]
Abstract
Suicide continues to be a major cause of mortality in adolescents with limited treatment options.1,2 Effective treatments, both therapy and medication, are available for treating depression, but even with the best combination, treatment remission rates are low.3 The most common approach to treating suicidality, which includes suicidal ideation and suicidal behavior, is to address concomitant depression. Ketamine and its enantiomers have shown rapid anti-suicidal effects in adults with MDD, and intranasal esketamine is approved for treating treatment-resistant depression (TRD) in adults.4,5 The effectiveness of ketamine for the treatment of depression frequently lags behind the treatment of suicidality. There are also many methodological differences and barriers to assessing the effectiveness of short-term treatments. These include measurement of change over short time frames, measurement of suicidality, and so forth. Finally, the use of novel short-term treatments in treating chronic depression and suicidality in real-world situations is unclear.
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Affiliation(s)
- Graham J Emslie
- University of Texas Southwestern Medical Center, Dallas, Texas, and Children's Health, Children's Medical Center, Dallas, Texas.
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Namgung E, Ha E, Yoon S, Song Y, Lee H, Kang HJ, Han JS, Kim JM, Lee W, Lyoo IK, Kim SJ. Identifying unique subgroups in suicide risks among psychiatric outpatients. Compr Psychiatry 2024; 131:152463. [PMID: 38394926 DOI: 10.1016/j.comppsych.2024.152463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/27/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The presence of psychiatric disorders is widely recognized as one of the primary risk factors for suicide. A significant proportion of individuals receiving outpatient psychiatric treatment exhibit varying degrees of suicidal behaviors, which may range from mild suicidal ideations to overt suicide attempts. This study aims to elucidate the transdiagnostic symptom dimensions and associated suicidal features among psychiatric outpatients. METHODS The study enrolled patients who attended the psychiatry outpatient clinic at a tertiary hospital in South Korea (n = 1, 849, age range = 18-81; 61% women). A data-driven classification methodology was employed, incorporating a broad spectrum of clinical symptoms, to delineate distinctive subgroups among psychiatric outpatients exhibiting suicidality (n = 1189). A reference group of patients without suicidality (n = 660) was included for comparative purposes to ascertain cluster-specific sociodemographic, suicide-related, and psychiatric characteristics. RESULTS Psychiatric outpatients with suicidality (n = 1189) were subdivided into three distinctive clusters: the low-suicide risk cluster (Cluster 1), the high-suicide risk externalizing cluster (Cluster 2), and the high-suicide risk internalizing cluster (Cluster 3). Relative to the reference group (n = 660), each cluster exhibited distinct attributes pertaining to suicide-related characteristics and clinical symptoms, covering domains such as anxiety, externalizing and internalizing behaviors, and feelings of hopelessness. Cluster 1, identified as the low-suicide risk group, exhibited less frequent suicidal ideation, planning, and multiple attempts. In the high-suicide risk groups, Cluster 2 displayed pronounced externalizing symptoms, whereas Cluster 3 was primarily defined by internalizing and hopelessness symptoms. Bipolar disorders were most common in Cluster 2, while depressive disorders were predominant in Cluster 3. DISCUSSION Our findings suggest the possibility of differentiating psychiatric outpatients into distinct, clinically relevant subgroups predicated on their suicide risk. This research potentially paves the way for personalizing interventions and preventive strategies that address cluster-specific characteristics, thereby mitigating suicide-related mortality among psychiatric outpatients.
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Affiliation(s)
- Eun Namgung
- Asan Institute for Life Sciences, Asan Medical Center, Seoul, South Korea
| | - Eunji Ha
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
| | - Sujung Yoon
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea; Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Yumi Song
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea; Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Hyangwon Lee
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea; Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Jung-Soo Han
- Department of Biological Sciences, Konkuk University, Seoul, South Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Wonhye Lee
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, South Korea
| | - In Kyoon Lyoo
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea; Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea; Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, South Korea.
| | - Seog Ju Kim
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, South Korea.
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Hong M, Lee SM, Han KM, Kim KH, Paik JW. Suicide death and other-cause mortality in psychiatric patients: A South Korean study using nationwide claims data. J Affect Disord 2024; 352:288-295. [PMID: 38387668 DOI: 10.1016/j.jad.2024.02.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION It is well-known that suicide and excess mortality are high in patients with psychiatric illnesses and this has long been an important issue in the field of mental health. We aim to investigate suicide and other-cause deaths in patients with psychiatric illnesses. METHODS This retrospective, population-based cohort was based on the National Health Insurance claims data of the first admission with a principal diagnosis of major psychiatric disorder between 2010 and 2011, and followed up to 2020. A total of 95,855 participants were enrolled. Suicide and other-cause mortality were assessed through Log-rank test and Kaplan-Meier curve. RESULTS There were 95,855 patients, with an average age of 48.2 years. The number of suicide deaths and other-cause deaths was 2408 (288.1 per 100,000 person-years) and 15,192 (1817.6 per 100,000 person-years), respectively. The rate of healthcare utilization prior to suicide was 95.0 %, and the rate of utilization prior to one week before suicide was 43.5 %. The risk of suicide was highest in patients with depression, followed by alcohol use disorder, schizophrenia, and bipolar disorder. CONCLUSIONS This study revealed various factors related to healthcare utilization associated with suicide and other-cause deaths in psychiatric patients. Educating frontline healthcare professionals, psychiatrists, emergency department personnel, and general practice doctors using such as Gatekeeper program is important to prevent suicides.
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Affiliation(s)
- Minha Hong
- Department of Psychiatry, Myongji Hospital, Hanyang University College of Medicine, 55 Hwasu-ro 14 beon-gil, Deogyang-gu, Goyang 10475, South Korea; UNC Neuroscience Center, University of North Carolina, Chapel Hill, NC, USA
| | - Sang Min Lee
- Department of Psychiatry, Kyung Hee University School of Medicine, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, South Korea
| | - Kyu-Man Han
- Department of Psychiatry, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyoung-Hoon Kim
- Department of Health Administration, College of Nursing and Health, Kongju National University, 56 Gongjudaehak-ro, Gongju-si, Chungcheongnam-do 32588, South Korea.
| | - Jong-Woo Paik
- Department of Psychiatry, Kyung Hee University School of Medicine, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, South Korea.
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Wu Q, Xing X, Yang M, Bai Z, He Q, Cheng Q, Hu J, Wang H, Fan Y, Su H, Liu Z, Cheng J. Increased Suicide Mortality and Reduced Life Expectancy Associated With Ambient Heat Exposure. Am J Prev Med 2024; 66:780-788. [PMID: 38311191 DOI: 10.1016/j.amepre.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION Ambient heat exposure is a risk factor for suicide in many regions of the world. However, little is known about the extent to which life expectancy has been shortened by heat-related suicide deaths. This study aimed to evaluate the short-term effects of heat on suicide mortality and quantify the reduced life expectancy associated with heat in China. METHODS A time-stratified, case-crossover analysis in 2023 was performed during the warm season (May to September) from 2016 to 2020 to assess the short-term association between extreme heat (the 95th percentile of mean temperature) and suicide mortality in Anhui Province, China. A subgroup analysis was performed according to sex, age, marital status, suicide type, and region. The attributable fraction and years of life lost due to heat were calculated, and the heat-related life expectancy loss was estimated. RESULTS This study included 9,642 suicide deaths, with an average age of 62.4 years and 58.8% of suicides in males. Suicide risk was associated with an 80.7% increase (95% confidence interval [CI]: 21.4%-68.9%) after exposure to extreme heat (30.6°C) in comparison to daily minimum temperature (7.9°C). Subgroup analysis revealed that heat-related suicide risk was more prominent in the married population than in the unmarried population. Heat was estimated to be associated with 31.7% (95% CI: 18.0%-43.2%) of the suicides, corresponding to 7.0 years of loss in life expectancy for each decedent. CONCLUSIONS Heat exposure was associated with an increased risk of suicide and reduced life expectancy. However, further prospective studies are required to confirm this relationship.
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Affiliation(s)
- Qiyue Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - Xiuya Xing
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China; Public Health Research Institute of Anhui Province, Hefei, China
| | - Min Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - Zhongliang Bai
- Department of Health Services Management, School of Health Services Management, Anhui Medical University, Hefei, China
| | - Qin He
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China; Public Health Research Institute of Anhui Province, Hefei, China
| | - Qianyao Cheng
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China; Public Health Research Institute of Anhui Province, Hefei, China
| | - Jingyao Hu
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China; Public Health Research Institute of Anhui Province, Hefei, China
| | - Huadong Wang
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China; Public Health Research Institute of Anhui Province, Hefei, China
| | - Yinguang Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - Hong Su
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - Zhirong Liu
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China; Public Health Research Institute of Anhui Province, Hefei, China.
| | - Jian Cheng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China.
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Xu L, Liu C, Liu Q, Wang X, Yang Z, Liang M, Liu Z. A special type of homicide-suicide: A retrospective study of the characteristics of extended suicide. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2024; 94:101987. [PMID: 38663173 DOI: 10.1016/j.ijlp.2024.101987] [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: 03/11/2024] [Revised: 04/09/2024] [Accepted: 04/17/2024] [Indexed: 06/15/2024]
Abstract
Extended suicide, a specific type of homicide-suicide event, has severe social consequences yet remains lacking systematic research. This retrospective study investigated 51 cases of extended suicide involving mental disorders in central China with aim of better understanding risk factors for such events and guiding prevention strategies. Over an 8-year period from 2015 to 2022, cases were collected from forensic institutions, and demographic characteristics, case details, and psychiatric data were recorded. The 51 incidents involved 51 perpetrators and 79 victims, with more female perpetrators (58.8%) and more female victims (54.4%). The average age of the perpetrators was 36.1, and most were married (88.2%). Almost all of the victims were family members of the perpetrator, like the most numerous children (64.6%), followed by spouses (24.1%). The most common homicide mode of death was mechanical asphyxia (38.0%), followed by sharp devices (36.7%) and drug poisoning (16.5%). Depressive disorders (76.5%) were the most common diagnosis of mental disorder for perpetrators. The study analyzed the unique characteristics of extended suicide to enrich such data. These findings help strengthen the screening and identification of potential perpetrators and victims to prevent such cases from occurring.
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Affiliation(s)
- Luyao Xu
- Department of Forensic Medicine, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Cong Liu
- Department of Forensic Medicine, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Quan Liu
- Hubei Key Laboratory of the Forensic Science (Hubei University of Police), Wuhan 430035, China
| | - Xuemei Wang
- Department of Forensic Medicine, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ziqian Yang
- Department of Forensic Medicine, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Man Liang
- Department of Forensic Medicine, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Zilong Liu
- Department of Forensic Medicine, Huazhong University of Science and Technology, Wuhan 430030, China.
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Akinyemi O, Ogundare T, Wedeslase T, Hartmann B, Odusanya E, Williams M, Hughes K, Cornwell Iii E. Trends in Suicides and Homicides in 21st Century America. Cureus 2024; 16:e61010. [PMID: 38910703 PMCID: PMC11194035 DOI: 10.7759/cureus.61010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Violent deaths, including suicides and homicides, pose a significant public health challenge in the United States. Understanding the trends and identifying associated risk factors is crucial for targeted intervention strategies. AIM To examine the trends in suicides and homicides over the past two decades and identify demographic and contextual predictors using the Center for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System online database. METHODS A retrospective analysis of mortality records from 2000 to 2020 was conducted, utilizing multivariate regression analyses. Covariates included age, race, sex, education, mental health conditions, and time period. Age-adjusted rates were employed to assess trends. RESULTS Over the 20 years, there was an upward trajectory in suicide rates, increasing from approximately 10/100,000 to over 14/100,000 individuals, which is a notable increase among American Indians (100.8% increase) and individuals aged 25 years and younger (45.3% increase). Homicide rates, while relatively stable, exhibited a significant increase in 2019-2020, with African Americans consistently having the highest rates and a significant increase among American Indians (73.2% increase). In the multivariate regression analysis, Individuals with advanced education (OR= 1.74, 95% CI= 1.70 - 1.78), depression (OR = 13.47, 95% CI = 13.04 - 13.91), and bipolar disorder (OR = 2.65, 95% CI = 2.44 - 2.88) had higher odds of suicide. Risk factors for homicide include African Americans (OR = 4.15, 95% CI = 4.08 - 4.23), Latinx (OR = 2.31, 95% CI = 2.26 - 2.37), people aged 25 years and younger, and those with lower educational attainment. CONCLUSION This study highlights the changing demographic pattern in suicides and homicides in the United States and the need for targeted public health responses. Means restriction, universal suicide screening, addressing mental health stigma, and implementing broad interventions that modify societal attitudes toward suicide and homicides are essential components of a comprehensive strategy.
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Affiliation(s)
| | - Temitope Ogundare
- Psychiatry and Behavioral Sciences, Boston University School of Medicine, Boston, USA
| | | | - Brandon Hartmann
- Medicine and Surgery, Howard University College of Medicine, Washington, USA
| | - Eunice Odusanya
- Medicine and Surgery, Howard University College of Medicine, Washington, USA
| | | | - Kakra Hughes
- Surgery, Howard University College of Medicine, Washington, USA
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Zhi D, Jiang R, Pearlson G, Fu Z, Qi S, Yan W, Feng A, Xu M, Calhoun V, Sui J. Triple Interactions Between the Environment, Brain, and Behavior in Children: An ABCD Study. Biol Psychiatry 2024; 95:828-838. [PMID: 38151182 PMCID: PMC11006588 DOI: 10.1016/j.biopsych.2023.12.019] [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: 07/27/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Environmental exposures play a crucial role in shaping children's behavioral development. However, the mechanisms by which these exposures interact with brain functional connectivity and influence behavior remain unexplored. METHODS We investigated the comprehensive environment-brain-behavior triple interactions through rigorous association, prediction, and mediation analyses, while adjusting for multiple confounders. Particularly, we examined the predictive power of brain functional network connectivity (FNC) and 41 environmental exposures for 23 behaviors related to cognitive ability and mental health in 7655 children selected from the Adolescent Brain Cognitive Development (ABCD) Study at both baseline and follow-up. RESULTS FNC demonstrated more predictability for cognitive abilities than for mental health, with cross-validation from the UK Biobank study (N = 20,852), highlighting the importance of thalamus and hippocampus in longitudinal prediction, while FNC+environment demonstrated more predictive power than FNC in both cross-sectional and longitudinal prediction of all behaviors, especially for mental health (r = 0.32-0.63). We found that family and neighborhood exposures were common critical environmental influencers on cognitive ability and mental health, which can be mediated by FNC significantly. Healthy perinatal development was a unique protective factor for higher cognitive ability, whereas sleep problems, family conflicts, and adverse school environments specifically increased risk of poor mental health. CONCLUSIONS This work revealed comprehensive environment-brain-behavior triple interactions based on the ABCD Study, identified cognitive control and default mode networks as the most predictive functional networks for a wide repertoire of behaviors, and underscored the long-lasting impact of critical environmental exposures on childhood development, in which sleep problems were the most prominent factors affecting mental health.
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Affiliation(s)
- Dongmei Zhi
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Rongtao Jiang
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Godfrey Pearlson
- Department of Psychiatry and Neurobiology, Yale School of Medicine, New Haven, Connecticut
| | - Zening Fu
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science, Georgia Institute of Technology, Emory University, and Georgia State University, Atlanta, Georgia
| | - Shile Qi
- College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Weizheng Yan
- National Institute on Alcohol Abuse and Alcoholism, Lab of Neuroimaging, National Institutes of Health, Bethesda, Maryland
| | - Aichen Feng
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Ming Xu
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Vince Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science, Georgia Institute of Technology, Emory University, and Georgia State University, Atlanta, Georgia.
| | - Jing Sui
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China; Tri-institutional Center for Translational Research in Neuroimaging and Data Science, Georgia Institute of Technology, Emory University, and Georgia State University, Atlanta, Georgia.
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Zhou Y, Lan X, Wang C, Zhang F, Liu H, Fu L, Li W, Ye Y, Hu Z, Chao Z, Ning Y. Effect of Repeated Intravenous Esketamine on Adolescents With Major Depressive Disorder and Suicidal Ideation: A Randomized Active-Placebo-Controlled Trial. J Am Acad Child Adolesc Psychiatry 2024; 63:507-518. [PMID: 37414272 DOI: 10.1016/j.jaac.2023.05.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/05/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE Suicide is a major cause of death in adolescents with limited treatment options. Ketamine and its enantiomers have shown rapid anti-suicidal effects in adults with major depressive disorder (MDD), but their efficacy in adolescents is unknown. We conducted an active, placebo-controlled trial to determine the safety and efficacy of intravenous esketamine in this population. METHOD A total of 54 adolescents (aged 13-18 years) with MDD and suicidal ideation were included from an inpatient setting and randomly assigned (1:1) to receive 3 infusions of esketamine (0.25 mg/kg) or midazolam (0.02mg/kg) over 5 days, with routine inpatient care and treatment. Changes from baseline to 24 hours after the final infusion (day 6) in the scores of the Columbia Suicide Severity Rating Scale (C-SSRS) Ideation and Intensity (primary outcome) and the Montgomery-Åsberg Depression Rating Scale (MADRS, key secondary outcome) were analyzed using linear mixed models. In addition, the 4-week clinical treatment response was a key secondary outcome. RESULTS The mean changes in C-SSRS Ideation and Intensity scores from baseline to day 6 were significantly greater in the esketamine group than in the midazolam group (Ideation, -2.6 [SD = 2.0] vs -1.7 [SD = 2.2], p = .007; Intensity, -10.6 [SD = 8.4] vs -5.0 [SD = 7.4], p = .002), and the changes in MADRS scores from baseline to day 6 were significantly greater in the esketamine group than in the midazolam group (-15.3 [SD = 11.2] vs -8.8 [SD = 9.4], p = .004). The rates of antisuicidal and antidepressant responses at 4 weeks posttreatment were 69.2% and 61.5% after esketamine, and were 52.5% and 52.5% after midazolam, respectively. The most common adverse events in the esketamine group were nausea, dissociation, dry mouth, sedation, headache, and dizziness. CONCLUSION These preliminary findings indicate that 3-dose intravenous esketamine, added to routine inpatient care and treatment, was an effective and well-tolerated therapy for treating adolescents with MDD and suicidal ideation. CLINICAL TRIAL REGISTRATION INFORMATION A study to evaluate the efficacy and safety of Esketamine combined with oral antidepressants in the treatment of major depressive disorder with suicidal ideation; http://www.chictr.org.cn; ChiCTR2000041232. DIVERSITY & INCLUSION STATEMENT We worked to ensure that the study questionnaires were prepared in an inclusive way. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. We actively worked to promote sex and gender balance in our author group.
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Affiliation(s)
- Yanling Zhou
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaofeng Lan
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chengyu Wang
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Fan Zhang
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Haiyan Liu
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ling Fu
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weicheng Li
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yanxiang Ye
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhibo Hu
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ziyuan Chao
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuping Ning
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.
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Yip PSF, Caine ED, Yeung CY, Law YW, Ho RTH. Suicide prevention in Hong Kong: pushing boundaries while building bridges. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 46:101061. [PMID: 38616984 PMCID: PMC11011221 DOI: 10.1016/j.lanwpc.2024.101061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/15/2024] [Accepted: 03/26/2024] [Indexed: 04/16/2024]
Abstract
Hong Kong is a natural laboratory for studying suicides-small geographic footprint, bustling economic activity, rapidly changing socio-demographic transitions, and cultural crossroads. Its qualities also intensify the challenges posed when seeking to prevent them. In this viewpoint, we showed the research and practices of suicide prevention efforts made by the Hong Kong Jockey Club Centre for Suicide Research and Prevention (CSRP), which provide the theoretical underpinning of suicide prevention and empirical evidence. CSRP adopted a multi-level public health approach (universal, selective and indicated), and has collaboratively designed, implemented, and evaluated numerous programs that have demonstrated effectiveness in suicide prevention and mental well-being promotion. The center serves as a hub and a catalyst for creating, identifying, deploying, and evaluating suicide prevention initiatives, which have the potential to reduce regional suicides rates when taken to scale and sustained.
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Affiliation(s)
- Paul Siu Fai Yip
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Pofulam, Hong Kong SAR, China
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Eric D. Caine
- Center for the Study and Prevention of Suicide, University of Rochester Medical Center, Rochester, NY, USA
- Canandaigua VA Center of Excellence for Suicide Prevention, Canandaigua, NY, USA
| | - Cheuk Yui Yeung
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Pofulam, Hong Kong SAR, China
- School of Social Work, University of Maryland, Baltimore, MD, USA
| | - Yik Wa Law
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Pofulam, Hong Kong SAR, China
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Rainbow Tin Hung Ho
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Centre on Behavioral Health, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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25
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Stas P, Hoorelbeke K, De Jaegere E, Pauwels K, Portzky G. Suicide risk, related factors and the impact of COVID-19 amongst suicide prevention helpline callers: A network analysis. J Affect Disord 2024; 351:372-380. [PMID: 38302063 DOI: 10.1016/j.jad.2024.01.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND The COVID-19 pandemic brought along many known risk factors for suicide. It is important to map out contributing and protective factors for suicide risk and examine possible changes in these associations during pandemics such as COVID-19. The current study aimed to examine how information on risk and protective factors obtained through a suicide prevention helpline is linked to the assessed suicide risk and the possible impact of the COVID-19 pandemic. METHODS Data on 9474 calls registered by operators of the suicide prevention helpline of Flanders (i.e., part of Belgium) were analysed using network analysis. Using network analyses allowed for a data-driven examination of direct and indirect pathways through which risk and protective factors are associated to perceived suicide risk. The network before and during COVID-19 were compared to examine the possible impact of the pandemic. RESULTS Our findings suggest that different vulnerability and protective factors contribute to perceived suicide risk. Experiencing a break-up, abuse, previous attempt(s), experienced difficulties with the healthcare system and availability of resources were directly and uniquely associated with perceived suicide risk before and during COVID-19. LIMITATIONS Main limitations of this study are the possible bias of operator assessment accuracy, absence of several important psychological risk factors and the use of cross-sectional data. CONCLUSIONS The current study provides insight in the effect of COVID-19 on suicidality and its risk and protective factors amongst suicide prevention helpline users, a population with high risk of suicide. Implications for suicide prevention helplines are discussed.
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Affiliation(s)
- Pauline Stas
- Flemish Centre of Expertise in Suicide Prevention, Department of Head and Skin, Ghent University, Ghent, Belgium.
| | - Kristof Hoorelbeke
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Eva De Jaegere
- Flemish Centre of Expertise in Suicide Prevention, Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Kirsten Pauwels
- Flemish Centre of Expertise in Suicide Prevention, Department of Head and Skin, Ghent University, Ghent, Belgium; Suicide Prevention Centre, Brussels, Belgium
| | - Gwendolyn Portzky
- Flemish Centre of Expertise in Suicide Prevention, Department of Head and Skin, Ghent University, Ghent, Belgium
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Schulz P, Zapata I, Huzij T. Examination of medical student and physician attitudes towards suicide reveals need for required training. Front Public Health 2024; 12:1331208. [PMID: 38633234 PMCID: PMC11021567 DOI: 10.3389/fpubh.2024.1331208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/20/2024] [Indexed: 04/19/2024] Open
Abstract
The attitudes of healthcare providers towards suicidal patients are known to influence their motivation to treat patients during a suicidal crisis. Patients who attempted suicide are more likely to have recently visited a primary care provider who is not necessarily sufficiently trained in managing a suicidal patient rather than a mental health provider who is trained to do so. For those reasons, documenting medical students and physicians' attitudes towards suicide can help in the development of effective intervention training to prepare them to manage these types of patients. In this mini review, attitudes towards suicidal patients, the effectiveness of training on changing their attitudes are discussed. In summary, primary care providers are recognized as a top area where improvements can prevent suicides; providing proper suicide prevention training can effectively improve attitudes and quality of care for suicidal patients.
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Affiliation(s)
- Paulyna Schulz
- Rocky Vista University College of Osteopathic Medicine, Englewood, CO, United States
| | - Isain Zapata
- Department of Biomedical Sciences, Rocky Vista University College of Osteopathic Medicine, Englewood, CO, United States
| | - Teodor Huzij
- Department of Osteopathic Principles and Practice, Rocky Vista University College of Osteopathic Medicine, Englewood, CO, United States
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Gabilondo A, Muela A, Belarra B, De Sayas A, García J, López P, Reich H, Iruin Á. [Evaluation of BIZI, a new Spanish-language online program for community-based suicide preventionAvaliação do BIZI, um novo programa on-line em espanhol para prevenção de suicídio com base na comunidade]. Rev Panam Salud Publica 2024; 48:e20. [PMID: 38562956 PMCID: PMC10984240 DOI: 10.26633/rpsp.2024.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/15/2023] [Indexed: 04/04/2024] Open
Abstract
Objective To evaluate the BIZI program, a Spanish-language gatekeeper training program with a novel online self-learning format that is brief and open-access. It was developed as part of the suicide prevention strategy in Euskadi (Spain) to improve community-based suicide prevention. Methods A group of experts from different fields created the program and tested its usability in a preliminary phase. A single-group design was used for the evaluation, with repeated measurements (before, immediately after, and after three months). Online questionnaires were used to evaluate the program's impact on core competencies for gatekeepers, as well as adherence to content and user satisfaction. Community agents (educators and social workers, among others) who responded to an invitation sent by regional public health coordinators were included in the study. Results In total, 728 people accessed the training, and 86% completed it; 569 people completed the assessment (81.2% women, mean age 41.4 years). The core gatekeeper competencies of attitude, self-efficacy, and knowledge improved significantly, and improvement was sustained ≥3 months in a subsample (P = 0.0001). Conclusions The results are promising and suggest that BIZI is useful in improving the capacity and willingness of community agents to identify people at risk and refer them to specialized resources. Its novel format gives it important advantages over other more common gatekeeper training programs, facilitating its dissemination in low-resource environments. It is the first program of its kind whose effectiveness has been demonstrated and also the first available in Spanish.
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Affiliation(s)
- Andrea Gabilondo
- Instituto de Investigación en Salud Biogipuzkoa Servicio Vasco de Salud (Osakidetza) Donostia-San Sebastián España Instituto de Investigación en Salud Biogipuzkoa, Servicio Vasco de Salud (Osakidetza), Donostia-San Sebastián, España
| | - Alexander Muela
- Facultad de Psicología Universidad del País Vasco Donostia-San Sebastián España Facultad de Psicología, Universidad del País Vasco, Donostia-San Sebastián, España
| | - Begoña Belarra
- Osasun Eskola Servicio Vasco de Salud (Osakidetza) Vitoria-Gasteiz España Osasun Eskola, Servicio Vasco de Salud (Osakidetza), Vitoria-Gasteiz, España
| | - Andrea De Sayas
- Osasun Eskola Servicio Vasco de Salud (Osakidetza) Vitoria-Gasteiz España Osasun Eskola, Servicio Vasco de Salud (Osakidetza), Vitoria-Gasteiz, España
| | - Jon García
- Instituto de Investigación en Salud Biogipuzkoa Servicio Vasco de Salud (Osakidetza) Bilbao España Instituto de Investigación en Salud Biogipuzkoa, Servicio Vasco de Salud (Osakidetza), Bilbao, España
| | - Puy López
- Osasun Eskola Servicio Vasco de Salud (Osakidetza) Vitoria-Gasteiz España Osasun Eskola, Servicio Vasco de Salud (Osakidetza), Vitoria-Gasteiz, España
| | - Hanna Reich
- Fundación Alemana contra la Depresión Frankfurt Alemania Fundación Alemana contra la Depresión, Frankfurt, Alemania
| | - Álvaro Iruin
- Instituto de Investigación en Salud Biogipuzkoa Servicio Vasco de Salud (Osakidetza) Donostia-San Sebastián España Instituto de Investigación en Salud Biogipuzkoa, Servicio Vasco de Salud (Osakidetza), Donostia-San Sebastián, España
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Zisook S, Moutier CY, Rush AJ, Johnson GR, Tal I, Chen PJ, Davis LL, Hicks PB, Wilcox J, Planeta B, Lauro KW, Scrymgeour AA, Kasckow J, Mohamed S. Effect of next-step antidepressant treatment on suicidal ideation: findings from the VAST-D trial. Psychol Med 2024; 54:1172-1183. [PMID: 37859623 DOI: 10.1017/s0033291723003008] [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: 10/21/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) contributes to suicide risk. Treating MDD effectively is considered a key suicide prevention intervention. Yet many patients with MDD do not respond to their initial medication and require a 'next-step'. The relationship between next-step treatments and suicidal thoughts and behaviors is uncharted. METHOD The VA Augmentation and Switching Treatments for Depression trial randomized 1522 participants to one of three next-step treatments: Switching to Bupropion, combining with Bupropion, and augmenting with Aripiprazole. In this secondary analysis, features associated with lifetime suicidal ideation (SI) and attempts (SA) at baseline and current SI during treatment were explored. RESULTS Compared to those with SI only, those with lifetime SI + SA were more likely to be female, divorced, or separated, unemployed; and to have experienced more childhood adversity. They had a more severe depressive episode and were more likely to respond to 'next-step' treatment. The prevalence of SI decreased from 46.5% (694/1492) at baseline to 21.1% (315/1492) at end-of-treatment. SI during treatment was associated with baseline SI; low positive mental health, more anxiety, greater severity and longer duration of current MDD episode; being male and White; and treatment with S-BUP or C-BUP as compared to A-ARI. CONCLUSION SI declines for most patients during next-step medication treatments. But about 1 in 5 experienced emergent or worsening SI during treatment, so vigilance for suicide risk through the entire 12-week acute treatment period is necessary. Treatment selection may affect the risk of SI.
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Affiliation(s)
- Sidney Zisook
- University of California San Diego, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | | | - A John Rush
- Duke Medical School, Durham, NC, USA
- Duke-National University of Singapore, Singapore
| | - Gary R Johnson
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ilanit Tal
- VA San Diego Healthcare System, San Diego, CA, USA
| | - P J Chen
- Department of Psychiatry, VA Northeast Ohio Healthcare System, and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Lori L Davis
- Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA
| | - Paul B Hicks
- Department of Psychiatry, Texas A&M College of Medicine, Temple, TX, USA
| | - James Wilcox
- Department of Veterans Affairs, Phoenix, AZ, USA
| | - Beata Planeta
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | | | - Alexandra A Scrymgeour
- Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM, USA
| | - John Kasckow
- University of Pittsburgh Physicians, Pittsburgh, PA, USA
| | - Somaia Mohamed
- Veterans Affairs (VA) New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, CT, USA
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Young E, Szucs LE, Suarez NA, Wilkins NJ, Hertz M, Ivey-Stephenson A. Disparities and Trends in Middle School Students' Suicidal Thoughts and Behaviors: Results From the Youth Risk Behavior Survey, 2015-2019. J Adolesc Health 2024; 74:720-728. [PMID: 38127017 PMCID: PMC10960693 DOI: 10.1016/j.jadohealth.2023.11.008] [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: 04/20/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE To examine trends and racial and ethnic disparities in early adolescent suicidal thoughts and behaviors in the years immediately prior to the COVID-19 pandemic. METHODS This study used pooled data from Centers for Disease Control and Prevention's middle school Youth Risk Behavior Survey (n = 127,912) between 2015 and 2019. Three dichotomized measures of suicide-related behaviors were assessed: suicidal thoughts, planning, and attempts. Weighted prevalence estimates with 95% confidence intervals were calculated for each survey year. Linear trends examined disparities in the prevalence of suicidal thoughts and behaviors, overall and by student demographic characteristics. Main effects odds ratios compared estimates among racial and ethnic minority adolescents with non-Hispanic White students, controlling for sex and grade. RESULTS Significant linear increases were observed for the percentage of middle school students who reported seriously thinking about suicide (18.2%-22.3%), ever making a suicide plan (11.8%-14.7%), and ever attempting suicide (6.9%-9.3%). Racial and ethnic minority students, other than non-Hispanic Asian, showed higher odds of suicidal thoughts and behaviors compared with non-Hispanic White students. DISCUSSION Findings indicate a need for comprehensive suicide prevention to address health equity and disparities in suicide-related behaviors among middle school-aged adolescents.
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Affiliation(s)
- Emily Young
- Division of Adolescent and School Health, The Centers for Disease Control and Prevention, Atlanta, Georgia; Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, Tennessee.
| | - Leigh E Szucs
- Division of Adolescent and School Health, The Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicolas A Suarez
- Division of Adolescent and School Health, The Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Natalie J Wilkins
- Division of Adolescent and School Health, The Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marci Hertz
- Division of Overdose Prevention, The Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Asha Ivey-Stephenson
- Division of Injury Prevention, The Centers for Disease Control and Prevention, Atlanta, Georgia
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Polillo A, Cleverley K, Wiljer D, Mishna F, Voineskos AN. Digital Disconnection: A Qualitative Study of Youth and Young Adult Perspectives on Cyberbullying and the Adoption of Auto-Detection or Software Tools. J Adolesc Health 2024; 74:837-846. [PMID: 38206225 DOI: 10.1016/j.jadohealth.2023.11.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 11/05/2023] [Accepted: 11/22/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE The purpose of this study was to understand the needs of youth and young adults, current gaps around safeguarding social media, and factors affecting adoption of data-driven auto-detection or software tools. METHODS This qualitative study is the first step of a larger initiative that aims to use participatory action research and co-design principles to develop a digital tool that targets cyberbullying. Youth and young adults aged 16-21 years were recruited to participate in semistructured focus groups between March 2020 and November 2021. Thematic analysis was used to develop themes, with a member-checking process to validate the findings. RESULTS Six focus groups were completed with 39 participants and five themes were generated from the analysis. Participants described the mental health impacts of cyberbullying on young people, the stigma associated with it, and the need for more mental health resources. They felt that additional efforts are needed to improve the school environment, school-based interventions, and training protocols to ensure that youth feel safe reporting cyberbullying. Most participants were open to using a digital solution but raised concerns around the trustworthiness of artificial intelligence and wanted it to be co-designed with young people, integrated across platforms, informed by data-driven decisions, and transparent with users. DISCUSSION Youth and young adults are accepting of a low-risk digital cyberbullying solution as current interventions are not meeting their needs.
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Affiliation(s)
- Alexia Polillo
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kristin Cleverley
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - David Wiljer
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; UHN Digital, University Health Network, Toronto, Ontario, Canada
| | - Faye Mishna
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Aristotle N Voineskos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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31
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Hudgins J, Mannix C, Mannix R. Exposure to potentially lethal weapons and drugs among U.S. adolescents with recent depressive symptoms or suicidality in the Adolescent Behaviors and Experiences Survey. Psychiatry Res 2024; 334:115827. [PMID: 38442478 DOI: 10.1016/j.psychres.2024.115827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/19/2024] [Accepted: 02/24/2024] [Indexed: 03/07/2024]
Abstract
The scope of lethal means exposure (i.e. guns, intravenous drugs, prescription drugs) relative to depressive symptoms and suicidality in adolescents is not well described. Using the Adolescent Behaviors and Experiences Survey (ABES), we found lethal means exposure increased in a dose dependent manner with increasing depressive symptoms, adjusting for age, sex, race, and ethnicity. Adolescent males were more than 6 times more likely to have exposure to guns and intravenous drugs compared to adolescent females.
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Affiliation(s)
- Joel Hudgins
- Division of Emergency Medicine, Boston Children's Hospital, Boston Massachusetts 02115, USA; Harvard Medical School, Boston Massachusetts, USA
| | | | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children's Hospital, Boston Massachusetts 02115, USA; Harvard Medical School, Boston Massachusetts, USA.
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Üzer A, Uran C, Yılmaz E, Şahin ŞN, Ersin MK, Yılmaz RH, Çıkla A. The relationship between chronotype, psychological pain, problematic social media use, and suicidality among university students in Turkey. Chronobiol Int 2024; 41:504-512. [PMID: 38373906 DOI: 10.1080/07420528.2024.2320226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 02/13/2024] [Indexed: 02/21/2024]
Abstract
Chronotype has been extensively linked to various psychological outcomes, including suicide, which significantly impacts the mortality rate among young adults worldwide. Research on the extent of these links is still ongoing. This cross-sectional study aimed to explore the complex relationships between chronotype, internet addiction, problematic social media use (PSMU), psychological pain, and suicidality in a student population. A total of 571 Turkish students (65.3% female, mean age 20.3 ± 1.63 years) completed the following scales: the Suicide Probability Scale (SPS), the Mee-Bunney Psychological Pain Assessment Scale (MBPPAS), the Social Media Disorder Scale (SMDS), the Internet Addiction Test (IAT), the Morningness - Eveningness Questionnaire (MEQ), and the Hospital Anxiety and Depression Scale (HADS). The results showed that the relationship between chronotype and suicidality was partially mediated by SMDS and MBPPAS but not by anxiety, depression, or IAT. These findings suggest that psychological pain and PSMU may be important factors that contribute to suicidality in evening-type individuals. These findings have significant implications for the development of interventions aimed at reducing suicidality among evening-type individuals. By addressing the underlying factors of psychological pain and PSMU, it may be possible to mitigate the increased risk of suicidality among this population.
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Affiliation(s)
- Ahmet Üzer
- Faculty of Medicine, Department of Psychiatry, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Ceren Uran
- Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Elif Yılmaz
- Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Şeima Nur Şahin
- Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Muhammet Kaan Ersin
- Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Rohat Hasret Yılmaz
- Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Ayça Çıkla
- Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
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Goueslard K, Quantin C, Jollant F. Self-harm and suicide death in the three years following hospitalization for intentional self-harm in adolescents and young adults: A nationwide study. Psychiatry Res 2024; 334:115807. [PMID: 38387165 DOI: 10.1016/j.psychres.2024.115807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/11/2024] [Accepted: 02/17/2024] [Indexed: 02/24/2024]
Abstract
Self-harm is frequent in youths. This study aimed to assess the risk of self-harm and mortality over a three-year period following self-harm hospitalization. Data were extracted from national databases in France. All patients aged 12 to 24 years and hospitalized for self-harm in 2013-2014 were included and compared to age- and sex-matched individuals with no self-harm hospitalization during this period. Cox proportional hazards regression models were used. Overall, 34,533 individuals were hospitalized for self-harm in 2013-2014 (70.8 % females, 79.6 % self-poisoning), with a peak among females aged 14-16. Comparison with 103,599 matched controls showed significantly higher rates of past self-harm, somatic and psychiatric disorders, and dispensed drugs in youth hospitalized for self-harm. During follow-up, they significantly more often repeated self-harm (20.9 vs. 0.1 %), died from any cause (0.6 vs 0.03 %) and from suicide (0.2 vs 0.01 %), particularly during the first year. The choice of a violent self-harm means at inclusion increased the risk of suicide during follow-up. Psychiatric disorders were a significant risk factor for all outcomes. In conclusion, at least one in five youths will self-harm, and one in two hundred will die in the three years following hospitalization for self-harm. Reinforced follow-up care is necessary in this population.
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Affiliation(s)
- Karine Goueslard
- Service de Biostatistiques et d'Information Médicale (DIM), CHU Dijon Bourgogne, France
| | - Catherine Quantin
- Service de Biostatistiques et d'Information Médicale (DIM), CHU Dijon Bourgogne, France; Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, F21000 Dijon, France; Inserm, CESP, 94807, Villejuif, France
| | - Fabrice Jollant
- Department of psychiatry, Faculty of Medicine, Université Paris Saclay, Le Kremlin-Bicêtre, France; Department of psychiatry, Hôpital Bicêtre, APHP, Le Kremlin-Bicêtre, France; Department of psychiatry, CHU Nîmes, Nîmes, France; McGill Group for Suicide Studies, Department of psychiatry, McGill University, Montréal, Québec, Canada; Moods Research Team, INSERM UMR-1178, CESP, Le Kremlin-Bicêtre, France.
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Jankowsky K, Steger D, Schroeders U. Predicting Lifetime Suicide Attempts in a Community Sample of Adolescents Using Machine Learning Algorithms. Assessment 2024; 31:557-573. [PMID: 37092544 PMCID: PMC10903120 DOI: 10.1177/10731911231167490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Suicide is a major global health concern and a prominent cause of death in adolescents. Previous research on suicide prediction has mainly focused on clinical or adult samples. To prevent suicides at an early stage, however, it is important to screen for risk factors in a community sample of adolescents. We compared the accuracy of logistic regressions, elastic net regressions, and gradient boosting machines in predicting suicide attempts by 17-year-olds in the Millennium Cohort Study (N = 7,347), combining a large set of self- and other-reported variables from different categories. Both machine learning algorithms outperformed logistic regressions and achieved similar balanced accuracies (.76 when using data 3 years before the self-reported lifetime suicide attempts and .85 when using data from the same measurement wave). We identified essential variables that should be considered when screening for suicidal behavior. Finally, we discuss the usefulness of complex machine learning models in suicide prediction.
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Michalek IM, Koczkodaj P, Michalek M, Caetano Dos Santos FL. Unveiling the silent crisis: global burden of suicide-related deaths among children aged 10-14 years. World J Pediatr 2024; 20:371-391. [PMID: 38238639 PMCID: PMC11052841 DOI: 10.1007/s12519-023-00781-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/22/2023] [Indexed: 04/29/2024]
Abstract
BACKGROUND The rise in suicides among children aged 10-14 years demands urgent attention globally. This study aims to assess the global burden of suicide-related deaths in this age group from 1990 to 2019, considering factors such as sex, geography, and sociodemographics, to inform prevention strategies and interventions. METHODS The data from Global Burden of Disease 2019, encompassing 204 countries and territories, were analyzed to investigate deaths and years of life lost (YLLs) due to suicide among children aged 10-14 years. Statistical analyses, including mortality rates, YLLs, and the sociodemographic index (SDI), were conducted using standardized tools. RESULTS In 2019, a total of 8327 [95% uncertainty interval (UI) = 7073-9685] children aged 10-14 years died globally due to suicide, with a mortality rate of 1.30 (95% UI = 1.10-1.51) per 100,000. The rates varied across countries/territories ranging between 0.05 (95% UI = 0.02-0.10) in South Africa and 7.49 (95% UI = 5.13-10.57) in Greenland. The contribution of suicide-related deaths to all-cause mortality ranged from 0.07% (95% UI = 0.04%-0.15%) in South Africa to 33.02% (95% UI = 24.36%-41.53%) in Greenland. Worldwide, there were approximately 636,196 (95% UI = 540,383-740,009) YLLs due to suicide, with a rate of 99.07 (95% UI = 84.15-115.23) per 100,000. The association between SDI and suicide-related deaths was evident, with higher contributions observed in countries with higher SDI. CONCLUSIONS This study reveals a concerning global burden of suicide-related deaths among children aged 10-14 years. Despite progress in reducing mortality rates, suicide remains a significant issue. While overall rates have declined, the percentage of deaths caused by suicide in this age group is increasing.
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Affiliation(s)
- Irmina Maria Michalek
- Department of Cancer Epidemiology and Primary Prevention, Maria Sklodowska-Curie National Research Institute of Oncology, ul. Wawelska 15 B, Warsaw, Poland.
| | - Pawel Koczkodaj
- Department of Cancer Epidemiology and Primary Prevention, Maria Sklodowska-Curie National Research Institute of Oncology, ul. Wawelska 15 B, Warsaw, Poland
| | - Marzena Michalek
- Private Psychiatric Practice-Marzena Michalek, MD, Siedlce, Poland
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Blosnich JR, Haydinger A, Rhoades H, De Luca SM. Differences in Beliefs About Suicide by Occupation in a Representative Sample of Adults in the United States, General Social Survey 2002-2021. Arch Suicide Res 2024; 28:439-453. [PMID: 36916390 PMCID: PMC10500038 DOI: 10.1080/13811118.2023.2190363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVE Beliefs about suicide are important aspects of suicide prevention gatekeeper trainings. This study sought to determine if workers in finance- and legal/judicial-related industries have significantly different levels of suicide acceptability compared to the general US population. METHOD Cross-sectional data are from the 2002 to 2021 General Social Survey (GSS). Suicide acceptability was measured with four dichotomous items to which respondents indicated yes/no if they thought someone has the right to end their life in four negative life scenarios. Occupational categories were coded based on U.S. Census Bureau occupation and industry codes. Covariates for multiple logistic regression analyses included age, educational attainment, sex, race, ethnicity, survey year, and religiosity. RESULTS Among the 15,166 respondents, 651 people worked in finance-related occupations and 319 people worked in legal/judicial-related occupations. In adjusted models, people in finance-related occupations had greater odds of endorsing suicide as acceptable if one has an incurable disease (aOR = 1.25, 95%CI = 1.03-1.52) and marginally greater odds of endorsing suicide as acceptable if one dishonors their family (aOR = 1.31, 95%CI = 0.99-1.74) than the general adult population. People in legal/judicial-related occupations were more likely to endorse 3 of the 4 suicide acceptability items compared to the general adult population, however these differences were not statistically significant after accounting for demographic factors. CONCLUSION Workers in non-clinical industries that frequently see clients during negative life events are prime audiences for gatekeeper trainings but may have entrenched beliefs about suicide acceptability. Research is needed to determine how these beliefs may impact gatekeeper training.
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Affiliation(s)
- John R. Blosnich
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W. 34 Street, Los Angeles, CA, USA 90089
| | - Alexandra Haydinger
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W. 34 Street, Los Angeles, CA, USA 90089
| | - Harmony Rhoades
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W. 34 Street, Los Angeles, CA, USA 90089
| | - Susan M. De Luca
- The MetroHealth System, Population Health Research Institute, Center for Health Care Research and Policy, 2500 MetroHealth Drive, Cleveland, OH, USA 44109
- Case Western Reserve University, School of Medicine, 9501 Euclid Ave., Cleveland OH 44106
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Lavigne JE, Stover AN, Gamble A, Tudor G, Cross WF, Carpenter DM. A randomized controlled trial protocol for a virtual, scalable suicide prevention gatekeeper training program for community pharmacy staff (Pharm-SAVES). Contemp Clin Trials Commun 2024; 38:101268. [PMID: 38380343 PMCID: PMC10878835 DOI: 10.1016/j.conctc.2024.101268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/04/2024] [Accepted: 02/07/2024] [Indexed: 02/22/2024] Open
Abstract
Background Suicide prevention gatekeeping is a skill that may support community (retail) pharmacists in managing patients who present with suicide warning signs. A brief, virtual, case-based training intervention was tailored to the retail setting (Pharm-SAVES). To test training effectiveness, a randomized controlled trial (RCT) protocol was developed for use in pharmacies across four states. Objective To introduce the trial protocol for assessing the effectiveness for increasing the proportion of staff who recognize patients displaying warning signs and self-report engaging in gatekeeping, including asking if the patient is considering suicide. Methods This study uses a parallel cluster-randomized controlled trial to recruit 150 pharmacy staff in community pharmacies in four states with two groups (intervention and control). The control group completes Pharm-SAVES online suicide prevention gatekeeper training and all assessment surveys at baseline after training and at 1-month follow-up. The experimental group completes all control group training and assessments plus interactive video role-play patient cases. Conclusion We hypothesize that compared to those in the control group, experimental group trainees exposed to the interactive video role play patient cases will be more likely to recognize warning signs in patient cases and self-report engaging in gatekeeping.
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Affiliation(s)
- Jill E. Lavigne
- Wegmans School of Pharmacy, St John Fisher University, United States
| | | | - Abigail Gamble
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, United States
| | - Gail Tudor
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, United States
| | - Wendi F. Cross
- University of Rochester School of Medicine and Dentistry, United States
| | - Delesha M. Carpenter
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, United States
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Lesinskienė S, Karalienė V, Pociūtė K, Šambaras R. Possible Mental Health Interventions for Family Members of a Close Relative Who Has Suicidal Thoughts or Committed Suicide: A Pilot Project at a Mental Health Center. J Clin Med 2024; 13:2032. [PMID: 38610797 PMCID: PMC11012435 DOI: 10.3390/jcm13072032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/25/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Suicides are an actual issue, especially in Lithuania, where, despite significant efforts, the number of suicides remains very high. In cases of suicide, society painfully loses its members, and the relatives of the person who committed suicide, engaged in self-harm, or attempted suicide face many negative experiences. Methods: The purpose of this article is to describe the pilot project applied for 2 years in the Mental Health Center (MHC) in the city of Vilnius, Lithuania, in organizing and providing services to people whose relatives committed suicide or attempted suicide or self-harm. This prevention and early intervention program, organized by an interdisciplinary team at an MHC, appeared appropriate, effective, and well-attended. Program clients could participate anonymously and have the opportunity to choose the time and the right services for themselves from the offered program services package. Results: Providing the possibility for family members to receive flexible mental health services at the primary center increased the attractiveness of the program and reduced stigma. Conclusions: The program results demonstrated the applicability of the implementation of such an initiative as a relevant possibility when providing complex help for the relatives of self-harming and/or suicidal people.
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Affiliation(s)
- Sigita Lesinskienė
- Clinic of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania; (V.K.); (K.P.); (R.Š.)
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Mournet AM, Kellerman JK, Kleiman EM. Associations between feelings of safety, concerns about firearms on campus and suicidal thoughts and behaviours among college students. Inj Prev 2024; 30:171-175. [PMID: 38050010 DOI: 10.1136/ip-2023-045060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
BACKGROUND Perceptions of safety on campus may be related to a variety of factors such as concerns about campus violence, especially firearm violence, and mental health, particularly suicidal thoughts and behaviours (STBs). The present analyses aim to describe associations between feelings of safety, concerns about firearms on campus and STBs among college students. METHODS This study uses data from the American College Health Association-National College Health Assessment wave III (n=24 682 participants across k=29 schools). Multilevel logistic regressions and cumulative link mixed models examine the associations between feelings of safety, concerns about firearm violence on campus and presence of STBs in the past year. RESULTS Participants who reported being concerned about firearm violence felt significantly less safe. Feeling unsafe at night was significantly associated with suicidal ideation and suicide attempts. Individuals with concerns about firearm safety on campus were up to 42% more likely to report suicidal ideation compared with those reporting they were not at all concerned about campus firearm violence. DISCUSSION With associations highlighting increased risk of STBs among those with reduced safety feelings and heightened concerns about firearms, there is a need for college campuses to intervene and promote campus safety, with particular consideration for the presence of firearms on campus and the implications of allowing such weapons to be present in environments with increasing instances of firearm violence.
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Affiliation(s)
| | - John K Kellerman
- Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Evan M Kleiman
- Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
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Zhang Y, He Y, Pang Y, Su Z, Wang Y, Zhou Y, Lu Y, Jiang Y, Han X, Song L, Wang L, Li Z, Lv X, Wang Y, Yao J, Liu X, Zhou X, He S, Song L, Li J, Wang B, Tang L. Suicidal ideation in Chinese patients with advanced breast cancer: a multi-center mediation model study. BMC Psychol 2024; 12:139. [PMID: 38475847 DOI: 10.1186/s40359-024-01607-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
PURPOSE The pathways underpinning suicide ideation (SI) and certain physical and psychological factors in patients with advanced breast cancer remain unclear. This study develops and validates a mediation model that delineates the associations between several multidimensional variables and SI in Chinese patients with advanced breast cancer. METHODS Patients with advanced breast cancer (n = 509) were recruited as study participants from 10 regional cancer centers across China from August 2019 to December 2020. Participants were required to complete five questionnaires using an electronic patient-reported outcomes (ePRO) system: 9 item- Patient Health Questionnaire (PHQ-9), Hospital Anxiety and Depression Scale (HADS), Insomnia Severity Index (ISI), 5-level EQ-5D (EQ-5D-5L), and MD Anderson Symptom Inventory (MDASI). Risk factors for SI were identified using multivariable logistic regression, and inputted into serial multiple mediation models to elucidate the pathways linking the risk factors to SI. RESULTS SI prevalence was 22.8% (116/509). After adjusting for covariates, depression (odds ratio [OR] = 1.384), emotional distress (OR = 1.107), upset (OR = 0.842), and forgetfulness (OR = 1.236) were identified as significant independent risk factors (all p < 0.05). The ORs indicate that depression and distress have the strongest associations with SI. Health status has a significant indirect effect (OR=-0.044, p = 0.005) and a strong total effect (OR=-0.485, p < 0.001) on SI, mediated by insomnia severity and emotional distress. CONCLUSIONS There is a high SI prevalence among Chinese patients with advanced breast cancer. Our analysis revealed predictive pathways from poor health to heightened SI, mediated by emotional distress and insomnia. Regular management of distress and insomnia can decrease suicide risk in this vulnerable population.
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Affiliation(s)
- Yening Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-oncology, Peking University Cancer Hospital &Institute, Fu-Cheng Road 52, Hai-Dian District, 100142, Beijing, China
| | - Yi He
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-oncology, Peking University Cancer Hospital &Institute, Fu-Cheng Road 52, Hai-Dian District, 100142, Beijing, China
| | - Ying Pang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-oncology, Peking University Cancer Hospital &Institute, Fu-Cheng Road 52, Hai-Dian District, 100142, Beijing, China
| | - Zhongge Su
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-oncology, Peking University Cancer Hospital &Institute, Fu-Cheng Road 52, Hai-Dian District, 100142, Beijing, China
| | - Yu Wang
- Department of Breast Cancer Radiotherapy, Cancer Hospital, Chinese Academy of Medical Sciences, Shanxi Medical University, Taiyuan, China
| | - Yuhe Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-oncology, Peking University Cancer Hospital &Institute, Fu-Cheng Road 52, Hai-Dian District, 100142, Beijing, China
| | - Yongkui Lu
- The Fifth Department of Chemotherapy, The Affiliated Cancer Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yu Jiang
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xinkun Han
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-oncology, Peking University Cancer Hospital &Institute, Fu-Cheng Road 52, Hai-Dian District, 100142, Beijing, China
| | - Lihua Song
- Department of Breast Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, China
| | - Liping Wang
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zimeng Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-oncology, Peking University Cancer Hospital &Institute, Fu-Cheng Road 52, Hai-Dian District, 100142, Beijing, China
| | - Xiaojun Lv
- Department of Oncology, Xiamen Humanity Hospital, Xiamen, China
| | - Yan Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-oncology, Peking University Cancer Hospital &Institute, Fu-Cheng Road 52, Hai-Dian District, 100142, Beijing, China
| | - Juntao Yao
- Department of Integrated Chinese and Western Medicine, Shaanxi Provincial Cancer Hospital Affiliated to Medical College of Xi'an Jiaotong University, Xi'an, China
| | - Xiaohong Liu
- Department of Clinical Spiritual Care, The Affiliated Cancer Hospital of Xiangya School of Medicine, Hunan Cancer Hospital, Central South University, Changsha, China
| | - Xiaoyi Zhou
- Radiotherapy Center, Hubei Cancer Hospital, Wuhan, China
| | - Shuangzhi He
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-oncology, Peking University Cancer Hospital &Institute, Fu-Cheng Road 52, Hai-Dian District, 100142, Beijing, China
| | - Lili Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-oncology, Peking University Cancer Hospital &Institute, Fu-Cheng Road 52, Hai-Dian District, 100142, Beijing, China
| | - Jinjiang Li
- Department of Psycho-oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, China
| | - Bingmei Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-oncology, Peking University Cancer Hospital &Institute, Fu-Cheng Road 52, Hai-Dian District, 100142, Beijing, China
| | - Lili Tang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-oncology, Peking University Cancer Hospital &Institute, Fu-Cheng Road 52, Hai-Dian District, 100142, Beijing, China.
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Wexler L, Ginn J, White L, Schmidt T, Rataj S, Wells CC, Schultz K, Kapoulea EA, McEachern D, Habecker P, Laws H. Considering the importance of 'Communities of Practice' and Health Promotion Constructs for Upstream Suicide Prevention. RESEARCH SQUARE 2024:rs.3.rs-3976483. [PMID: 38559170 PMCID: PMC10980165 DOI: 10.21203/rs.3.rs-3976483/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background Suicide is a serious and growing health inequity for Alaska Native (AN) youth (ages 15-24), who experience suicide rates significantly higher than the general U.S. youth population. In low-resourced, remote communities, building on the local and cultural resources found in remote AN communities to increase uptake of prevention behaviors like lethal means reduction, interpersonal support, and postvention can be more effective at preventing suicide than a risk-referral process. This study expands the variables we hypothesize as important for reducing suicide risk and supporting wellbeing. These variables are: 1) perceived suicide prevention self-efficacy, 2) perceived wellness self-efficacy, and 3) developing a 'community of practice' (CoP) for prevention/wellness work. Method With a convenience sample (N = 398) of participants (ages 15+) in five remote Alaska Native communities, this study characterizes respondents' social roles: institutional role if they have a job that includes suicide prevention (e.g. teachers, community health workers) and community role if their primary role is based on family or community positioning (e.g. Elder, parent). The cross-sectional analysis then explores the relationship between respondents' wellness and prevention self-efficacy and CoP as predictors of their self-reported suicide prevention and wellness promotion behaviors: (1) working together with others (e.g. community initiatives), (2) offering interpersonal support to someone, (3) reducing access to lethal means, and (4) reducing suicide risk for others after a suicide death in the community. Results Community and institutional roles are vital, and analyses detected distinct patterns linking our dependent variables to different preventative behaviors. Findings associated wellness self-efficacy and CoP (but not prevention self-efficacy) with 'working together' behaviors, wellness and prevention self-efficacy (but not CoP) with interpersonal supportive behaviors; both prevention self-efficacy and CoP with higher postvention behaviors. Only prevention self-efficacy was associated with lethal means reduction. Conclusions The study widens the scope of suicide prevention. Promising approaches to suicide prevention in rural low-resourced communities include: (1) engaging people in community and institutional roles, (2) developing communities of practice for suicide prevention among different sectors of a community, and (3) broadening the scope of suicide prevention to include wellness promotion as well as suicide prevention.
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Hodge L, Bucalo B, Ritz H, Sampson T, Song C, Suh E, Tang J, Varghese S, Warren T, Yeske K. Thirteen years progress: a scoping review of suicide prevention initiatives in post-secondary settings. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-10. [PMID: 38466319 DOI: 10.1080/07448481.2024.2308259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 01/10/2024] [Indexed: 03/12/2024]
Abstract
Objective: Describe the literature on suicide prevention initiatives (SPIs) in post-secondary settings internationally since 2010. Methods: A scoping review and bibliographic search were conducted across MEDLINE, PsycINFO, CINAHL, and Scopus. Two reviewers independently screened articles and extracted data in consultation with a community social work team. Included articles described SPIs in post-secondary settings. Secondary sources and articles unavailable in English were excluded. Results: After identifying 931 citations, 76 articles representing five continents were included. Included articles spanned 2010 to 2023. Most articles represented North America, used quantitative methods, and focused on gatekeepers. SPIs in post-secondary settings were characterized by standardized and commercially available training programs and a wide variety of 'in-house' initiatives unique to campus communities. Conclusions: The quantity of research on SPIs in post-secondary settings has not kept pace with escalating mental health issues and the extent to which suicide is an urgent public health issue for young adults.
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Affiliation(s)
- Lesley Hodge
- University of Alberta, Edmonton, Alberta, Canada
| | - Brianna Bucalo
- Wellness Supports Community Social Work Team, University of Alberta, Edmonton, Alberta, Canada
| | - Heather Ritz
- Wellness Supports Community Social Work Team, University of Alberta, Edmonton, Alberta, Canada
| | - Tiffany Sampson
- Wellness Supports Community Social Work Team, University of Alberta, Edmonton, Alberta, Canada
| | - Claire Song
- University of Alberta, Edmonton, Alberta, Canada
| | - Erin Suh
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | - Kyra Yeske
- University of Alberta, Edmonton, Alberta, Canada
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Chiu L, Corpus GH, Lien M, Chu JP. The Culturally Infused Curricular Framework (CICF) for Suicide Prevention Trainings. Health Promot Pract 2024:15248399241234064. [PMID: 38439682 DOI: 10.1177/15248399241234064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
Although suicide prevention trainings (SPT) have been a standard approach for suicide prevention for years, researchers have noted a need for more clarity in the definition of core competencies for SPTs, particularly in the areas of diversity and culture. Recent research has identified key theoretically- and empirically-based cultural considerations for suicide prevention, but translation is needed to infuse these standards for culture-related competencies into SPTs. This study performed a systematic literature review with a thematic synthesis analytic approach to establish a set of curricular guidelines for infusion of cultural considerations into SPTs. The study also examined the extent to which existing community trainings already incorporate cultural components. Based on the thematic synthesis of 39 SPT studies from 2010 to 2020 and seminal reviews of the cultural and suicide literature, results identified three overarching categories of cultural curricular competencies (suicide knowledge and awareness, suicide intervention skills, and curriculum delivery) and 14 core cultural curricular subthemes for community trainings (e.g., culturally informed risk factors and warning signs, systemic inequities, etc.). These three categories with 14 core cultural curricular competencies comprise the Culturally Infused Curricular Framework (CICF) for Suicide Prevention Trainings. The majority of trainings (62%) included five or less out of 14 total possible core cultural competencies in their training curricula, pointing to insufficient integration of cultural components in existing community trainings. This study's research-based guideline establishes a culture-inclusive framework to strengthen content and approach of community trainings and suicide prevention across cultural groups.
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Affiliation(s)
- Lorna Chiu
- Palo Alto University, Palo Alto, CA, USA
| | | | - Mego Lien
- County of Santa Clara Behavioral Health Services, San Jose, CA, USA
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Fletcher CME, Woolford D, Gladigau J, Gunn KM. A 'Vocal Locals' social network campaign is associated with increased frequency of conversations about mental health and improved engagement in wellbeing-promoting activities in an Australian farming community. BMC Public Health 2024; 24:673. [PMID: 38431599 PMCID: PMC10909292 DOI: 10.1186/s12889-024-18193-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/23/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Farmers face numerous barriers to accessing professional mental health services and instead report a preference for informal support systems, such as lay or peer networks. Farmers also experience barriers to investing time in maintaining or improving their wellbeing, stemming from sociocultural norms and attitudes that are widespread in agricultural communities. The Vocal Locals social network campaign is an ifarmwell initiative that aims to promote conversations about wellbeing and challenge attitudes and behaviours that contribute to farmers' poor mental health. METHODS The Vocal Locals campaign was underpinned by the socio-ecological model which explains human behaviour as stemming from interactions between the individual, their closest social circle, the community, and broader society. The campaign ran in Loxton, South Australia, from June to August 2022. Ten community members (8/10 farmers) became 'Vocal Locals' and were supported to share 'calls-to-action' to encourage people in their social networks to engage in wellbeing-promoting activities. A broader communications campaign reinforced key messages and amplified Vocal Locals' activities in the community. The intrapersonal and community-level impacts of the campaign were evaluated via pre- and post-campaign surveys of Vocal Locals and community members respectively. RESULTS Vocal Locals reported significantly lower psychological distress (p = .014), and higher positive mental wellbeing (p = .011), levels of general mental health knowledge (p = .022), and confidence helping someone with poor mental health (p = .004) following the intervention. However, changes in stigmatising beliefs about mental illness, confidence recognising poor mental health, and confidence and comfort speaking to others about mental health were non-significant. Community members who were familiar with the campaign reported having significantly more wellbeing-related conversations post-campaign compared to before (p = .015). Respondents also reported being more comfortable speaking to others about mental health or wellbeing (p = .001) and engaging more in activities to maintain or improve their wellbeing (p = .012) following the campaign. CONCLUSIONS The Vocal Locals social network campaign is an example of how science and community can be brought together to achieve meaningful outcomes. The campaign may serve as a model for others who wish to challenge attitudinal or knowledge-related barriers to help-seeking and improve engagement in wellbeing-promoting activities in difficult-to-reach communities.
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Affiliation(s)
- Chloe M E Fletcher
- IIMPACT in Health, Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, 5000, Australia
| | - Dale Woolford
- IIMPACT in Health, Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, 5000, Australia
| | - John Gladigau
- Gladigau Enterprises Pty Ltd, Loxton, SA, 5333, Australia
| | - Kate M Gunn
- IIMPACT in Health, Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, 5000, Australia.
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Krysinska K, Andriessen K, Bandara P, Reifels L, Flego A, Page A, Schlichthorst M, Pirkis J, Mihalopoulos C, Khanh-Dao Le L. The Cost-Effectiveness of Psychosocial Interventions Following Self-Harm in Australia. CRISIS 2024; 45:118-127. [PMID: 37904498 DOI: 10.1027/0227-5910/a000926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Background: Psychosocial interventions following self-harm in adults, in particular cognitive behavioral therapy (CBT), can be effective in lowering the risk of repeated self-harm. Aims: To evaluate the cost-effectiveness of CBT for reducing repeated self-harm in the Australian context. Method: The current study adopted the accessing cost-effectiveness (ACE) approach using return-on-investment (ROI) analysis. Uncertainty and sensitivity analyses (Sas) tested the robustness of the model outputs to changes in three assumptions: general practitioner referral pathway (SA1), private setting intervention delivery (SA2), and training costs (SA3). Results: The intervention produced cost savings of A$ 46M (95% UI -223.7 to 73.3) and A$ 18.3M (95% UI -86.2 to 24.6), subject to the effect of intervention lasting 2- or 1-year follow-up. The ROI ratio reduced to 5.22 in SA1 (95% UI -10.1 to 27.9), 2.5 in SA2 (95% UI -4.8 to 13.3), and 5.1 in SA3 (95% UI -9.8 to 27.8). Limitations: We assumed that the effectiveness would reduce 50% within 5 years in the base case, and we used Australian data and a partial social perspective. Conclusions: The current study demonstrated cost-effectiveness of CBT for adults who have self-harmed with the return-on-investment ratio of A$ 2.3 to $6.0 for every A$ 1 invested.
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Affiliation(s)
- Karolina Krysinska
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
| | - Karl Andriessen
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
| | - Piumee Bandara
- Translational Health Research Institute, Western Sydney University, NSW, Australia
| | - Lennart Reifels
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
| | - Anna Flego
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, NSW, Australia
| | - Marisa Schlichthorst
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Health Economics Division, Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Long Khanh-Dao Le
- Health Economics Division, Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Kawashima D, Kawamoto S, Shiraga K, Kheibari A, Cerel J, Kawano K. Suicide Attitudes Among Suicide Loss Survivors and Their Adaptation to Loss: A Cross-Cultural Study in Japan and the United States. OMEGA-JOURNAL OF DEATH AND DYING 2024; 88:1258-1274. [PMID: 35345933 DOI: 10.1177/00302228211051512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Survivors' adaptation to a suicide loss is likely influenced by their attitudes toward suicide and their respective sociocultural contexts. Our study aimed to compare suicide attitudes and their association with depressive symptoms and sense of community safety in Japanese and American suicide loss survivors. A total of 193 Japanese survivors and 232 American survivors completed online surveys. The results show that Japanese survivors tended not to consider suicide as an illness or to recognize that others understood their experience but were more likely than American survivors to consider suicide as justifiable. Regression analyses indicated that taking suicide as a right was associated with depressive symptoms. Further, their sense of being understood by others was positively correlated with perceived community safety in both samples, but justifying suicide and considering it to be an illness was positively related to perceived community safety only among Japanese survivors.
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Affiliation(s)
| | | | - Keisuke Shiraga
- School of Education, Joetsu University of Education, Joetsu, Japan
| | - Athena Kheibari
- School of Social Work, Wayne State University, Detroit, MI, USA
| | - Julie Cerel
- College of Social Work, University of Kentucky, Lexington, KY, USA
| | - Kenji Kawano
- College of Comprehensive Psychology, Ritsumeikan University, Ibaraki, Japan
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Arseniev-Koehler A, Mays VM, Foster JG, Chang KW, Cochran SD. Gendered Patterns in Manifest and Latent Mental Health Indicators Among Suicide Decedents: 2003-2020 National Violent Death Reporting System (NVDRS). Am J Public Health 2024; 114:S268-S277. [PMID: 37948056 PMCID: PMC10976443 DOI: 10.2105/ajph.2023.307427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 11/12/2023]
Abstract
Objectives. To investigate differences in the documentation of mental health symptomology between male and female suicide decedents in the 2003-2020 US National Violent Death Reporting System (NVDRS). Methods. Using information on 271 998 suicides in the 2003-2020 NVDRS, we evaluated precoded mental health-related variables and topic model-derived latent mental health themes in the law enforcement and coroner or medical examiner death narratives compiled by trained public health workers. Results. Public health records of male compared with female suicides were less likely to include notations of mental health conditions or treatment interventions. However, topic modeling of death summaries revealed that male suicide decedents were more likely to evidence several subclinical cognitive and emotional indicators of distress. Conclusions. Suicide death records vary by gender, both in recorded evidence for mental health conditions at time of death and in accompanying narratives describing proximal circumstances surrounding these deaths. Our findings hint that patterns of subclinical mental health changes among men might be less well captured in commonly used mental health indicators, suggesting that prevention efforts may benefit from measures that also target assessment of subclinical distress. (Am J Public Health. 2024;114(S3):S268-S277. https://doi.org/10.2105/AJPH.2023.307427).
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Affiliation(s)
- Alina Arseniev-Koehler
- Alina Arseniev-Koehler is with the Division of Biomedical Informatics, University of California, San Diego, La Jolla, and the Department of Sociology, Purdue University, West Lafayette, IN. Vickie M. Mays is with the Department of Psychology, University of California, Los Angeles (UCLA), and the Department of Health Policy and Management, UCLA Fielding School of Public Health. Jacob G. Foster is with the Department of Sociology, UCLA. Kai-Wei Chang is with the Department of Computer Science, UCLA Samueli School of Engineering. Susan D. Cochran is with the Department of Epidemiology, UCLA Fielding School of Public Health, and the Department of Statistics, UCLA. Vickie M. Mays and Susan D. Cochran served as guest editors for this supplemental issue
| | - Vickie M Mays
- Alina Arseniev-Koehler is with the Division of Biomedical Informatics, University of California, San Diego, La Jolla, and the Department of Sociology, Purdue University, West Lafayette, IN. Vickie M. Mays is with the Department of Psychology, University of California, Los Angeles (UCLA), and the Department of Health Policy and Management, UCLA Fielding School of Public Health. Jacob G. Foster is with the Department of Sociology, UCLA. Kai-Wei Chang is with the Department of Computer Science, UCLA Samueli School of Engineering. Susan D. Cochran is with the Department of Epidemiology, UCLA Fielding School of Public Health, and the Department of Statistics, UCLA. Vickie M. Mays and Susan D. Cochran served as guest editors for this supplemental issue
| | - Jacob G Foster
- Alina Arseniev-Koehler is with the Division of Biomedical Informatics, University of California, San Diego, La Jolla, and the Department of Sociology, Purdue University, West Lafayette, IN. Vickie M. Mays is with the Department of Psychology, University of California, Los Angeles (UCLA), and the Department of Health Policy and Management, UCLA Fielding School of Public Health. Jacob G. Foster is with the Department of Sociology, UCLA. Kai-Wei Chang is with the Department of Computer Science, UCLA Samueli School of Engineering. Susan D. Cochran is with the Department of Epidemiology, UCLA Fielding School of Public Health, and the Department of Statistics, UCLA. Vickie M. Mays and Susan D. Cochran served as guest editors for this supplemental issue
| | - Kai-Wei Chang
- Alina Arseniev-Koehler is with the Division of Biomedical Informatics, University of California, San Diego, La Jolla, and the Department of Sociology, Purdue University, West Lafayette, IN. Vickie M. Mays is with the Department of Psychology, University of California, Los Angeles (UCLA), and the Department of Health Policy and Management, UCLA Fielding School of Public Health. Jacob G. Foster is with the Department of Sociology, UCLA. Kai-Wei Chang is with the Department of Computer Science, UCLA Samueli School of Engineering. Susan D. Cochran is with the Department of Epidemiology, UCLA Fielding School of Public Health, and the Department of Statistics, UCLA. Vickie M. Mays and Susan D. Cochran served as guest editors for this supplemental issue
| | - Susan D Cochran
- Alina Arseniev-Koehler is with the Division of Biomedical Informatics, University of California, San Diego, La Jolla, and the Department of Sociology, Purdue University, West Lafayette, IN. Vickie M. Mays is with the Department of Psychology, University of California, Los Angeles (UCLA), and the Department of Health Policy and Management, UCLA Fielding School of Public Health. Jacob G. Foster is with the Department of Sociology, UCLA. Kai-Wei Chang is with the Department of Computer Science, UCLA Samueli School of Engineering. Susan D. Cochran is with the Department of Epidemiology, UCLA Fielding School of Public Health, and the Department of Statistics, UCLA. Vickie M. Mays and Susan D. Cochran served as guest editors for this supplemental issue
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Mikolič P, Vinko M, Ropret N, Roškar S. Suicide Methods in Slovenia - Characteristics andTime Trends 2001-2020. CRISIS 2024; 45:93-99. [PMID: 37554045 DOI: 10.1027/0227-5910/a000918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Background: Between 2001 and 2020, Slovenia lost 8,952 lives due to suicides, two thirds of them by hanging. Aim: To analyze trends in suicide methods between 2001 and 2020 and to explore relationships between suicide methods and selected sociodemographic characteristic. Methods: We focused on methods accounting for 95.7% of all suicides. We performed joinpoint regression to examine changes in suicide rates by respective methods and multivariate logistic regression analyses to study sociodemographics associated with specific suicide methods. Results: A gender-specific annual decrease in suicide rates was observed in all methods except for sharp objects and jumping or lying in front of a moving object. Age was statistically significant in the use of firearms and jumping or lying in front of a moving object, while gender was significant in all methods. Associations were found between education, marital status, region of residence, and various suicide methods. Limitations: The results are potentially culturally specific. Conclusion: Certain sociodemographics seem to be associated with the selection of the method.
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Affiliation(s)
- Petra Mikolič
- Mental Health Centre, National Institute of Public Health, Ljubljana, Slovenia
| | - Matej Vinko
- Mental Health Centre, National Institute of Public Health, Ljubljana, Slovenia
| | - Nina Ropret
- Health Data Centre, National Institute of Public Health, Ljubljana, Slovenia
| | - Saška Roškar
- Mental Health Centre, National Institute of Public Health, Ljubljana, Slovenia
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Balt E, Mérelle S, Popma A, Creemers D, Heesen K, van Eijk N, van den Brand I, Gilissen R. Sociodemographic and psychosocial risk factors of railway suicide a mixed-methods study combining data of all suicide decedents in the Netherlands with data from a psychosocial autopsy study. BMC Public Health 2024; 24:607. [PMID: 38408949 PMCID: PMC10895750 DOI: 10.1186/s12889-024-18120-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/15/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Railway suicide has profound implications for the victims and their family, and affects train drivers, railway personnel, emergency services and witnesses. To inform a multilevel prevention strategy, more knowledge is required about psychosocial and precipitating risk factors of railway suicide. METHODS Data from Statistics Netherlands of all suicides between 2017 and 2021 (n = 9.241) of whom 986 died by railway suicide and interview data from a psychosocial autopsy of railway suicide decedents (n = 39) were integrated. We performed logistic regression analyses to identify sociodemographic predictors of railway suicide compared to other methods of suicide. The Constant Comparative Method was subsequently employed on interview data from the psychosocial autopsy to identify patterns in psychosocial risk factors for railway suicide. RESULTS The strongest predictors of railway suicide compared to other suicide methods were young age (< 30 years old), native Dutch, a high educational level, living in a multi-person household (especially living with parents or in an institution), living in a rural area and a high annual household income of > 150.000 euros. Several subgroups emerged in the psychosocial autopsy interviews, which specifically reflect populations at risk of railway suicide. These subgroups were [1] young adult males with autism spectrum disorder who strived for more autonomy and an independent life, [2] young adult females with persistent suicidal thoughts and behaviours, [3] middle-aged males with a persistent mood disorder who lived with family and who faced stressors proximal to the suicide in personal and professional settings, [4] male out-of-the-blue suicides and [5] persons with psychotic symptoms and a rapid deterioration. CONCLUSIONS based on our findings we propose and discuss several recommendations to prevent railway suicide. We must continue to invest in a safe railway environment by training personnel and installing barriers. Additionally, we should adopt prevention strategies that align the needs of subgroups at increased risk, including young females who have attempted other methods of suicide and young males with autism spectrum disorder. Future research should determine the cost-effectiveness and feasibility of low-maintenance, automated interventions near crossings and psychiatric facilities.
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Affiliation(s)
- Elias Balt
- 113 Suicide Prevention, Amsterdam, Netherlands.
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50
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Heuschen CBBCM, Bolhuis K, Zantvoord JB, Arjadi R, Denys DAJP, Nauta MH, Lok A, Bockting CL. Internet-based behavioural activation therapy versus online psychoeducation for self-reported suicidal ideation in individuals with depression in Indonesia: a secondary analysis of an RCT. BMJ MENTAL HEALTH 2024; 27:e300918. [PMID: 38382937 PMCID: PMC10882357 DOI: 10.1136/bmjment-2023-300918] [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: 10/20/2023] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Southeast Asia has the highest suicide mortality worldwide. To improve our knowledge on the effectiveness of interventions for suicidal ideation (SI) in individuals with depression in Indonesia, we conducted a secondary analysis of a randomised controlled trial. OBJECTIVE We explored whether an internet-based behavioural activation (BA) intervention ('Guided Act and Feel Indonesia' (GAF-ID)) was superior in targeting SI compared with online-delivered psychoeducation (PE). METHODS In total, 313 participants were randomised between treatment allocation. The SI item of the Patient Health Questionnaire-9 was the primary outcome measure. Mediation analyses were conducted to identify if BA at week 10 mediated the relationship between intervention and SI at week 24. FINDINGS The GAF-ID intervention was not superior in reducing SI compared with online minimal PE at week 10 (OR 0.61, 95% CI (0.37 to 1.01)), nor at week 24 (OR 0.84, 95% CI (0.47 to 1.52)). SI at week 24 was not mediated by BA at week 10 (b=-0.03, 95% CI (-0.05 to 0.00), p=0.07). CONCLUSIONS In individuals with depression in Indonesia, the GAF-ID intervention was not superior in reducing self-reported SI compared with PE. Also, the association between treatment condition and SI at week 24 was not mediated via BA at week 10. CLINICAL IMPLICATIONS This study supports the need for further research on the efficacy of psychological treatments targeting SI in the Southeast Asia context.
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Affiliation(s)
| | - Koen Bolhuis
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jasper B Zantvoord
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Retha Arjadi
- Faculty of Psychology, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Damiaan A J P Denys
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Maaike H Nauta
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Anja Lok
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Claudi L Bockting
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
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