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Serpico S, Manikath James R, Koizumi N, Ortiz J. Unintentional Injury Death Among Solid Organ Transplant Recipients: Trends and Risk Factors. Angiology 2024; 75:486-493. [PMID: 37040182 DOI: 10.1177/00033197231169918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Unintentional injury death (UID) is a leading cause of mortality worldwide, and individuals with chronic diseases are at higher risk. Though organ transplant can improve the lives of those with chronic disease, these individuals remain in suboptimal physical and mental health after surgery that predisposes them to UID. To quantify the scale of UID among solid organ transplant recipients, we performed a retrospective analysis using United Network of Organ Sharing data from adults who underwent kidney, liver or pancreas transplant between 2000-2021. Our study aimed to identify risk factors for UID in this cohort by comparing basic patient, donor, and transplant characteristics of the groups (UID or all other cause death). The largest proportion of UID was seen in the kidney group (.8%), followed by liver (.7%) and then pancreas (.3%). Male sex was the most significant risk factor among kidney and liver recipients. Whites had a higher risk for UID relative to their non-White counterparts in the kidney and liver groups. In both groups, advancing age conferred a protective effect, whereas higher functional status was a risk factor. Our findings shed new light on a significant source of mortality within the transplant population.
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Affiliation(s)
- Scott Serpico
- Department of Clinical Research, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Rosy Manikath James
- School of Public Policy and Gov't, George Mason University, Arlington, TX, USA
| | - Naoru Koizumi
- School of Public Policy and Gov't, George Mason University, Arlington, TX, USA
| | - Jorge Ortiz
- Department of Transplantation and Surgery, Erie County Medical Center, Buffalo, NY, USA
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Christiansen E, Reilev M, Larsen CP, Bilenberg N, Agerbo E. The joint effect of mental illness and parental suicide attempt on offspring suicide attempt and death: A Danish nationwide, registry-based study using multistate modeling. Psychiatry Res 2024; 334:115824. [PMID: 38447460 DOI: 10.1016/j.psychres.2024.115824] [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: 09/26/2023] [Revised: 02/18/2024] [Accepted: 02/24/2024] [Indexed: 03/08/2024]
Abstract
AIM The aim of this study was to analyse the joint impact of moderate-to-severe mental illness and parental suicidal attempts on suicidal attempt and premature death. METHODS Using the Danish, nationwide health registries, a cohort study was conducted including the birth cohorts 1983-1989. Cox regression and multistate models were used to estimate relative and absolute risks of suicide attempt and premature death. OUTCOME We included 384,569 individuals and 7,218 individuals experienced their first suicide attempt during follow-up, while 2,762 individuals died of all causes. Joined exposure to parental suicide attempt and own mental illness increased the relative risk of suicide attempt (HR 22.57) and premature death all causes (HR 3.17). The absolute risk of suicide attempt before the age of 35 years was 20 % for offspring exposed to both parental suicide attempts and own mental illness (23 % for women vs. 15 % for men), while the risk of death was 4 % (0.6 % for women vs. 7 % for men). CONCLUSION Exposure to both parental suicide attempt and own mental illness increases the relative and absolute risks of suicide attempt and premature death with considerable differences across sex. These findings are important in the clinical assessment of individuals with suicidal behavior.
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Affiliation(s)
- Erik Christiansen
- Centre for Suicide Research, Odense, Denmark; The Research Unit in Psychiatry - child and adults, Psychiatry in the Region of Southern Denmark, Aabenraa, Denmark; Department of Regional Health Research, Odense, University of Southern Denmark, Denmark.
| | - Mette Reilev
- Centre for Suicide Research, Odense, Denmark; Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Denmark; The Research Unit in Psychiatry - child and adults, Psychiatry in the Region of Southern Denmark, Aabenraa, Denmark
| | - Christina Petrea Larsen
- Centre for Suicide Research, Odense, Denmark; Department of Regional Health Research, Odense, University of Southern Denmark, Denmark
| | - Niels Bilenberg
- Child and Adolescent Psychiatry Odense, Mental Health Services in the Region of Southern Denmark, Denmark
| | - Esben Agerbo
- CIRRAU - Centre for Integrated Register-based Research, BSS - School of Business and Social Sciences, Aarhus University, Denmark; NCRR - National Centre for Register-based Research, BSS - School of Business and Social Sciences, Aarhus University, Denmark
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Zerekidze A, Li M, Refisch A, Shameya J, Sobanski T, Walter M, Wagner G. Impact of Toxoplasma gondii and Human Microbiome on Suicidal Behavior: A Systematic Review. J Clin Med 2024; 13:593. [PMID: 38276099 PMCID: PMC10816148 DOI: 10.3390/jcm13020593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Suicide remains a persistent global health challenge, resisting widespread prevention efforts. According to previous findings, toxoplasmosis is particularly associated with altered decision making, which could lead to risk-taking behavior, thereby increasing the likelihood for suicidal behavior (SB). In addition, discussion about the role of microbiome in psychiatric disorders has emerged lately, which also makes it relevant to investigate its role in the context of SB. Therefore, two systematic reviews are integrated in this paper, and the existing knowledge is comprehensively summarized regarding the association between microbial pathogens and SB. METHODS We conducted a systematic search with keywords including SB and Toxoplasma gondii (Suicid* AND Toxoplasm*) and microbiome (Suicid* AND Microbiome AND Microbiota) throughout PubMed and Scopus to retrieve related studies up to 9 November 2023, identifying 24 eligible records. The subjects of the included studies had to have fulfilled the criteria of an SB disorder as defined by DSM-5, and death cases needed to have been defined as suicide. RESULTS Most studies reported significant association between toxoplasmosis and SB, suggesting a higher likelihood of SB in the infected population. Regarding the microbiome, only very few studies investigated an association between SB and alterations in the microbiome. Based on six included studies, there were some indications of a link between changes in the microbiome and SB. CONCLUSION The cognitive aspects of decision making in T. gondii-infected individuals with SB should be further investigated to unravel the underlying mechanisms. Further sufficiently powered studies are needed to establish a link between SB and alterations in the microbiome.
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Affiliation(s)
- Ani Zerekidze
- Department of Psychiatry and Psychotherapy, Jena Center for Mental Health, Jena University Hospital, 07743 Jena, Germany
| | - Meng Li
- Department of Psychiatry and Psychotherapy, Jena Center for Mental Health, Jena University Hospital, 07743 Jena, Germany
- Circuits Underlying Mental Health (C-I-R-C), Jena-Magdeburg-Halle, 07743 Jena, Germany
| | - Alexander Refisch
- Department of Psychiatry and Psychotherapy, Jena Center for Mental Health, Jena University Hospital, 07743 Jena, Germany
- Circuits Underlying Mental Health (C-I-R-C), Jena-Magdeburg-Halle, 07743 Jena, Germany
| | - Justina Shameya
- Department of Psychiatry and Psychotherapy, Jena Center for Mental Health, Jena University Hospital, 07743 Jena, Germany
| | - Thomas Sobanski
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Center for Mental Health, Thueringen-Kliniken “Georgius Agricola”, 07318 Saalfeld, Germany;
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, Jena Center for Mental Health, Jena University Hospital, 07743 Jena, Germany
- Circuits Underlying Mental Health (C-I-R-C), Jena-Magdeburg-Halle, 07743 Jena, Germany
- German Center for Mental Health (DZPG), Partner Site Jena, 07743 Jena, Germany
| | - Gerd Wagner
- Department of Psychiatry and Psychotherapy, Jena Center for Mental Health, Jena University Hospital, 07743 Jena, Germany
- Circuits Underlying Mental Health (C-I-R-C), Jena-Magdeburg-Halle, 07743 Jena, Germany
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McHugh CM, Iorfino F, Zmicerevska N, Song YJC, Skinner A, Scott EM, Hickie IB. Premature mortality in young people accessing early intervention youth mental healthcare: data-linkage cohort study. BJPsych Open 2023; 9:e76. [PMID: 37092680 PMCID: PMC10134286 DOI: 10.1192/bjo.2023.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Understanding premature mortality risk from suicide and other causes in youth mental health cohorts is essential for delivering effective clinical interventions and secondary prevention strategies. AIMS To establish premature mortality risk in young people accessing early intervention mental health services and identify predictors of mortality. METHOD State-wide data registers of emergency departments, hospital admissions and mortality were linked to the Brain and Mind Research Register, a longitudinal cohort of 7081 young people accessing early intervention care, between 2008 and 2020. Outcomes were mortality rates and age-standardised mortality ratios (SMR). Cox regression was used to identify predictors of all-cause mortality and deaths due to suicide or accident. RESULTS There were 60 deaths (male 63.3%) during the study period, 25 (42%) due to suicide, 19 (32%) from accident or injury and eight (13.3%) where cause was under investigation. All-cause SMR was 2.0 (95% CI 1.6-2.6) but higher for males (5.3, 95% CI 3.8-7.0). The mortality rate from suicide and accidental deaths was 101.56 per 100 000 person-years. Poisoning, whether intentional or accidental, was the single greatest primary cause of death (26.7%). Prior emergency department presentation for poisoning (hazard ratio (HR) 4.40, 95% CI 2.13-9.09) and psychiatric admission (HR 4.01, 95% CI 1.81-8.88) were the strongest predictors of mortality. CONCLUSION Premature mortality in young people accessing early intervention mental health services is greatly increased relative to population. Prior health service use and method of self-harm are useful predictors of future mortality. Enhanced care pathways following emergency department presentations should not be limited to those reporting suicidal ideation or intent.
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Affiliation(s)
- Catherine M McHugh
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; and Discipline of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Frank Iorfino
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | | | | | - Adam Skinner
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; and School of Medicine, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
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Kim J, Park EC. Associations of stroke with all-cause and cause-specific mortality: A population-based matched cohort study. J Public Health (Oxf) 2023; 45:66-74. [PMID: 35220438 DOI: 10.1093/pubmed/fdac011] [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: 02/13/2020] [Revised: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aimed to assess the specific associations between stroke and all-cause and cause-specific mortality among Korean adults. METHODS We used data extracted from the Korean National Health Insurance claims database from 2002 to 2013, including information on individuals with or without stroke aged 20 years and older. Patients with intracerebral hemorrhage, ischemic stroke or unspecified stroke were classified as stroke patients, while a reference population matched in terms of sex and age were also selected. The outcomes were all-cause mortality, natural causes of death (i.e. all natural causes, death by stroke and death by other diseases) and suicide. Survival analysis was performed using the Cox proportional hazards model. RESULTS Of the 73 150 eligible participants-including 14 630 stroke patients and 58 520 age- and sex-matched controls-11 121 (15.2%) died during the study period. Of them, 10 513 participants (94.5%) died of natural causes, including 1653 (14.5%) who died due to stroke and 8860 (79.7%) who died due to other diseases. Two hundred and fifty patients (2.2%) died by suicide. Stroke patients showed higher adjusted hazard ratios (HR) for all-cause (HR = 6.48, 95% CI, 3.87-10.86), all-natural-cause (HR = 2.68, 95% CI, 2.53-2.84), stroke (HR = 21.16, 95% CI, 17.49-25.61), other disease (HR = 1.69, 95% CI, 1.58-1.81) and suicide mortality (HR = 3.34, 95% CI, 2.24-4.98) than those without stroke. The effect size of stroke for suicide mortality was greater than that for other causes of mortality (except stroke mortality). CONCLUSIONS Stroke was associated with a higher risk of all-cause, natural cause and suicide mortality; stroke was more strongly associated with risk of suicide mortality than with any mortality for any other causes. From a policy standpoint, these results suggest the need for greater supportive care to prevent unnatural deaths among stroke patients.
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Affiliation(s)
- Juyeong Kim
- Department of Public Health, Sahmyook University, Seoul 01795, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul 03722, Republic of Korea.,Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 10711, Republic of Korea
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Incidence and risk factors for suicide, death due to substance use, and violent/accidental death in people with HIV. AIDS 2023; 37:161-171. [PMID: 36250262 DOI: 10.1097/qad.0000000000003402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Deaths due to suicide, substance use and violence/accident may reflect similar risk factors and overlap in their classification. This study aimed to investigate incidence and risk factors of mortality among people with HIV (PWH) due to these three related causes. DESIGN Prospectively collected data from PWH at least 18 years old and under active follow-up in the EuroSIDA study from 2007 to 2019 were analysed. METHODS Cause-specific Cox regression analysis was used to assess risk factors. RESULTS A total of 17 881 participants were included, comprising 149 327 person-years of follow-up (PYFU). Forty participants died by suicide {incidence rate [IR] [95% confidence interval (CI)]: 0.3/1000 PYFU (0.2, 0.4)} 93 from substance use [IR (95% CI): 0.6/1000 PYFU (0.5, 0.8)], and 57 by violence/accident [IR (95% CI): 0.4/1000 PYFU (0.3, 0.5)]. An AIDS diagnosis within the last 12 months was associated with nine-fold increased risk of suicide vs. no history of AIDS [adjusted hazard ratio (aHR): 9.06; 95% CI: 2.07, 39.7]. Male gender was associated with double the risk of violent/accidental death (aHR: 2.28; 95% CI: 1.09, 4.78). PWH in Eastern Europe and those who acquired HIV by injection drug use (IDU) demonstrated a greater risk of death due to substance use or violence/accident. CONCLUSIONS The association between a recent diagnosis of AIDS and suicide highlights a critical period for intervention. HIV infection acquired through IDU demonstrated an expected relationship with death due to substance use and violent/accidental deaths. Increased risk of death due to substance use and violence/accident in Eastern Europe demands investigation into specific differences that may drive that association.
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Leather JZ, Keyworth C, Kapur N, Campbell SM, Armitage CJ. Examining drivers of self-harm guideline implementation by general practitioners: A qualitative analysis using the theoretical domains framework. Br J Health Psychol 2022; 27:1275-1295. [PMID: 35416355 PMCID: PMC9790562 DOI: 10.1111/bjhp.12598] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/29/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES This study aimed to (1) examine barriers and enablers to General Practitioners' (GP) use of National Institute for Health and Care Excellence (NICE) guidelines for self-harm and (2) recommend potential intervention strategies to improve implementation of them in primary care. DESIGN Qualitative interview study. METHODS Twenty-one telephone interviews, semi-structured around the capabilities, opportunities and motivations model of behaviour change (COM-B), were conducted with GPs in the United Kingdom. The Theoretical Domains Framework was employed as an analytical framework. Using the Behaviour Change Wheel, Behaviour Change Techniques (BCTs), intervention functions and exemplar interventions were identified. RESULTS GPs valued additional knowledge about self-harm risk assessments (knowledge), and communication skills were considered to be fundamental to high-pressure consultations (cognitive and interpersonal skills). GPs did not engage with the guidelines due to concerns that they would be a distraction from patient cues about risk during consultations (memory, attention and decision processes), and perceptions that following the guidance is difficult due to time pressures and lack of access to mental health referrals (environmental context and resources). Clinical uncertainty surrounding longer term care for people that self-harm, particularly patients that are waiting for or cannot access a referral, drives GPs to rely on their professional judgement over the guidance (beliefs about capabilities). CONCLUSIONS Three key drivers related to information and skill needs, guideline engagement and clinical uncertainty need to be addressed to support GPs to be able to assess and manage self-harm. Five intervention functions and ten BCT groups were identified as potential avenues for intervention design.
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Affiliation(s)
- Jessica Z. Leather
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchester Academic Health Science CentreManchesterUK,Manchester Centre for Health PsychologyDivision of Psychology and Mental HealthSchool of Health SciencesUniversity of ManchesterManchesterUK
| | | | - Nav Kapur
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchester Academic Health Science CentreManchesterUK,Centre for Mental Health and SafetyUniversity of ManchesterManchester Academic Health Science CentreManchesterUK,Greater Manchester Mental Health NHS Foundation TrustManchester Academic Health Science CentreManchesterUK
| | - Stephen M. Campbell
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchester Academic Health Science CentreManchesterUK,Centre for Primary Care and Health Services ResearchSchool of Health SciencesUniversity of ManchesterManchesterUK
| | - Christopher J. Armitage
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchester Academic Health Science CentreManchesterUK,Manchester Centre for Health PsychologyDivision of Psychology and Mental HealthSchool of Health SciencesUniversity of ManchesterManchesterUK,Manchester University NHS Foundation TrustManchester Academic Health Science CentreManchesterUK,NIHR Manchester Biomedical Research CentreManchester University NHS Foundation TrustManchester Academic Health Science CentreThe Nowgen CentreManchesterUK
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Kurisu K, Fujimori M, Harashima S, Akechi T, Matsuda T, Saika K, Yoshiuchi K, Miyashiro I, Uchitomi Y. Suicide, other externally caused injuries, and cardiovascular disease within 2 years after cancer diagnosis: A nationwide population-based study in Japan (J-SUPPORT 1902). Cancer Med 2022; 12:3442-3451. [PMID: 35941747 PMCID: PMC9939211 DOI: 10.1002/cam4.5122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/13/2022] [Accepted: 07/19/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND This study aimed to investigate the risk of death by suicide, other externally caused injuries (ECIs), or cardiovascular disease for patients with cancer. METHODS We used data from the National Cancer Registry, which include the entire population in Japan. Patients diagnosed with cancer from January 1 to December 31, 2016 were included, and their follow-up period was set to 2 years. The standardized mortality ratio (SMR) of death by suicide, other ECIs, and cardiovascular disease was calculated compared with the general population. Multivariate Poisson or negative binomial regression analysis was used to quantify the adjusted relative risks of factors of interest. RESULTS We evaluated 1,070,876 patients with cancer. The 2-year follow-up SMR was 1.84 (95% confidence interval [CI]: 1.71-1.99) for suicide, 1.30 (95% CI: 1.24-1.37) for other ECIs, and 1.19 (95% CI: 1.17-1.21) for cardiovascular disease. The SMR was higher with shorter follow-up periods but was significant 13-24 months after cancer diagnosis. The SMRs at 0-1 month and 13-24 months, respectively, were 4.40 (95% CI: 3.51-5.44) and 1.31 (95% CI: 1.14-1.50) for suicide; 2.27 (95% CI: 1.94-2.63) and 1.27 (95% CI: 1.18-1.37) for other ECIs; and 2.38 (95% CI: 2.27-2.50) and 1.07 (95% CI: 1.04-1.10) for cardiovascular disease. The multivariate analyses showed that patients with cancers other than localized tumors had significantly high relative risks of death for each cause. CONCLUSION Suicide prevention countermeasures for patients with cancer, especially those with advanced disease immediately after diagnosis, are warranted.
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Affiliation(s)
- Ken Kurisu
- Division of Supportive Care, Survivorship and Translational Research, Group for Supportive Care and Survivorship Research, Institute for Cancer ControlNational Cancer Center JapanTokyoJapan,Department of Stress Sciences and Psychosomatic Medicine, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Maiko Fujimori
- Division of Supportive Care, Survivorship and Translational Research, Group for Supportive Care and Survivorship Research, Institute for Cancer ControlNational Cancer Center JapanTokyoJapan
| | - Saki Harashima
- Division of Supportive Care, Survivorship and Translational Research, Group for Supportive Care and Survivorship Research, Institute for Cancer ControlNational Cancer Center JapanTokyoJapan,Department of Stress Sciences and Psychosomatic Medicine, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive‐Behavioral MedicineNagoya City University, Graduate School of Medical SciencesNagoyaJapan
| | - Tomohiro Matsuda
- Division of International Health Policy Research, Institute for Cancer ControlNational Cancer Center JapanTokyoJapan
| | - Kumiko Saika
- Division of International Health Policy Research, Institute for Cancer ControlNational Cancer Center JapanTokyoJapan
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Isao Miyashiro
- Cancer Control CenterOsaka International Cancer InstituteOsakaJapan
| | - Yosuke Uchitomi
- Division of Supportive Care, Survivorship and Translational Research, Group for Supportive Care and Survivorship Research, Institute for Cancer ControlNational Cancer Center JapanTokyoJapan,Innovation Center for Supportive, Palliative and Psychosocial CareNational Cancer CenterTokyoJapan
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Isaacs JY, Smith MM, Sherry SB, Seno M, Moore ML, Stewart SH. Alcohol use and death by suicide: A meta-analysis of 33 studies. Suicide Life Threat Behav 2022; 52:600-614. [PMID: 35181905 DOI: 10.1111/sltb.12846] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/02/2021] [Accepted: 01/21/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Decades of research show an association between alcohol use and death by suicide. However, findings on the temporal link between alcohol use and death by suicide are unclear. In the most comprehensive meta-analysis on the topic to date, we analyzed data from longitudinal studies to determine if alcohol use is a risk for death by suicide. We also explored moderators to uncover conditions where the alcohol use-suicide link is strengthened/weakened. METHODS Our literature search of six databases yielded 33 eligible studies involving 10,253,101 participants (community, psychiatric, and military samples). RESULTS Alcohol use was associated with a 94% increase in the risk of death by suicide. Specifically, random-effects meta-analysis revealed alcohol use displayed small-to-large significant risk and odds ratios with suicide for quantity of alcohol use and alcohol use diagnosis/alcohol-related problems. Meta-regression generally indicated larger effect sizes for studies with a higher percentage of women, younger age, unadjusted estimates, longer follow-up periods, military samples, and higher frequencies and quantities of alcohol use (relative to drinker/non-drinker status). CONCLUSION Our study highlights alcohol use as a substantive risk factor for death by suicide and underscores the importance of monitoring alcohol use among suicidal individuals and screening for suicidality among heavier alcohol users.
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Affiliation(s)
- Jason Y Isaacs
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Martin M Smith
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Simon B Sherry
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Martin Seno
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mackenzie L Moore
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sherry H Stewart
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Psychiatry, QEII Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
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Liu BP, Jia CX, Qin P, Zhang YY, Yu YK, Luo X, Li SX. Associating factors of suicide and repetition following self-harm: A systematic review and meta-analysis of longitudinal studies. EClinicalMedicine 2022; 49:101461. [PMID: 35747199 PMCID: PMC9126760 DOI: 10.1016/j.eclinm.2022.101461] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/26/2022] [Accepted: 05/04/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Longitudinal evidence for sociodemographic and clinic factors deviating risk for suicide and repetition following SH (self-harm) varied greatly. METHODS A comprehensive search of PubMed, Web of Science, EMBASE, and PsycINFO was conducted from January 1st, 2010 to April 5th, 2022. Longitudinal studies focusing on examining associating factors for suicide and repetition following SH were included. PROSPERO registration CRD42021248695. FINDINGS The present meta-analysis synthesized data from 62 studies published from Jan. 1st, 2010. The associating factors of SH repetition included female gender (RR, 95%CI: 1.11, 1.04-1.18, I2=82.8%), the elderly (compared with adolescents and young adults, RR, 95%CI: 0.67, 0.52-0.87, I2=86.3%), multiple episodes of SH (RR, 95%CI: 1.97, 1.51-2.57, I2=94.3%), diagnosis (RR, 95%CI: 1.60, 1.27-2.02, I2=92.7%) and treatment (RR, 95%CI: 1.59, 1.40-1.80, I2=93.3%) of psychiatric disorder. Male gender (RR, 95%CI: 2.03, 1.80-2.28, I2=83.8%), middle-aged adults (compared with adolescents and young adults, RR, 95%CI: 2.40, 1.87-3.08, I2=74.4%), the elderly (compared with adolescents and young adults, RR, 95%CI: 4.38, 2.98-6.44, I2=76.8%), physical illness (RR, 95%CI: 1.95, 1.56-2.43, I2=0), multiple episodes of SH (RR, 95%CI: 2.02, 1.58-2.58, I2=87.4%), diagnosis (RR, 95%CI: 2.13, 1.67-2.71, I2=90.9%) and treatment (RR, 95%CI: 1.36, 1.16-1.58, I2=58.6%) of psychiatric disorder were associated with increased risk of suicide following SH. INTERPRETATION Due to the substantial heterogeneity for clinic factors of suicide and repetition following SH, these results need to be interpreted with caution. Clinics should pay more attention to the cases with SH repetition, especially with poor physical and psychiatric conditions. FUNDING This work was supported by National Natural Science Foundation of China (NSFC) [No: 82103954; 30972527; 81573233].
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Affiliation(s)
- Bao-Peng Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Cun-Xian Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
- Corresponding author at: Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine of University of Oslo, Oslo, Norway
| | - Ying-Ying Zhang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Yao-Kun Yu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Xiao Luo
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Shi-Xue Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Corresponding author at: Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
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Chen Y, Yu K, Xiong J, Zhang J, Zhou S, Dai J, Wu M, Wang S. Suicide and Accidental Death Among Women With Primary Ovarian Cancer: A Population-Based Study. Front Med (Lausanne) 2022; 9:833965. [PMID: 35372450 PMCID: PMC8966220 DOI: 10.3389/fmed.2022.833965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/21/2022] [Indexed: 01/09/2023] Open
Abstract
Background Women with ovarian cancer had the highest suicidal rate among all patients with gynecological malignancies, but no large studies about suicide and accidental death for women with ovarian cancers in detail were conducted. We aimed to determine the relative risk of suicide and accidental death among patients with ovarian cancer to that of the general population, and to identify risk factors associated with suicide and accidental death. Methods Data are from the SEER (surveillance, epidemiology, and end results) cancer registry of women diagnosed with ovarian cancer data from 18 registries for the years 1973–2016. The study population comprised 149,204 patients after inclusion and exclusion criteria were applied. Standardized mortality ratios (SMRs) were calculated and Fine-Gray models were fitted to identify risk factors associated with suicidal and accidental death among cancer patients, with stratifications on demographic and tumor-related characteristics. Results Women with ovarian cancer had a higher risk of suicide and accidental death than the cancer-free group [SMR = 1.86; 95% CI (1.54–2.25) and SMR = 1.54; 95% CI (1.39–1.71)]. Subgroup analysis indicated that only patients with type II epithelial ovarian cancer [SMR = 2.31; 95% CI (1.83–2.91)] had an increased risk of suicide, and those with type I and type II epithelial ovarian cancer [SMR = 1.65; 95% CI (1.39–1.97) and SMR = 1.49; 95% CI (1.30–1.70)] were at a higher risk of accidental death. Patients with ovarian cancer who were younger, white, diagnosed with high-grade, non-metastatic cancer and pelvic exenteration were at a higher risk of suicide. The advanced age, earlier year of diagnosis, and non-metastatic cancer were associated with a higher risk of accidental death. Additionally, pelvic exenteration increased the risk of suicide but not the risk of accidental death among women with primary ovarian cancer. Conclusions Women with ovarian cancer had a higher risk of suicide and accidental death compared with the general population. The findings suggested that clinicians should identify high-risk subgroups of ovarian cancer patients for suicide and accidental death as early as possible, with appropriate prevention strategies.
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Affiliation(s)
- Ying Chen
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaixu Yu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaqiang Xiong
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jinjin Zhang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Su Zhou
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Dai
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Meng Wu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shixuan Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Chatterjee D, Rai R. Choosing Death Over Survival: A Need to Identify Evolutionary Mechanisms Underlying Human Suicide. Front Psychol 2021; 12:689022. [PMID: 34803791 PMCID: PMC8595259 DOI: 10.3389/fpsyg.2021.689022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 10/01/2021] [Indexed: 11/24/2022] Open
Abstract
The act of killing self contradicts the central purpose of human evolution, that is, survival and propagation of one’s genetic material. Yet, it continues to be one of the leading causes of human death. A handful of theories in the realm of evolutionary psychology have attempted to explain human suicide. The current article analyses the major components of certain prominent viewpoints, namely, Inclusive fitness, Bargaining model, Pain-Brain model, Psychological aposematism, and few other perspectives. The article argues that relatively more weightage has been given to understanding ultimate (the “why”) rather than proximate (the “how”) functionality of suicidal acts. Evolutionary theorists have consistently pointed out that to comprehensively understand a trait or behavior, one needs to delineate not only how it supports survival but also the evolution of the mechanisms underlying the trait or behavior. Existing theories on suicide have primarily focused on its fitness benefits on surviving kin instead of providing evolutionary explanations of the more complex mechanisms leading up to such self-destructive motivations. Thus, the current paper attempts to highlight this gap in theorizing while suggesting probable proximate explanations of suicide which stresses the need to diffuse attention paid to fitness consequences of the act alone. We speculate that such explorations are needed in order to build a robust and comprehensive evolutionary theory of human suicide.
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Affiliation(s)
- Diya Chatterjee
- Department of Humanities and Social Sciences, Indian Institute of Technology, Kharagpur, India
| | - Rishabh Rai
- Department of Humanities and Social Sciences, Indian Institute of Technology, Kharagpur, India
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Prabhakar D, Peterson EL, Hu Y, Chawa S, Rossom RC, Lynch FL, Lu CY, Waitzfelder BE, Owen-Smith AA, Williams LK, Beck A, Simon GE, Ahmedani BK. Serious Suicide Attempts and Risk of Suicide Death. CRISIS 2021; 42:343-350. [PMID: 33151092 PMCID: PMC8096861 DOI: 10.1027/0227-5910/a000729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: In the US, more than one million people attempt suicide each year. History of suicide attempt is a significant risk factor for death by suicide; however, there is a paucity of data from the US general population on this relationship. Aim: The objective of this study was to examine suicide attempts needing medical attention as a risk for suicide death. Method: We conducted a case-control study involving eight US healthcare systems. A total of 2,674 individuals who died by suicide from 2000 to 2013 were matched to 267,400 individuals by year and location. Results: Prior suicide attempt associated with a medical visit increases risk for suicide death by 39.1 times, particularly for women (OR = 79.2). However, only 11.3% of suicide deaths were associated with an attempt that required medical attention. The association was the strongest for children 10-14 years old (OR = 98.0). Most suicide attempts were recorded during the 20-week period prior to death. Limitations: Our study is limited to suicide attempts for which individuals sought medical care. Conclusion: In the US, prior suicide attempt is associated with an increased risk of suicide death; the risk is high especially during the period immediately following a nonlethal attempt.
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Affiliation(s)
- Deepak Prabhakar
- Sheppard Pratt Health System, 6501 North Charles Street, Baltimore, MD, 21204
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Harashima S, Fujimori M, Akechi T, Matsuda T, Saika K, Hasegawa T, Inoue K, Yoshiuchi K, Miyashiro I, Uchitomi Y, J Matsuoka Y. Death by suicide, other externally caused injuries and cardiovascular diseases within 6 months of cancer diagnosis (J-SUPPORT 1902). Jpn J Clin Oncol 2021; 51:744-752. [PMID: 33529336 DOI: 10.1093/jjco/hyab001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To conduct the first national population-based study in Japan to characterize risks of death by suicide, other externally caused injuries and cardiovascular diseases within 6 months of cancer diagnosis. METHODS Cancer patients diagnosed between 1 January and 30 June 2016 and registered in the National Cancer Registry in Japan were followed up until death or 6 months after diagnosis. We calculated standardized mortality ratios and excess absolute risks per 10 000 person-years for death by suicide, other externally caused injuries and cardiovascular diseases compared with the Japanese general population. RESULTS Of 546 148 patients with cancer (249 116 person-years at risk), we observed 145 suicides, 298 deaths due to other externally caused injuries and 2366 cardiovascular deaths during the follow-up period. Standardized mortality ratios within 6 months were 2.68 for suicide (95% confidence interval, 2.26-3.16; excess absolute risk, 3.65), 1.49 for other externally caused injuries (95% confidence interval, 1.32-1.67; excess absolute risk, 3.92) and 1.38 for cardiovascular diseases (95% confidence interval, 1.33-1.44; excess absolute risk, 26.85). Risks were highest during the first month after cancer diagnosis (standardized mortality ratios: suicide, 4.06 [95% confidence interval, 2.90-5.53]; other externally caused injuries, 2.66 [95% confidence interval, 2.17-3.12] and cardiovascular diseases, 2.34 [95% confidence interval, 2.18-2.51]). CONCLUSIONS The first 6 months, and especially the first month, after cancer diagnosis were found to be a critical period for risks of death by suicide, other externally caused injuries and cardiovascular diseases. Our findings suggest that oncologists need to evaluate suicidal and cardiovascular risks of patients immediately after cancer diagnosis and provide preventive interventions.
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Affiliation(s)
- Saki Harashima
- Division of Behavioral Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan.,Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Maiko Fujimori
- Division of Behavioral Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tomohiro Matsuda
- Center for Cancer Registries, Center for Cancer Control and Information Services, National Cancer Center Japan, Tokyo, Japan
| | - Kumiko Saika
- Center for Cancer Registries, Center for Cancer Control and Information Services, National Cancer Center Japan, Tokyo, Japan
| | - Takaaki Hasegawa
- Center for Psycho-Oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
| | - Keisuke Inoue
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan.,Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Yosuke Uchitomi
- Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka J Matsuoka
- Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
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Yu K, Wu B, Chen Y, Kang H, Song K, Dong Y, Peng R, Li F. Suicide and accidental deaths among patients with primary malignant bone tumors. J Bone Oncol 2021; 27:100353. [PMID: 33889483 PMCID: PMC8047448 DOI: 10.1016/j.jbo.2021.100353] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/09/2021] [Accepted: 03/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background It has been recognized that cancer is associated with a higher risk of suicide or accidental death. Earlier studies have evidenced that patients with malignant bone tumors usually experience psychological dysfunction and physical disability following surgery, which are shared risk factors between suicidal and accidental deaths. To our knowledge, there is no large population-based study on the risk of suicide or accidental death among patients with malignant bone tumors. Questions/purposes This study aimed to determine whether patients with primary malignant bone tumors are at a higher risk of suicide and accidental death than the general population and to identify the demographic and tumour-related characteristics and type of surgery associated with a higher risk of suicide and accidental death among these patients. Methods Overall, 50,817 patients diagnosed with primary malignant bone tumors between 1973 and 1975 were identified from the Surveillance, Epidemiology, and End Results database. The standardised mortality ratio (SMR) was calculated based on the general population's mortality data, gathered by the National Center for Health Statistics. The Cox regression model was developed to determine risk factors associated with a higher risk of suicide and accidental death. Results Patients with primary malignant bone tumors had a higher risk of suicide and accidental death than the general population in the United States (US) (SMR = 2.17; 95% confidence interval (CI) [1.80-2.62] and SMR = 1.73; 95% CI [1.54-1.95]). Compared with limb salvage, amputation significantly increased the risk of suicide (SMR = 3.99; 95% CI [2.52-6.34], hazard ratio (HR) = 2.32; 95% CI [1.31-4.09]; P < 0.01) but did not increase the risk of accidental death (SMR = 1.61; 95% CI [1.07-2.42], HR = 1.11; 95% CI [0.71-1.74]; P = 0.65). Higher suicide risk was observed among older patients whose age at diagnosis was more than 60 years (HR = 4.04; 95% CI [1.98-8.26]; P < 0.001), males (HR = 3.48; 95% CI [2.16-5.62]; P < 0.001), and whites (HR = 3.71; 95% CI [1.17-11.73]; P < 0.001). The risk of suicide and accidental death was highest in the first year after diagnosis (SMR = 2.95; 95% CI [1.86-4.69] and SMR = 2.02; 95% CI [1.48-2.74]). Conclusion We first reported that patients with primary malignant bone tumors had a higher risk of suicide and accidental death than the general US population. Therefore, clinicians should pay more attention to the psychological status, physical function, and cognitive level of these survivors.
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Affiliation(s)
- Kaixu Yu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Bian Wu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Ying Chen
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Honglei Kang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Kehan Song
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yimin Dong
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Renpeng Peng
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Feng Li
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Yang K, Zheng Y, Peng J, Chen J, Feng H, Yu K, Chen Y, Luo W, Yang P, Yang Y, Wu B. Incidence of Death From Unintentional Injury Among Patients With Cancer in the United States. JAMA Netw Open 2020; 3:e1921647. [PMID: 32083692 PMCID: PMC7043194 DOI: 10.1001/jamanetworkopen.2019.21647] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Previous studies have suggested that patients with cancer may be at an increased risk of death from unintentional injury, but to our knowledge, no large studies have examined the rates of death from unintentional injury among patients with cancer. OBJECTIVE To characterize the incidence of death from unintentional injury among patients with cancer in the United States. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included patients diagnosed with a first primary cancer between January 1, 1973, and December 31, 2015, identified from the Surveillance, Epidemiology, and End Results (SEER) program data. Comparisons with the general US population were based on mortality data collected by the National Center for Health Statistics. Analyses were performed from February 1, 2019, to August 15, 2019. MAIN OUTCOMES AND MEASURES Rates and standardized mortality ratios (SMRs) of death from unintentional injury among patients with cancer. RESULTS A total of 8 271 020 patients with cancer were included in this study (50.2% female; mean [SD] age, 63.0 [15.7] years). Among them, 40 599 deaths from unintentional injury were identified. The rates of death from unintentional injury were 81.90 per 100 000 person-years among patients with cancer and 51.21 per 100 000 person-years in the corresponding US general population. The SMR of death from unintentional injury was 1.60 (95% CI, 1.58-1.61). Higher rates of death from unintentional injury were associated with increasing age at diagnosis (≥80 years; rate ratio [RR], 2.91; 95% CI, 2.84-2.98; P < .001), male sex (RR, 1.69; 95% CI, 1.66-1.73; P < .001), American Indian or Alaskan Native population (RR, 1.48; 95% CI, 1.30-1.68; P < .001), and being unmarried (RR, 1.23; 95% CI, 1.18-1.28; P < .001). Rates of death from unintentional injury were the highest in patients with cancers of the liver (200.37 per 100 000 person-years), brain (175.04 per 100 000 person-years), larynx (148.78 per 100 000 person-years), and esophagus (144.98 per 100 000 person-years). The SMRs were the highest in the first month after cancer diagnosis. CONCLUSIONS AND RELEVANCE This study found that the incidence of death from unintentional injury among patients with cancer was significantly higher than that in the general population in the United States. The rates of death from unintentional injury varied by age, sex, race/ethnicity, marital status, cancer site, disease stage, and time since diagnosis. The findings suggest that death from unintentional injury among patients with cancer requires further attention and that initiatives to identify patients at risk and to develop targeted prevention strategies should be prioritized.
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Affiliation(s)
- Kunyu Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yongqiang Zheng
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiangtong Peng
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiayuan Chen
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huayi Feng
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaixu Yu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Chen
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenjing Luo
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Pengcheng Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yun Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bian Wu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Harashima S, Fujimori M, Akechi T, Matsuda T, Saika K, Hasegawa T, Inoue K, Yoshiuchi K, Miyashiro I, Uchitomi Y, Matsuoka YJ. Suicide, other externally caused injuries and cardiovascular death following a cancer diagnosis: study protocol for a nationwide population-based study in Japan (J-SUPPORT 1902). BMJ Open 2019; 9:e030681. [PMID: 31278108 PMCID: PMC6615787 DOI: 10.1136/bmjopen-2019-030681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION A growing body of literature has demonstrated that cancer patients have a higher risk of suicide and cardiovascular mortality compared with the general population, especially immediately after a cancer diagnosis. Using data from the National Cancer Registry in Japan launched in January 2016, we will conduct the first nationwide population-based study in Japan to compare incidence of death by suicide, other externally caused injuries (ECIs) and cardiovascular disease following a cancer diagnosis with that of the general population in Japan. We will also aim to identify the patient subgroups and time periods associated with particularly high risk. METHODS AND ANALYSIS Our study subjects will consist of cancer cases diagnosed between 1 January 2016 and 31 December 2016 in Japan and they will be observed until 31 December 2018. We will calculate standardised mortality ratios (SMRs) and excess absolute risks (EARs) for suicide, other ECIs and cardiovascular death compared with the general population in Japan, after adjustment for sex, age and prefecture. SMRs and EARs will be calculated separately in relation to a number of factors: sex; age at diagnosis; time since cancer diagnosis; prefecture of residence at diagnosis; primary tumour site; behaviour code of tumour; extension of tumour; whether definitive surgery of the primary site was performed; and presence/absence of multiple primary tumours. ETHICS AND DISSEMINATION The study protocol was approved by the institutional review board and ethics committee of the National Cancer Center Japan and Nagoya City University Graduate School of Medical Sciences. The findings will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER UMIN000035118; Pre-results.
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Affiliation(s)
- Saki Harashima
- Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
- Department of Stress Sciences and Psychosomatic Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Maiko Fujimori
- Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tomohiro Matsuda
- Center for Cancer Registries, Center for Cancer Control and Information Services, National Cancer Center Japan, Tokyo, Japan
| | - Kumiko Saika
- Center for Cancer Registries, Center for Cancer Control and Information Services, National Cancer Center Japan, Tokyo, Japan
| | - Takaaki Hasegawa
- Division of Psycho-Oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
| | - Keisuke Inoue
- Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Yosuke Uchitomi
- Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
- Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka J Matsuoka
- Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
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Steeg S, Webb RT, Mok PLH, Pedersen CB, Antonsen S, Kapur N, Carr MJ. Risk of dying unnaturally among people aged 15–35 years who have harmed themselves and inflicted violence on others: a national nested case-control study. LANCET PUBLIC HEALTH 2019; 4:e220-e228. [DOI: 10.1016/s2468-2667(19)30042-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/28/2019] [Accepted: 03/07/2019] [Indexed: 10/26/2022]
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19
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Cawley R, Pontin EE, Touhey J, Sheehy K, Taylor PJ. What is the relationship between rejection and self-harm or suicidality in adulthood? J Affect Disord 2019; 242:123-134. [PMID: 30173060 DOI: 10.1016/j.jad.2018.08.082] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/26/2018] [Accepted: 08/17/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Rejection is an adverse experience that may help explain the heightened risk of self-harm and suicide amongst many societal groups. The aim of this systematic review was to determine the relationship between rejection experiences and self-harm and suicidal ideation. METHOD The databases PsychINFO, CINAHL, Medline and Web of Science were searched from inception until May 2017 using key search terms. Quantitative studies were included if they were; (i) mean sample age over 18; (ii) in the English language; (iii) and had a measure of self-harm or suicidal behaviour and a measure of rejection. The results were synthesised narratively. RESULTS Eighteen studies were identified for the review. Fifteen out of the eighteen studies found a significant positive association between rejection and self-harm. This association was identified within several marginalised groups known to be at risk of self-harm, including those from lesbian, gay or bisexual sexuality or those who identify as transgender. LIMITATIONS Heterogeneity between the measures of self-harm, suicidal behaviour and rejection, as well as the lack of longitudinal analyses made it difficult to draw firm conclusions. CONCLUSION Perceived rejection may leave some individuals at risk of self-harm and might account for the elevated risk in marginalised societal groups. Interventions focused on modifying rejection experiences may help reduce the risk of self-harm in this population.
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Affiliation(s)
- Rosanne Cawley
- Institute of Psychology, Health & Society, University of Liverpool, Liverpool L69 3GB, United Kingdom.
| | - Eleanor E Pontin
- Institute of Psychology, Health & Society, University of Liverpool, Liverpool L69 3GB, United Kingdom
| | - Jade Touhey
- Institute of Psychology, Health & Society, University of Liverpool, Liverpool L69 3GB, United Kingdom
| | - Kate Sheehy
- Institute of Psychology, Health & Society, University of Liverpool, Liverpool L69 3GB, United Kingdom
| | - Peter James Taylor
- Division of Psychology & Mental Health, University of Manchester, Manchester, United Kingdom
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20
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Madsen T, Nordentoft M, Benros ME. Self-harm, Traumatic Brain Injury, and Suicide-Reply. JAMA 2018; 320:2485. [PMID: 30561477 DOI: 10.1001/jama.2018.17562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Trine Madsen
- Danish Research Institute of Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- Danish Research Institute of Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Michael E Benros
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
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Aburto JM, Wensink M, van Raalte A, Lindahl-Jacobsen R. Potential gains in life expectancy by reducing inequality of lifespans in Denmark: an international comparison and cause-of-death analysis. BMC Public Health 2018; 18:831. [PMID: 29973183 PMCID: PMC6033219 DOI: 10.1186/s12889-018-5730-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reducing lifespan inequality is increasingly recognized as a health policy objective. Whereas lifespan inequality declined with rising longevity in most developed countries, Danish life expectancy stagnated between 1975 and 1995 for females and progressed slowly for males. It is unknown how Danish lifespan inequality changed, which causes of death drove these developments, and where the opportunities for further improvements lie now. METHODS We present an analytical strategy based on cause-by-age decompositions to simultaneously analyze changes in Danish life expectancy and lifespan inequality from 1960 to 2014, as well as current Swedish-Danish differences. RESULTS Stagnation in Danish life expectancy coincided with a shorter period of stagnation in lifespan inequality (1975-1990). The stagnation in life expectancy was mainly driven by increases in cancer and non-infectious respiratory mortality at higher ages (-.63 years) offsetting a reduction in cardiovascular and infant mortality (+ 1.52 years). Lifespan inequality stagnated because most causes of death did not show compression over the time period. Both these observations were consistent with higher smoking-related mortality in Danes born in 1919-1939. After 1995, life expectancy and lifespan equality increased in lockstep, but still lag behind Sweden, mainly due to infant mortality and cancer. CONCLUSIONS Since 1960, Danish improvements in life expectancy and lifespan equality were halted by smoking-related mortality in those born 1919-1939, while also reductions in old-age cardiovascular mortality held back lifespan equality. The comparison with Sweden suggests that Denmark can reduce inequality in lifespans and increase life expectancy through a consistent policy target: reducing cancer and infant mortality.
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Affiliation(s)
- José Manuel Aburto
- Center on Population Dynamics & Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9, DK-5000 Odense C, Denmark
- Max Planck Institute for Demographic Research, 18057 Rostock, Germany
| | - Maarten Wensink
- Center on Population Dynamics & Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9, DK-5000 Odense C, Denmark
| | - Alyson van Raalte
- Max Planck Institute for Demographic Research, 18057 Rostock, Germany
| | - Rune Lindahl-Jacobsen
- Center on Population Dynamics & Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9, DK-5000 Odense C, Denmark
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Barrett P, Griffin E, Corcoran P, O'Mahony MT, Arensman E. Self-harm among the homeless population in Ireland: A national registry-based study of incidence and associated factors. J Affect Disord 2018; 229:523-531. [PMID: 29351886 DOI: 10.1016/j.jad.2017.12.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/20/2017] [Accepted: 12/26/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Self-harm is a strong predictor of future suicide, but little is known about self-harm among the homeless population. The study aim was to estimate the incidence of self-harm among the homeless population and to assess factors associated with self-harm. METHODS Data on self-harm presentations to 34 hospital emergency departments in Ireland were collected by the National Self-Harm Registry Ireland (NSHRI). Index presentations between 2010 and 2014 were included for the homeless and fixed residence populations. Incidence rates of self-harm were calculated using NSHRI data and census estimates. Factors associated with self-harm and repeated self-harm were analysed by multivariable-adjusted logistic regression. RESULTS The age-standardised incidence rate of self-harm was 30 times higher among the homeless (5572 presentations per 100,000) compared with those with a fixed residence (187 presentations per 100,000). Homeless people had significantly higher odds of being male (OR 1.86, 95%CI 1.56-2.23), presenting with self-cutting (vs. overdose, OR 2.15, 95%CI 1.74-2.66) and having psychiatric admission (vs. general admission, OR 2.43, 95%CI 1.66-3.57). Homeless people had higher odds of self-harm repetition within 12 months (vs. fixed residence, OR 1.46, 95%CI 1.21-1.77). The odds of repetition were significantly increased among homeless who engaged in self-cutting (vs. overdose, OR 1.76, 95%CI 1.17-2.65) and did not receive psychiatric review at index presentation (vs. reviewed, OR 1.54, 95%CI 1.05-2.26). LIMITATIONS The study only reflects self-harm presenting to hospital, and assumes no change in homelessness status after index presentation. Residual confounding may affect the results. CONCLUSION There is a disproportionate burden of self-harm among the homeless. Targeted preventive actions are warranted.
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Affiliation(s)
- Peter Barrett
- Department of Public Health (Cork & Kerry), St. Finbarr's Hospital, Douglas Road, Cork, Ireland.
| | - Eve Griffin
- National Suicide Research Foundation, Western Gateway Building, University College Cork, Cork, Ireland
| | - Paul Corcoran
- National Suicide Research Foundation, Western Gateway Building, University College Cork, Cork, Ireland
| | - Mary T O'Mahony
- Department of Public Health (Cork & Kerry), St. Finbarr's Hospital, Douglas Road, Cork, Ireland
| | - Ella Arensman
- National Suicide Research Foundation, Western Gateway Building, University College Cork, Cork, Ireland; School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland
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Birtwistle J, Kelley R, House A, Owens D. Combination of self-harm methods and fatal and non-fatal repetition: A cohort study. J Affect Disord 2017; 218:188-194. [PMID: 28477496 DOI: 10.1016/j.jad.2017.04.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 02/16/2017] [Accepted: 04/19/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Assessment and aftercare for people who self-harm needs to be related to an understanding of risks of adverse outcomes. We aimed to determine whether self-harm by a combination of methods and its early repetition are associated with adverse outcomes - especially non-fatal repetition and suicide. METHOD 10,829 consecutive general hospital attendances due to self-harm in one large English city were monitored, through scrutiny of Emergency Department attendances, over three years and followed up to determine the incidence of non-fatal repetition. Subsequent deaths, by any cause and by suicide, were determined from national statistical records. RESULTS 6155 patients accounted for the 10,829 episodes: 72% by self-poisoning, 21% self-injury, and 746 episodes (7%) due to a combination of methods. After a combined-methods index episode, non-fatal repetition (P=0.001) and suicide (P=0.002) occurred sooner and more frequently than it did among those who had self-poisoned. Further hospital attendance due to self-harm within a month was associated with a 3.7-fold (95% CI 2.1-6.4) risk of subsequent suicide. LIMITATIONS The data exclude self-harm episodes that do not result in a hospital attendance. Index episodes in the study are not generally life-time first episodes so follow-up data are based on an arbitrary start-point. Both of these limitations are common to all studies of this kind. CONCLUSIONS At psychosocial assessment and the making of aftercare arrangements, combined methods of self-harm or another recent episode should be considered 'red-flag' indicators for attention to care.
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Affiliation(s)
- Jacqueline Birtwistle
- Institute of Health Sciences, School of Medicine, University of Leeds, United Kingdom
| | - Rachael Kelley
- Institute of Health Sciences, School of Medicine, University of Leeds, United Kingdom
| | - Allan House
- Institute of Health Sciences, School of Medicine, University of Leeds, United Kingdom
| | - David Owens
- Institute of Health Sciences, School of Medicine, University of Leeds, United Kingdom.
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Walter F, Carr MJ, Mok PL, Astrup A, Antonsen S, Pedersen CB, Shaw J, Webb RT. Premature Mortality Among Patients Recently Discharged From Their First Inpatient Psychiatric Treatment. JAMA Psychiatry 2017; 74:485-492. [PMID: 28296989 PMCID: PMC5417353 DOI: 10.1001/jamapsychiatry.2017.0071] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Nationwide cohorts provide sufficient statistical power for examining premature, cause-specific mortality in patients recently discharged from inpatient psychiatric services. OBJECTIVE To investigate premature mortality in a nationwide cohort of patients recently discharged from inpatient psychiatric treatment at ages 15 to 44 years. DESIGN, SETTING, AND PARTICIPANTS This single-cohort design included all persons born in Denmark (N = 1 683 385) between January 1, 1967, and December 31, 1996. Exactly 48 599 of these Danish residents were discharged from an inpatient psychiatric unit or ward on or after their 15th birthday, which took place during this study's observation period from January 1, 1982, through December 31, 2011. This group of patients was followed up beginning on their 15th birthday until their death, emigration, or December 31, 2011, whichever came first. Individuals discharged from inpatient psychiatric care at least once before their 15th birthday (n = 5882) were excluded from the study. All data were obtained from the Danish Civil Registration System, Psychiatric Central Research Register, and Register of Causes of Death. Data analysis took place between February 1, 2016, and December 10, 2016. MAIN OUTCOMES AND MEASURES Incidence rates and incidence rate ratios (IRRs) for all-cause mortality and for an array of unnatural and natural causes of death among patients recently discharged from an inpatient psychiatric unit vs persons not admitted to a psychiatric facility. Primary analysis considered risk within the year of first discharge. RESULTS Of the 48 599 discharged patients who were included in the study, 25 006 (51.4%) were female, 35 660 (73.4%) were aged 15 to 29 years, and 33 995 (70.0%) had a length of stay of 30 days or less. Compared with persons not admitted, patients discharged had an elevated risk for all-cause mortality within 1 year (IRR, 16.2; 95% CI, 14.5-18.0). The relative risk for unnatural death (IRR, 25.0; 95% CI, 22.0-28.4) was much higher than for natural death (IRR, 8.6; 95% CI, 7.0-10.7). The highest IRR found was for suicide at 66.9 (95% CI, 56.4-79.4), followed by alcohol-related death at 42.0 (95% CI, 26.6-66.1). Among the psychiatric diagnostic categories assessed, psychoactive substance abuse conferred the highest risk for all-cause mortality (IRR, 24.8; 95% CI, 21.0-29.4). Across the array of cause-specific outcomes examined, risk of premature death during the first year after discharge was markedly higher than the risk of death beyond the first year of discharge. CONCLUSIONS AND RELEVANCE Clinicians may help protect patients after discharge by serving as a liaison between primary and secondary health services to ensure they are receiving holistic care. Early intervention programs for drug and alcohol misuse could substantially decrease the greatly elevated mortality risk among these patients.
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Affiliation(s)
- Florian Walter
- Centre for Mental Health and Safety, University of Manchester, UK
| | - Matthew J. Carr
- Centre for Mental Health and Safety, University of Manchester, UK
| | - Pearl L.H. Mok
- Centre for Mental Health and Safety, University of Manchester, UK
| | - Aske Astrup
- Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark,National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Sussie Antonsen
- Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark,National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Carsten B. Pedersen
- Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark,National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Jenny Shaw
- Centre for Mental Health and Safety, University of Manchester, UK
| | - Roger T. Webb
- Centre for Mental Health and Safety, University of Manchester, UK
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25
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Carr MJ, Ashcroft DM, Kontopantelis E, While D, Awenat Y, Cooper J, Chew-Graham C, Kapur N, Webb RT. Premature Death Among Primary Care Patients With a History of Self-Harm. Ann Fam Med 2017; 15:246-254. [PMID: 28483890 PMCID: PMC5422086 DOI: 10.1370/afm.2054] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/16/2016] [Accepted: 12/30/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Self-harm is a public health problem that requires a better understanding of mortality risk. We undertook a study to examine premature mortality in a nationally representative cohort of primary care patients who had harmed themselves. METHODS During 2001-2013, a total of 385 general practices in England contributed data to the Clinical Practice Research Datalink with linkage to Office for National Statistics mortality records. We identified 30,017 persons aged 15 to 64 years with a recorded episode of self-harm. We estimated the relative risks of all-cause and cause-specific natural and unnatural mortality using a comparison cohort of 600,258 individuals matched on age, sex, and general practice. RESULTS We found an elevated risk of dying prematurely from any cause among the self-harm cohort, especially in the first year of follow-up (adjusted hazard ratio for that year, 3.6; 95% CI, 3.1-4.2). In particular, suicide risk was especially high during the first year (adjusted hazard ratio, 54.4; 95% CI, 34.3-86.3); although it declined sharply, it remained much higher than that in the comparison cohort. Large elevations of risk throughout the follow-up period were also observed for accidental, alcohol-related, and drug poisoning deaths. At 10 years of follow-up, cumulative incidence values were 6.5% (95% CI, 6.0%-7.1%) for all-cause mortality and 1.3% (95% CI, 1.2%-1.5%) for suicide. CONCLUSIONS Primary care patients who have harmed themselves are at greatly increased risk of dying prematurely by natural and unnatural causes, and especially within a year of a first episode. These individuals visit clinicians at a relatively high frequency, which presents a clear opportunity for preventive action. Primary care patients with myriad comorbidities, including self-harming behavior, mental disorder, addictions, and physical illnesses, will require concerted, multipronged, multidisciplinary collaborative care approaches.
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Affiliation(s)
- Matthew J Carr
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Carr, While, Awenat, Cooper, Kapur, Webb); Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Ashcroft); NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK (Ashcroft); Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Kontopantelis); Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK (Chew-Graham); West Midlands NIHR Collaborative Leadership in Applied Health Research and Care (CLAHRC), Birmingham, UK (Chew-Graham).
| | - Darren M Ashcroft
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Carr, While, Awenat, Cooper, Kapur, Webb); Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Ashcroft); NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK (Ashcroft); Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Kontopantelis); Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK (Chew-Graham); West Midlands NIHR Collaborative Leadership in Applied Health Research and Care (CLAHRC), Birmingham, UK (Chew-Graham)
| | - Evangelos Kontopantelis
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Carr, While, Awenat, Cooper, Kapur, Webb); Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Ashcroft); NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK (Ashcroft); Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Kontopantelis); Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK (Chew-Graham); West Midlands NIHR Collaborative Leadership in Applied Health Research and Care (CLAHRC), Birmingham, UK (Chew-Graham)
| | - David While
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Carr, While, Awenat, Cooper, Kapur, Webb); Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Ashcroft); NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK (Ashcroft); Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Kontopantelis); Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK (Chew-Graham); West Midlands NIHR Collaborative Leadership in Applied Health Research and Care (CLAHRC), Birmingham, UK (Chew-Graham)
| | - Yvonne Awenat
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Carr, While, Awenat, Cooper, Kapur, Webb); Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Ashcroft); NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK (Ashcroft); Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Kontopantelis); Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK (Chew-Graham); West Midlands NIHR Collaborative Leadership in Applied Health Research and Care (CLAHRC), Birmingham, UK (Chew-Graham)
| | - Jayne Cooper
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Carr, While, Awenat, Cooper, Kapur, Webb); Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Ashcroft); NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK (Ashcroft); Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Kontopantelis); Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK (Chew-Graham); West Midlands NIHR Collaborative Leadership in Applied Health Research and Care (CLAHRC), Birmingham, UK (Chew-Graham)
| | - Carolyn Chew-Graham
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Carr, While, Awenat, Cooper, Kapur, Webb); Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Ashcroft); NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK (Ashcroft); Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Kontopantelis); Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK (Chew-Graham); West Midlands NIHR Collaborative Leadership in Applied Health Research and Care (CLAHRC), Birmingham, UK (Chew-Graham)
| | - Nav Kapur
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Carr, While, Awenat, Cooper, Kapur, Webb); Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Ashcroft); NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK (Ashcroft); Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Kontopantelis); Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK (Chew-Graham); West Midlands NIHR Collaborative Leadership in Applied Health Research and Care (CLAHRC), Birmingham, UK (Chew-Graham)
| | - Roger T Webb
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Carr, While, Awenat, Cooper, Kapur, Webb); Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Ashcroft); NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK (Ashcroft); Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Kontopantelis); Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK (Chew-Graham); West Midlands NIHR Collaborative Leadership in Applied Health Research and Care (CLAHRC), Birmingham, UK (Chew-Graham)
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Clinical Prediction of Suicide and Undetermined Death: A Pseudo-Prospective Clinical and Medico-Legal Study of Substance Abusers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14030310. [PMID: 28304357 PMCID: PMC5369146 DOI: 10.3390/ijerph14030310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/01/2017] [Accepted: 03/14/2017] [Indexed: 12/02/2022]
Abstract
This study examines aspects of prediction of suicide and death of undetermined intent. We investigated all consecutive, autopsied patients between 1993 and 1997 who had been in contact with the Addiction Centre in Malmö from 1968 onwards. The staff was asked, shortly after autopsy but before they knew of the manner of death, if they thought the patient had committed suicide. The case records were blindly evaluated, and toxicological autopsy findings for alcohol in blood samples investigated. The specificity of prediction was 83% and significantly more often correct than the sensitivity, which was only 45% for suicide and for suicide/death of undetermined intent (93% versus 39%). Suicidal communication was more often considered non-serious before death of undetermined intent than before suicide. The former could be predicted by ideation but not by suicide attempt reported in case records, unlike suicide, which was predicted by both. The undetermined group also showed higher levels of alcohol in the blood at autopsy. We concluded that more serious clinical investigation of suicidal feelings, which may be hidden and not taken seriously, and treatment of alcohol use disorders with active follow-up appear urgent in the efforts to prevent suicide.
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Idenfors H, Strömsten LMJ, Renberg ES. Non-psychiatric inpatient care preceding admission for self-harm in young people. J Psychosom Res 2016; 88:8-13. [PMID: 27521645 DOI: 10.1016/j.jpsychores.2016.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 06/28/2016] [Accepted: 06/28/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Many young people contact health services before they harm themselves intentionally. However, they often seek care for non-suicidal or non-psychiatric causes despite having suicidal thoughts. We investigated the non-psychiatric hospital diagnoses received by young people during the year before their first admission to hospital for self-harm. METHODS From a national register, we selected people who were hospitalised for an episode of self-harm during the period 1999-2009, at which time they were aged 16 to 24. We compared them with matched controls regarding the probability for having been admitted with different diagnoses during the year preceding the self-harm admission. RESULTS The study included 48,705 young people (16,235 cases and 32,470 controls). Those admitted for self-harm were more likely than controls to have been hospitalised for non-psychiatric reasons, which included symptomatic diagnoses such as abdominal pain, syncope/collapse, unspecified convulsions, and chest pain. Certain chronic somatic illnesses were also overrepresented, such as epilepsy, diabetes mellitus type 1, and asthma. CONCLUSION Symptomatic diagnoses were more common in those who had been admitted for self-harm. It is possible that psychiatric problems could have been the cause of the symptoms in some of these admissions where no underlying illness could be found, and if this was not uncovered it might lead to a delay in suicide risk assessment. For several chronic illnesses, when admitted to hospital, a psychiatric evaluation might be indicated.
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Affiliation(s)
- Hans Idenfors
- Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden.
| | - Lotta M J Strömsten
- Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden
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Yamauchi T, Inagaki M, Yonemoto N, Iwasaki M, Akechi T, Sawada N, Iso H, Noda M, Tsugane S. History of diabetes and risk of suicide and accidental death in Japan: The Japan Public Health Centre-based Prospective Study, 1990–2012. DIABETES & METABOLISM 2016; 42:184-91. [DOI: 10.1016/j.diabet.2015.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 10/30/2015] [Accepted: 11/25/2015] [Indexed: 11/28/2022]
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Impact of the recent recession on self-harm: Longitudinal ecological and patient-level investigation from the Multicentre Study of Self-harm in England. J Affect Disord 2016; 191:132-8. [PMID: 26655123 DOI: 10.1016/j.jad.2015.11.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 10/20/2015] [Accepted: 11/01/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Economic recessions are associated with increases in suicide rates but there is little information for non-fatal self-harm. AIMS To investigate the impact of the recent recession on rates of self-harm in England and problems faced by patients who self-harm. METHOD Analysis of data from the Multicentre Study of Self-harm in England for 2001-2010 and local employment statistics for Oxford, Manchester and Derby, including interrupted time series analyses to estimate the effect of the recession on rates of self-harm. RESULTS Rates of self-harm increased in both genders in Derby and in males in Manchester in 2008-2010, but not in either gender in Oxford, results which largely followed changes in general population unemployment. More patients who self-harm were unemployed in 2008-10 compared to before the recession. The proportion in receipt of sickness or disability allowances decreased. More patients of both genders had employment and financial problems in 2008-2010 and more females also had housing problems, changes which were also largely found in employed patients. LIMITATIONS We have assumed that the recession began in 2008 and information on problems was only available for patients having a psychosocial assessment. CONCLUSIONS Increased rates of self-harm were found in areas where there were greater rises in rates of unemployment. Work, financial and housing problems increased in people who self-harmed. Changes in welfare benefits may have contributed. DECLARATION OF INTEREST None.
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Townsend E, Ness J, Waters K, Kapur N, Turnbull P, Cooper J, Bergen H, Hawton K. Self-harm and life problems: findings from the Multicentre Study of Self-harm in England. Soc Psychiatry Psychiatr Epidemiol 2016; 51:183-92. [PMID: 26499114 DOI: 10.1007/s00127-015-1136-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 10/13/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE Self-harm is a major clinical problem and is strongly linked to suicide. It is important to understand the problems faced by those who self-harm to design effective clinical services and suicide prevention strategies. We investigated the life problems experienced by patients presenting to general hospitals for self-harm. METHODS Data for 2000-2010 from the Multicentre Study of Self-harm in England were used to investigate life problems associated with self-harm and their relationship to patient and clinical characteristics, including age, gender, repeat self-harm and employment status. RESULTS Of 24,598 patients (36,431 assessed episodes), 57% were female and with a mean age of 33.1 years (SD 14.0 years), 92.6% were identified as having at least one contributing life problem. The most frequently reported problems at first episode of self-harm within the study period were relationship difficulties (especially with partners). Mental health issues and problems with alcohol were also very common (especially in those aged 35-54 years, and those who repeated self-harm). Those who repeated self-harm were more likely to report problems with housing, mental health and dealing with the consequences of abuse. CONCLUSIONS Self-harm usually occurs in the context of multiple life problems. Clinical services for self-harm patients should have access to appropriate care for provision of help for relationship difficulties and problems concerning alcohol and mental health issues. Individualised clinical support (e.g. psychological therapy, interventions for alcohol problems and relationship counselling) for self-harm patients facing these life problems may play a crucial role in suicide prevention.
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Affiliation(s)
- Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, University Park, Nottingham, NG72RD, UK.
| | - Jennifer Ness
- Centre for Self-Harm and Suicide Prevention Research, Research and Development Centre, Derbyshire Healthcare NHS Foundation Trust, Kingsway, Derby, DE22 3LZ, UK
| | - Keith Waters
- Centre for Self-Harm and Suicide Prevention Research, Research and Development Centre, Derbyshire Healthcare NHS Foundation Trust, Kingsway, Derby, DE22 3LZ, UK
| | - Navneet Kapur
- Centre for Suicide Prevention, University of Manchester, Centre for Mental Health and Safety, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Pauline Turnbull
- Centre for Suicide Prevention, University of Manchester, Centre for Mental Health and Safety, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Jayne Cooper
- Centre for Suicide Prevention, University of Manchester, Centre for Mental Health and Safety, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Helen Bergen
- Centre for Suicide Research, University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Keith Hawton
- Centre for Suicide Research, University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
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Haw C, Casey D, Holmes J, Hawton K. Suicidal Intent and Method of Self-Harm: A Large-scale Study of Self-Harm Patients Presenting to a General Hospital. Suicide Life Threat Behav 2015; 45:732-46. [PMID: 25916308 DOI: 10.1111/sltb.12168] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 03/02/2015] [Indexed: 11/30/2022]
Abstract
Data from the Oxford Monitoring System for Attempted Suicide (2004-2011) were used to study hospital presentations for self-harm in which Suicidal Intent Scale (SIS) scores were obtained (N = 4,840). Regression of medians was used to control for the confounding effect of age and gender. Higher estimated median SIS scores were associated with increasing age, male gender, self-poisoning versus self-injury, multiple methods of self-harm versus self-injury alone, use of gas (mainly carbon monoxide), dangerous methods of self-injury (including hanging, gunshot), and use of alcohol as part of the act. For self-poisoning patients, there was a correlation between the number of tablets taken and the total SIS score. Compared with self-poisoning with paracetamol and paracetamol-containing compounds, self-poisoning with antipsychotics was associated with a lower median SIS score while antidepressants had the same estimated median as paracetamol. Use of alcohol within 6 hours of self-harm was associated with lower SIS scores. In conclusion, certain methods of self-harm, particularly dangerous methods of self-injury and self-poisoning with gas, were associated with high intent and should alert clinicians to potential higher risk of suicide. However, apart from use of gas, suicidal intent cannot be inferred from type of drugs used for self-poisoning.
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Affiliation(s)
- Camilla Haw
- Academic Centre, St Andrew's, Cliftonville, Northampton, UK.,Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Deborah Casey
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Jane Holmes
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
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Turnbull P, Webb R, Kapur N, Clements C, Bergen H, Hawton K, Ness J, Waters K, Townsend E, Cooper J. Variation by ethnic group in premature mortality risk following self-harm: a multicentre cohort study in England. BMC Psychiatry 2015; 15:254. [PMID: 26482436 PMCID: PMC4615884 DOI: 10.1186/s12888-015-0637-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 10/06/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Incidence and risk factors for self-harm vary according to ethnicity. People who self-harm have been shown to have increased risk of premature death, but little is known about mortality following self-harm in ethnic minority groups. METHODS A prospective cohort study of self-harm presentations to three English cities (Derby, Manchester, Oxford) between 2000 and 2010. We linked to a national mortality dataset to investigate premature death in South Asian and Black people in comparison with White people to the end of 2012. RESULTS Ethnicity was known for 72% of the 28,512 study cohort members: 88% were White, 5% were South Asian, and 3% were Black. After adjusting for age, gender and area-level socioeconomic deprivation, the risk of all-cause mortality was lower in South Asian (hazard ratio [HR] 0.51, 95% confidence interval [CI] 0.42 - 0.62) and Black people (HR 0.46, 95% CI 0.39 - 0.55) versus White people. Suicide risk was significantly lower in Black people (HR 0.43, 95% CI 0.19 - 0.97) than in White people. Prevalence of risk factors for premature death, such as previous self-harm, psychiatric treatment or concurrent alcohol misuse, was lower in South Asian and Black people than in White people. CONCLUSIONS The risk of death following self-harm is lower in South Asian and Black people than White people in the UK, and they also have lower prevalence of risk factors for premature death. Awareness of both protective and risk factors might help to inform clinical decisions following assessment.
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Affiliation(s)
- Pauline Turnbull
- Centre for Mental Health and Safety, Centre for Suicide Prevention, The University of Manchester, Manchester, UK.
| | - Roger Webb
- Centre for Mental Health and Safety, Centre for Suicide Prevention, The University of Manchester, Manchester, UK.
| | - Nav Kapur
- Centre for Mental Health and Safety, Centre for Suicide Prevention, The University of Manchester, Manchester, UK. .,Manchester Mental Health and Social Care Trust, Manchester, UK.
| | - Caroline Clements
- Centre for Mental Health and Safety, Centre for Suicide Prevention, The University of Manchester, Manchester, UK.
| | - Helen Bergen
- Centre for Suicide Research, Department of Psychiatry, Warneford Hospital, The University of Oxford, Oxford, UK.
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, Warneford Hospital, The University of Oxford, Oxford, UK.
| | - Jennifer Ness
- Derbyshire Healthcare NHS Foundation Trust, Royal Derby Hospital, Derby, UK.
| | - Keith Waters
- Derbyshire Healthcare NHS Foundation Trust, Royal Derby Hospital, Derby, UK.
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, The University of Nottingham, Nottingham, UK.
| | - Jayne Cooper
- Centre for Mental Health and Safety, Centre for Suicide Prevention, The University of Manchester, Manchester, UK.
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Kwok CL, Yip PSF, Gunnell D, Kuo CJ, Chen YY. Non-fatal repetition of self-harm in Taipei City, Taiwan: cohort study. Br J Psychiatry 2015; 204:376-82. [PMID: 24482442 DOI: 10.1192/bjp.bp.113.130179] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Repeat self-harm is an important risk factor for suicide. Few studies have explored risk factors for non-fatal repeat self-harm in Asia. AIMS To investigate the risk of non-fatal repeat self-harm in a large cohort of patients presenting to hospital in Taipei City, Taiwan. METHOD Prospective cohort study of 7601 patients with self-harm presenting to emergency departments (January 2004-December 2006). Survival analysis was used to examine the rates, timing and factors associated with repeat self-harm. RESULTS In total 778 (10.2%) patients presented to hospital with one or more further episodes of self-harm. The cumulative risk of non-fatal repetition within 1 year of a self-harm episode was 9.3% (95% CI 8.7-10.1). The median time to repetition within 1 year was 105 days. Females had a higher incidence of repeat self-harm than males (adjusted hazard ratio 1.25, 95% CI 1.05-1.48) but males had shorter median time to repetition (107 v. 80 days). Other independent risk factors for repeat self-harm within 1 year of an index episode were: young age, self-harm by medicine overdose and increasing number of repeat episodes of self-harm. CONCLUSIONS The risk of non-fatal repeat self-harm in Taipei City is lower than that seen in the West. Risk factors for repeat non-fatal self-harm differ from those for fatal self-harm. The first 3 months after self-harm is a crucial period for intervention.
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Affiliation(s)
- Chi-Leung Kwok
- Chi-Leung Kwok, BSc (ActuarSc), Paul S. F. Yip, PhD, Hong Kong Jockey Club Center for Suicide Research and Prevention, and Department of Social Work and Social Administration, University of Hong Kong, Hong Kong; David Gunnell, MD, PhD, School of Social and Community Medicine, University of Bristol, UK; Chian-Jue Kuo, Taipei City Psychiatric Center, Taipei City Hospital, and School of Medicine, Taipei Medical University, Taipei, Taiwan; Ying-Yeh Chen, MD, ScD, Taipei City Psychiatric Center, Taipei City Hospital, and Institute of Public Health and Department of Public Health, National Yang-Ming University, Taipei, Taiwan
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Dalela D, Krishna N, Okwara J, Preston MA, Abdollah F, Choueiri TK, Reznor G, Sammon JD, Schmid M, Kibel AS, Nguyen PL, Menon M, Trinh QD. Suicide and accidental deaths among patients with non-metastatic prostate cancer. BJU Int 2015; 118:286-97. [DOI: 10.1111/bju.13257] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Deepansh Dalela
- Division of Urologic Surgery and Center for Surgery and Public Health; Harvard Medical School; Brigham and Women's Hospital/Dana-Farber Cancer Institute; Boston MA USA
- VUI Center for Outcomes Research, Analytics and Evaluation; Vattikuti Urology Institute; Henry Ford Health System; Detroit MI USA
| | - Nandita Krishna
- Division of Urologic Surgery and Center for Surgery and Public Health; Harvard Medical School; Brigham and Women's Hospital/Dana-Farber Cancer Institute; Boston MA USA
| | - James Okwara
- Division of Urologic Surgery and Center for Surgery and Public Health; Harvard Medical School; Brigham and Women's Hospital/Dana-Farber Cancer Institute; Boston MA USA
| | - Mark A. Preston
- Division of Urologic Surgery and Center for Surgery and Public Health; Harvard Medical School; Brigham and Women's Hospital/Dana-Farber Cancer Institute; Boston MA USA
| | - Firas Abdollah
- VUI Center for Outcomes Research, Analytics and Evaluation; Vattikuti Urology Institute; Henry Ford Health System; Detroit MI USA
| | - Toni K. Choueiri
- Department of Medical Oncology; Harvard Medical School; Brigham and Women's Hospital/Dana-Farber Cancer Institute; Boston MA USA
| | - Gally Reznor
- Division of Urologic Surgery and Center for Surgery and Public Health; Harvard Medical School; Brigham and Women's Hospital/Dana-Farber Cancer Institute; Boston MA USA
| | - Jesse D. Sammon
- VUI Center for Outcomes Research, Analytics and Evaluation; Vattikuti Urology Institute; Henry Ford Health System; Detroit MI USA
| | - Marianne Schmid
- Division of Urologic Surgery and Center for Surgery and Public Health; Harvard Medical School; Brigham and Women's Hospital/Dana-Farber Cancer Institute; Boston MA USA
| | - Adam S. Kibel
- Division of Urologic Surgery and Center for Surgery and Public Health; Harvard Medical School; Brigham and Women's Hospital/Dana-Farber Cancer Institute; Boston MA USA
| | - Paul L. Nguyen
- Department of Radiation Oncology; Harvard Medical School; Brigham and Women's Hospital/Dana-Farber Cancer Institute; Boston MA USA
| | - Mani Menon
- VUI Center for Outcomes Research, Analytics and Evaluation; Vattikuti Urology Institute; Henry Ford Health System; Detroit MI USA
| | - Quoc-Dien Trinh
- Division of Urologic Surgery and Center for Surgery and Public Health; Harvard Medical School; Brigham and Women's Hospital/Dana-Farber Cancer Institute; Boston MA USA
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Chen IM, Liao SC, Lee MB, Wu CY, Lin PH, Chen WJ. Risk factors of suicide mortality among multiple attempters: A national registry study in Taiwan. J Formos Med Assoc 2015; 115:364-71. [PMID: 26279174 DOI: 10.1016/j.jfma.2015.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 07/04/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND/PURPOSE Little is known about the risk factors of suicide mortality among multiple attempters. This study aims to investigate the predictors of suicidal mortality in a prospective cohort of attempters in Taiwan, focusing on the time interval and suicide method change between the last two nonfatal attempts. METHODS The representative data retrieved from the National Suicide Surveillance System (NSSS) was linked with National Mortality Database to identify the causes of death in multiple attempters during 2006-2008. Cox-proportional hazard models were applied to calculate the hazard ratios for the predictors of suicide. RESULTS Among the 55,560 attempters, 6485 (11.7%) had survived attempts ranging from one to 11 times; 861 (1.5%) eventually died by suicide. Multiple attempters were characterized by female (OR = 1.56, p < 0.0001), nonrecipient of national aftercare service (OR = 1.62, p < 0.0001), and current contact with mental health services (OR = 3.17, p < 0.0001). Most multiple attempters who survived from hanging (68.1%) and gas poisoning (61.9%) chose the same method in the following fatal episode. Predictors of suicidal death were identified as male, older age (≥ 45 years), shorter interval and not maintaining methods of low lethality in the last two nonfatal attempts. Receipt of nationwide aftercare was associated with lower risk of suicide but the effect was insignificant. CONCLUSION The time interval of the last two nonfatal attempts and alteration in the lethality of suicide method were significant factors for completed suicide. Risk assessment involving these two factors may be necessary for multiple attempters in different clinical settings. Effective strategies for suicide prevention emphasizing this high risk population should be developed in the future.
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Affiliation(s)
- I-Ming Chen
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shih-Cheng Liao
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Been Lee
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Department of Psychiatry, National Taiwan University College of Medicine, Taipei, Taiwan; National Suicide Prevention Centre, Taipei, Taiwan.
| | - Chia-Yi Wu
- School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Hsien Lin
- Department of Psychiatry, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Wei J Chen
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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Hawton K, Bergen H, Cooper J, Turnbull P, Waters K, Ness J, Kapur N. Suicide following self-harm: findings from the Multicentre Study of self-harm in England, 2000-2012. J Affect Disord 2015; 175:147-51. [PMID: 25617686 DOI: 10.1016/j.jad.2014.12.062] [Citation(s) in RCA: 216] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 12/30/2014] [Accepted: 12/31/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Self-harm is a key risk factor for suicide and it is important to have contemporary information on the extent of risk. METHODS Mortality follow-up to 2012 of 40,346 self-harm patients identified in the three centres of the Multicentre Study of Self-harm in England between 2000 and 2010. RESULTS Nineteen per cent of deaths during the study period (N=2704) were by suicide, which occurred in 1.6% of patients (2.6% of males and 0.9% of females), during which time the risk was 49 times greater than the general population risk. Overall, 0.5% of individuals died by suicide in the first year, including 0.82% of males and 0.27% of females. While the absolute risk of suicide was greater in males, the risk relative to that in the general population was higher in females. Risk of suicide increased with age. While self-poisoning had been the most frequent method of self-harm, hanging was the most common method of subsequent suicide, particularly in males. The number of suicides was probably a considerable underestimate as there were also a large number of deaths recorded as accidents, the majority of which were poisonings, these often involving psychotropic drugs. LIMITATIONS The study was focussed entirely on hospital-presenting self-harm. CONCLUSIONS The findings underline the importance of prevention initiatives focused on the self-harm population, especially during the initial months following an episode of self-harm. Estimates using suicide and open verdicts may underestimate the true risk of suicide following self-harm; inclusion of accidental poisonings may be warranted in future risk estimates.
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Affiliation(s)
- Keith Hawton
- Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford, UK.
| | - Helen Bergen
- Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Jayne Cooper
- Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Oxford Road, Manchester, UK
| | - Pauline Turnbull
- Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Oxford Road, Manchester, UK
| | - Keith Waters
- Derbyshire Healthcare NHS Foundation Trust, Royal Derby Hospital, Derby, UK
| | - Jennifer Ness
- Derbyshire Healthcare NHS Foundation Trust, Royal Derby Hospital, Derby, UK
| | - Nav Kapur
- Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Oxford Road, Manchester, UK
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Woolf M, Bantjes J, Kagee A. THE CHALLENGES OF SCHOOL-BASED YOUTH SUICIDE PREVENTION: EXPERIENCES AND PERCEPTIONS OF MENTAL HEALTH PROFESSIONALS IN SOUTH AFRICAN SCHOOLS. THE SOCIAL WORK PRACTITIONER-RESEARCHER 2015; 27:20-44. [PMID: 27990493 PMCID: PMC5157121 DOI: 10.25159/2415-5829/776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Youth suicidal behaviour poses a significant public health concern. Mental health care professionals working in schools have an important role to play in youth suicide prevention initiatives, although little is known of the experiences of this group of professionals in the developing world. The aim of this study was to explore the experiences of mental health professionals working in South African schools and document their insights, attitudes and beliefs regarding youth suicidal behaviour. In-depth semi-structured interviews were conducted with seven school-based mental health care professionals and data were analysed using Thematic Analysis. Participants reported that they relied on a reactive strategy by responding to youths who were in crisis. They were challenged by a lack of support from faculty staff, lack of access to resources, and heavy caseloads. Findings highlight the need for a proactive and collaborative approach to suicide prevention among mental health care professionals, teachers and parents in South African schools and improved training and supervision.
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Affiliation(s)
- Maryke Woolf
- Master's Student, Department of Psychology, University of Stellenbosch
| | - Jason Bantjes
- Lecturer, Department of Psychology, University of Stellenbosch
| | - Ashraf Kagee
- Professor, Department of Psychology, University of Stellenbosch
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38
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An assessment of suicide attempts by self-poisoning in the west of Iran. J Forensic Leg Med 2014; 27:1-5. [DOI: 10.1016/j.jflm.2014.07.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 06/06/2014] [Accepted: 07/07/2014] [Indexed: 11/20/2022]
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Bergen H, Hawton K, Webb R, Cooper J, Steeg S, Haigh M, Ness J, Waters K, Kapur N. Alcohol-related mortality following self-harm: a multicentre cohort study. JRSM Open 2014; 5:2054270414533326. [PMID: 25289146 PMCID: PMC4100241 DOI: 10.1177/2054270414533326] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives To assess alcohol-related premature death in people who self-harm compared to the general population, including variation by socioeconomic deprivation. Design A retrospective longitudinal cohort analysis from the Multicentre Study of self-harm in England, 1 January 2000 to 31 December 2010, with cause-specific mortality follow-up through to 31 December 2012. Setting Six emergency departments in Oxford, Manchester and Derby. Participants All individuals aged 15 years or more who presented with self-harm (n = 39,014) to general hospital emergency departments, together with follow-up mortality information from the Data Linkage Service of the Health and Social Care Information Centre. Main outcome measures Standardised mortality ratios (observed/expected number of deaths: SMRs) and mean number of years of life lost (YLL) were estimated for alcohol-related mortality. Patients’ characteristics and clinical management following self-harm were also examined. Results After 7.5 years’ (median) follow-up, 2695 individuals (6.9%) had died, significantly more males (9.5%) than females (5.0%), including 307 (11.4%) from alcohol-related causes. Alcohol-related death was more frequent than expected in both males (SMR 8.5, 95% CI 7.3 to 9.8) and females (11.6, 9.8 to 13.7), equating to 33.7 YLL (95% CI 32.4 to 35.0) in males and 38.1 YLL (36.6 to 39.6) in females. It was not associated with area-level socioeconomic deprivation. Alcohol-related death was associated with unemployed/sick/disabled status, alcohol use during self-harm, referral to drug/alcohol services and lack of psychosocial assessment following self-harm. Conclusions Hospital-presenting self-harm patients should receive assessment following self-ham according to national guidance to enable early identification and treatment of alcohol problems.
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Affiliation(s)
- Helen Bergen
- Department of Psychiatry, Centre for Suicide Research, Warneford Hospital, University of Oxford, Headington, Oxford OX3 7JX, UK
| | - Keith Hawton
- Department of Psychiatry, Centre for Suicide Research, Warneford Hospital, University of Oxford, Headington, Oxford OX3 7JX, UK
| | - Roger Webb
- Centre for Suicide Prevention in the Centre for Mental Health and Risk, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK
| | - Jayne Cooper
- Centre for Suicide Prevention in the Centre for Mental Health and Risk, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK
| | - Sarah Steeg
- Centre for Suicide Prevention in the Centre for Mental Health and Risk, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK
| | - Matthew Haigh
- Centre for Suicide Prevention in the Centre for Mental Health and Risk, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK ; Department of Psychology, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - Jennifer Ness
- Derbyshire Healthcare NHS Foundation Trust, Mental Health Liaison Team, Royal Derby Hospital, Derby DE22 3NE, UK
| | - Keith Waters
- Derbyshire Healthcare NHS Foundation Trust, Mental Health Liaison Team, Royal Derby Hospital, Derby DE22 3NE, UK
| | - Navneet Kapur
- Centre for Suicide Prevention in the Centre for Mental Health and Risk, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK
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40
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Death by suicide and other externally caused injuries after stroke in Japan (1990-2010): the Japan Public Health Center-based prospective study. Psychosom Med 2014; 76:452-9. [PMID: 24979581 DOI: 10.1097/psy.0000000000000079] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE No large population-based prospective study has investigated the risks of suicide and death by other externally caused injuries (ECIs) among stroke patients. The purpose of this study was to examine whether stroke increases the risks of suicide and ECI deaths. METHODS We analyzed data from the Japan Public Health Center-based Prospective Study between 1990 and 2010. Poisson regression models were used to calculate adjusted risk ratios (RR) for suicide and ECI deaths. To adjust for unmeasured confounders, case-crossover analyses of all stroke patients who died by suicide and ECIs were also performed. RESULTS A population-based cohort of 93,027 Japanese residents was established. During the follow-up period, 4793 residents had been diagnosed as having stroke. During this period, there were 22 suicides and 53 ECI deaths among stroke patients and 490 suicides and 675 ECI deaths among those who were stroke-free. Stroke patients were at increased risk for death by suicide and ECIs within the first 5 years after a stroke (suicide: RR = 10.2, 95% confidence interval [CI] = 6.3-16.6; ECI: RR = 12.8, 95% confidence interval = 9.0-18.2). Furthermore, case-crossover analyses confirmed the results of the Poisson regression models. CONCLUSIONS The RRs of suicide and ECI deaths within the first 5 years after a stroke were noticeably high. These findings underscore the need for clinicians and health care professionals to be aware of causes of death after a stroke and closely monitor patients during the first few poststroke years.
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Yamauchi T, Inagaki M, Yonemoto N, Iwasaki M, Inoue M, Akechi T, Iso H, Tsugane S. Death by suicide and other externally caused injuries following a cancer diagnosis: the Japan Public Health Center-based Prospective Study. Psychooncology 2014; 23:1034-41. [DOI: 10.1002/pon.3529] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 02/06/2014] [Accepted: 02/28/2014] [Indexed: 01/09/2023]
Affiliation(s)
- Takashi Yamauchi
- Center for Suicide Prevention, National Institute of Mental Health; National Center of Neurology and Psychiatry; 4-1-1 Ogawahigashi, Kodaira Tokyo 187-8553 Japan
| | - Masatoshi Inagaki
- Department of Neuropsychiatry; Okayama University Hospital; Shikata-cho, Kita-ku Okayama 700-8558 Japan
| | - Naohiro Yonemoto
- Department of Epidemiology and Biostatistics, Translational Medical Center; National Center of Neurology and Psychiatry; 4-1-1 Ogawahigashi, Kodaira Tokyo 187-8553 Japan
| | - Motoki Iwasaki
- Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening; National Cancer Center; 5-1-1 Tsukiji, Chuo-ku Tokyo 104-0045 Japan
| | - Manami Inoue
- Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening; National Cancer Center; 5-1-1 Tsukiji, Chuo-ku Tokyo 104-0045 Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine; Nagoya City University Graduate School of Medical Sciences; Mizuho-cho, Mizuho-ku Nagoya 467-8601 Japan
| | - Hiroyasu Iso
- Department of Social and Environmental Medicine, Graduate School of Medicine; Osaka University; 2-2 Yamadaoka, Suita-shi Osaka 565-0871 Japan
| | - Shoichiro Tsugane
- Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening; National Cancer Center; 5-1-1 Tsukiji, Chuo-ku Tokyo 104-0045 Japan
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Jones P, Gunnell D, Platt S, Scourfield J, Lloyd K, Huxley P, John A, Kamran B, Wells C, Dennis M. Identifying probable suicide clusters in wales using national mortality data. PLoS One 2013; 8:e71713. [PMID: 24015189 PMCID: PMC3756004 DOI: 10.1371/journal.pone.0071713] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 07/02/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Up to 2% of suicides in young people may occur in clusters i.e., close together in time and space. In early 2008 unprecedented attention was given by national and international news media to a suspected suicide cluster among young people living in Bridgend, Wales. This paper investigates the strength of statistical evidence for this apparent cluster, its size, and temporal and geographical limits. METHODS AND FINDINGS The analysis is based on official mortality statistics for Wales for 2000-2009 provided by the UK's Office for National Statistics (ONS). Temporo-spatial analysis was performed using Space Time Permutation Scan Statistics with SaTScan v9.1 for suicide deaths aged 15 and over, with a sub-group analysis focussing on cases aged 15-34 years. These analyses were conducted for deaths coded by ONS as: (i) suicide or of undetermined intent (probable suicides) and (ii) for a combination of suicide, undetermined, and accidental poisoning and hanging (possible suicides). The temporo-spatial analysis did not identify any clusters of suicide or undetermined intent deaths (probable suicides). However, analysis of all deaths by suicide, undetermined intent, accidental poisoning and accidental hanging (possible suicides) identified a temporo-spatial cluster (p = 0.029) involving 10 deaths amongst 15-34 year olds centred on the County Borough of Bridgend for the period 27(th) December 2007 to 19(th) February 2008. Less than 1% of possible suicides in younger people in Wales in the ten year period were identified as being cluster-related. CONCLUSIONS There was a possible suicide cluster in young people in Bridgend between December 2007 and February 2008. This cluster was smaller, shorter in duration, and predominantly later than the phenomenon that was reported in national and international print media. Further investigation of factors leading to the onset and termination of this series of deaths, in particular the role of the media, is required.
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Affiliation(s)
- Phillip Jones
- College of Medicine, Institute of Life Sciences 2, Swansea University, Swansea, United Kingdom
| | - David Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Stephen Platt
- Centre for Population Health Sciences, University of Edinburgh Medical School, United Kingdom
| | | | - Keith Lloyd
- College of Medicine, Institute of Life Sciences 2, Swansea University, Swansea, United Kingdom
| | - Peter Huxley
- College of Medicine, Institute of Life Sciences 2, Swansea University, Swansea, United Kingdom
| | - Ann John
- College of Medicine, Institute of Life Sciences 2, Swansea University, Swansea, United Kingdom
| | - Babar Kamran
- College of Medicine, Institute of Life Sciences 2, Swansea University, Swansea, United Kingdom
| | - Claudia Wells
- Office for National Statistics, Government Buildings, Newport, United Kingdom
| | - Michael Dennis
- College of Medicine, Institute of Life Sciences 2, Swansea University, Swansea, United Kingdom
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43
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Abstract
Suicide prevention must be transformed by integrating injury prevention and mental health perspectives to develop a mosaic of common risk public health interventions that address the diversity of populations and individuals whose mortality and morbidity contribute to the burdens of suicide and attempted suicide. Emphasizing distal preventive interventions, strategies must focus on people and places--and on related interpersonal factors and social contexts--to alter the life trajectories of people before they become suicidal. Attention also must be paid to those in the middle years--the age with the greatest overall burden. We need scientific and social processes that define priorities and assess their potential for reducing what has been a steadily increasing rate of suicide during the past decade.
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Affiliation(s)
- Eric D Caine
- Injury Control Research Center for Suicide Prevention, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY 14642-8409, USA.
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Hawton K, Bergen H, Kapur N, Cooper J, Steeg S, Ness J, Waters K. Repetition of self-harm and suicide following self-harm in children and adolescents: findings from the Multicentre Study of Self-harm in England. J Child Psychol Psychiatry 2012; 53:1212-9. [PMID: 22537181 DOI: 10.1111/j.1469-7610.2012.02559.x] [Citation(s) in RCA: 192] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Self-harm (intentional self-poisoning and self-injury) in children and adolescents is often repeated and is associated with increased risk of future suicide. We have investigated factors associated with these outcomes. METHOD We used data collected in the Multicentre Study of Self-harm in England on all self-harm hospital presentations by individuals aged 10-18 years between 2000 and 2007, and national death information on these individuals to the end of 2010. Cox hazard proportional models were used to identify independent and multivariable predictors of repetition of self-harm and of suicide. RESULTS Repetition of self-harm occurred in 27.3% of individuals (N = 3920) who presented between 2000 and 2005 and were followed up until 2007. Multivariate analysis showed that repetition was associated with age, self-cutting, and previous self-harm and psychiatric treatment. Of 51 deaths in individuals who presented between 2000 and 2007 and were followed up to 2010 (N = 5133) half (49.0%) were suicides. The method used was usually different to that used for self-harm. Multivariate analysis showed that suicide was associated with male gender [Hazard ratio (HR) = 2.4, 95% CI 1.2-4.8], self-cutting (HR = 2.1, 95% CI 1.1-3.7) and prior psychiatric treatment at initial presentation (HR = 4.2, 95% CI 1.7-10.5). It was also associated with self-cutting and history of psychiatric treatment at the last episode before death, and history of previous self harm. CONCLUSIONS Self-cutting as a method of self-harm in children and adolescents conveys greater risk of suicide (and repetition) than self-poisoning although different methods are usually used for suicide. The findings underline the need for psychosocial assessment in all cases.
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Affiliation(s)
- Keith Hawton
- Centre for Suicide Research, University of Oxford, Oxford, UK.
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45
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Bergen H, Hawton K, Waters K, Ness J, Cooper J, Steeg S, Kapur N. Premature death after self-harm: a multicentre cohort study. Lancet 2012; 380:1568-74. [PMID: 22995670 DOI: 10.1016/s0140-6736(12)61141-6] [Citation(s) in RCA: 178] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND People who self-harm have an increased risk of premature death. The aim of this study was to investigate cause-specific premature death in individuals who self-harm, including associations with socioeconomic deprivation. METHODS We undertook a cohort study of patients of all ages presenting to emergency departments in Oxford, Manchester, and Derby, UK, after self-poisoning or self-injury between Jan 1, 2000, and Dec 31, 2007. Postcodes of individuals' place of residence were linked to the Index of Multiple Deprivation 2007 in England. Mortality information was supplied by the Medical Research Information Service of the National Health Service. Patients were followed up to the end of 2009. We calculated age-standardised mortality ratios (SMRs) and years of life lost (YLL), and we tested for associations with socioeconomic deprivation. FINDINGS 30 950 individuals presented with self-harm and were followed up for a median of 6·0 years (IQR 3·9-7·9). 1832 (6·1%) patients died before the end of follow-up. Death was more likely in patients than in the general population (SMR 3·6, 95% CI 3·5-3·8), and occurred more in males (4·1, 3·8-4·3) than females (3·2, 2·9-3·4). Deaths due to natural causes were 2-7·5 times more frequent than was expected. For individuals who died of any cause, mean YLL was 31·4 years (95% CI 30·5-32·2) for male patients and 30·7 years (29·5-31·9) for female patients. Mean YLL for natural-cause deaths was 25·9 years (25·7-26·0) for male patients and 25·5 years (25·2-25·8) for female patients, and for external-cause deaths was 40·2 years (40·0-40·3) and 40·0 years (39·7-40·5), respectively. Disease of the circulatory (13·1% in males; 13·0% in females) and digestive (11·7% in males; 17·8% in females) systems were major contributors to YLL from natural causes. All-cause mortality increased with each quartile of socioeconomic deprivation in male patients (χ(2) trend 39·6; p<0·0001), female patients (13·9; p=0·0002), and both sexes combined (55·4; p<0·0001). Socioeconomic deprivation was related to mortality in both sexes combined from natural causes (51·0; p<0·0001) but not from external causes (0·30; p=0·58). Alcohol problems were associated with death from digestive-system disease, drug misuse with mental and behavioural disorders, and physical health problems with circulatory-system disease. INTERPRETATION Physical health and life expectancy are severely compromised in individuals who self-harm compared with the general population. In the management of self-harm, clinicians assessing patients' psychosocial problems should also consider their physical needs. FUNDING Department of Health Policy Research Programme.
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Affiliation(s)
- Helen Bergen
- University of Oxford Centre for Suicide Research, Department of Psychiatry, Warneford Hospital, Headington, Oxford, UK
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