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McMahon EM, Cully G, Corcoran P, Arensman E, Griffin E. Advancing early detection of suicide? A national study examining socio-demographic factors, antecedent stressors and long-term history of self-harm. J Affect Disord 2024; 350:372-378. [PMID: 38232777 DOI: 10.1016/j.jad.2024.01.030] [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: 06/22/2023] [Revised: 12/04/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND A range of factors including mental disorders, adverse events and history of self-harm are associated with suicide risk. Further examination is needed of the characteristics of suicides which occur without established risk factors, using national surveillance systems. METHODS Data on all suicides in Ireland from 2015 to 2017 were drawn from the Irish Probable Suicide Deaths Study (IPSDS). Variables examined included socio-demographics, psychiatric history and precipitant stressors. Suicide data were linked with data on prior self-harm from the National Self-Harm Registry Ireland (NSHRI). Latent Class Analysis (LCA) was used to identify sub-groups of suicide cases. RESULTS Of the 1809 individuals who died by suicide, 401 (22.2 %) had a history of hospital-treated self-harm. Four distinct profiles of suicides were identified. One group was marked by high levels of prior self-harm and mental health conditions. Two of the groups included few individuals with a history of self-harm but had notably high levels of mental health conditions. These two groups had relatively high levels of reported chronic pain or illness but differed in terms of socio-demographics. The final group, predominantly male, had markedly low levels of mental health conditions or self-harm but high levels of personal stressors and substance use. LIMITATIONS The use of coronial data may be limited by bias in the collecting of information from the deceased's family members. CONCLUSIONS A sub-group of suicide cases exists without any psychiatric or self-harm history but with salient occupational or health-related proximal stressors. Suicide prevention interventions should include occupational settings and should promote mental health literacy.
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Affiliation(s)
- E M McMahon
- School of Public Health, University College Cork, Cork, Ireland; National Suicide Research Foundation, Cork, Ireland.
| | - G Cully
- School of Public Health, University College Cork, Cork, Ireland; National Suicide Research Foundation, Cork, Ireland
| | - P Corcoran
- School of Public Health, University College Cork, Cork, Ireland; National Suicide Research Foundation, Cork, Ireland
| | - E Arensman
- School of Public Health, University College Cork, Cork, Ireland; National Suicide Research Foundation, Cork, Ireland; Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
| | - E Griffin
- School of Public Health, University College Cork, Cork, Ireland; National Suicide Research Foundation, Cork, Ireland
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Peden AE, Taylor DH, Franklin RC. Pre-Existing Medical Conditions: A Systematic Literature Review of a Silent Contributor to Adult Drowning. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148863. [PMID: 35886717 PMCID: PMC9324568 DOI: 10.3390/ijerph19148863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/19/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022]
Abstract
Medical conditions can increase drowning risk. No prior study has systematically reviewed the published evidence globally regarding medical conditions and drowning risk for adults. MEDLINE (Ovid), PubMed, EMBASE, Scopus, PsycINFO (ProQuest) and SPORTDiscus databases were searched for original research published between 1 January 2005 and 31 October 2021 that reported adult (≥15 years) fatal or non-fatal drowning of all intents and pre-existing medical conditions. Conditions were grouped into the relevant International Classifications of Diseases (ICD) codes. Eighty-three studies were included (85.5% high-income countries; 38.6% East Asia and Pacific region; 75.9% evidence level III-3). Diseases of the nervous system (n = 32 studies; 38.6%), mental and behavioural conditions (n = 31; 37.3%) and diseases of the circulatory system (n = 25; 30.1%) were the most common categories of conditions. Epilepsy was found to increase the relative risk of drowning by 3.8 to 82 times, with suggested preventive approaches regarding supervised bathing or showering. Drowning is a common suicide method for those with schizophrenia, psychotic disorders and dementia. Review findings indicate people with pre-existing medical conditions drown, yet relatively few studies have documented the risk. There is a need for further population-level research to more accurately quantify drowning risk for pre-existing medical conditions in adults, as well as implementing and evaluating population-level attributable risk and prevention strategies.
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Affiliation(s)
- Amy E. Peden
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW 2052, Australia;
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia;
| | - Danielle H. Taylor
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia;
| | - Richard C. Franklin
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia;
- Correspondence:
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Murphy PT, Clogher L, van Laar A, O'Regan R, McManus S, McIntyre A, O'Connell A, Geraghty M, Henry G, Hallahan B. The impact of service user's suicide on mental health professionals. Ir J Psychol Med 2022; 39:74-84. [PMID: 30777583 DOI: 10.1017/ipm.2019.4] [Citation(s) in RCA: 10] [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] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Our principle objective was to examine the personal and professional impact of service user (SU) suicide on mental health professionals (MHPs). We also wished to explore putative demographic or clinical factors relating to SUs or MPHs that could influence the impact of SU suicide for MHPs and explore factors MHPs report as helpful in reducing distress following SU suicide. METHODS A mixed-method questionnaire with quantitative and thematic analysis was utilised. RESULTS Quantitative data indicated SU suicide was associated with personal and professional distress with sadness (79.5%), shock (74.5%) and surprise (68.7%) particularly evident with these phenomena lasting less than a year for more than 90% of MHPs. MHPs also reported guilt, reduced self-confidence and a fear of negative publicity. Thematic analysis indicated that some MHPs had greater expertise when addressing SU suicidal ideation and in supporting colleagues after experiencing a SU suicide. Only 17.7% of MHPs were offered formal support following SU suicide. CONCLUSION SU suicide impacts MHPs personally and professionally in both a positive and negative fashion. A culture and clear pathway of formal support for MHPs to ascertain the most appropriate individualised support dependent on the distress they experience following SU suicide would be optimal.
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Affiliation(s)
- P T Murphy
- Galway Mental Health Service, HSE West, Health Centre, Brackernagh, Ballinasloe, Galway, Ireland
- Department of Psychology, HSE West, Merlin Park University Hospital, Galway, Ireland
- Department of Psychiatry, University Hospital Galway, Galway, Ireland
| | - L Clogher
- Department of Psychology, HSE West, Merlin Park University Hospital, Galway, Ireland
| | - A van Laar
- Department of Liaison Psychiatry, University Hospital Galway, Galway, Ireland
| | - R O'Regan
- Child and Adolescent Mental Health Services, Inpatient Unit, Merlin Park Hospital Galway, Galway, Ireland
| | - S McManus
- Department of Psychology, HSE West, Merlin Park University Hospital, Galway, Ireland
| | - A McIntyre
- Department of Psychiatry, University Hospital Galway, Galway, Ireland
| | - A O'Connell
- Department of Psychology, HSE West, Merlin Park University Hospital, Galway, Ireland
| | - M Geraghty
- Department of Psychiatry, University Hospital Galway, Galway, Ireland
| | - G Henry
- Department of Psychiatry, University Hospital Galway, Galway, Ireland
| | - B Hallahan
- Department of Psychiatry, University Hospital Galway, Galway, Ireland
- School of Medicine, National University of Ireland Galway, Galway, Ireland
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McMorrow C, Nerney D, Cullen N, Kielty J, vanLaar A, Davoren M, Conlon L, Brodie C, McDonald C, Hallahan B. Psychiatric and psycho-social characteristics of suicide completers: a 13-year comprehensive evaluation of psychiatric case records and post-mortem findings. Eur Psychiatry 2022; 65:e14. [PMID: 35067234 PMCID: PMC8853853 DOI: 10.1192/j.eurpsy.2021.2264] [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: 11/25/2022] Open
Abstract
Currently, there are limited data comparing demographic and clinical characteristics of individuals who died by probable suicide and who did and did not previously attend mental health services (MHSs). This study compared demographic and clinical factors for both groups, in a Western region of Ireland over a 13-year period. Postmortem reports between January 1, 2006 and March 31, 2019 were reviewed for 400 individuals who died by probable suicide. Relevant sociodemographic and clinical data were extracted from individuals’ lifetime case notes. One hundred and fifty nine individuals (40%) had attended MHSs at some stage (“attendee”). Hanging was the most common method of suicide (61%), followed by drowning (18%) for both attendees and nonattendees of MHSs, with more violent methods utilized overall by nonattendees (p = 0.028). Sixty-eight percent of individuals who previously attempted hanging subsequently died utilizing this method. A higher proportion of attendees were female compared to nonattendees of MHSs (28.9 vs. 14.5%, p = 0.001). Recurrent depressive disorder (55%) was the most common diagnosed mental health disorder. For individuals with a diagnosis of schizophrenia, 39% had antipsychotic medications detectable in their toxicology reports. In conclusion, the majority of people who died by probable suicide had never had contact with MHSs, and nonattendees overall were more likely to utilize violent methods of suicide. Nonconcordance with psychotropic medications in psychotic patients and previous hanging attempt were highlighted as potential risk factors for death by probable suicide.
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Fogarty B, Houghton S, Galavan E, O'Súilleabháin PS. Clinicians' Experience of Collaboration in the Treatment of Suicidal Clients Within the Collaborative Assessment and Management of Suicidality Framework. OMEGA-JOURNAL OF DEATH AND DYING 2021; 87:424-447. [PMID: 34056984 DOI: 10.1177/00302228211020579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION There is little known about the clinicians' experience of collaboration using the Collaborative Assessment and Management of Suicide (CAMS) framework. This study aimed to give voice to the clinician experience. METHOD A qualitative design utilised semi-structured interviews with ten psychologists who worked in a Suicide Assessment and Treatment Service (SATS) in Ireland which utilises the CAMS framework. RESULTS An Interpretative Phenomenological Analysis (IPA) approach revealed several important findings. The superordinate themes included 'Finding Safety', 'Regulation of the Self', 'Connecting', and 'Systemic Challenges'. DISCUSSION The CAMS framework plays an important role in providing a safe base for the clinician (in terms of understanding suicidality, in addition to the structures of the framework). It provides a mechanism in which to process difficult emotions, and a way of communicating a formulation of suicide to the treating team. Importantly, the CAMS emerged as facilitating a collaborative, therapeutic way of working.
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Affiliation(s)
- Bríd Fogarty
- Department of Psychology, University of Limerick, Ireland
| | | | | | - Páraic S O'Súilleabháin
- Department of Psychology, University of Limerick, Ireland.,Health Research Institute, University of Limerick, Ireland
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Banerjee D, Varshney P, Vajawat B. "Guarding the Gatekeepers": Suicides among Mental Health Professionals and Scope of Prevention, A Review. Psychiatry Res 2020; 294:113501. [PMID: 33065373 PMCID: PMC7543698 DOI: 10.1016/j.psychres.2020.113501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/03/2020] [Indexed: 12/02/2022]
Abstract
Suicide is a social evil that is considered to be a global epidemic. Mental healthcare professionals (MHP) (psychiatrists, clinical psychologists, psychiatric social work, etc.) are often involved as 'gatekeepers' in the management of suicidality and suicide prevention. Even though the risk of suicide in medical profession has received attention in research, there has been scarcity of literature related to the same in MHPs. They are not immune to the perils of psychological distress and its cascading consequences including suicide, contrary to the popular societal myths. The intrinsic and extrinsic pressures of the profession, persistent discourse in managing the psychological distress of others, professional burnout, self-stigma, societal apathy and easy access to psychotropics are certain factors making the MHPs more vulnerable. This disengagement and stress can contribute to depression, anxiety and complex trauma in the MHPs. The situation is furthermore compounded in developing countries with resource constraints, low MHP: patient ratio and inflexibility of work schedules. This makes tailored interventions, peer counselling, periodic mental health screenings and administrative understanding and accountability necessary at all levels. Keeping this in background, the review glances at the risk factors of suicide related to MHPs, highlights the problem statement and discusses the possible interventions.
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Affiliation(s)
- Debanjan Banerjee
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
| | - Prateek Varshney
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Bhavika Vajawat
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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Morrissey J, Higgins A. “Attenuating Anxieties”: A grounded theory study of mental health nurses’ responses to clients with suicidal behaviour. J Clin Nurs 2018; 28:947-958. [DOI: 10.1111/jocn.14717] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 10/17/2018] [Accepted: 11/03/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Jean Morrissey
- Mental Health NursingSchool of Nursing and MidwiferyTrinity College Dublin Dublin Ireland
| | - Agnes Higgins
- Mental Health NursingSchool of Nursing and MidwiferyTrinity College Dublin Dublin Ireland
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Abdullah M, Khalily MT, Ahmad I, Hallahan B. Psychological autopsy review on mental health crises and suicide among youth in Pakistan. Asia Pac Psychiatry 2018; 10:e12338. [PMID: 30280522 DOI: 10.1111/appy.12338] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 08/02/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Ascertaining putative sociodemographic and clinical causes for death by probable suicide can potentially help implement region-specific strategies to reduce suicide rates. In this study, we wanted to investigate methods utilized and the psychosocial and mental health characteristics of youths (aged 12-26 y) who died by probable suicide. METHOD We examined data from mental health clinical files and forensic reports and performed qualitative psychological autopsy interview from more than multiple sources for each youth who died by probable suicide between 1 May and 31 December 2015 in the Khyber Pakhtunkhwa Province of Pakistan. RESULTS The two most common methods of probable suicide were by firearm use and self-poisoning utilizing pesticides that were significantly associated with male and female gender, respectively. The most common mental health difficulties were major depressive disorder and harmful use of psychoactive substances. Other clinical features particularly evident included thoughts of self-harm, irritability and aggression, low self-esteem, treatment nonadherence, family dispute, and financial distress. CONCLUSION Efforts to reduce the ease of access to firearms and pesticides may potentially have a beneficial effect in reducing the suicide rate in this region of Pakistan.
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Affiliation(s)
- Mudassar Abdullah
- Department of Psychology, International Islamic University, Islamabad, Pakistan
| | | | - Irshad Ahmad
- Department of Psychology, International Islamic University, Islamabad, Pakistan
| | - Brian Hallahan
- Department of Psychiatry, National University of Ireland, Galway, Ireland
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Iqtidar M, Sharma K, Mullaney R, Kelly E, Keevans M, Cullinane M, Kennedy H, Mohan D. Deaths in custody in the Irish prison service: 5-year retrospective study of drug toxicology and unnatural deaths. BJPsych Open 2018; 4:401-403. [PMID: 30294449 PMCID: PMC6171332 DOI: 10.1192/bjo.2018.53] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 07/15/2018] [Accepted: 08/06/2018] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED Mental health and substance misuse disorders are associated with unnatural deaths in prisoners. Deaths in Irish prisons between 2009 and 2014 were retrospectively analysed using coroner's findings, including post-mortem toxicology. There were 69 deaths in custody, 38 of which met inclusion criteria. All deaths by overdose (16) were positive for illicit drugs; 53% of deaths (8 of 15) due to hanging were also positive for illicit drugs, and 29% of deaths (2 of 7) from other causes were toxicology positive. In conclusion, 26 unnatural deaths (68%) were associated with use of illicit drugs, which are a major contributory factor to deaths of prisoners. DECLARATION OF INTEREST None.
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Affiliation(s)
- Madeeha Iqtidar
- Senior Registrar, National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Ireland
| | - Kapil Sharma
- Senior Registrar, National Forensic Mental Health Service, Central Mental Hospital, Dundrum and Department of Psychiatry, Trinity College Dublin, Ireland
| | - Ronan Mullaney
- Senior Registrar, National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Ireland
| | - Enda Kelly
- National Operational Nurse Manager, Mountjoy Prison, Ireland
| | - Mary Keevans
- Complex Nurse Manager, Mountjoy Prison and Irish Prison Service, Ireland
| | - Myra Cullinane
- Dublin District Coroner, Department of Justice and Equality, Ireland
| | - Harry Kennedy
- Senior Registrar, National Forensic Mental Health Service, Central Mental Hospital, Dundrum and Department of Psychiatry, Trinity College Dublin, Ireland
| | - Damian Mohan
- Senior Registrar, National Forensic Mental Health Service, Central Mental Hospital, Dundrum and Department of Psychiatry, Trinity College Dublin, Ireland
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