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Singh G, Hansen JP, Hulgaard D, Damkjær M, Christiansen E. Impact of COVID-19 restrictions on self-poisoning behaviour with mild analgesics in Danish youth. Nord J Psychiatry 2024; 78:431-439. [PMID: 38625374 DOI: 10.1080/08039488.2024.2339433] [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: 09/27/2023] [Accepted: 03/20/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND The COVID-19 pandemic prompted the implementation of precautions to contain the disease, including lockdowns and social isolation. Previous studies have investigated suicide rates among children and adolescents during the pandemic and have found varying results. We speculated how the two lockdowns influenced suicidal behaviour in children and adolescents in Denmark. OBJECTIVE This study aimed to investigate the effect of lockdowns during the COVID-19 pandemic on suicide attempts, as measured by the incidence rate in all self-poisonings with mild analgesics among children and adolescents. METHODS This national Danish registry-based study on children and adolescents used Poisson regression and interrupted time series analysis to examine the incidence rates and trends of self-poisonings with mild analgesics from 2019 to mid-2021. RESULTS For the period of this study, 1655 self-poisonings were registered. During the first lockdown, there was a slight, not statistically significant, decrease in self-poisoning rates (incidence rate ratio [IRR]) 0.98) compared to no lockdown. During the second lockdown, there was a significant increase in self-poisonings for the whole Danish population (IRR 1.85) with girls being slightly higher at risk (IRR 1.87). Being a girl or between the ages of 13-17 years old were risk factors for self-poisoning. CONCLUSION These findings indicate that the restrictions enforced during the second lockdown greatly impacted youth mental health, especially girls, leading to an 85% increase in self-poisonings. We hope for increased awareness of mental health in children and adolescents during possible future lockdowns.
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Affiliation(s)
- Gurbhej Singh
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Jonathan Pommer Hansen
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Ditte Hulgaard
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
- Research Unit Mental Health, Children and Adult, Aabenraa, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Mads Damkjær
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Erik Christiansen
- Research Unit Mental Health, Children and Adult, Aabenraa, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Centre for Suicide Research, Odense, Denmark
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Liu L, Pollock NJ, Contreras G, Xu Y, Thompson W. Hospitalizations and emergency department visits for self-harm in Canada during the first two years of the COVID-19 pandemic: A time series analysis. J Affect Disord 2024; 355:505-512. [PMID: 38548198 DOI: 10.1016/j.jad.2024.03.123] [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: 07/12/2023] [Revised: 02/08/2024] [Accepted: 03/23/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Rates of hospitalizations and emergency department (ED) visits due to self-harm are important indicators for understanding the impact of the COVID-19 pandemic on mental health. The objective of this study was to assess changes in self-harm hospitalizations and ED visits in Canada during the first two years of the pandemic. METHODS Rates of self-harm hospitalizations and ED visits during the pandemic were predicted based on regression analyses that modeled trends over a 5-year pre-pandemic period from fiscal year 2015 to 2019. The ratios of observed and model predicted (expected) rates in 2020 and 2021 were estimated separately to assess changes during the pandemic. RESULTS Overall, rates of self-harm hospitalizations and ED visits were lower than expected during the pandemic, especially in 2020. In 2021, rates for females returned to near-expected levels; but they remained lower than expected for males. Females aged 10-14 years had higher than expected rates. The rate ratio of observed rate over expected rate was 1.2 in 2020 but further increased to 1.8 in 2021 for both hospitalizations and ED visits. Higher than expected rates were also observed among females aged 15-19 years in 2021 only. LIMITATIONS Suicide attempts and non-suicidal self-harm cases could not be distinguished. CONCLUSIONS We observed lower than or close to expected rates of self-harm hospitalizations and ED visits during the pandemic for most population groups. The increased rates for young females highlights the importance of continued surveillance post-pandemic and targeted mental health services and suicide prevention programs.
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Affiliation(s)
- Li Liu
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada.
| | - Nathaniel J Pollock
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada; Discipline of Emergency Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Gisèle Contreras
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Yuan Xu
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Wendy Thompson
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
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Elhawary AE, Lashin HI, Fnoon NF, Sagah GA. Evaluation of the rate and pattern of suicide attempts and deaths by self-poisoning among Egyptians before and during the COVID-19 pandemic. Toxicol Res (Camb) 2023; 12:1113-1125. [PMID: 38145090 PMCID: PMC10734599 DOI: 10.1093/toxres/tfad103] [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: 08/23/2023] [Revised: 09/25/2023] [Accepted: 10/17/2023] [Indexed: 12/26/2023] Open
Abstract
Background Concerns about increased suicidal attempts, especially by self-poisoning as a consequence of Coronavirus disease 2019 (COVID-19) pandemic have been raised worldwide. Aim of the study This study aimed to evaluate the rate and pattern of suicide attempts and deaths by self-poisoning among patients admitted to Tanta University Poisoning Control Center one year before and following COVID-19 pandemic declaration in Egypt. It was conducted on the medical records of 3,200 poisoned patients, from March 2019 to February 2021. Demographic, toxicological data and patients' outcomes were collected. Results During the pandemic year, 63.8% of total admitted patients alleged suicidal self-poisoning. Adults significantly decreased from 59% to 52.3%, while adolescents significantly increased from 34.6% to 41.7%. Monthly numbers of admitted suicidal self-poisoned patients significantly decreased during the lockdown but significantly increased from 7% to 26.5%, during the peak of the second wave of the pandemic as well as suicidal deaths (increased from 1.9% to 21.2%). Suicidal self-poisoning in females increased late in the pandemic year and suicidal self-poisoning deaths were significantly reported from rural areas (P = 0.025). The delay time was significantly longer, length of hospital stay was significantly shorter, intensive care unit admission rates and suicidal deaths were significantly increased during the pandemic year (P < 0.001, 0.026, <0.001, <0.001, respectively). Phosphides were the most commonly used poison for committing suicide and suicidal deaths during this year. Conclusion Psychological support should be directed to females and adolescents, especially from rural areas in Egypt to help reduce suicidal attempts and deaths by self-poisoning during any future pandemics and lockdowns.
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Affiliation(s)
- Amira Elsayed Elhawary
- Forensic Medicine and Clinical Toxicology Department, 6 floor, Faculty of Medicine, Tanta University, Medical Campus, Al‑Geish Street, Tanta, Gharbia 31527, Egypt
| | - Heba Ibrahim Lashin
- Forensic Medicine and Clinical Toxicology Department, 6 floor, Faculty of Medicine, Tanta University, Medical Campus, Al‑Geish Street, Tanta, Gharbia 31527, Egypt
| | - Noha Fawzy Fnoon
- Neuropsychiatry Department, Faculty of Medicine, Tanta University, Medical Campus, Al‑Geish Street, Tanta, Gharbia 31527, Egypt
| | - Ghada Attia Sagah
- Forensic Medicine and Clinical Toxicology Department, 6 floor, Faculty of Medicine, Tanta University, Medical Campus, Al‑Geish Street, Tanta, Gharbia 31527, Egypt
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Sahoo S, Patra S. A Rapid Systematic Review of the Prevalence of Suicide and Self-Harm Behaviors in Adolescents During the COVID-19 Pandemic. CRISIS 2023; 44:497-505. [PMID: 37194641 DOI: 10.1027/0227-5910/a000906] [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: 05/18/2023]
Abstract
Background: COVID-19 has caused psychological, social, and physical isolation in adolescents resulting in varying rates of suicidal behavior and self-harm. Aims: We investigated the pandemic's impact on adolescent suicidal behavior and self-harm by reviewing the existing literature. Methods: We searched PubMed using keywords: adolescent, suicide, suicidal behavior, self-harm, prevalence, and COVID-19 and included studies reporting primary data only. Results: Of the 551 studies identified, we included 39 studies in the final analysis. Two of the six high-quality population-based suicide registry studies reported increased suicide rates during the pandemic. Seven of fifteen emergency department-based studies out of which four were of high quality and three high-quality population-based health registry studies reported increased self-harm. A few school and community-based surveys and national helpline data also reported an increase in suicidal behavior or self-harm. Limitations: Methodological heterogeneity of the included studies. Conclusions: There is wide variation in study methodology, population, settings, and age groups in the included studies. Suicidal behavior and self-harm were increased in specific study settings and adolescent populations during the pandemic. More methodologically rigorous research is needed to evaluate the impact of COVID-19 on adolescent suicidal behavior and self-harm.
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Affiliation(s)
- Swapnajeet Sahoo
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Suravi Patra
- Department of Psychiatry, All India Institute of Medical Sciences Bhubaneswar, India
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Pearson M, Dawson A, Raubenheimer J, Senerathna L, Conigrave K, Lee KSK, Rajapakse T, Pushpakumara PHGJ, Siribaddana S, Soerensen JB, Konradsen F, Jan S, Dawson AJ, Buckley N, Abeysinghe R, Siriwardhana P, Priyadarshana C, Haber PS, Dzidowska M, Abeykoon P, Glozier N. Community-based alcohol education intervention (THEATRE) study to reduce harmful effects of alcohol in rural Sri Lanka: design and adaptation of a mixed-methods stepped wedge cluster randomised control trial. BMJ Open 2023; 13:e064722. [PMID: 37321807 PMCID: PMC10276966 DOI: 10.1136/bmjopen-2022-064722] [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: 05/19/2022] [Accepted: 04/19/2023] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION Alcohol consumption is a leading cause of mortality, morbidity and adverse social sequelae in Sri Lanka. Effective community-based, culturally adapted or context-specific interventions are required to minimise these harms. We designed a mixed-methods stepped wedge cluster randomised control trial of a complex alcohol intervention. This paper describes the initial trial protocol and subsequent modifications following COVID-19. METHODS AND ANALYSIS We aimed to recruit 20 villages (approximately n=4000) in rural Sri Lanka. The proposed intervention consisted of health screening clinics, alcohol brief intervention, participatory drama, film, and public health promotion materials to be delivered over 12 weeks.Following disruptions to the trial resulting from the Easter bombings in 2019, COVID-19 and a national financial crisis, we adapted the study in two main ways. First, the interventions were reconfigured for hybrid delivery. Second, a rolling pre-post study evaluating changes in alcohol use, mental health, social capital and financial stress as the primary outcome and implementation and ex-ante economic analysis as secondary outcomes. ETHICS AND DISSEMINATION The original study and amendments have been reviewed and granted ethical approval by Rajarata University of Sri Lanka (ERC/2018/21-July 2018 and February 2022) and the University of Sydney (2019/006). Findings will be disseminated locally in collaboration with the community and stakeholders.The new hybrid approach may be more adaptable, scalable and generalisable than the planned intervention. The changes will allow a closer assessment of individual interventions while enabling the evaluation of this discontinuous event through a naturalistic trial design. This may assist other researchers facing similar disruptions to community-based studies. TRIAL REGISTRATION The trial is registered with the Sri Lanka Clinical Trials Registry; https://slctr.lk/trials/slctr-2018-037.
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Affiliation(s)
- Melissa Pearson
- Centre for Pesticide Suicide Prevention, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Andrew Dawson
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Jacques Raubenheimer
- Biomedical Informatics and Digital Health, University of Sydney, Sydney, New South Wales, Australia
| | - Lalith Senerathna
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Health Promotion, Faculty of Applied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | - Katherine Conigrave
- Sydney Medical School, Royal Prince Albert Hospital, Camperdown, New South Wales, Australia
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Camperdown, New South Wales, Australia
| | - K S Kylie Lee
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Thilini Rajapakse
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Pahala Hangidi Gedara Janaka Pushpakumara
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Family Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Peradeniya, Sri Lanka
| | - Sisira Siribaddana
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Jane Brandt Soerensen
- Global Health Section, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Konradsen
- Global Health Section, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stephen Jan
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Angela J Dawson
- Faculty of Health, World Health Collaborating Centre, University of Technology, Sydney, Sydney, New South Wales, Australia
| | - Nicholas Buckley
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Biomedical Informatics and Digital Health, University of Sydney, Sydney, New South Wales, Australia
| | - Ranil Abeysinghe
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Prabash Siriwardhana
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Health Promotion, Faculty of Applied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | - Chamil Priyadarshana
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Paul S Haber
- Sydney Medical School, Royal Prince Albert Hospital, Camperdown, New South Wales, Australia
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Monika Dzidowska
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | | | - Nick Glozier
- Brain and Mind Research Institute, University of Sydney, Sydney, New South Wales, Australia
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Roversi M, Martini M, Musolino A, Pisani M, Zampini G, Genuini L, Bottari G, Di Nardo M, Stoppa F, Marano M. Drug self-poisoning in adolescents: A report of 267 cases. Toxicol Rep 2023; 10:680-685. [PMID: 37304378 PMCID: PMC10247951 DOI: 10.1016/j.toxrep.2023.05.012] [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: 04/06/2023] [Revised: 05/17/2023] [Accepted: 05/28/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction The current study aims at describing a sample of adolescents admitted to a tertiary referral pediatric hospital for drug self-poisoning and to identify variables that could explain and predict a higher severity of intoxication. Methods We retrospectively reviewed the cases of drug self-poisoning in adolescents admitted to the Bambino Gesù Children's Hospital between January 2014 and June 2022 requiring consultation by the local Pediatric Poison Control Center (PPCC). We reported the type and class of drug ingested and correlated the clinical characteristics of the patients with their Poison Severity Score. Results The data of 267 patients were reported. Most patients were female (85.8 %), with a median age of 15.8 years at presentation. Half of the patients were symptomatic at admission (44.2 %), and most had at least one psychiatric comorbidity (71.1 %). Most patients were hospitalized (79.6 %), 16.6 % of cases required antidote administration and a minority required intensive care. Most patients received a PSS score of 0 (59.6 %). The most frequently ingested drug was acetaminophen (28.1 %) followed by ibuprofen (10.1 %) and aripiprazole (10.1 %). Antipsychotics as a class were the most abused drugs (33.1 %). The correlation of clinical variables with the PSS showed that older and male patients were more prone to be severely intoxicated. Conclusions This single-center study identifies the most commonly ingested drugs in a large sample of adolescents with voluntary drug self-poisoning, also showing that older and male patients are more susceptible to severe intoxication.
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Affiliation(s)
- Marco Roversi
- Clinical Trial Area, Development and Implementation of Drugs, Vaccines, and Medical Devices for pediatric use, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Matteo Martini
- Pediatric Poison Control Centre, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonio Musolino
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Mara Pisani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giorgio Zampini
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Leonardo Genuini
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Gabriella Bottari
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Francesca Stoppa
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Marco Marano
- Pediatric Poison Control Centre, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Zheng W, Han L, Fan Y, Yi M, Lu X, Yang J, Peng X, Yang Y. Association of mental health status between self-poisoning suicide patients and their family members: a matched-pair analysis. BMC Psychiatry 2023; 23:294. [PMID: 37118663 PMCID: PMC10144897 DOI: 10.1186/s12888-023-04779-9] [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: 01/30/2023] [Accepted: 04/12/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND The objective of this study was to examine the relationship of mental health status between self-poisoning suicide patients and their family members, and it also sought to identify potential patient's risk and parental factors for the prediction of suicide attempt, anxiety, and depression. METHODS In this study, 151 poisoned patients were prospectively included, and they were matched 1:1 with 151 family members. We gathered information on patient's and their matched family member's demographics, lifestyle choices, mental health status, level of intimacy, and history of psychiatry disease. The relationship of patient's and their family member's mental health state was investigated using a correlation matrix. Multivariable analyses (multiple logistic regression) were conducted among patients and their matched family members, to identify potential risk factors for self-poisoning suicide, anxiety, and depression. RESULTS Of the total patients, 67.55% (102/151) attempted self-poisoning suicide. Poisoned patients had more severe anxiety and depression symptoms than their matched family members, and this difference was even more pronounced among patients with self-poisoning suicide. Generalized anxiety disorder-7 (GAD-7) score for family members was significantly and favorably correlated with patient's GAD-7 score after eliminating non-suicide patients and their matched family members. The patient health questionnaire-9 (PHQ-9) score showed a similar pattern, and the family member's PHQ-9 score was strongly and favorably associated with patient's PHQ-9 and Beck hopelessness scale-20 (BHS-20) score. Multivariable analysis showed that married marital status (P = 0.038), quitting smoking (P = 0.003), sedentary time of 1 to 6 h (P = 0.013), and participation in a sports more than five times per week (P = 0.046) were all significantly associated with a lower risk of suicide by self-poisoning, while a more serious anxiety state (P = 0.001) was significantly associated with a higher risk of self-poisoning suicide. Multivariable analysis demonstrated that, specifically among self-poisoning suicide patients, married marital status (P = 0.011) and no history of psychiatry disease (P < 0.001) were protective factors for anxiety, while divorced or widowed marital status (P = 0.004), a sedentary time of 1 to 3 h (P = 0.022), and a higher monthly income (P = 0.027) were significant contributors to anxiety. The propensity of additional family-matched characteristics to predict patient's suicidality, anxiety, and depression was also examined. CONCLUSIONS Self-poisoning suicide patients have severe mental health issues. Patients who self-poison have a close connection to their family member's mental health, particularly their levels of anxiety and depression. According to the findings, being married and adopting healthy lifestyle habits, such as quitting smoking and drinking, increasing their physical activity levels, and managing their idle time, are able to help patients with mental health concerns and even suicidal thoughts.
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Affiliation(s)
- Wenjing Zheng
- Department of Chemical Poisoning Treatment, Senior Department of Hematology, Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Limei Han
- Department of Chemical Poisoning Treatment, Senior Department of Hematology, Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Yanna Fan
- Department of Radiotherapy, Senior Department of Oncology, Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Min Yi
- Institute of Medical Information and Library, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoxia Lu
- Department of Chemical Poisoning Treatment, Senior Department of Hematology, Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Juan Yang
- Department of Emergency, Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Xiaobo Peng
- Department of Chemical Poisoning Treatment, Senior Department of Hematology, Fifth Medical Center of PLA General Hospital, Beijing, China.
| | - Ying Yang
- Nursing Department, Fifth Medical Center of PLA General Hospital, Beijing, China.
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Barlattani T, D'Amelio C, Capelli F, Mantenuto S, Rossi R, Socci V, Stratta P, Di Stefano R, Rossi A, Pacitti F. Suicide and COVID-19: a rapid scoping review. Ann Gen Psychiatry 2023; 22:10. [PMID: 36932453 PMCID: PMC10020759 DOI: 10.1186/s12991-023-00441-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/03/2023] [Indexed: 03/19/2023] Open
Abstract
There is considerable interest in exploring effects of coronavirus disease 2019 (COVID-19) pandemic on mental health. Suicide is one of the leading causes of mortality worldwide and changes in daily life brought by the pandemic may be additional risk factors in people with pre-existing mental disorders. This rapid PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) scoping review aims to identify and analyze current evidence about the relation between COVID-19 pandemic outbreak, along with COVID-19 disease and severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection, and suicide in individuals with previously diagnosed mental disorders. First, we conducted a comprehensive review of the literature, then proceeded to discuss findings in a narrative way. Tables were constructed and articles sorted according to the studies' methodologies. 53 papers were eventually identified as eligible, among which 33 are cross-sectional studies, 9 are longitudinal studies, and 11 studies using other methodologies. Despite suffering from a mental disorder is a risk factor for suicidal behavior per se, the advent of COVID-19 pandemic may exacerbate this relation. Nevertheless, data addressing a clear correlation between suicidal behavior and the pandemic outbreak are still controversial. Longitudinal analysis using validated suicide scales and multicenter studies could provide deeper insight and knowledge about this topic.
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Affiliation(s)
- Tommaso Barlattani
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio, 67100, Coppito, L'Aquila, Italy.
| | - Chiara D'Amelio
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio, 67100, Coppito, L'Aquila, Italy
| | - Francesco Capelli
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio, 67100, Coppito, L'Aquila, Italy
| | - Simonetta Mantenuto
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio, 67100, Coppito, L'Aquila, Italy
| | - Rodolfo Rossi
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier, 1, 00133, Rome, Italy
| | - Valentina Socci
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio, 67100, Coppito, L'Aquila, Italy
| | - Paolo Stratta
- Department of Mental Health Sulmona-Avezzano-L'Aquila, ASL 1, Abruzzo, Italy
| | - Ramona Di Stefano
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio, 67100, Coppito, L'Aquila, Italy
| | - Alessandro Rossi
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio, 67100, Coppito, L'Aquila, Italy
| | - Francesca Pacitti
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio, 67100, Coppito, L'Aquila, Italy
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Rajapakse T, Silva T, Hettiarachchi NM, Gunnell D, Metcalfe C, Spittal MJ, Knipe D. The Impact of the COVID-19 Pandemic and Lockdowns on Self-Poisoning and Suicide in Sri Lanka: An Interrupted Time Series Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1833. [PMID: 36767200 PMCID: PMC9914278 DOI: 10.3390/ijerph20031833] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/11/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
Evidence from high-income countries suggests that the impact of COVID-19 on suicide and self-harm has been limited, but evidence from low- and middle-income countries is lacking. Using data from a hospital-based self-poisoning register (January 2019-December 2021) and data from national records (2016-2021) of suicide in Sri Lanka, we aimed to assess the impact of the pandemic on both self-poisoning and suicide. We examined changes in admissions for self-poisoning and suicide using interrupted time series (ITS) analysis. For the self-poisoning hospital admission ITS models, we defined the lockdown periods as follows: (i) pre-lockdown: 01/01/2019-19/03/2020; (ii) first lockdown: 20/03/2020-27/06/2020; (iii) post-first lockdown: 28/06/2020-11/05/2021; (iv) second lockdown: 12/05/2021-21/06/2021; and (v) post-second lockdown: 22/06/2021-31/12/2021. For suicide, we defined the intervention according to the pandemic period. We found that during lockdown periods, there was a reduction in hospital admissions for self-poisoning, with evidence that admission following self-poisoning remained lower during the pandemic than would be expected based on pre-pandemic trends. In contrast, there was no evidence that the rate of suicide in the pandemic period differed from that which would be expected. As the long-term socioeconomic impacts of the pandemic are realised, it will be important to track rates of self-harm and suicide in LMICs to inform prevention.
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Affiliation(s)
- Thilini Rajapakse
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya 20400, Sri Lanka
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya 20400, Sri Lanka
| | - Tharuka Silva
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya 20400, Sri Lanka
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya 20400, Sri Lanka
| | | | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
- National Institute of Health Research Biomedical Research Centre, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
| | - Chris Metcalfe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
| | - Matthew J. Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Duleeka Knipe
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya 20400, Sri Lanka
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
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Chidiac AS, Buckley NA, Noghrehchi F, Cairns R. Paracetamol (acetaminophen) overdose and hepatotoxicity: mechanism, treatment, prevention measures, and estimates of burden of disease. Expert Opin Drug Metab Toxicol 2023; 19:297-317. [PMID: 37436926 DOI: 10.1080/17425255.2023.2223959] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/05/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION Paracetamol is one of the most used medicines worldwide and is the most common important poisoning in high-income countries. In overdose, paracetamol causes dose-dependent hepatotoxicity. Acetylcysteine is an effective antidote, however despite its use hepatotoxicity and many deaths still occur. AREAS COVERED This review summarizes paracetamol overdose and toxicity (including mechanisms, risk factors, risk assessment, and treatment). In addition, we summarize the epidemiology of paracetamol overdose worldwide. A literature search on PubMed for poisoning epidemiology and mortality from 1 January 2017 to 26 October 2022 was performed to estimate rates of paracetamol overdose, liver injury, and deaths worldwide. EXPERT OPINION Paracetamol is widely available and yet is substantially more toxic than other analgesics available without prescription. Where data were available, we estimate that paracetamol is involved in 6% of poisonings, 56% of severe acute liver injury and acute liver failure, and 7% of drug-induced liver injury. These estimates are limited by lack of available data from many countries, particularly in Asia, South America, and Africa. Harm reduction from paracetamol is possible through better identification of high-risk overdoses, and better treatment regimens. Large overdoses and those involving modified-release paracetamol are high-risk and can be targeted through legislative change.
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Affiliation(s)
- Annabelle S Chidiac
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, Australia
- New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia
| | - Nicholas A Buckley
- New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia
- Faculty of Medicine and Health, School of Medical Sciences, Discipline of Biomedical Informatics and Digital Health, The University of Sydney, Sydney, Australia
| | - Firouzeh Noghrehchi
- Faculty of Medicine and Health, School of Medical Sciences, Discipline of Biomedical Informatics and Digital Health, The University of Sydney, Sydney, Australia
| | - Rose Cairns
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, Australia
- New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia
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11
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He J, Ning P, Schwebel DC, Yang Y, Li L, Cheng P, Rao Z, Hu G. Injury mortality and morbidity changes due to the COVID-19 pandemic in the United States. Front Public Health 2022; 10:1001567. [PMID: 36408028 PMCID: PMC9666887 DOI: 10.3389/fpubh.2022.1001567] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction The COVID-19 pandemic significantly changed society. We aimed to examine the systematic impact of the COVID-19 on injury burden in the United States. Methods We extracted mortality and morbidity data from CDC WONDER and WISQARS. We estimated age-standardized injury mortality rate ratio and morbidity rate ratio (MtRR and MbRR) with 95% confidence interval (95% CI) for all injuries, all unintentional injuries, homicide/assault by all methods, suicide/self-harm by all methods, as well as other 11 specific unintentional or intentional injury categories. Injury rate ratios were compared for 2020 vs. 2019 to those of 2019 vs. 2018 to demonstrate the influence of the COVID-19 pandemic on fatal and nonfatal injury burden. The ratio of MtRRs (RMtRR) and the ratio of MbRRs (RMbRR) with 95% CI between 2020 vs. 2019 and 2019 vs. 2018 were calculated separately. Results The COVID-19 pandemic was associated with an increase in injury mortality (RMtRR = 1.12, 95% CI: 1.11, 1.13) but injury morbidity decreased (RMbRR = 0.88, 95% CI: 0.88, 0.89) when the changes of these rates from 2019 to 2020 were compared to those from 2018 to 2019. Mortality disparities between the two time periods were primarily driven by greater mortality during the COVID-influenced 2020 vs. 2019 from road traffic crashes (particularly motorcyclist mortality), drug poisoning, and homicide by firearm. Similar patterns were not present from 2019 vs. 2018. There were morbidity reductions from road traffic crashes (particularly occupant and pedestrian morbidity from motor vehicle crashes), unintentional falls, and self-harm by suffocation from 2019 to 2020 compared to the previous period. Change patterns in sexes and age groups were generally similar, but exceptions were observed for some injury types. Conclusions The COVID-19 pandemic significantly changed specific injury burden in the United States. Some discrepancies also existed across sex and age groups, meriting attention of injury researchers and policymakers to tailor injury prevention strategies to particular populations and the environmental contexts citizens face.
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Affiliation(s)
- Jieyi He
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Peishan Ning
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - David C. Schwebel
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Yang Yang
- Department of Statistics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, United States
| | - Li Li
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Peixia Cheng
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Zhenzhen Rao
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Guoqing Hu
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China,*Correspondence: Guoqing Hu
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12
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Wagner GA, Almeida TRFD, Araújo ALD, Munhoz DM, Andrade PG. Time series analysis of the suicide attempts assisted by firefighters from 2017 to 2021 in São Paulo, Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2022; 25:e220026. [PMID: 36259886 DOI: 10.1590/1980-549720220026] [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: 04/19/2022] [Accepted: 08/22/2022] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE This study aimed to analyze the time trends of suicide attempts assisted by the Fire Department of the Military Police of the State of São Paulo (Corpo de Bombeiros da Polícia Militar do Estado de São Paulo - CBPMESP) from 2017 to 2021, between sexes. METHODS This is an ecological study of 11,435 suicide attempts assisted by CBPMESP calls from January 2017 to December 2021. Three seasonal auto-regressive integrated moving average with exogenous (SARIMAX) models were adjusted considering total population, only men, and only women. RESULTS The total occurrences of suicide attempts were stationary in the prepandemic period but had an increased growth pattern after the pandemic began. This trend was higher among men, due to (1) lower assistance of suicide attempts during early pandemic than in the prepandemic period and (2) significant increased assistance after the beginning of vaccination against COVID-19, followed by a decrease, but with a tendency to increase, in the long-term pandemic. CONCLUSION Our results indicate a growth in the long-term suicide attempts during COVID-19. The beginning of vaccination was not considered significant in the reduction of CBPMESP attendances. These results corroborate the need for a multisectoral national suicide prevention strategy to mitigate the effects of the pandemic on mental health in the State of São Paulo.
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Affiliation(s)
- Gabriela Arantes Wagner
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Preventive Medicine - São Paulo (SP), Brazil
| | - Tiago Regis Franco de Almeida
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Preventive Medicine - São Paulo (SP), Brazil
- Polícia Militar do Estado de São Paulo, Higher School of Fire Department - São Paulo (SP), Brazil
| | - Adriana Leandro de Araújo
- Polícia Militar do Estado de São Paulo, Geostatistics section of the Operational Department of the Fire Department - São Paulo (SP), Brazil
| | - Diógenes Martins Munhoz
- Polícia Militar do Estado de São Paulo, Higher School of Fire Department - São Paulo (SP), Brazil
| | - Pedro Gomes Andrade
- Instituto de Pesquisa Econômica Aplicada, Diretoria de Estudos e Políticas do Estado, das Instituições e da Democracia - São Paulo (SP), Brazil
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13
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Rahimi-Ardabili H, Feng X, Nguyen PY, Astell-Burt T. Have Deaths of Despair Risen during the COVID-19 Pandemic? A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12835. [PMID: 36232135 PMCID: PMC9564909 DOI: 10.3390/ijerph191912835] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
This systematic review synthesized literature on potential impacts of protracted isolation and other disruptions during the COVID-19 pandemic on deaths of despair (suicide, overdoses, and drug-related liver diseases). Five electronic databases were searched yielding 70 eligible articles. Extant evidence mostly from high-income countries indicates COVID-19-related disruption may not have influenced suicide rates so far, but there have been reports of increased drug-related and liver disease mortality. Minority groups and women were more vulnerable, indicating the need for stronger equity focus on pandemic recovery and resilience strategies. Further high-quality studies with longer-term follow-up, especially from low-income countries, will inform these strategies.
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Affiliation(s)
- Hania Rahimi-Ardabili
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney 2109, Australia
- Population Wellbeing and Environment Research Lab (PowerLab), Wollongong 2522, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney 2052, Australia
| | - Xiaoqi Feng
- Population Wellbeing and Environment Research Lab (PowerLab), Wollongong 2522, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney 2052, Australia
- School of Health and Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong 2522, Australia
| | - Phi-Yen Nguyen
- Population Wellbeing and Environment Research Lab (PowerLab), Wollongong 2522, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney 2052, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3800, Australia
| | - Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), Wollongong 2522, Australia
- School of Health and Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong 2522, Australia
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14
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DePina A, Barros H, Tiffany A, Stresman G. Sustaining surveillance as an intervention during the COVID-19 pandemic in Cabo Verde and implications for malaria elimination. Front Immunol 2022; 13:956864. [PMID: 36275761 PMCID: PMC9582766 DOI: 10.3389/fimmu.2022.956864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/20/2022] [Indexed: 12/03/2022] Open
Abstract
Cabo Verde reported the first case of COVID-19 on March 19, 2020. Containment measures were quickly implemented and over 80,000 COVID-19 tests were performed in 2020 with 11,840 confirmed infections (2% of the population) and 154 deaths. In a setting where the last locally acquired malaria case was reported in January 2018, any interruptions to malaria care-seeking have the potential for infections to go untreated and transmission re-establishing. This work aims to determine whether there was any change in the number of people seeking care or being tested for malaria and, using an interrupted time series analysis, identify if any change was associated with implemented COVID-19 measures. Routinely collected surveillance data for outpatient visits, testing for malaria and COVID-19 were aggregated by month for each health facility (outpatient and malaria) or by municipality (COVID-19) from 2017 through 2020. The timeline of COVID-19 measures was generated based on when and where they were implemented. Results show that there was a marked shift in care-seeking in Cabo Verde. Overall, the mean number of observed outpatient visits decreased from 2,057 visits per month during 2017-2019 to 1,088 in 2020, an estimated 28% reduction. However, malaria testing rates per 1,000 outpatient visits after the pandemic began increased by 8% compared to expected trends. Results suggest that the pandemic impacted care-seeking but led to a non-significant increase in testing for malaria per 1,000 outpatient visits. With the cessation of international travel, the risk of imported infections seeding new transmission declined suggesting the risk of undetected transmission was low. It is important for countries to understand their specific malaria risks and vulnerabilities in order to ensure that any progress towards the interruption of malaria transmission can be sustained.
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Affiliation(s)
- Adilson DePina
- Programa de Eliminação do Paludismo, CCS-SIDA, Ministério da Saúde, Praia, Cabo Verde
- Ecole Doctorale Sciences de la Vie, de la Santé et de l’Environnement - Université Cheikh Anta Diop, Dakar, Senegal
| | - Helga Barros
- Unidade de Estatística, Delegacia de Saúde da Praia, Praia, Cabo Verde
| | - Amanda Tiffany
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Gillian Stresman
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Epidemiology Department, College of Public Health, University of South Florida, Tampa, FL, United States
- *Correspondence: Gillian Stresman, ;
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15
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Steeg S, John A, Gunnell DJ, Kapur N, Dekel D, Schmidt L, Knipe D, Arensman E, Hawton K, Higgins JPT, Eyles E, Macleod-Hall C, McGuiness LA, Webb RT. The impact of the COVID-19 pandemic on presentations to health services following self-harm: systematic review. Br J Psychiatry 2022; 221:603-612. [PMID: 35816104 DOI: 10.1192/bjp.2022.79] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Evidence on the impact of the pandemic on healthcare presentations for self-harm has accumulated rapidly. However, existing reviews do not include studies published beyond 2020. AIMS To systematically review evidence on presentations to health services following self-harm during the COVID-19 pandemic. METHOD A comprehensive search of databases (WHO COVID-19 database; Medline; medRxiv; Scopus; PsyRxiv; SocArXiv; bioRxiv; COVID-19 Open Research Dataset, PubMed) was conducted. Studies published from 1 January 2020 to 7 September 2021 were included. Study quality was assessed with a critical appraisal tool. RESULTS Fifty-one studies were included: 57% (29/51) were rated as 'low' quality, 31% (16/51) as 'moderate' and 12% (6/51) as 'high-moderate'. Most evidence (84%, 43/51) was from high-income countries. A total of 47% (24/51) of studies reported reductions in presentation frequency, including all six rated as high-moderate quality, which reported reductions of 17-56%. Settings treating higher lethality self-harm were overrepresented among studies reporting increased demand. Two of the three higher-quality studies including study observation months from 2021 reported reductions in self-harm presentations. Evidence from 2021 suggests increased numbers of presentations among adolescents, particularly girls. CONCLUSIONS Sustained reductions in numbers of self-harm presentations were seen into the first half of 2021, although this evidence is based on a relatively small number of higher-quality studies. Evidence from low- and middle-income countries is lacking. Increased numbers of presentations among adolescents, particularly girls, into 2021 is concerning. Findings may reflect changes in thresholds for help-seeking, use of alternative sources of support and variable effects of the pandemic across groups.
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Affiliation(s)
- Sarah Steeg
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester, UK; and Manchester Academic Health Science Centre, UK
| | - Ann John
- Medical School, Swansea University, UK; and Public Health Wales NHS Trust, UK
| | - David J Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, UK; and National Institute for Health Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, UK
| | - Nav Kapur
- Division of Psychology and Mental Health, University of Manchester, UK;NIHR Greater Manchester Patient Safety Translational Research Centre, UK; and Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Dana Dekel
- Department of Population Psychiatry, Suicide and Informatics, Swansea University, UK
| | - Lena Schmidt
- Sciome LLC, North Carolina, USA; Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Ella Arensman
- School of Public Health and National Suicide Research Foundation, University College Cork, Ireland; and Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Australia
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, UK; and Warneford Hospital, Oxford Health NHS Foundation Trust, UK
| | - Julian P T Higgins
- National Institute for Health Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, UK; National Institute for Health Research Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, UK; and Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Emily Eyles
- National Institute for Health Research Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, UK; and Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | | | - Luke A McGuiness
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Roger T Webb
- Division of Psychology and Mental Health, University of Manchester, UK; and NIHR Greater Manchester Patient Safety Translational Research Centre, UK
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Sinyor M, Knipe D, Borges G, Ueda M, Pirkis J, Phillips MR, Gunnell D. Suicide Risk and Prevention During the COVID-19 Pandemic: One Year On. Arch Suicide Res 2022; 26:1944-1949. [PMID: 34425066 DOI: 10.1080/13811118.2021.1955784] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Emerging data from high and upper-middle-income countries indicate that suicide rates generally did not increase during the initial months of the COVID-19 pandemic, yet the pandemic's impact on suicide is complex. We discuss the nuances of this relationship, how it may evolve over time, and describe the specific steps that governments and societies must take to mitigate harm and prevent suicides in the late stages and aftermath of the pandemic.
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17
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Kirtley OJ, Janssens JJ, Kaurin A. Open Science in Suicide Research Is Open for Business. CRISIS 2022; 43:355-360. [PMID: 35915973 DOI: 10.1027/0227-5910/a000859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Olivia J Kirtley
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Belgium
| | - Julie J Janssens
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Belgium
| | - Aleksandra Kaurin
- Faculty of Health/School of Psychology and Psychiatry, Witten/Herdecke University, Germany
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18
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Duarte F, Jiménez-Molina Á. Suicide and quarantine during the COVID-19 pandemic: Do we know everything? Soc Sci Med 2022; 309:115253. [PMID: 35961215 PMCID: PMC9356570 DOI: 10.1016/j.socscimed.2022.115253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 07/01/2022] [Accepted: 07/29/2022] [Indexed: 12/02/2022]
Abstract
Background There is widespread concern over the impact of COVID-19 and lockdown measures on suicidal behaviour. We assessed their effects on suicide and hospitalization for attempted suicide during the initial phase of the pandemic in Chile. Methods We used panel data at the county and month level from January 1, 2016 to December 31, 2020 on suicides and related hospitalizations and a pandemic quarantine dataset. Poisson regression models and a difference-in-difference (DiD) methodology was used to estimate the impact of quarantine on both measures. Findings Suicide and hospitalizations for attempted suicide decreased (18% and 5.8%, respectively) during the COVID-19 outbreak in Chile (March–December 2020) compared to the same period in 2016–2019. The DiD analysis showed that there was at least a 13.2% reduction in suicides in quarantined counties relative to counties without such restrictions. This reduction was in male suicides and unaffected by age. There was no significant difference between quarantined and non-quarantined counties in terms of hospitalization for suicide attempts. Conclusions This study shows a significant quarantine effect on reducing suicide during the initial phase of the COVID-19 pandemic in Chile. Changes in the number of hospitalizations for suicide attempts do not explain the differences between quarantined and non-quarantined counties.
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The effect of the COVID-19 lockdown on mental health care use in South Africa: an interrupted time-series analysis. Epidemiol Psychiatr Sci 2022; 31:e43. [PMID: 35703078 PMCID: PMC9245492 DOI: 10.1017/s2045796022000270] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIMS The coronavirus disease 2019 (COVID-19) pandemic and ensuing restrictions have negatively affected the mental health and well-being of the general population, and there is increasing evidence suggesting that lockdowns have led to a disruption of health services. In March 2020, South Africa introduced a lockdown in response to the COVID-19 pandemic, entailing the suspension of all non-essential activities and a complete ban of tobacco and alcohol sales. We studied the effect of the lockdown on mental health care utilisation rates in private-sector care in South Africa. METHODS We conducted an interrupted time-series analysis using insurance claims from 1 January 2017 to 1 June 2020 of beneficiaries 18 years or older from a large private sector medical insurance scheme. We calculated weekly outpatient consultation and hospital admission rates for organic mental disorders, substance use disorders, serious mental disorders, depression, anxiety, other mental disorders, any mental disorder and alcohol withdrawal syndrome. We calculated adjusted odds ratios (OR) for the effect of the lockdown on weekly outpatient consultation and hospital admission rates and the weekly change in rates during the lockdown until 1 June 2020. RESULTS 710 367 persons were followed up for a median of 153 weeks. Hospital admission rates (OR 0.38; 95% confidence interval (CI) 0.33-0.44) and outpatient consultation rates (OR 0.74; 95% CI 0.63-0.87) for any mental disorder decreased substantially after the introduction of the lockdown and did not recover to pre-lockdown levels by 1 June 2020. Health care utilisation rates for alcohol withdrawal syndrome doubled after the introduction of the lockdown, but the statistical uncertainty around the estimates was large (OR 2.24; 95% CI 0.69-7.24). CONCLUSIONS Mental health care utilisation rates for inpatient and outpatient services decreased substantially after the introduction of the lockdown. Hospital admissions and outpatient consultations for alcohol withdrawal syndrome increased after the introduction of the lockdown, but statistical uncertainty precludes strong conclusions about a potential unintended effect of the alcohol sales ban. Governments should integrate strategies for ensuring access and continuity of essential mental health services during lockdowns in pandemic preparedness planning.
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Knipe D, John A, Padmanathan P, Eyles E, Dekel D, Higgins JPT, Bantjes J, Dandona R, Macleod-Hall C, McGuinness LA, Schmidt L, Webb RT, Gunnell D. Suicide and self-harm in low- and middle- income countries during the COVID-19 pandemic: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000282. [PMID: 36962383 PMCID: PMC10021274 DOI: 10.1371/journal.pgph.0000282] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 04/05/2022] [Indexed: 04/12/2023]
Abstract
There is widespread concern over the potential impact of the COVID-19 pandemic on suicide and self-harm globally, particularly in low- and middle-income countries (LMIC) where the burden of these behaviours is greatest. We synthesised the evidence from the published literature on the impact of the pandemic on suicide and self-harm in LMIC. This review is nested within a living systematic review (PROSPERO ID CRD42020183326) that continuously identifies published evidence (all languages) through a comprehensive automated search of multiple databases (PubMed; Scopus; medRxiv, PsyArXiv; SocArXiv; bioRxiv; the WHO COVID-19 database; and the COVID-19 Open Research Dataset by Semantic Scholar (up to 11/2020), including data from Microsoft Academic, Elsevier, arXiv and PubMed Central.) All articles identified by the 4th August 2021 were screened. Papers reporting on data from a LMIC and presenting evidence on the impact of the pandemic on suicide or self-harm were included. Methodological quality was assessed using an appropriate tool, and a narrative synthesis presented. A total of 22 studies from LMIC were identified representing data from 12 countries. There was an absence of data from Africa, the Pacific, and the Caribbean. The reviewed studies mostly report on the early months of COVID-19 and were generally methodologically poor. Few studies directly assessed the impact of the pandemic. The most robust evidence, from time-series studies, indicate either a reduction or no change in suicide and self-harm behaviour. As LMIC continue to experience repeated waves of the virus and increased associated mortality, against a backdrop of vaccine inaccessibility and limited welfare support, continued efforts are needed to track the indirect impact of the pandemic on suicide and self-harm in these countries.
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Affiliation(s)
- Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Ann John
- Population Data Science, Swansea University Medical School, Swansea, United Kingdom
| | - Prianka Padmanathan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Emily Eyles
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Dana Dekel
- Population Data Science, Swansea University Medical School, Swansea, United Kingdom
| | - Julian P. T. Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Jason Bantjes
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Rakhi Dandona
- Public Health Foundation of India, Gurugram, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Catherine Macleod-Hall
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Luke A. McGuinness
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Lena Schmidt
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Sciome LLC, Research Triangle Park, Durham, NC, United States of America
| | - Roger T. Webb
- Division of Psychology & Mental Health, University of Manchester, Manchester, United Kingdom
- National Institute of Health Research Greater Manchester Patient Safety Translational Research Centre, Manchester, United Kingdom
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
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Alghafees MA, Abdulmonen A, Eid M, Alhussin GI, Alosaimi MQ, Alduhaimi GS, Albogami MT, Alhelail M. Poisoning-related emergency department visits: the experience of a Saudi high-volume toxicology center. Ann Saudi Med 2022; 42:36-44. [PMID: 35112588 PMCID: PMC8812162 DOI: 10.5144/0256-4947.2022.36] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Acute poisoning is a major contributing factor to mortality and morbidity. There is a lack of research on the epidemiology of acute poisoning risk factors in Saudi Arabia. OBJECTIVES Descriptive overview of poisoning cases at a tertiary care center. DESIGN Descriptive, medical record review. SETTINGS Tertiary care center in Riyadh. PATIENTS AND METHODS From the electronic medical record system, we collected demographic information, medical history, and the poisoning history on all emergency department visits diagnosed as acute poisoning from January 2016 to January 2021. Patients were classed as children (<18 years old) or adults, and further classified by body mass index. MAIN OUTCOME MEASURES Intensive care unit (ICU) admission, organ transplantation, and mortality were classified as poor outcomes. SAMPLE SIZE 492 adults and 1013 children (<18 years old) were identified. RESULTS The most frequent agent in poisoning for both groups was acetaminophen (n=52, 10.57% and n=100, 9.87%, respectively). The ICU admission rate was 6.7% and 4.8%, and the mortality rate 0.8% and 0.3%, respectively. The accidental poisoning rate was 57.7% among adults (n=284) and 67.6% among children (n=658). The suicide intention rate was 11.2% (n=55) and 7.4% (n=75) among adults and children, respectively. The management for both populations was nonspecific, involving observation, supportive measures, and symptomatic treatment. CONCLUSION Although the ICU admission rates were consistent with reported data, the mortality rate was marginally lower. The pediatric predominance in the population implies a lack of caregiver education in the region regarding the safe storage of drugs and household products, as well as the use of child-resistant packaging. The high rate of accidental poisoning in both age groups should prompt further investment to promote public health education on the rational use and safe storage of toxic agents and self-protection. The high suicide intention rate needs to be investigated to develop multidisciplinary risk prevention strategies. LIMITATIONS Single center, retrospective, small population size. CONFLICT OF INTEREST None.
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Affiliation(s)
| | - Abdullah Abdulmonen
- From the Department of Emergency Medicine, King Abdulaziz Medical City.,From the Department of Medicine, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mahmoud Eid
- From the Department of Emergency Medicine, King Abdulaziz Medical City.,From the Department of Medicine, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | | | | | - Ghadah Saad Alduhaimi
- From the College of Medicine, King Saud bin Abdulaziz University for Health Sciences
| | | | - Mohammed Alhelail
- From the Department of Emergency Medicine, King Abdulaziz Medical City.,From the Department of Medicine, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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