1
|
Hunt IM, Baird A, Turnbull P, Ibrahim S, Shaw J, Appleby L, Kapur N. Psychiatric in-patient care in England: as safe as it can be? An examination of in-patient suicide between 2009 and 2020. Psychol Med 2024; 54:1702-1708. [PMID: 38213183 DOI: 10.1017/s0033291723003628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND Psychiatric in-patients have a greatly elevated risk of suicide. We aimed to examine trends in in-patient suicide rates and determine if characteristics of in-patients who died by suicide have changed over time. METHODS We identified all in-patients in England who died by suicide between 2009 and 2020 from the National Confidential Inquiry into Suicide and Safety in Mental Health. Suicide rates were calculated using data from Hospital Episodes Statistics. RESULTS The rate of in-patient suicide per 100 000 bed days fell by 41.9% between 2009-2011 and 2018-2020. However, since 2016 the rate has remained static with no significant fall. Rates fell in men, those aged 30-59, and those with schizophrenia and other delusional disorders or personality disorder. Rates also fell for suicide by hanging (including hanging on the ward) and jumping. No falls were seen in suicide rates among women, younger and older age groups, and those with affective disorder. There was no indication of a transfer of risk to the post-discharge period or to home treatment/crisis care. More in-patients in the latter part of the study were aged under 25, were on authorised leave, and had psychiatric comorbidity. CONCLUSIONS In-patient suicide has significantly fallen since 2009, suggesting patient safety may have improved. The recent slowdown in the fall in rates, however, highlights that renewed preventative efforts are needed. These should include a greater focus on women, younger and older patients, and those with affective disorder. Careful reviews prior to granting leave are important to ensure a safe transition into the community.
Collapse
Affiliation(s)
- Isabelle M Hunt
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Alison Baird
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Pauline Turnbull
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Saied Ibrahim
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jenny Shaw
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Louis Appleby
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Nav Kapur
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester; and Mersey Care NHS Foundation Trust, Prescot, UK
| |
Collapse
|
2
|
Mulligan LD, Bojanić L, Hunt IM, Baird A, Turnbull P, Kapur N, Appleby L, Shaw J. Substance use and self-poisoning in schizophrenia: 11-year findings from a national clinical survey of suicide in mental health patients in the UK. Schizophr Res 2024; 267:254-260. [PMID: 38581828 DOI: 10.1016/j.schres.2024.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/03/2023] [Accepted: 03/28/2024] [Indexed: 04/08/2024]
Abstract
Suicide is the leading cause of unnatural death among people with schizophrenia. Substance use is a highly prevalent comorbid feature of schizophrenia and a modifiable risk factor for suicide. However, no studies have examined changes in the frequency of substance use or self-poisoning in those who died by suicide over time. Knowing this could support more tailored approaches to reducing specific risk factors and access to means in those with schizophrenia who are at risk of suicide. We conducted an 11-year observational study on a clinical survey of people with schizophrenia in the UK who died by suicide within 12 months of contact with mental health services between 2010 and 2020 (n = 2718). Overall, alcohol, cannabis and stimulants were the most frequently reported substances. The odds of lifetime use significantly increased over time for cannabis, stimulants, heroin, and benzodiazepines. There were differences in socio-demographic, behavioural and clinical factors between those with recent and historical alcohol and drug use before death. Deaths by hanging, jumping and self-poisoning were the most common suicide methods. Though deaths by hanging significantly increased over time, deaths by self-poisoning significantly decreased, especially by means of psychotropic medication and opioids. To improve risk management, clinical efforts should focus on identifying and treating people with schizophrenia using specific substances. Nationwide initiatives for improving safety in prescribing could be contributing to reduced risks of suicide via self-poisoning in this group.
Collapse
Affiliation(s)
- Lee D Mulligan
- Division of Psychology & Mental Health, Faculty of Biology, Medicine & Health, University of Manchester, M13 9PL, UK.
| | - Lana Bojanić
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL, UK
| | - Isabelle M Hunt
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL, UK
| | - Alison Baird
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL, UK
| | - Pauline Turnbull
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL, UK
| | - Nav Kapur
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL, UK; NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, M13 9PL, UK; Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Louis Appleby
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL, UK
| | - Jenny Shaw
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL, UK
| |
Collapse
|
3
|
Rodway C, Ibrahim S, Westhead J, Bojanić L, Turnbull P, Appleby L, Bacon A, Dale H, Harrison K, Kapur N. Suicide after leaving the UK Armed Forces 1996-2018: A cohort study. PLoS Med 2023; 20:e1004273. [PMID: 37552686 PMCID: PMC10409259 DOI: 10.1371/journal.pmed.1004273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 07/06/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND There are comparatively few international studies investigating suicide in military veterans and no recent UK-wide studies. This is important because the wider context of being a UK Armed Forces (UKAF) veteran has changed in recent years following a period of intensive operations. We aimed to investigate the rate, timing, and risk factors for suicide in personnel who left the UKAF over a 23-year period. METHODS AND FINDINGS We carried out a retrospective cohort study of suicide in personnel who left the regular UKAF between 1996 and 2018 linking national databases of discharged personnel and suicide deaths, using survival analysis to examine the risk of suicide in veterans compared to the general population and conditional logistic regression to investigate factors most strongly associated with suicide after discharge. The 458,058 individuals who left the UKAF accumulated over 5,852,100 person years at risk, with a median length of follow-up of 13 years, were mostly male (91%), and had a median age of 26 years at discharge. 1,086 (0.2%) died by suicide. The overall rate of suicide in veterans was slightly lower than the general population (standardised mortality ratio, SMR [95% confidence interval, CI] 94 [88 to 99]). However, suicide risk was 2 to 3 times higher in male and female veterans aged under 25 years than in the same age groups in the general population (age-specific mortality ratios ranging from 160 to 409). Male veterans aged 35 years and older were at reduced risk of suicide (age-specific mortality ratios 47 to 80). Male sex, Army service, discharge between the ages of 16 and 34 years, being untrained on discharge, and length of service under 10 years were associated with higher suicide risk. Factors associated with reduced risk included being married, a higher rank, and deployment on combat operations. The rate of contact with specialist NHS mental health services (273/1,086, 25%) was lowest in the youngest age groups (10% for 16- to 19-year-olds; 23% for 20- to 24-year-olds). Study limitations include the fact that information on veterans was obtained from administrative databases and the role of pre-service vulnerabilities and other factors that may have influenced later suicide risk could not be explored. In addition, information on contact with support services was only available for veterans in contact with specialist NHS mental health services and not for those in contact with other health and social care services. CONCLUSIONS In this study, we found suicide risk in personnel leaving the UKAF was not high but there are important differences according to age, with higher risk in young men and women. We found a number of factors which elevated the risk of suicide but deployment was associated with lower risk. The focus should be on improving and maintaining access to mental health care and social support for young service leavers, as well as implementing general suicide prevention measures for all veterans regardless of age.
Collapse
Affiliation(s)
- Cathryn Rodway
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Saied Ibrahim
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Jodie Westhead
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Lana Bojanić
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Pauline Turnbull
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Andy Bacon
- Armed Forces Team, NHS England, London, United Kingdom
- Westminster Centre for Research in Veterans, University of Chester, Chester, United Kingdom
| | - Harriet Dale
- Ministry of Defence, Defence Statistics Health, Bristol, United Kingdom
| | - Kate Harrison
- Ministry of Defence, Defence Statistics Health, Bristol, United Kingdom
| | - Nav Kapur
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Research Centre, University of Manchester, Manchester, United Kingdom
- Mersey Care NHS Foundation Trust, Liverpool, United Kingdom
| |
Collapse
|
4
|
Mughal F, Bojanić L, Rodway C, Graney J, Ibrahim S, Quinlivan L, Steeg S, Tham SG, Turnbull P, Appleby L, Webb RT, Kapur N. Recent GP consultation before death by suicide in middle-aged males: a national consecutive case series study. Br J Gen Pract 2023; 73:e478-e485. [PMID: 37130612 PMCID: PMC10170520 DOI: 10.3399/bjgp.2022.0589] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/28/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Reducing suicide risk in middle-aged males (40-54 years) is a national priority. People have often presented to their GP within 3 months before suicide thus highlighting an opportunity for early intervention. AIM To describe the sociodemographic characteristics and identify antecedents in middle-aged males who recently consulted a GP before dying by suicide. DESIGN AND SETTING This study was a descriptive examination of suicide in a national consecutive sample of middle-aged males in 2017 in England, Scotland, and Wales. METHOD General population mortality data were obtained from the Office for National Statistics and National Records of Scotland. Information was collected about antecedents considered relevant to suicide from data sources. Logistic regression examined associations with final recent GP consultation. Males with lived experience were consulted during the study. RESULTS In 2017, a quarter (n = 1516) of all suicide deaths were in middle-aged males. Data were attained on 242 males: 43% had their last GP consultation within 3 months of suicide; and a third of these males were unemployed and nearly half were living alone. Males who saw a GP recently before suicide were more likely to have had recent self-harm and work-related problems than males who had not. Having a current major physical illness, recent self-harm, presenting with a mental health problem, and recent work-related issues were associated with having a last GP consultation close to suicide. CONCLUSION Clinical factors were identified that GPs should be alert to when assessing middle-aged males. Personalised holistic management may have a role in preventing suicide in these individuals.
Collapse
Affiliation(s)
- Faraz Mughal
- School of Medicine, Keele University, Keele; honorary clinical research fellow, Division of Psychology and Mental Health, University of Manchester, Manchester; affiliate, NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester
| | - Lana Bojanić
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), School of Health Sciences, University of Manchester, Manchester
| | - Cathryn Rodway
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), School of Health Sciences, University of Manchester, Manchester
| | - Jane Graney
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), School of Health Sciences, University of Manchester, Manchester
| | - Saied Ibrahim
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), School of Health Sciences, University of Manchester, Manchester
| | - Leah Quinlivan
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester
| | - Sarah Steeg
- School of Health Sciences, University of Manchester, Manchester
| | - Su-Gwan Tham
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), School of Health Sciences, University of Manchester, Manchester
| | - Pauline Turnbull
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), School of Health Sciences, University of Manchester, Manchester
| | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), School of Health Sciences, University of Manchester, Manchester
| | - Roger T Webb
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester
| | - Nav Kapur
- NCISH, School of Health Sciences, University of Manchester, Manchester; Manchester Academic Health Sciences Centre, Manchester; Greater Manchester Mental Health NHS Foundation Trust, Manchester; NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester
| |
Collapse
|
5
|
Geoffroy MC, Arseneault L, Girard A, Ouellet-Morin I, Power C. Association of childhood bullying victimisation with suicide deaths: findings from a 50-year nationwide cohort study. Psychol Med 2023; 53:4152-4159. [PMID: 35388770 PMCID: PMC10317807 DOI: 10.1017/s0033291722000836] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 02/23/2022] [Accepted: 03/09/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Bullying victimisation has been associated with increased risk of suicide ideation and attempt throughout the lifespan, but no study has yet examined whether it translates to a greater risk of death by suicide. We aimed to determine the association of bullying victimisation with suicide mortality. METHODS Participants were drawn from the 1958 British birth cohort, a prospective follow-up of all births in 1 week in Britain in 1958. We conducted logistic regressions on 14 946 participants whose mothers reported bullying victimisation at 7 and 11 years with linked information on suicide deaths through the National Health Service Central Register. RESULTS Fifty-five participants (48 males) had died by suicide between the age 18 and 52 years. Bullying victimisation was associated with suicide mortality; a one standard deviation increases in bullying victimisation linked to an increased odds for suicide mortality [odds ratio (OR) 1.29; 1.02-1.64] during adulthood. The OR attenuated by 11% after adjustment for individual (e.g. behavioural and emotional problems) and familial characteristics (e.g. adverse childhood experiences, 1.18; 0.92-1.51). Analysis of bullying victimisation frequency categories yields similar results: compared with individuals who had not been bullied, those who had been frequently bullied had an increased odds for suicide mortality (OR 1.89; 0.99-3.62). CONCLUSION Our study suggests that individuals who have been frequently bullied have a small increased risk of dying by suicide, when no other risk factors is considered. Suicide prevention might start in childhood, with bullying included in a range of inter-correlated vulnerabilities encompassing behavioural and emotional difficulties and adverse experiences within the family.
Collapse
Affiliation(s)
- Marie-Claude Geoffroy
- Departments of Psychiatry and Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Louise Arseneault
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alain Girard
- CHU Sainte-Justine Research Center, Montreal, Canada
| | | | - Chris Power
- UCL Great Ormond Street Institute of Child Health, London, UK
| |
Collapse
|
6
|
Lu FW, Conway E, Liang YL, Chen YY, Gunnell D, Chang SS. Space-time self-harm and suicide clusters in two cities in Taiwan. Epidemiol Psychiatr Sci 2023; 32:e37. [PMID: 37258458 DOI: 10.1017/s2045796023000513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
AIMS Suicidal acts may cluster in time and space and lead to community concerns about further imitative suicidal episodes. Although suicide clusters have been researched in previous studies, less is known about the clustering of non-fatal suicidal behaviour (self-harm). Furthermore, most previous studies used crude temporal and spatial information, e.g., numbers aggregated by month and residence area, for cluster detection analysis. This study aimed to (i) identify space-time clusters of self-harm and suicide using daily incidence data and exact address and (ii) investigate the characteristics of cluster-related suicidal acts. METHODS Data on emergency department presentations for self-harm and suicide deaths in Taipei City and New Taipei City, Taiwan, were used in this study. In all-age and age-specific analyses, self-harm and suicide clusters were identified using space-time permutation scan statistics. A cut-off of 0.10 for the p value was used to identify possible clusters. Logistic regression was used to investigate the characteristics associated with cluster-related episodes. RESULTS A total of 5,291 self-harm episodes and 1,406 suicides in Taipei City (2004-2006) and 20,531 self-harm episodes and 2,329 suicides in New Taipei City (2012-2016) were included in the analysis. In the two cities, two self-harm clusters (n [number of self-harm episodes or suicide deaths in the cluster] = 4 and 8 in Taipei City), four suicide clusters (n = 3 in Taipei City and n = 4, 11 and 4 in New Taipei City) and two self-harm and suicide combined clusters (n = 4 in Taipei City and n = 8 in New Taipei City) were identified. Space-time clusters of self-harm, suicide, and self-harm and suicide combined accounted for 0.05%, 0.59%, and 0.08% of the respective groups of suicidal acts. Cluster-related episodes of self-harm and suicide were more likely to be male (adjusted odds ratio [aOR] = 2.22, 95% confidence interval [CI] 1.26, 3.89) and young people aged 10-29 years (aOR = 2.72, 95% CI 1.43, 5.21) than their cluster-unrelated counterparts. CONCLUSIONS Space-time clusters of self-harm, suicide, and self-harm and suicide combined accounted for a relatively small proportion of suicidal acts and were associated with some sex/age characteristics. Focusing on suicide deaths alone may underestimate the size of some clusters and/or lead to some clusters being overlooked. Future research could consider combining self-harm and suicide data and use social connection information to investigate possible clusters of suicidal acts.
Collapse
Affiliation(s)
- Fang-Wen Lu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Erica Conway
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
- Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ya-Lun Liang
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ying-Yeh Chen
- Taipei City Psychiatric Centre, Taipei City Hospital, Taipei, Taiwan
- Institute of Public Health and Department of Public Health, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - David Gunnell
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol, Bristol, UK
- National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, UK
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
- Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
7
|
Ramos-Martín J, Contreras-Peñalver MÁ, Moreno-Küstner B. Classification of suicidal behavior calls in emergency medical services: a systematic review. Int J Emerg Med 2023; 16:27. [PMID: 37069512 PMCID: PMC10108483 DOI: 10.1186/s12245-023-00504-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 04/02/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND The aim of this systematic review was to examine the classification of calls for suicidal behavior in emergency medical services (EMS). METHODS A search strategy was carried out in four electronic databases on calls for suicidal behavior in EMS published between 2010 and 2020 in Spanish and English. The outcome variables analyzed were the moment of call classification, the professional assigning the classification, the type of classification, and the suicide codes. RESULTS Twenty-five studies were included in the systematic review. The EMS classified the calls at two moments during the service process. In 28% of the studies, classification was performed during the emergency telephone call and in 36% when the professional attended the patient at the scene. The calls were classified by physicians in 40% of the studies and by the telephone operator answering the call in 32% of the studies. In 52% of the studies, classifications were used to categorize the calls, while in 48%, this information was not provided. Eighteen studies (72%) described codes used to classify suicidal behavior calls: a) codes for suicidal behavior and self-injury, and b) codes related to intoxication, poisoning or drug abuse, psychiatric problems, or other methods of harm. CONCLUSION Despite the existence of international disease classifications and standardized suicide identification systems and codes in EMS, there is no consensus on their use, making it difficult to correctly identify calls for suicidal behavior.
Collapse
Affiliation(s)
- Javier Ramos-Martín
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico. Universidad de Málaga, Doctor Ortiz Ramos, S/N 29010, Málaga, Spain.
| | - M Ángeles Contreras-Peñalver
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico. Universidad de Málaga, Doctor Ortiz Ramos, S/N 29010, Málaga, Spain
| | - Berta Moreno-Küstner
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico. Universidad de Málaga, Doctor Ortiz Ramos, S/N 29010, Málaga, Spain
- Grupo Andaluz de Investigación Psicosocial (GAP) (CTS-945), Málaga, Spain
- Instituto de Biomedicina de Málaga (IBIMA), Málaga, Spain
| |
Collapse
|
8
|
Tham SG, Hunt IM, Turnbull P, Appleby L, Kapur N, Knipe D. Suicide among psychiatric patients who migrated to the UK: a national clinical survey. EClinicalMedicine 2023; 57:101859. [PMID: 36895802 PMCID: PMC9989630 DOI: 10.1016/j.eclinm.2023.101859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Within the UK, limited research has examined migration and suicide risk. To assist with tailoring mental health care to the needs of different migrant groups, it is important to identify the clinical profile and antecedents to suicide. METHODS We focussed on two groups of migrants: those resident in the UK for less than 5 years (recent migrants) and those seeking permission to stay in the UK. Data on mental health patients who died by suicide in the UK between 2011 and 2019 were obtained as part of the National Confidential Inquiry into Suicide and Safety in Mental Health. FINDINGS 13,948 patients died by suicide between 2011 and 2019: 593 were recent migrants with 48 seeking permission to stay in the UK. The overall suicide rate between 2011 and 2017 for patients seeking to stay was 23.8/100,000 (95% CI 17.3-32.1). There was some uncertainty around this estimate but it appeared higher than the general population suicide rate of 10.6/100,000 population (95% CI 10.5-10.7; p = .0001) for the same period. A higher proportion of migrants were from an ethnic minority group (15% recent migrants vs. 70% seeking to remain vs. 7% non-migrants) and more were viewed as at low long-term risk of suicide (63% recent migrants vs. 76% seeking to remain vs. 57% non-migrants). A higher proportion of recent migrants died within three months of discharge from psychiatric in-patient care (19% vs. 14%) compared to non-migrants. Proportionally more patients seeking to remain had a diagnosis of schizophrenia and other delusional disorders (31% vs. 15%) and more had experienced recent life events compared to non-migrants (71% vs. 51%). INTERPRETATION A higher proportion of migrants had severe or acute illness at the time of their suicide. This may be linked to a range of serious stressors and/or lack of connection with services that could have identified signs of illness early. However, clinicians often viewed these patients as low risk. Mental health services should consider the breadth of stressors migrants may face and adopt a multi-agency approach to suicide prevention. FUNDING The Healthcare Quality Improvement Partnership.
Collapse
Affiliation(s)
- Su-Gwan Tham
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
- Corresponding author. National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, 2nd Floor Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK.
| | - Isabelle M. Hunt
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Pauline Turnbull
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Nav Kapur
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Duleeka Knipe
- Population Health Sciences, University of Bristol, Bristol, UK
| |
Collapse
|
9
|
Geulayov G, Casey D, Bale E, Brand F, Clements C, Farooq B, Kapur N, Ness J, Waters K, Patel A, Hawton K. Risk of suicide in patients who present to hospital after self-cutting according to site of injury: findings from the Multicentre Study of Self-harm in England. Psychol Med 2023; 53:1400-1408. [PMID: 34344489 DOI: 10.1017/s0033291721002956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND We compared the risk of death by suicide following hospital presentation for self-harm according to site of self-cut/stab. METHOD We included 54 999 self-harm presentations (involving 31 419 individuals) to hospitals in the Multicentre Study of Self-harm in England (1/1/2004-31/12/2014), with mortality follow-up to 31/12/2019. Information on method of self-harm was obtained through monitoring in hospitals. Information about mortality was obtained through linkage with NHS Digital. We assessed the association of site of self-cut with death by suicide using mixed effect models. RESULTS In total, 10 790 (19.6%) hospital presentations involved self-cutting/stabbing, 7489 of which (69.4%) were due to laceration to the arm/wrist alone, 1846 episodes (17.1%) involved cutting elsewhere on the body, and 1455 (13.5%) were due to laceration to unknown site. Controlling for confounders, presentation to a hospital following self-cut/stab to bodily parts other than wrist/arm was associated with greater chance of subsequent suicide relative to presentation after self-poisoning alone [adjusted odds ratio (aOR) 1.75, 95% confidence interval (CI) 1.03-2.96, p = 0.038]. The likelihood of suicide after presentation for cutting/stabbing the wrist/arm alone was comparable to that of patients who had self-poisoned alone. Presentations after laceration involving the neck were associated with a four-fold greater chance of subsequent suicide relative to self-poisoning (aOR 4.09, 95% CI 1.80-9.30, p = 0.001). CONCLUSIONS Patients who attend hospital after self-cutting/stabbing are a heterogeneous group in terms of characteristics, methods of cutting/stabbing and risk of subsequent suicide. Risk of suicide is greater in individuals who self-cut/stab to parts of the body other than the wrist or arm, especially the neck.
Collapse
Affiliation(s)
- Galit Geulayov
- Department of Psychiatry, Centre for Suicide Research, University of Oxford, Warneford Hospital, Oxford, UK
| | - Deborah Casey
- Department of Psychiatry, Centre for Suicide Research, University of Oxford, Warneford Hospital, Oxford, UK
| | - Elizabeth Bale
- Department of Psychiatry, Centre for Suicide Research, University of Oxford, Warneford Hospital, Oxford, UK
| | - Fiona Brand
- Department of Psychiatry, Centre for Suicide Research, University of Oxford, Warneford Hospital, Oxford, UK
| | - Caroline Clements
- Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Bushra Farooq
- Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Nav Kapur
- Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Jennifer Ness
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Keith Waters
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Anita Patel
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Keith Hawton
- Department of Psychiatry, Centre for Suicide Research, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| |
Collapse
|
10
|
Goueslard K, Jollant F, Cottenet J, Bechraoui-Quantin S, Rozenberg P, Simon E, Quantin C. Hospitalisation for non-lethal self-harm and premature mortality in the 3 years following adolescent pregnancy: Population-based nationwide cohort study. BJOG 2023. [PMID: 36808811 DOI: 10.1111/1471-0528.17432] [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: 05/11/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVE To evaluate the risk of non-lethal self-harm and mortality related to adolescent pregnancy. DESIGN Nationwide population-based retrospective cohort. SETTING Data were extracted from the French national health data system. POPULATION We included all adolescents aged 12-18 years with an International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) code for pregnancy in 2013-2014. METHODS Pregnant adolescents were compared with age-matched non-pregnant adolescents and with first-time pregnant women aged 19-25 years. MAIN OUTCOME MEASURES Any hospitalisation for non-lethal self-harm and mortality during a 3-year follow-up period. Adjustment variables were age, a history of hospitalisation for physical diseases, psychiatric disorders, self-harm and reimbursed psychotropic drugs. Cox proportional hazards regression models were used. RESULTS In 2013-2014, 35 449 adolescent pregnancies were recorded in France. After adjustment, pregnant adolescents had an increased risk of subsequent hospitalisation for non-lethal self-harm in comparison with both non-pregnant adolescents (n = 70 898) (1.3% vs 0.2%, HR 3.06, 95% CI 2.57-3.66) and pregnant young women (n = 233 406) (0.5%, HR 2.41, 95% CI 2.14-2.71). Rates of hospitalisation for non-lethal self-harm were lower during pregnancy and higher between 12 and 8 months pre-delivery, 3-7 months postpartum and in the month following abortion. Mortality was significantly higher in pregnant adolescents (0.7‰) versus pregnant young women (0.4‰, HR 1.74, 95% CI 1.12-2.72), but not versus non-pregnant adolescents (0.4‰, HR 1.61, 95% CI 0.92-2.83). CONCLUSIONS Adolescent pregnancy is associated with an increased risk of hospitalisation for non-lethal self-harm and premature death. Careful psychological evaluation and support should be systematically implemented for adolescents who are pregnant.
Collapse
Affiliation(s)
- Karine Goueslard
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France
| | - Fabrice Jollant
- Department of Psychiatry, Paris-Saclay University and Academic Hospital (CHU) Bicêtre, Le Kremlin-Bicêtre, France.,Department of Psychiatry, Nîmes Academic Hospital (CHU), Nîmes, France.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,MOODS Research Team, Centre de recherche en Epidémiologie et santé des populations (CESP), Institut national de la santé et de la recherche médicale (Inserm), Le Kremlin-Bicêtre, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France
| | - Sonia Bechraoui-Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France.,Gynecology, Obstetrics and Fetal Medicine, University Hospital, Dijon, France
| | - Patrick Rozenberg
- Department of Obstetrics and Gynecology, Hôpital Intercommunal de Poissy, Université Versailles Saint-Quentin, Poissy, France
| | - Emmanuel Simon
- Gynecology, Obstetrics and Fetal Medicine, University Hospital, Dijon, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France.,Inserm, High-Dimensional Biostatistics for Drug Safety and Genomics, CESP, Université Paris-Saclay, Université Versailles Saint-Quentin, Université Paris-Sud, Villejuif, France
| |
Collapse
|
11
|
Favril L, Yu R, Uyar A, Sharpe M, Fazel S. Risk factors for suicide in adults: systematic review and meta-analysis of psychological autopsy studies. EVIDENCE-BASED MENTAL HEALTH 2022; 25:148-155. [PMID: 36162975 PMCID: PMC9685708 DOI: 10.1136/ebmental-2022-300549] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022]
Abstract
QUESTION Effective prevention of suicide requires a comprehensive understanding of risk factors. STUDY SELECTION AND ANALYSIS Five databases were systematically searched to identify psychological autopsy studies (published up to February 2022) that reported on risk factors for suicide mortality among adults in the general population. Effect sizes were pooled as odds ratios (ORs) using random-effects models for each risk factor examined in at least three independent samples. FINDINGS A total of 37 case-control studies from 23 countries were included, providing data on 40 risk factors in 5633 cases and 7101 controls. The magnitude of effect sizes varied substantially both between and within risk factor domains. Clinical factors had the strongest associations with suicide, including any mental disorder (OR=13.1, 95% CI 9.9 to 17.4) and a history of self-harm (OR=10.1, 95% CI 6.6 to 15.6). By comparison, effect sizes were smaller for other domains relating to sociodemographic status, family history, and adverse life events (OR range 2-5). CONCLUSIONS A wide range of predisposing and precipitating factors are associated with suicide among adults in the general population, but with clear differences in their relative strength. PROSPERO REGISTRATION NUMBER CRD42021232878.
Collapse
Affiliation(s)
- Louis Favril
- Faculty of Law and Criminology, Ghent University, Ghent, Belgium
| | - Rongqin Yu
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Abdo Uyar
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Michael Sharpe
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
| |
Collapse
|
12
|
King TL, Disney G, Sutherland G, Kavanagh A, Spittal MJ, Simons K. Associations between workers’ compensation and self-harm: A retrospective case-series study of hospital admissions data. THE LANCET REGIONAL HEALTH - WESTERN PACIFIC 2022; 30:100614. [DOI: 10.1016/j.lanwpc.2022.100614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
13
|
Augarde E, Gunnell D, Mars B, Hickman M. An ecological study of temporal trends in 'deaths of despair' in England and Wales. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1135-1144. [PMID: 35247059 PMCID: PMC9090864 DOI: 10.1007/s00127-022-02251-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 02/18/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE There is growing interest in the concept of 'deaths of despair' (DoD)-defined as deaths from three causes: suicide, drug poisoning, and alcohol-related conditions-as a more comprehensive indicator of the impact of psychological distress on mortality. The purpose of this study is to investigate the degree of commonality in trends and geographic patterning of deaths from these causes in England and Wales. METHODS WHO mortality data were used to calculate age-standardised, sex-specific temporal trends in DoD mortality and in mortality from suicide, drug poisonings, and alcohol-related conditions in England and Wales, 2001-2016. Three-year average crude rates were calculated for English local authorities for 2016-2018 and associations between rates were assessed using Spearman's rank correlation. RESULTS Between 2001 and 2016, the DoD mortality rate increased by 21·6% (males) and 16·9% (females). The increase was largely due to a rise in drug poisoning deaths, with limited tracking between trends in mortality by each cause. DoD mortality risk was highest in middle-aged people; there were rises in all age groups except 15-24 year old males and 65 + females. There were strong positive correlations (r = 0.66(males) and 0.60(females)) between local authority-area drug poisoning and alcohol-specific mortality rates in 2016-2018. Correlations of these outcomes with suicide were weaker (r = 0.29-0.54). CONCLUSIONS DoD mortality is increasing in England and Wales but there is limited evidence of commonality in the epidemiology of cause-specific mortality from the component causes of DoD (suicide, drug poisoning and alcohol-related conditions), indicating the need for tailored prevention for each outcome.
Collapse
Affiliation(s)
- Elizabeth Augarde
- Population Health Sciences, University of Bristol, Bristol, UK. .,Department of Health and Social Care, London, UK.
| | - David Gunnell
- Population Health Sciences, University of Bristol, Bristol, UK.,NIHR Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Becky Mars
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Matthew Hickman
- Population Health Sciences, University of Bristol, Bristol, UK.,NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK.,NIHR School of Public Health Research, University of Bristol, Bristol, UK
| |
Collapse
|
14
|
Martínez-Alés G, Gimbrone C, Rutherford C, Keyes K, López-Cuadrado T. Role of Foreign-Born Status on Suicide Mortality in Spain Between 2000 and 2019: An Age-Period-Cohort Analysis. Int J Public Health 2022; 67:1604538. [PMID: 35664647 PMCID: PMC9156625 DOI: 10.3389/ijph.2022.1604538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: To examine recent age-period-cohort effects on suicide among foreign-born individuals, a particularly vulnerable sociodemographic group in Spain. Methods: Using 2000-2019 mortality data from Spain's National Institute of Statistics, we estimated age-period-cohort effects on suicide mortality, stratified by foreign-born status (native- vs. foreign-born) and, among the foreign-born, by Spanish citizenship status, a proxy for greater socioeconomic stability. Results: Annual suicide mortality rates were lower among foreign- than native-born individuals. There was heterogeneity in age-period-cohort effects between study groups. After 2010, suicide mortality increased markedly among the foreign-born-especially for female cohorts born around 1950, and slightly among native-born women-especially among female cohorts born after the 1960s. Among native-born men, suicide increased linearly with age and remained stable over time. Increases in suicide among the foreign-born were driven by increases among individuals without Spanish citizenship-especially among cohorts born after 1975. Conclusion: After 2010, suicide in Spain increased markedly among foreign-born individuals and slightly among native-born women, suggesting an association between the downstream effects of the 2008 economic recession and increases in suicide mortality among socioeconomically vulnerable populations.
Collapse
Affiliation(s)
- Gonzalo Martínez-Alés
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Instituto de Investigacion Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Catherine Gimbrone
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Caroline Rutherford
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Katherine Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Teresa López-Cuadrado
- National Centre of Epidemiology, Carlos III Health Institute (ISCIII), Madrid, Spain
| |
Collapse
|
15
|
Rock KL, Reynolds LM, Rees P, Copeland CS. Highlighting the hidden dangers of a 'weak' opioid: Deaths following use of dihydrocodeine in England (2001-2020). Drug Alcohol Depend 2022; 233:109376. [PMID: 35248998 DOI: 10.1016/j.drugalcdep.2022.109376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/12/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dihydrocodeine (DHC) is considered a 'weak' opioid, but there is evidence of its increasing misuse in overdose deaths. This research aims to analyse trends in DHC-related deaths in England relevant to source and dose of DHC, and decedent demographics. METHODS Cases from England reported to the National Programme on Substance Abuse Deaths (NPSAD) where DHC was identified at post-mortem and/or implicated in death between 2001 and 2020 were extracted for analysis. RESULTS 2071 DHC-related deaths were identified. The greatest number of deaths involved illicitly obtained DHC and a significant increase in these deaths was recorded over time (r = 0.5, p = 0.03). However, there was a concurrent decline in the implication rate of DHC in causing death (r = -0.6, p < 0.01). Fatalities were primarily due to accidental overdose (64.8%) and misuse was highly prevalent in combination with additional central nervous system depressants (95.3%), namely illicit heroin/morphine and diazepam. In contrast, when DHC was obtained over-the-counter (OTC) suicide mortality accounted for almost half of the deaths (42.5%). Differences in polysubstance use were also identified, with less heroin/morphine and benzodiazepine co-detection, but increased OTC codeine co-detection. CONCLUSIONS DHC misuse in England is increasing. The pharmacological consideration of DHC as a 'weak' opioid may be misinterpreted by users, leading to accidental overdosing. There is an urgent need to understand increasing polypharmacy in overdose deaths. Additionally, suicides involving DHC is a potential cause for concern and a review of OTC opioid-paracetamol preparations is necessary to determine whether the benefits of these medications continue to outweigh the risks of intentional overdose.
Collapse
Affiliation(s)
- Kirsten L Rock
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Medicine, King's College London, Franklin-Wilkins Building, Stamford Street, London SE1 9NH, UK.
| | - Laura M Reynolds
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Medicine, King's College London, Franklin-Wilkins Building, Stamford Street, London SE1 9NH, UK
| | - Paul Rees
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Medicine, King's College London, Franklin-Wilkins Building, Stamford Street, London SE1 9NH, UK
| | - Caroline S Copeland
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Medicine, King's College London, Franklin-Wilkins Building, Stamford Street, London SE1 9NH, UK; National Programme on Substance Abuse Deaths, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK
| |
Collapse
|
16
|
Clements C, Farooq B, Hawton K, Geulayov G, Casey D, Waters K, Ness J, Patel A, Townsend E, Appleby L, Kapur N. Self-harm in people experiencing homelessness: investigation of incidence, characteristics and outcomes using data from the Multicentre Study of Self-Harm in England. BJPsych Open 2022; 8:e74. [PMID: 35317881 PMCID: PMC9059614 DOI: 10.1192/bjo.2022.30] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND People who experience homelessness are thought to be at high risk of suicide, but little is known about self-harm in this population. AIMS To examine characteristics and outcomes in people experiencing homelessness who presented to hospital following self-harm. METHOD Data were collected via specialist assessments and/or hospital patient records from emergency departments in Manchester, Oxford and Derby, UK. Data were collected from 1 January 2000 to 31 December 2016, with mortality follow-up via data linkage with NHS Digital to 31 December 2019. Trend tests estimated change in self-harm over time; descriptive statistics described characteristics associated with self-harm. Twelve-month repetition and long-term mortality were analysed using Cox proportional hazards models and controlled for age and gender. RESULTS There were 4841 self-harm presentations by 3270 people identified as homeless during the study period. Presentations increased after 2010 (IRR = 1.09, 95% CI 1.04-1.14, P < 0.001). People who experienced homelessness were more often men, White, aged under 54 years, with a history of previous self-harm and contact with psychiatric services. Risk of repetition was higher than in domiciled people (HR = 2.05, 95% CI 1.94-2.17, P < 0.001), as were all-cause mortality (HR = 1.45, 95% CI 1.32-1.59. P < 0.001) and mortality due to accidental causes (HR = 2.93, 95% CI 2.41-3.57, P < 0.001). CONCLUSIONS People who self-harm and experience homelessness have more complex needs and worse outcomes than those who are domiciled. Emergency department contact presents an opportunity to engage people experiencing homelessness with mental health, drug and alcohol, medical and housing services, as well as other sources of support.
Collapse
Affiliation(s)
- Caroline Clements
- Centre for Mental Health and Safety, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK
| | - Bushra Farooq
- Centre for Mental Health and Safety, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Galit Geulayov
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Deborah Casey
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Keith Waters
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Jennifer Ness
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Anita Patel
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, UK
| | - Louis Appleby
- Centre for Mental Health and Safety, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK
| | - Navneet Kapur
- Centre for Mental Health and Safety, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK; and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; and National Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
| |
Collapse
|
17
|
Rodway C, Ibrahim S, Tham SG, Turnbull P, Kapur N, Appleby L. Bereavement and suicide bereavement as an antecedent of suicide in children and young people: Prevalence and characteristics. J Affect Disord 2022; 300:280-288. [PMID: 34958813 DOI: 10.1016/j.jad.2021.12.063] [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: 05/05/2021] [Revised: 11/11/2021] [Accepted: 12/19/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION There is limited research into bereavement and suicide bereavement as an antecedent of suicide in young people. METHODS We extracted information on the antecedents of suicide from official reports, primarily coroner inquests, on a 3-year national consecutive case series of all UK deaths by suicide in people aged 10-19. RESULTS Between 2014 and 2016, there were 595 suicides by young people. 134 (25%) had been previously or recently bereaved; 51 (9%) by suicide, mainly of a friend or acquaintance. This is equivalent to 1 in 4 and 1 in 11, respectively, of all young people who die by suicide. Bereavement added to existing adversities - many antecedents of suicide were more likely in young people who were bereaved compared to those who were not, but there were few differences in the experiences of young people bereaved by suicide compared to other causes. LIMITATIONS This was an observational, not a risk factor study, and we did not use a control group. It is difficult to obtain data on non-suicide controls due to the ethical implications in contacting families, and the fact of suicide itself, its impact on disclosure and the reluctance of potential controls distorting any comparisons. CONCLUSION Lasting bereavement support needs to be routinely and immediately available for young people, including those who have experienced the death of a friend or acquaintance. Vigilance of agencies for bereaved young people is required, especially if there is evidence of other adversities.
Collapse
Affiliation(s)
- Cathryn Rodway
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Oxford Road 2nd Floor Jean McFarlane Building, Manchester, M13 9PL, UK.
| | - Saied Ibrahim
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Oxford Road 2nd Floor Jean McFarlane Building, Manchester, M13 9PL, UK
| | - Su-Gwan Tham
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Oxford Road 2nd Floor Jean McFarlane Building, Manchester, M13 9PL, UK
| | - Pauline Turnbull
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Oxford Road 2nd Floor Jean McFarlane Building, Manchester, M13 9PL, UK
| | - Nav Kapur
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Oxford Road 2nd Floor Jean McFarlane Building, Manchester, M13 9PL, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Oxford Road 2nd Floor Jean McFarlane Building, Manchester, M13 9PL, UK
| |
Collapse
|
18
|
Padmanathan P, Forbes H, Redaniel MT, Gunnell D, Lewer D, Moran P, Watson B, Degenhardt L, Hickman M. Self-harm and suicide during and after opioid agonist treatment among primary care patients in England: a cohort study. Lancet Psychiatry 2022; 9:151-159. [PMID: 34921800 DOI: 10.1016/s2215-0366(21)00392-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/09/2021] [Accepted: 09/15/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The first 4 weeks after initiation and cessation of opioid agonist treatment for opioid dependence are associated with an increased risk of all-cause mortality and overdose. We aimed to investigate whether the rate of self-harm and suicide among people who were prescribed opioid agonist treatment differs during initiation, cessation, and the remainder of time on and off treatment. METHODS We did a retrospective cohort study and used health-care records from UK Clinical Practice Research Datalink, linked to mortality and hospital admission data, for adults (age 18-75 years at cohort entry) who were prescribed opioid agonist treatment at least once in primary care in England between Jan 2, 1998, and Nov 30, 2018. We estimated rates and adjusted risk ratios (aRRs) of hospital admissions for self-harm and death by suicide, comparing time during and after treatment, as well as comparing stable periods of time on treatment with treatment initiation, cessation, and the remaining time off treatment. FINDINGS Between Jan 2, 1998, and Nov 30, 2018, 8070 patients (5594 [69·3%] men and 2476 [30·7%] women) received 17 004 episodes of opioid agonist treatment over 40 599 person-years. Patients were mostly of White ethnicity (7006 [86·8%] patients). 807 episodes of self-harm (1·99 per 100 person-years) and 46 suicides (0·11 per 100 person-years) occurred during the study period. The overall age-standardised and sex-standardised mortality ratio for suicide was 7·5 times (95% CI 5·5-10·0) higher in the study cohort than in the general population. Opioid agonist treatment was associated with a reduced risk of self-harm (aRR in periods off treatment 1·50 [95% CI 1·21-1·88]), but was not significantly associated with suicide risk (aRR in periods off treatment 1·21 [0·64-2·28]). Risk of self-harm (aRR 2·60 [95% CI 1·83-3·70]) and suicide (4·68 [1·63-13·42]) were both elevated in the first 4 weeks after stopping opioid agonist treatment compared with stable periods on treatment. INTERPRETATION Stable periods of opioid agonist treatment are associated with reduced risk of self-harm, emphasising the importance of improving retention of patients in treatment. The first month following cessation of opioid agonist treatment is a period of increased risk of suicide and self-harm, during which additional psychosocial support is required. FUNDING Medical Research Council.
Collapse
Affiliation(s)
- Prianka Padmanathan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Bristol Specialist Drug and Alcohol Service, Avon and Wiltshire Mental Health Partnership NHS Trust, Bath, UK.
| | - Harriet Forbes
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Maria Theresa Redaniel
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Applied Research Collaboration West, Bristol, UK
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute of Health Research Biomedical Research Centre at the University Hospitals, Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Dan Lewer
- Institute of Epidemiology and Healthcare, University College London, London, UK
| | - Paul Moran
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Applied Research Collaboration West, Bristol, UK; National Institute of Health Research Biomedical Research Centre at the University Hospitals, Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Ben Watson
- Bristol Specialist Drug and Alcohol Service, Avon and Wiltshire Mental Health Partnership NHS Trust, Bath, UK
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute of Health Research Biomedical Research Centre at the University Hospitals, Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| |
Collapse
|
19
|
Odd D, Stoianova S, Williams T, Sleap V, Blair P, Fleming P, Wolfe I, Luyt K. Child mortality in England during the COVID-19 pandemic. Arch Dis Child 2022; 107:14-20. [PMID: 34911683 PMCID: PMC8219479 DOI: 10.1136/archdischild-2020-320899] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 04/25/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Using the National Child Mortality Database (NCMD), this work aims to investigate and quantify the characteristics of children dying of COVID-19, and to identify any changes in rate of childhood mortality during the pandemic. DESIGN We compared the characteristics of the children who died in 2020, split by SARS-CoV-2 status. A negative binomial regression model was used to compare mortality rates in lockdown (23 March-28 June), with those children who died in the preceding period (6 January-22 March), as well as a comparable period in 2019. SETTING England. PARTICIPANTS Children (0-17 years). MAIN OUTCOME MEASURES Characteristics and number of the children who died in 2020, split by SARS-CoV-2 status. RESULTS 1550 deaths of children between 6th of January and 28 June 2020 were notified to the NCMD; 437 of the deaths were linked to SARS-CoV-2 virology records, 25 (5.7%) had a positive PCR result. PCR-positive children were less likely to be white (37.5% vs 69.4%, p=0.003) and were older (12.2 vs 0.7 years, p<0.0006) compared with child deaths without evidence of the virus. All-cause mortality rates were similar during lockdown compared with both the period before lockdown in 2020 (rate ratio (RR) 0.93 (0.84 to 1.02)) and a similar period in 2019 (RR 1.02 (0.92 to 1.13)). CONCLUSIONS There is little to suggest that there has been excess mortality during the period of lockdown. The apparent higher frequency of SARS-CoV-2-positive tests among children from black, Asian and minority ethnic groups is consistent with findings in adults. Ongoing surveillance is essential as the pandemic continues.
Collapse
Affiliation(s)
- David Odd
- National Child Mortality Database, Bristol Medical School, University of Bristol, Bristol, UK
- School of Medicine, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Sylvia Stoianova
- National Child Mortality Database, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tom Williams
- National Child Mortality Database, Bristol Medical School, University of Bristol, Bristol, UK
| | - Vicky Sleap
- National Child Mortality Database, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Blair
- National Child Mortality Database, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Academic Child Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Fleming
- National Child Mortality Database, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Academic Child Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ingrid Wolfe
- School of Life Course Sciences, Department of Women and Children's Health, King's College London, London, UK
- Evelina London Children's Hospital, London, UK
| | - Karen Luyt
- National Child Mortality Database, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
20
|
Hunt IM, Richards N, Bhui K, Ibrahim S, Turnbull P, Halvorsrud K, Saini P, Kitson S, Shaw J, Appleby L, Kapur N. Suicide rates by ethnic group among patients in contact with mental health services: an observational cohort study in England and Wales. Lancet Psychiatry 2021; 8:1083-1093. [PMID: 34762843 DOI: 10.1016/s2215-0366(21)00354-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Recent evidence on suicide rates among psychiatric patients from minority ethnic backgrounds is scarce. We aimed to examine suicide rates among minority ethnic psychiatric patients and describe their social and clinical characteristics. METHODS We did a retrospective observational cohort study on a national case-series of patients in England and Wales who died by suicide within 12 months of contact with mental health services between 2007 and 2018. Data were collected as part of the National Confidential Inquiry into Suicide and Safety in Mental Health. Suicide rates and standardised mortality ratios (SMRs) were estimated for South Asian (Indian, Pakistani, and Bangladeshi), Black African, Black Caribbean, Chinese, and White patients. FINDINGS A total of 698 patients in the four minority ethnic groups of South Asian, Black Caribbean, Black African, and Chinese were included (482 [69%] men; 216 [31%] women; mean age 41 years [SD 14·9, range 12-91] and compared with 13 567 White patients (9030 [66·6%] men; 4537 [33·4%] women; mean age 48 years [SD 15·8, range 10-100]). Rates and SMRs for suicide among minority ethnic patients were lower than for White patients (2·73 deaths, 95% CI 2·68-2·78) per 100 000 population. Differences were found between ethnic groups with higher suicide rates in Black Caribbean patients (1·89 deaths [95% CI 1·55-2·23] per 100 000 population) and lower rates in South Asian patients (1·49 deaths [1·33-1·64] per 100 000 population). There was an increase in rates among White patients in 2007-12 followed by a fall but no change among other ethnic groups. Schizophrenia was more common among Black African patients (54%) and Black Caribbean patients (44%), while affective disorder was more common among South Asian patients (41%). Minority ethnic patients overall showed markers of social adversity and received higher intensity care yet were viewed by clinicians as at lower risk than White patients. INTERPRETATION Effective approaches to prevention might differ between minority ethnic groups. Clinicians and the services in which they work should be aware of the common and distinct social and clinical needs of minority ethnic patients with mental illness. FUNDING The Healthcare Quality Improvement Partnership.
Collapse
Affiliation(s)
- Isabelle M Hunt
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK.
| | - Nicola Richards
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Kamaldeep Bhui
- Department of Psychiatry, University of Oxford, Oxford, UK; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; Synergi Collaborative Centre, University of Oxford, Oxford, UK
| | - Saied Ibrahim
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Pauline Turnbull
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Kristoffer Halvorsrud
- Department of Psychiatry, University of Oxford, Oxford, UK; NIHR ARC North Thames, Department of Applied Health Research, University College London, London, UK
| | - Pooja Saini
- School of Psychology, Liverpool John Moore's University, Liverpool, UK
| | - Sadie Kitson
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Jenny Shaw
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Nav Kapur
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK; NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| |
Collapse
|
21
|
Odd D, Williams T, Appleby L, Gunnell D, Luyt K. Child suicide rates during the COVID-19 pandemic in England. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021; 6:100273. [PMID: 34841386 PMCID: PMC8604801 DOI: 10.1016/j.jadr.2021.100273] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 01/31/2023] Open
Abstract
Background There is concern about the impact of COVID-19, and the control measures to prevent the spread, on children's mental health. The aim of this work was to identify if there had been a rise of childhood suicide during the COVID pandemic. Method Using data from England's National Child Mortality Database (NCMD) the characteristics and rates of children dying of suicide between April and December 2020 were compared with those in 2019. In a subset (1st January to 17th May 2020) further characteristics and possible contributing factors were obtained. Results A total of 193 likely childhood deaths by suicide were reported. There was no evidence overall suicide deaths were higher in 2020 than 2019 (RR 1.09 (0.80-1.48), p = 0.584) but weak evidence that the rate in the first lockdown period (April to May 2020) was higher than the corresponding period in 2019 (RR 1.56 (0.86-2.81), p = 0.144). Characteristics of individuals were similar between periods. Social restrictions (e.g. to education), disruption to care and support services, tensions at home and isolation appeared to be contributing factors. Limitations As child suicides are fortunately rare, the analysis is based on small numbers of deaths with limited statistical power to detect anything but major increases in incidence. Conclusion We found no consistent evidence that child suicide deaths increased during the COVID-19 pandemic although there was a possibility that they may have increased during the first UK lockdown. A similar peak was not seen during the following months, or the second lockdown.
Collapse
Affiliation(s)
- David Odd
- School of Medicine, Division of Population Medicine, Cardiff University, UK.,National Child Mortality Database, Bristol Medical School, University of Bristol, St Michael's Hospital, Southwell Street, Bristol, UK
| | - Tom Williams
- National Child Mortality Database, Bristol Medical School, University of Bristol, St Michael's Hospital, Southwell Street, Bristol, UK
| | - Louis Appleby
- Division of Psychology & Mental Health, University of Manchester, UK
| | - David Gunnell
- NIHR Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Karen Luyt
- National Child Mortality Database, Bristol Medical School, University of Bristol, St Michael's Hospital, Southwell Street, Bristol, UK
| |
Collapse
|
22
|
Farooq B, Clements C, Hawton K, Geulayov G, Casey D, Waters K, Ness J, Patel A, Kelly S, Townsend E, Appleby L, Kapur N. Self-harm in children and adolescents by ethnic group: an observational cohort study from the Multicentre Study of Self-Harm in England. THE LANCET. CHILD & ADOLESCENT HEALTH 2021; 5:782-791. [PMID: 34555352 PMCID: PMC9766885 DOI: 10.1016/s2352-4642(21)00239-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Studies report an increasing incidence of self-harm in children and adolescents, but the extent to which this is seen in different ethnic groups is unclear. We aimed to investigate rates of emergency department presentations for self-harm in children and adolescents by ethnicity, as well as to examine their demographic characteristics, clinical characteristics, and outcomes. METHODS In this observational cohort study, we used data on hospital emergency department presentations for self-harm in children and adolescents aged 10-19 years between 2000 and 2016 from the Multicentre Study of Self-harm in England. This study collects data from five general hospitals in Manchester, Oxford, and Derby in the UK, and defines self-harm as any act of intentional self-injury or self-poisoning, regardless of intent. All children and adolescents aged 10-19 years for whom ethnicity data were available were included. Mortality follow-up was available through linkage with mortality records from the Office for National Statistics. Rates of self-harm over time, demographic and clinical characteristics, and self-harm methods were investigated by ethnic group. Risk of repeat self-harm and mortality following an initial presentation for self-harm was compared by ethnic group using Kaplan-Meier curves and Cox proportional hazards models. FINDINGS Of 14 894 individuals who presented at hospitals with self-harm, 11 906 had data for ethnicity, of whom 10 211 (85·8%) were White, 344 (2·9%) were Black, 619 (5·2%) were South Asian, and 732 (6·1%) were other non-White. Rates of self-harm were highest in White children and adolescents but increased between 2009 and 2016 in all ethnicities. Mean annual rates of self-harm per 100 000 population were 574 for White, 225 for Black, 260 for South Asian, and 344 for other non-White groups. Increases in rates of self-harm between 2009 and 2016 appeared slightly greater in Black groups (incidence rate ratio 1·07 [95% CI 1·03-1·11]), South Asian groups (1·05 [1·01-1·09]), and other non-White groups (1·11 [1·06-1·16]) than in White groups (1·02 [1·00-1·03]). Children and adolescents from a minority ethnic background were more likely to live in areas of high deprivation and were less likely to receive a specialist psychosocial assessment than were White children and adolescents. Children and adolescents from minority ethnic groups were also less likely to repeat self-harm. However, there were no differences in suicide mortality by ethnic group, although the numbers were small. INTERPRETATION Minority ethnic children and adolescents accounted for an increased proportion of self-harm presentations to hospital over time compared with White ethnic groups. The minority ethnic groups also tended to be more socioeconomically disadvantaged and were less likely to receive a psychosocial assessment. Socioeconomic disparities need to be addressed, and equitable access to culturally sensitive comprehensive psychosocial assessments must be ensured. FUNDING UK Department of Health and Social Care.
Collapse
Affiliation(s)
- Bushra Farooq
- Centre for Mental Health and Safety, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
| | - Caroline Clements
- Centre for Mental Health and Safety, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Keith Hawton
- Department of Psychiatry, Centre for Suicide Research, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Galit Geulayov
- Department of Psychiatry, Centre for Suicide Research, University of Oxford, Warneford Hospital, Oxford, UK
| | - Deborah Casey
- Department of Psychiatry, Centre for Suicide Research, University of Oxford, Warneford Hospital, Oxford, UK
| | - Keith Waters
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Jennifer Ness
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Anita Patel
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Samantha Kelly
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Louis Appleby
- Centre for Mental Health and Safety, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Nav Kapur
- Centre for Mental Health and Safety, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; The National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
| |
Collapse
|
23
|
McDonald K, Machado DB, Castro-de-Araujo LFS, Kiss L, Palfreyman A, Barreto ML, Devakumar D, Lewis G. Trends in method-specific suicide in Brazil from 2000 to 2017. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1779-1790. [PMID: 33782727 PMCID: PMC8429168 DOI: 10.1007/s00127-021-02060-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/10/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Understanding long-term patterns of suicide methods can inform public health policy and prevention strategies. In Brazil, firearm-related policies may be one salient target for suicide prevention. This study describes trends in method-specific suicide at the national and state-levels in Brazil, with a particular focus on firearm-related suicides. METHODS Brazilian mortality data for suicide and undetermined intent among people aged 10 years and older between 2000 and 2017 were obtained from the National Mortality Information System. We examined national and state-level trends in age-standardised suicide rates for hanging, self-poisoning, firearms, jumping from a high place, other, and unspecified methods. We also compared total rates of mortality from suicide and undetermined intent over the period. Applying Joinpoint regression, we tested changes in trends of firearm-specific suicide rates. RESULTS The total suicide rate increased between 2000 and 2017. Rates of hanging, self-poisoning by drugs or alcohol and jumping from a high place showed the largest increases, while firearm-specific suicide rates decreased over the study period. Trends in methods of suicide varied by sex and state. CONCLUSION It is of public health concern that suicide rates in Brazil have risen this millennium. Restricting access to firearms might be an effective approach for reducing firearm-specific suicides, especially in states where firearm availability remains particularly high. Treatment and management of substance misuse may also be an important target for suicide prevention policies. More work is needed to understand the causes of rising suicide rates in Brazil and to improve the mental health of the population.
Collapse
Affiliation(s)
- Keltie McDonald
- Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Daiane Borges Machado
- Center of Data and Knowledge Integration for Health (CIDACS), Salvador, Brazil
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Luís F S Castro-de-Araujo
- Center of Data and Knowledge Integration for Health (CIDACS), Salvador, Brazil
- The University of Melbourne, Department of Psychiatry, Austin Health, Heidelberg, VIC, Australia
| | - Lígia Kiss
- Institute for Global Health, University College London, London, UK
| | | | - Maurício L Barreto
- Center of Data and Knowledge Integration for Health (CIDACS), Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | | | - Glyn Lewis
- Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| |
Collapse
|
24
|
Martínez-Alés G, Pamplin JR, Rutherford C, Gimbrone C, Kandula S, Olfson M, Gould MS, Shaman J, Keyes KM. Age, period, and cohort effects on suicide death in the United States from 1999 to 2018: moderation by sex, race, and firearm involvement. Mol Psychiatry 2021; 26:3374-3382. [PMID: 33828236 PMCID: PMC8670065 DOI: 10.1038/s41380-021-01078-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/09/2021] [Accepted: 03/24/2021] [Indexed: 12/31/2022]
Abstract
The role of sex, race, and suicide method on recent increases in suicide mortality in the United States remains unclear. Estimating the age, period, and cohort effects underlying suicide mortality trends can provide important insights for the causal hypothesis generating process. We generated updated age-period-cohort effect estimates of recent suicide mortality rates in the US, examining the putative roles of sex, race, and method for suicide, using data from all death certificates in the US between 1999 and 2018. After designating deaths as attributable to suicide according to ICD-10 underlying cause of death codes X60-X84, Y87.0, and U03, we (i) used hexagonal grids to describe rates of suicide by age, period, and cohort visually and (ii) modeled sex-, race-, and suicide method-specific age, period, and cohort effects. We found that, while suicide mortality increased in the US between 1999 and 2018 across age, sex, race, and suicide method, there was substantial heterogeneity in age and cohort effects by method, sex, and race, with a first peak of suicide risk in youth, a second peak in older ages-specific to male firearm suicide, and increased rates among younger cohorts of non-White individuals. Our findings should prompt discussion regarding age-specific clinical firearm safety interventions, drivers of minoritized populations' adverse early-life experiences, and racial differences in access to and quality of mental healthcare.
Collapse
Affiliation(s)
| | - John R Pamplin
- Center for Urban Science and Progress, New York University, New York, NY, USA
| | | | | | - Sasikiran Kandula
- Department of Environmental Health Sciences, Columbia University, New York, NY, USA
| | - Mark Olfson
- Department of Epidemiology, Columbia University, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Madelyn S Gould
- Department of Epidemiology, Columbia University, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Jeffrey Shaman
- Department of Environmental Health Sciences, Columbia University, New York, NY, USA
| | | |
Collapse
|
25
|
Sinyor M, Tran US, Garcia D, Till B, Voracek M, Niederkrotenthaler T. Suicide mortality in the United States following the suicides of Kate Spade and Anthony Bourdain. Aust N Z J Psychiatry 2021; 55:613-619. [PMID: 33300363 DOI: 10.1177/0004867420976844] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The suicides of Kate Spade and Anthony Bourdain, two major American icons, in a span of days in June 2018 represent a unique and tragic natural experiment to characterize associations with actual suicides in the aftermath of celebrity suicides. The aim of this study was to identify changes in suicide counts after their deaths. METHODS Suicide data were obtained from the United States' Centers for Disease Control and Prevention's public-use mortality file. A time-series analysis was performed, examining monthly suicide data by age group (⩽19, 20-44, 45-64 and ⩾65 years), for both men and women, for all suicide methods and for hanging versus non-hanging methods, from January 1999 to December 2018. Seasonal autoregressive integrated moving-average models were fitted to the pre-June 2018 period, estimating suicides in subsequent months and identifying deviations from expected values. The volume of Twitter posts about Kate Spade and Anthony Bourdain was used as a proxy of societal attention. RESULTS Tweets about the celebrities were mainly concentrated in June 2018 and faded quickly in July. Total suicides exceeded the 95% confidence interval for June and approximated the upper limit of the 95% confidence interval in July. Over this 2-month span, there were 418 (95% confidence interval = [184, 652]) more suicides than expected, including 275 (95% confidence interval = [79, 471]) excess suicides in men and 182 (95% confidence interval = [93, 271]) in women. These equate to 4.8%, 4.1% and 9.1% increases above expected counts. There were 392 (95% confidence interval = [271, 514]) excess suicides by hanging, a 14.5% increase, with no significant increase in all other methods combined. CONCLUSION AND RELEVANCE These findings demonstrate that mortality following celebrity suicides can occur at a similar magnitude to that observed for other public health emergencies. They underscore the urgency for interventions to mitigate imitation effects after celebrity suicide reporting.
Collapse
Affiliation(s)
- Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Ulrich S Tran
- School of Psychology, Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria.,Wiener Werkstaette for Suicide Research, Vienna, Austria
| | - David Garcia
- Complexity Science Hub Vienna, Vienna, Austria.,Section for Science of Complex Systems, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.,Institute of Interactive Systems and Data Science, Faculty of Computer Science and Biomedical Engineering, TU Graz, Graz, Austria
| | - Benedikt Till
- Wiener Werkstaette for Suicide Research, Vienna, Austria.,Unit Suicide Research & Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Martin Voracek
- School of Psychology, Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria.,Wiener Werkstaette for Suicide Research, Vienna, Austria
| | - Thomas Niederkrotenthaler
- Wiener Werkstaette for Suicide Research, Vienna, Austria.,Unit Suicide Research & Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
26
|
Thomas KH, Davies NM, Taylor AE, Taylor GMJ, Gunnell D, Martin RM, Douglas I. Risk of neuropsychiatric and cardiovascular adverse events following treatment with varenicline and nicotine replacement therapy in the UK Clinical Practice Research Datalink: a case-cross-over study. Addiction 2021; 116:1532-1545. [PMID: 33197082 PMCID: PMC8246946 DOI: 10.1111/add.15338] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 12/30/2019] [Accepted: 11/09/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND AIMS Varenicline and nicotine replacement therapy (NRT) are the most commonly used medications to quit smoking. Given their widespread use, monitoring adverse risks remains important. This study aimed to estimate the neuropsychiatric and cardiovascular risks associated with varenicline and NRT as used in routine UK care. DESIGN Case-cross-over study. SETTING UK-based electronic primary care records in the Clinical Practice Research Datalink from 2006 to 2015 linked to hospital and mortality data sets. PARTICIPANTS Adult smokers (n =282,429) observed during periods when exposed and not exposed to either varenicline or NRT. MEASUREMENTS Main outcomes included suicide, self-harm, myocardial infarction (MI), all-cause death and cause-specific death [MI, chronic obstructive pulmonary disease (COPD)]. In primary analyses, conditional logistic regression was used to compare the chance of varenicline or NRT exposure during the risk period (90 days prior to the event) with the chance of exposure during an earlier single reference period (91-180 days prior to the event) or multiple 90-day reference periods to increase statistical power. FINDINGS In the primary analyses, findings were inconclusive for the associations between varenicline and the main outcomes using a single reference period, while NRT was associated with MI [odds ratio (OR) = 1.40, 95% confidence interval (CI) = 1.18-1.67]. Using multiple reference periods, varenicline was associated with an increased risk of self-harm (OR = 1.32, 95% CI = 1.12-1.56) and suicide (OR = 3.56, 95% CI = 1.32-9.60) but a reduction in all-cause death (OR = 0.75, 95% CI = 0.61-0.93). NRT was associated with MI (OR = 1.54, 95% CI = 1.36-1.74), self-harm (OR = 1.30, 95% CI = 1.18-1.44) and deaths from MI (OR = 1.53, 95% CI = 1.11-2.10), COPD (OR = 1.33, 95% CI = 1.14-1.56) and all causes (OR = 1.28, 95% CI = 1.18-1.40) when using multiple reference periods. CONCLUSIONS There appear to be positive associations between (1) nicotine replacement therapy (NRT) and myocardial infarction, death and risk of self-harm and (2) varenicline and increased risk of self-harm and suicide, as well as a negative association between varenicline and all-cause death. The associations may not be causal. They may reflect health changes at the time of smoking cessation (nicotine replacement therapy is prescribed for people with cardiac problems) or be associated with quit attempts (exposure to both medicines was associated with self-harm).
Collapse
Affiliation(s)
- Kyla H. Thomas
- Bristol Medical School, Population Health SciencesUniversity of BristolBristolUK
| | - Neil M. Davies
- Bristol Medical School, Population Health SciencesUniversity of BristolBristolUK,Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK,K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNUNorwegian University of Science and TechnologyNorway
| | - Amy E. Taylor
- Bristol Medical School, Population Health SciencesUniversity of BristolBristolUK,National Institute for Health Research, Bristol Biomedical Research CentreUniversity Hospitals Bristol NHS Foundation Trust and University of BristolBristolUK
| | - Gemma M. J. Taylor
- Addiction and Mental Health Group (AIM), Department of PsychologyUniversity of BathBathUK
| | - David Gunnell
- Bristol Medical School, Population Health SciencesUniversity of BristolBristolUK,National Institute for Health Research, Bristol Biomedical Research CentreUniversity Hospitals Bristol NHS Foundation Trust and University of BristolBristolUK
| | - Richard M. Martin
- Bristol Medical School, Population Health SciencesUniversity of BristolBristolUK,Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK,National Institute for Health Research, Bristol Biomedical Research CentreUniversity Hospitals Bristol NHS Foundation Trust and University of BristolBristolUK
| | - Ian Douglas
- Department of Non‐communicable Disease Epidemiology, Faculty of Epidemiology and Population HealthLSHTMLondonUK
| |
Collapse
|
27
|
Oyekan PJ, Gorton HC, Copeland CS. Antihistamine-related deaths in England: Are the high safety profiles of antihistamines leading to their unsafe use? Br J Clin Pharmacol 2021; 87:3978-3987. [PMID: 33729599 DOI: 10.1111/bcp.14819] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/26/2021] [Accepted: 02/10/2021] [Indexed: 01/26/2023] Open
Abstract
AIMS Antihistamines are routinely taken to control allergic reactions or sedation to induce sleep. There are, however, growing concerns regarding sedating antihistamine misuse. This research aims to evaluate deaths related to antihistamines in England occurring during 2000-2019. METHODS Cases reported to the National Programme on Substance Abuse Deaths from England occurring in 2000-2019 with antihistamine detections at postmortem were extracted for analysis. RESULTS In total, 1666 antihistamine postmortem detections were identified from 1537 cases. Sedating antihistamines available for purchase under pharmacist supervision but without need for a prescription (pharmacy-only medications) were present in a significant majority of cases (85.2%, P < .01). Despite an increasing trend for antihistamine-related deaths over time, the proportion of deaths where an antihistamine was implicated declined over the same period. Specific concerns with regards to the misuse of these pharmacy-only sedating antihistamines are raised with regards to the significant proportion of cases that were concluded as suicide (20.9%, P < .01), and the high prevalence of their use in combination with other central nervous system depressants (94.8% of cases). CONCLUSION This is the first report in over 40 years regarding antihistamine-related mortality from England. The rising trend in sedating antihistamine-related deaths may be contributed to by their increasing availability and the perceived negligible dangers associated with antihistamines, both from the general public and learned professionals. Awareness of the dangerous sedative properties that some antihistamines possess is, however, heightened in individuals deliberately seeking these effects. Urgent review of sedating antihistamines currently assigned under the pharmacy-only classification is needed to achieve antihistamine harm reduction.
Collapse
Affiliation(s)
- Princess J Oyekan
- Institute of Pharmaceutical Sciences, King's College London, London, UK
| | - Hayley C Gorton
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK
| | - Caroline S Copeland
- Institute of Pharmaceutical Sciences, King's College London, London, UK.,Population Health Research Institute, St George's, University of London, London, UK
| |
Collapse
|
28
|
Richard-Devantoy S, Orri M, Bertrand JA, Greenway KT, Turecki G, Gunnell D, Power C, Geoffroy MC. Childhood cognitive skill trajectories and suicide by mid-adulthood: an investigation of the 1958 British Birth Cohort. Psychol Med 2021; 51:400-407. [PMID: 31736461 DOI: 10.1017/s0033291719003143] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Poor cognitive abilities and low intellectual quotient (IQ) are associated with an increased risk of suicide attempts and suicide mortality. However, knowledge of how this association develops across the life-course is limited. Our study aims to establish whether individuals who died by suicide by mid-adulthood are distinguishable by their child-to-adolescence cognitive trajectories. METHODS Participants were from the 1958 British Birth Cohort and were assessed for academic performance at ages 7, 11, and 16 and intelligence at 11 years. Suicides occurring by September 2012 were identified from linked national death certificates. We compared mean mathematics and reading abilities and rate of change across 7-16 years for individuals who died by suicide v. those still alive, with and without adjustment for potential early-life confounding factors. Analyses were based on 14 505 participants. RESULTS Fifty-five participants (48 males) had died by suicide by age 54 years. While males who died by suicide did not differ from participants still alive in reading scores at age 7 [effect size (g) = -0.04, p = 0.759], their reading scores had a less steep improvement up to age 16 compared to other participants. Adjustments for early-life confounding factors explained these differences. A similar pattern was observed for mathematics scores. There was no difference between individuals who died by suicide v. participants still alive on intelligence at 11 years. CONCLUSIONS While no differences in tests of academic performance and IQ were observed, individuals who died by suicide had a less steep improvement in reading abilities over time compared to same-age peers.
Collapse
Affiliation(s)
- Stéphane Richard-Devantoy
- McGill University & Douglas Mental Health University Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
- CISSS des Laurentides, St-Jerome, Quebec, Canada
| | - Massimiliano Orri
- McGill University & Douglas Mental Health University Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
- Bordeaux Population Health Research Centre, Inserm U1219, University of Bordeaux, Bordeaux, France
| | - Josie-Anne Bertrand
- CISSS des Laurentides, St-Jerome, Quebec, Canada
- The Douglas Research Center, Montréal, Québec, Canada
| | - Kyle T Greenway
- McGill University & Douglas Mental Health University Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
| | - Gustavo Turecki
- McGill University & Douglas Mental Health University Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
| | - David Gunnell
- Population Health Sciences, University of Bristol, Bristol, UK
- National Institute of Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Chris Power
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Marie-Claude Geoffroy
- McGill University & Douglas Mental Health University Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
| |
Collapse
|
29
|
Fortune S, Sharma V, Bowden L, Hobbs L, Marshall D, Mitchell C, Clarke A, Robinson J, Shave R, Macleod E, Witt KG, Hawton K, Jordan V, Hetrick SE. Prevention of self-harm and suicide in young people up to the age of 25 in education settings. Hippokratia 2021. [DOI: 10.1002/14651858.cd013844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sarah Fortune
- Department of Social and Community Health, Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | - Vartika Sharma
- Department of Psychological Medicine, Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
- Children and Young People Satellite, Cochrane Common Mental Disorders; The University of Auckland; Auckland New Zealand
| | - Linda Bowden
- Department of Psychological Medicine, Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | - Linda Hobbs
- Department of Psychological Medicine; Dunedin School of Medicine, University of Otago; Dunedin New Zealand
| | - David Marshall
- Centre for Reviews and Dissemination; University of York; York UK
- Cochrane Common Mental Disorders Group, Centre for Reviews and Dissemination; University of York; York UK
| | - Claire Mitchell
- Department of Psychological Medicine, Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | | | - Jo Robinson
- Orygen; Parkville, Melbourne Australia
- Centre for Youth Mental Health; The University of Melbourne; Melbourne Australia
| | - Roger Shave
- Clinical Advisory Services Aotearoa; Christchurch New Zealand
| | - Emily Macleod
- Research School of Psychology, ANU College of Health and Medicine; The Australian National University; Canberra Australia
| | - Katrina G Witt
- Orygen; Parkville, Melbourne Australia
- Centre for Youth Mental Health; The University of Melbourne; Melbourne Australia
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry; University of Oxford; Oxford UK
| | - Vanessa Jordan
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | - Sarah E Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
- Children and Young People Satellite, Cochrane Common Mental Disorders; The University of Auckland; Auckland New Zealand
| |
Collapse
|
30
|
Evidence for Underregistration of Suicide. Case Rep Psychiatry 2020; 2020:8873893. [PMID: 33274101 PMCID: PMC7676976 DOI: 10.1155/2020/8873893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/13/2020] [Accepted: 11/06/2020] [Indexed: 11/29/2022] Open
Abstract
In this case report, we will present two cases in which the Dutch municipal coroner registered a natural death, but treating psychiatrists doubted the validity of this decision on the grounds of clinical data and investigation. For both cases, we present evidence that deaths likely resulted from suicide, raising serious doubts about the accuracy of the registered cause of death. According to the WHO bulletin on suicide prevention, the national registration of suicide is unsatisfactory in many countries. The Netherlands is listed by the WHO as having one of the most accurate registration procedures. Nevertheless, there are indications that national registration, even in the Dutch system, is not infallible. In this case report, we present several ways in which the registration process is liable to error and evidence for underregistration of suicide rates.
Collapse
|
31
|
Snowdon J, Choi NG. Undercounting of suicides: Where suicide data lie hidden. Glob Public Health 2020; 15:1894-1901. [DOI: 10.1080/17441692.2020.1801789] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- John Snowdon
- Discipline of Psychiatry, Sydney University, Concord, Australia
| | - Namkee G. Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| |
Collapse
|
32
|
Abstract
OBJECTIVE To review rates of suicide and 'hidden suicide' in New Zealand (NZ), Australia, Ireland and Spain. METHOD Using estimated population figures and online cause-of-death data from four countries, rates of suicide and 'hidden suicide' in 2014-2016 were calculated and compared. RESULTS Age patterns and rates of suicide and 'hidden suicide' differ between these countries. The male suicide rate progressively rises across the age range in Spain but becomes lower in late life in Ireland. The male patterns in NZ and Australia are bimodal; male and female rates decrease in late life, with NZ lower than Australia. Māori age patterns are downward-sloping. Suicide rates of young Māori considerably exceed those of young non-Māori in NZ. CONCLUSIONS The NZ youth suicide peaks are attributable to high rates of Māori youth suicide. Rates of 'hidden suicide' are relatively low in the four countries.
Collapse
Affiliation(s)
- John Snowdon
- Sydney Medical School, Australia.,Centre for Mental Health, Concord Hospital, Australia
| |
Collapse
|
33
|
McLaughlin JC, Gunnell D. Suicide Deaths in University Students in a UK City Between 2010 and 2018 - Case Series. CRISIS 2020; 42:171-178. [PMID: 32722926 DOI: 10.1027/0227-5910/a000704] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: There are longstanding concerns over the mental health and suicide risk of university students in the UK and internationally. Aims: This study aimed to identify risk factors for suicide among students attending universities in a UK city. Method: Suicide deaths between January 2010 and July 2018 were identified from university records. An audit tool was used to collate data from university records and coroners' inquest files. Results: A total of 37 student deaths were identified. Only 10.8% of the students had disclosed a mental health issue at university entry. There was strong statistical evidence that students who died by suicide were more likely to have been male, experiencing academic difficulties (repeated years, changing course, and suspension of studies were all associated with a 5-30-fold increased risk), and in need of financial support compared with other students. Limitations: The coroners' records were only available for around half of the deaths. Healthcare records were not available. Conclusion: Markers of academic and financial difficulty should be considered as flags to identify students at heightened risk. Whilst the relative risk associated with academic difficulties is high, the absolute risk is low. Improved disclosure of mental health issues at university registration could facilitate targeted support for vulnerable students.
Collapse
Affiliation(s)
- Joanna C McLaughlin
- Public Health Department, Bath and North East Somerset Council, Bath, UK.,Bristol Medical School, University of Bristol, UK.,Public Health England South West Centre, Bristol, UK
| | - David Gunnell
- Bristol Medical School, University of Bristol, UK.,National Institute of Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, UK
| |
Collapse
|
34
|
Rodway C, Tham SG, Ibrahim S, Turnbull P, Kapur N, Appleby L. Children and young people who die by suicide: childhood-related antecedents, gender differences and service contact. BJPsych Open 2020; 6:e49. [PMID: 32390589 PMCID: PMC7331086 DOI: 10.1192/bjo.2020.33] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Worldwide suicide is commonest in young people and in many countries, including the UK, suicide rates in young people are rising. AIMS To investigate the stresses young people face before they take their lives, their contact with services that could be preventative and whether these differ in girls and boys. METHOD We identified a 3-year UK national consecutive case series of deaths by suicide in people aged 10-19, based on national mortality data. We extracted information on the antecedents of suicide from official investigations, primarily inquests. RESULTS Between 2014 and 2016, there were 595 suicides by young people, almost 200 per year; 71% were male (n = 425). Suicide rates increased from the mid-teens, most deaths occurred in those aged 17-19 (443, 74%). We obtained data about the antecedents of suicide for 544 (91%). A number of previous and recent stresses were reported including witnessing domestic violence, bullying, self-harm, bereavement (including by suicide) and academic pressures. These experiences were generally more common in girls than boys, whereas drug misuse (odds ratio (OR) = 0.54, 95% CI 0.35-0.83, P = 0.006) and workplace problems (OR 0.52, 95% CI 0.28-0.96, P = 0.04) were less common in girls. A total of 329 (60%) had been in contact with specialist children's services, and this was more common in girls (OR 1.86, 95% CI 1.19-2.94, P = 0.007). CONCLUSIONS There are several antecedents to suicide in young people, particularly girls, which are important in a multiagency approach to prevention incorporating education, social care, health services and the third sector. Some of these may also have contributed to the recent rise.
Collapse
Affiliation(s)
- Cathryn Rodway
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, UK
| | - Su-Gwan Tham
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, UK
| | - Saied Ibrahim
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, UK
| | - Pauline Turnbull
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, UK
| | - Nav Kapur
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester; and Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, UK
| |
Collapse
|
35
|
Mars B, Hird K, Bell F, James C, Gunnell D. Suicide among ambulance service staff: a review of coroner and employment records. Br Paramed J 2020; 4:10-15. [PMID: 33456374 PMCID: PMC7783904 DOI: 10.29045/14784726.2020.12.4.4.10] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: There is growing evidence to suggest that ambulance service staff may be at increased risk for suicide; however, few studies have explored risk factors within this occupational group. Aim: To investigate factors commonly associated with ambulance staff suicides. Method: Eleven ambulance service trusts across the United Kingdom were asked to return details of staff suicides occurring between January 2014 and December 2015. Coroners were then contacted to request permission to review the records of the deceased. Results: Fifteen suicides were identified (73% male, mean age 42 years). Inquest data were available on 12 deaths. The most common method used was hanging. Possible risk factors identified included recent return to work following a period of sickness absence, poor mental health, relationship and debt problems, history of self-harm and the loss of a driving licence/change in job role. Conclusion: Identifying characteristics of suicide among this high-risk group is important to inform the development of suicide prevention initiatives. Additional research is needed with an adequate control group to further explore the risk factors identified in this study.
Collapse
Affiliation(s)
- Becky Mars
- University of Bristol; University Hospitals Bristol NHS Foundation
| | | | | | | | - David Gunnell
- University of Bristol; University Hospitals Bristol NHS Foundation Trust
| |
Collapse
|
36
|
The incidence of suicide in University students in England and Wales 2000/2001-2016/2017: Record linkage study. J Affect Disord 2020; 261:113-120. [PMID: 31610312 DOI: 10.1016/j.jad.2019.09.079] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/11/2019] [Accepted: 09/30/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND There are growing concerns about the mental health and risk of suicide amongst university students. AIM To investigate trends in the incidence and characteristics of university student suicides in England & Wales for the academic years 2000/01 to 2016/17. METHOD Record linkage between Office for National Statistics mortality data and Higher Education Statistics Agency data for England and Wales. Poisson regression and chi-squared tests were used to investigate secular trends and the characteristics of students dying by suicide. RESULTS There were 1330 student suicide deaths from 2000/01 to 2016/17; the annual incidence in 2015/16-2016/17 was 4.7 per 100,000 students. There was evidence of a rise in incidence since 2009/10 (incidence rate ratio per year 1.04 ((95%CI 1.00-1.07) p = 0.029). Incidence in 2012/13 to 2016/17 was less than half the rate in the general population of a similar age. Incidence was higher in males than females and amongst undergraduates vs. postgraduates. There was some evidence of a reduced risk amongst black compared to white students (RR 0.53 (95%CI 0.32-0.88). Incidence was highest in January and lowest during the summer holidays (July-September). LIMITATIONS There was no age/sex or sociodemographic breakdown of the overall student population for 2000/01 to 2011/12. CONCLUSION Rates of suicide are considerably lower amongst students than the general population. In keeping with trends in young people in the wider population, the incidence of student suicide has increased since 2009/10. To inform prevention, research is needed to understand reasons for the rise in suicide in young people.
Collapse
|
37
|
Hawton K, Bale L, Brand F, Townsend E, Ness J, Waters K, Clements C, Kapur N, Geulayov G. Mortality in children and adolescents following presentation to hospital after non-fatal self-harm in the Multicentre Study of Self-harm: a prospective observational cohort study. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 4:111-120. [PMID: 31926769 DOI: 10.1016/s2352-4642(19)30373-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/25/2019] [Accepted: 10/25/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Self-harm and suicide in children and adolescents are growing problems, and self-harm is associated with a significant risk of subsequent death, particularly suicide. Long-term follow-up studies are necessary to examine the extent and nature of this association. METHODS For this prospective observational cohort study, we used data from the Multicentre Study of Self-harm in England for all individuals aged 10-18 years who presented to the emergency department of five study hospitals in Oxford, Manchester, and Derby after non-fatal self-harm between Jan 1, 2000, and Dec 31, 2013. Deaths were identified through the Office for National Statistics via linkage with data from NHS Digital up until Dec 31, 2015. The key outcomes were mortality after presentation to hospital for self-harm, categorised into suicide, accidental deaths, and death by other causes. We calculated incidence of suicide since first hospital presentation for self-harm and used Cox proportional hazard models to estimate the associations between risk factors (sex, age, previous self-harm) and suicide. FINDINGS Between Jan 1, 2000, and Dec 31, 2013, 9303 individuals aged 10-18 years presented to the study hospitals. 130 individuals were excluded because they could not be traced on the national mortality register or had missing data on sex or age, thus the resulting study sample consisted of 9173 individuals who had 13 175 presentations for self-harm. By the end of the follow-up on Dec 31, 2015, 124 (1%) of 9173 individuals had died. 55 (44%) of 124 deaths were suicides, 27 (22%) accidental, and 42 (34%) due to other causes. Of the 9173 individuals who presented for self-harm, 55 (0·6%) died by suicide. Most suicide deaths involved self-injury (45 [82%] of 55 deaths). Switching of method between self-harm and suicide was common, especially from self-poisoning to hanging or asphyxiation. The 12-month incidence of suicide in this cohort was more than 30 times higher than the expected rate in the general population of individuals aged 10-18 years in England (standardised mortality ratio 31·0, 95% CI 15·5-61·9). 42 (76%) of 55 suicides occurred after age 18 years and the annual incidence remained similar during more than 10 years of follow-up. Increased suicide risk was associated with male sex (adjusted hazard ratio 2·50, 95% CI 1·46-4·26), being an older adolescent at presentation to hospital for self-harm (1·82, 0·93-3·54), use of self-injury for self-harm (2·11, 1·17-3·81; especially hanging or asphyxiation [4·90, 1·47-16·39]), and repeated self-harm (1·87, 1·10-3·20). Accidental poisoning deaths were especially frequent among males compared with females (odds ratio 6·81, 95% CI 2·09-22·15). INTERPRETATION Children and adolescents who self-harm have a considerable risk of future suicide, especially males, older adolescents, and those who repeated self-harm. Risk might persist over several years. Switching of method from self-harm to suicide was common, usually from self-poisoning to self-injury (especially hanging or asphyxiation). Self-harm is also associated with risk of death from accidental poisoning, particularly involving drugs of abuse, especially in young males. FUNDING UK Department of Health and Social Care.
Collapse
Affiliation(s)
- Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
| | - Liz Bale
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Fiona Brand
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Ellen Townsend
- School of Psychology, Faculty of Science, Nottingham University, Nottingham, UK
| | - Jennifer Ness
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Keith Waters
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Caroline Clements
- Centre for Suicide Prevention, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Nav Kapur
- Centre for Suicide Prevention, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Galit Geulayov
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| |
Collapse
|
38
|
Witt K, Townsend E, Arensman E, Gunnell D, Hazell P, Taylor Salisbury T, Van Heeringen K, Hawton K. Psychosocial Interventions for People Who Self-Harm: Methodological Issues Involved in Trials to Evaluate Effectiveness. Arch Suicide Res 2020; 24:S32-S93. [PMID: 30955501 DOI: 10.1080/13811118.2019.1592043] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We have assessed the methodological quality of randomized controlled trials (RCTs) of interventions to prevent self-harm repetition and suicide. Trials were identified in two systematic reviews of RCTs of psychosocial treatments following a recent (within six months) episode of self-harm indexed in any of five electronic databases (CCDANCTR-Studies and References, CENTRAL, Medline, Embase, and PsycINFO) between 1 January, 1998 and 29 April, 2015. A total of 66 trials were included, 55 in adults and 11 in children and adolescents. While evidence for efficacy of some approaches has grown, there were few trials from low-to-middle income countries, little information on interventions for males, information on the control condition was often limited, data on suicides were often not reported, and, while trials have increased in size in recent years, most have included too few participants to detect clinically significant results. There are major limitations in many trials of interventions for individuals who self-harm. Improved methodology, especially with regard to study size, provision of details of control therapy, and evaluation of key outcomes, would enhance the evidence base for clinicians and service users.
Collapse
|
39
|
Time trends in suicide rates by domestic gas or car exhaust gas inhalation in Japan, 1968-1994. Epidemiol Psychiatr Sci 2019; 28:644-654. [PMID: 30103839 PMCID: PMC6998891 DOI: 10.1017/s2045796018000410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIMS A reduction in the carbon monoxide content of domestic gas and car exhaust gas has been associated with a decrease in gassing suicides in many western countries. In Japan, a reduction in the carbon monoxide content of domestic gas supply began in the early 1970s, and carbon monoxide emissions standards of new passenger cars were significantly strengthened in 1978. However, little is known about the impact of detoxification of these gases on gassing-related suicides in Japan. Therefore, we examined the changing patterns of suicide due to domestic gas or car exhaust gas inhalation by gender and age in Japan between 1968 and 1994. METHODS Suicide mortality data were obtained from the Vital Statistics of Japan. In this study, age was divided into four groups: 15-24, 25-44, 45-64 and 65+ years. Method of suicide was divided into three groups: domestic gas, car exhaust gas and non-gases. We calculated method-specific age-standardised suicide rates by gender within each of the four age groups. We applied joinpoint regression to the data and quantified the observed changes. RESULTS Suicide rates by domestic gas, regardless of gender and age, increased from 1968 to the mid-1970s and then decreased sharply. The proportion of all suicides accounted for by domestic gas was comparatively high in the mid-1970s among females aged 15-24 and 25-44 years, while for other gender-age-groups the proportion of domestic gas suicides remained small, even at the peak. For females aged 15-44 years, the decrease in domestic gas suicides appeared to cause a substantial decrease in overall suicides in this gender/age group. Car exhaust gas was a more common method for males, particularly those aged 25-64 years. Car exhaust gas suicide rates for males aged 25-64 years peaked in the mid-1980s, followed by a sharp decrease. CONCLUSIONS A reduction in the carbon monoxide content of the domestic gas, which began in the early 1970s in Japan, was associated with a decrease in domestic gas suicides for both genders of all ages. Concerning females aged 15-44 years, a decrease in domestic gas suicides caused a substantial decrease in overall suicides in this gender/age group since the proportion of domestic gas suicides among all suicides combined was comparatively large. However, it remains uncertain whether the introduction of catalytic converters in the 1970s in Japan resulted in a reduction of suicides from car exhaust gas inhalation.
Collapse
|
40
|
Abstract
Much of our knowledge about the risk factors for suicide comes from case-control studies that either use a psychological autopsy approach or are nested within large register-based cohort studies. We would argue that case-control studies are appropriate in the context of a rare outcome like suicide, but there are issues with using this design. Some of these issues are common in psychological autopsy studies and relate to the selection of controls (e.g. selection bias caused by the use of controls who have died by other causes, rather than live controls) and the reliance on interviewing informants (e.g. recall bias caused by the loved ones of cases having thought about the events leading up to the suicide in considerable detail). Register-based studies can overcome some of these problems because they draw upon contain information that is routinely collected for administrative purposes and gathered in the same way for cases and controls. However, they face issues that mean that psychological autopsy studies will still sometimes be the study design of choice for investigating risk factors for suicide. Some countries, particularly low and middle income countries, don't have sophisticated population-based registers. Even where they do exist, there will be variable of interest that are not captured by them (e.g. acute stressful life events that may immediately precede a suicide death), or not captured in a comprehensive way (e.g. suicide attempts and mental illness that do not result in hospital admissions). Future studies of risk factors should be designed to progress knowledge in the field and overcome the problems with the existing studies, particularly those using a case-control design. The priority should be pinning down the risk factors that are amenable to modification or mitigation through interventions that can successfully be rolled out at scale.
Collapse
|
41
|
Suicide by hanging is a priority for suicide prevention: method specific suicide in India (2001-2014). J Affect Disord 2019; 257:1-9. [PMID: 31299398 DOI: 10.1016/j.jad.2019.07.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/02/2019] [Accepted: 07/02/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND India accounts for over a quarter of the global burden of suicide. One of the most effective population level suicide prevention strategies has been restricting access to suicide means. METHOD Trends in method specific suicide rates (2001-14) were calculated using National Crime Records Bureau data stratified by sex, age-group, and geographical region. Multilevel negative binomial regression models stratified by sex and suicide method were specified to investigate associations between state-level indicators of economic development, education, agricultural pesticide use and religious factors. RESULTS Suicide by hanging increased by 56% (from 3.9 to 6.1 per 100,000) among males and by 24% (from 2.1 to 2.6 per 100,000) among females over the study period while incidence of insecticide poisoning decreased by 44% (from 2.7 to 1.5 per 100,000) among males and by 52% (from 1.7 to 0.8 per 100,000) among females. In general, states with higher levels of development, higher agricultural employment and higher literacy had higher rates of suicide for each suicide method. States with higher levels of agricultural pesticide use had higher rates of insecticide poisoning suicides. LIMITATION Reported rates might be an underestimation of the true rates as the official data used for the analysis likely underestimates the actual number of suicide deaths in India. CONCLUSION Responsible reporting of suicide by hanging in the media, and limiting fictional portrayals of this method may be useful areas for prevention. Further restrictions on production and sales of highly hazardous pesticides may also help with further reductions in suicide by pesticide poisoning.
Collapse
|
42
|
Appleby L, Turnbull P, Kapur N, Gunnell D, Hawton K. New standard of proof for suicide at inquests in England and Wales. BMJ 2019; 366:l4745. [PMID: 31358499 DOI: 10.1136/bmj.l4745] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Pauline Turnbull
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Nav Kapur
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - David Gunnell
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, UK
| |
Collapse
|
43
|
Mota NP, Chartier M, Ekuma O, Nie Y, Hensel JM, MacWilliam L, McDougall C, Vigod S, Bolton JM. Mental Disorders and Suicide Attempts in the Pregnancy and Postpartum Periods Compared with Non-Pregnancy: A Population-Based Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:482-491. [PMID: 30895808 PMCID: PMC6610562 DOI: 10.1177/0706743719838784] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To compare the rate of mental disorders (i.e., mood and anxiety, substance use, psychotic disorders) and suicide attempts within the same group of women across the pre-pregnancy, pregnancy, and postpartum periods, and between this perinatal cohort and a non-perinatal reference group. METHOD Data were from an administrative repository of residents in Manitoba, Canada. The perinatal cohort consisted of women aged 18 to 45 years who experienced >1 live birth pregnancy between 2011 and 2014 (n = 45,362). Pre-pregnancy, pregnancy, and postpartum periods were defined over consecutive 40-week intervals. The non-perinatal cohort consisted of age-matched women with no pregnancies during the same period (n = 139,705). A reference 40-week interval was defined from the individual's birthdate in the year they entered the cohort. Rate ratios of diagnosed mental disorders were adjusted (aRR) for demographic factors, parity, and mental health history. RESULTS Within the perinatal cohort, pregnancy was associated with a lower rate of diagnosed mood or anxiety disorder, substance use disorder, and suicide attempt relative to pre-pregnancy (aRR range, 0.22-0.82). Pregnancy also had lower rates of all outcomes compared with the postpartum period (aRR, 0.44-0.87). Postpartum had a higher rate of psychotic disorder compared with pre-pregnancy (aRR, 1.61; 95% CI, 1.17-2.21), but a lower rate of mood or anxiety disorder and suicide attempt. Compared with non-perinatal women, pregnancy was associated with lower rates of all outcomes (aRR range, 0.25-0.87). CONCLUSIONS Compared with a non-perinatal period, the rate of a diagnosed mental disorder is lower during pregnancy but begins to rise in the postpartum period, highlighting an important period for early identification and rapid access to intervention.
Collapse
Affiliation(s)
- Natalie P Mota
- 1 Departments of Clinical Health Psychology and Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mariette Chartier
- 2 Department of Community Health Sciences, University of Manitoba.,3 Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Okechukwu Ekuma
- 3 Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Yao Nie
- 3 Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Jennifer M Hensel
- 4 Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | - Simone Vigod
- 5 Department of Psychiatry, Women's College Hospital and Research Institute, Institute for Clinical Evaluative Sciences, the University of Toronto, Toronto, Ontario, Canada
| | - James M Bolton
- 6 Departments of Psychiatry, Psychology, and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
44
|
Clements C, Hawton K, Geulayov G, Waters K, Ness J, Rehman M, Townsend E, Appleby L, Kapur N. Self-harm in midlife: analysis using data from the Multicentre Study of Self-harm in England. Br J Psychiatry 2019; 215:1-8. [PMID: 31142393 DOI: 10.1192/bjp.2019.90] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In England suicide rates are highest in midlife (defined as age 40-59). Despite a strong link with suicide there has been little focus on self-harm in this age group.AimTo describe characteristics and treatment needs of people in midlife who present to hospital following self-harm. METHOD Data from the Multicentre Study of Self-harm in England were used to examine rates over time and characteristics of men and women who self-harm in midlife. Data (2000-2013) were collected via specialist assessments or hospital records. Trends were assessed by negative binomial regression models. Comparative analysis used logistic regression models for binary outcomes. Repetition and suicide mortality were assessed by Cox proportional hazards models. RESULTS A quarter of self-harm presentations were made by people in midlife (n = 24 599, 26%). Incidence rates increased over time in men, especially after 2008 (incidence rate ratio [IRR] 1.07, 95% CI 1.02-1.12, P < 0.01), and were positively correlated with national suicide incidence rates (r = 0.52, P = 0.05). Rates in women remained relatively stable (IRR 1.00, 95% CI 1.00-1.02, P = 0.39) and were not correlated with suicide. Alcohol use, unemployment, housing and financial factors were more common in men; whereas indicators of poor mental health were more common in women. In men and women 12-month repetition was 25%, and during follow-up 2.8% of men and 1.2% of women died by suicide. CONCLUSION Self-harm in midlife represents a key target for intervention. Addressing underlying issues, alcohol use and economic factors may help prevent further self-harm and suicide.Declaration of interestK.H. and N.K. are members of the Department of Health's National Suicide Prevention Advisory Group. N.K. chaired the National Institute for Health and Care Excellence (NICE) guideline development group for the longer-term management of self-harm and the NICE Topic Expert Group which developed the quality standards for self-harm services. N.K. also chairs the NICE guideline committee for the management of depression. All other authors declare no conflict of interest.
Collapse
Affiliation(s)
- Caroline Clements
- Research Associate,Centre for Mental Health and Safety,Manchester Academic Health Sciences Centre,The University of Manchester,UK
| | - Keith Hawton
- Professor of Psychiatry,Centre for Suicide Research,Department of Psychiatry,University of Oxford,UK
| | - Galit Geulayov
- Study Coordinator,Centre for Suicide Research,Department of Psychiatry,University of Oxford,UK
| | - Keith Waters
- Director,Centre for Self-harm and Suicide Prevention Research,Derbyshire Healthcare National Health Service Foundation Trust,UK
| | - Jennifer Ness
- Lead Health Services Researcher,Centre for Self-harm and Suicide Prevention Research,Derbyshire Healthcare National Health Service Foundation Trust,UK
| | - Muzamal Rehman
- Research Assistant,Centre for Self-harm and Suicide Prevention Research,Derbyshire Healthcare National Health Service Foundation Trust,UK
| | - Ellen Townsend
- Professor of Psychology,Self-Harm Research Group,School of Psychology,University of Nottingham,UK
| | - Louis Appleby
- Professor of Psychiatry,Centre for Mental Health and Safety,Manchester Academic Health Sciences Centre,The University of Manchester,UK
| | - Nav Kapur
- Professor of Psychiatry and Population Health,Centre for Mental Health and Safety,Manchester Academic Health Sciences Centre,The University of Manchester; and Honorary Consultant in Psychiatry,Greater Manchester Mental Health National Health Service Foundation Trust,UK
| |
Collapse
|
45
|
Abstract
BACKGROUND Previous research has documented marked occupational differences in suicide risk, but these estimates are 10 years old and based on potentially biased risk assessments.AimsTo investigate occupation-specific suicide mortality in England, 2011-2015. METHOD Estimation of indirectly standardised mortality rates for occupations/occupational groups based on national data. RESULTS Among males the highest risks were seen in low-skilled occupations, particularly construction workers (standardised mortality ratio [SMR] 369, 95% CI 333-409); low-skilled workers comprised 17% (1784/10 688) of all male suicides (SMR 144, 95% CI 137-151). High risks were also seen among skilled trade occupations (SMR 135 95% CI 130-139; 29% of male suicides). There was no evidence of increased risk among some occupations previously causing concern: male healthcare professionals and farmers. Among females the highest risks were seen in artists (SMR 399, 95% CI 244-616) and bar staff (SMR 182, 95% CI 123-260); nurses also had an increased risk (SMR 123, 95% CI 104-145). People in creative occupations and the entertainment industry - artists (both genders), musicians (males) and actors (males) - were at increased risk, although the absolute numbers of deaths in these occupations were low. In males (SMR 192, 95% CI 165-221) and females (SMR 170, 95% CI 149-194), care workers were at increased risk and had a considerable number of suicide deaths. CONCLUSIONS Specific contributors to suicide in high-risk occupations should be identified and measures - such as workplace-based interventions - put in place to mitigate this risk. The construction industry seems to be an important target for preventive interventions.Declaration of interestNone.
Collapse
Affiliation(s)
- Ben Windsor-Shellard
- Head of Lifestyle and Risk Factors Analysis,Health Analysis and Life Events,Office for National Statistics,UK
| | - David Gunnell
- Professor of Epidemiology,Population Health Sciences,Bristol Medical School,University of Bristol; andNational Institute of Health Research Biomedical Research Centre at the University Hospitals Bristol National Health Service Foundation Trust and the University of Bristol,UK
| |
Collapse
|
46
|
Relative toxicity of analgesics commonly used for intentional self-poisoning: A study of case fatality based on fatal and non-fatal overdoses. J Affect Disord 2019; 246:814-819. [PMID: 30634113 DOI: 10.1016/j.jad.2019.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/21/2018] [Accepted: 01/04/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Analgesics are used most frequently in fatal and non-fatal medicinal self-poisonings. Knowledge about their relative toxicity in overdose is important for clinicians and regulatory agencies. METHODS Using data for 2005-2012 we investigated case fatality (number of suicides relative to number of non-fatal self-poisonings) of paracetamol, aspirin, codeine, dihydrocodeine, tramadol, paracetamol with codeine (co-codamol), paracetamol with dihydrocodeine (co-dydramol), ibuprofen and co-proxamol (paracetamol plus dextropropoxyphene; withdrawn in the UK in 2008 due to high toxicity). Data on suicides obtained from the Office for National Statistics and on non-fatal self-poisonings from the Multicentre Study of Self-harm in England. Case fatality was estimated for each drug, using paracetamol as the reference category. RESULTS Compared to paracetamol and based on single drug deaths the case fatality index of dihydrocodeine was considerably elevated (odds ratio (OR) 12.81, 95% Confidence Interval (CI) 10.19-16.12). Case fatality indices for tramadol (OR 4.05, 95% CI 3.38-4.85) and codeine (OR 2.21, 95% CI 1.81-2.70) were also significantly higher than for paracetamol. The results when multiple drug deaths were included produced similar results. The relative toxicity of co-proxamol far exceeded that of the other analgesics. LIMITATIONS Data on fatal self-poisonings were based on national data, whereas those for non-fatal poisonings were based on local data. CONCLUSIONS Dihydrocodeine and tramadol are particularly toxic in overdose and codeine is also relatively toxic. They should be prescribed with caution, particularly to individuals at risk of self-harm.
Collapse
|
47
|
Ferrey AE, Geulayov G, Casey D, Wells C, Fuller A, Bankhead C, Ness J, Clements C, Gunnell D, Kapur N, Hawton K. Relative toxicity of mood stabilisers and antipsychotics: case fatality and fatal toxicity associated with self-poisoning. BMC Psychiatry 2018; 18:399. [PMID: 30587176 PMCID: PMC6307121 DOI: 10.1186/s12888-018-1993-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 12/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bipolar and other psychiatric disorders are associated with considerably increased risk of suicidal behaviour, which may include self-poisoning with medication used to treat the disorder. Therefore, choice of medication for treatment should include consideration of toxicity, especially for patients at risk. The aim of this study was to estimate the relative toxicity of specific drugs within two drug categories, antipsychotics and mood stabilizers, using large-scale databases to provide evidence that could assist clinicians in making decisions about prescribing, especially for patients at risk of suicidal behaviour. METHOD Two indices were used to assess relative toxicity of mood stabilisers and antipsychotics: case fatality (the ratio between rates of fatal and non-fatal self-poisoning) and fatal toxicity (the ratio between rates of fatal self-poisoning and prescription). Mood stabilisers assessed included lithium [reference], sodium valproate, carbamazepine, and lamotrigine, while antipsychotics included chlorpromazine [reference], clozapine, olanzapine, quetiapine and risperidone. Fatal self-poisoning (suicide) data were provided by the Office for National Statistics (ONS), non-fatal self-poisoning data by the Multicentre Study of Self-harm in England, and information on prescriptions by the Clinical Practice Research Datalink. The primary analysis focussed on deaths due to a single drug. Cases where the drug of interest was listed as the likely primary toxic agent in multiple drug overdoses were also analysed. The study period was 2005-2012. RESULTS There appeared to be little difference in toxicity between the mood stabilisers, except that based on case fatality where multiple drug poisonings were considered, carbamazepine was over twice as likely to result in death relative to lithium (OR 2.37 95% CI 1.16-4.85). Of the antipsychotics, clozapine was approximately18 times more likely to result in death when taken in overdose than chlorpromazine (single drug case fatality: OR 18.53 95% CI 8.69-39.52). Otherwise, only risperidone differed from chlorpromazine, being less toxic (OR 0.06 95% CI 0.01-0.47). CONCLUSIONS There was little difference in toxicity of the individual mood stabilisers. Clozapine was far more toxic than the other antipsychotics. The findings are relevant to prescribing policy, especially for patients at particular risk of suicidal behaviour.
Collapse
Affiliation(s)
- Anne E. Ferrey
- 0000 0004 1936 8948grid.4991.5Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK ,0000 0004 1936 8948grid.4991.5Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Galit Geulayov
- 0000 0004 1936 8948grid.4991.5Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Deborah Casey
- 0000 0004 1936 8948grid.4991.5Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Claudia Wells
- 0000 0001 2157 6840grid.426100.1Office for National Statistics, Newport, UK
| | - Alice Fuller
- 0000 0004 1936 8948grid.4991.5Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Clare Bankhead
- 0000 0004 1936 8948grid.4991.5Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jennifer Ness
- 0000 0004 0396 1667grid.418388.eCentre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Caroline Clements
- 0000000121662407grid.5379.8Centre for Suicide Prevention, University of Manchester, Manchester, UK
| | - David Gunnell
- 0000 0004 1936 7603grid.5337.2School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Navneet Kapur
- 0000000121662407grid.5379.8Centre for Suicide Prevention, University of Manchester, Manchester, UK
| | - Keith Hawton
- 0000 0004 1936 8948grid.4991.5Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| |
Collapse
|
48
|
Marrie RA, Walld R, Bolton JM, Sareen J, Patten SB, Singer A, Lix LM, Hitchon CA, El-Gabalawy R, Katz A, Fisk JD, Bernstein CN. Psychiatric comorbidity increases mortality in immune-mediated inflammatory diseases. Gen Hosp Psychiatry 2018; 53:65-72. [PMID: 29929117 DOI: 10.1016/j.genhosppsych.2018.06.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We determined the association between any common mental disorder (CMD: depression, anxiety disorder, bipolar disorder) and mortality and suicide in three immune-mediated inflammatory diseases (IMID), inflammatory bowel disease (IBD), multiple sclerosis (MS) and rheumatoid arthritis (RA), versus age-, sex- and geographically-matched controls. METHODS Using administrative data, we identified 28,384 IMID cases (IBD: 8695; MS: 5496; RA: 14,503) and 141,672 matched controls. We determined annual rates of mortality, suicide and suicide attempts. We evaluated the association of any CMD with all-cause mortality and suicide using multivariable Cox regression models. RESULTS In the IMID cohort, any CMD was associated with increased mortality. We observed a greater than additive interaction between depression and IMID status (attributable proportion 5.2%), but a less than additive interaction with anxiety (attributable proportion -13%). Findings were similar for MS and RA. In IBD, a less than additive interaction existed with depression and anxiety on mortality risk. The IMID cohort with any CMD had an increased suicide risk versus the matched cohort without CMD. CONCLUSION CMD are associated with increased mortality and suicide risk in IMID. In MS and RA, the effects of depression on mortality risk are greater than associations of these IMID and depression alone.
Collapse
Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Randy Walld
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - James M Bolton
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Jitender Sareen
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Alexander Singer
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Carol A Hitchon
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Renée El-Gabalawy
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Anesthesia and Perioperative Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Alan Katz
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - John D Fisk
- Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| |
Collapse
|
49
|
Geulayov G, Ferrey A, Casey D, Wells C, Fuller A, Bankhead C, Gunnell D, Clements C, Kapur N, Ness J, Waters K, Hawton K. Relative toxicity of benzodiazepines and hypnotics commonly used for self-poisoning: An epidemiological study of fatal toxicity and case fatality. J Psychopharmacol 2018; 32:654-662. [PMID: 29442611 DOI: 10.1177/0269881118754734] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The relative toxicity of anxiolytic and hypnotic drugs commonly used for self-poisoning was assessed using data on suicides, prescriptions and non-fatal self-poisonings in England, 2005-2012. Data on suicide by self-poisoning were obtained from the Office for National Statistics, information on intentional non-fatal self-poisoning was derived from the Multicentre Study of Self-harm in England and data on prescriptions in general practice from the Clinical Practice Research Datalink. We used two indices of relative toxicity: fatal toxicity (the number of fatal self-poisonings relative to the number of individuals prescribed each drug) and case fatality (the number of fatal relative to non-fatal self-poisonings). Diazepam was the reference drug in all analyses. Temazepam was 10 times (95% confidence interval 5.48-18.99) and zopiclone/zolpidem nine times (95% confidence interval 5.01-16.65) more toxic in overdose than diazepam (fatal-toxicity index). Temazepam and zopiclone/zolpidem were 13 (95% confidence interval 6.97-24.41) and 12 (95% confidence interval 6.62-22.17) times more toxic than diazepam, respectively (case-fatality index). Differences in alcohol involvement between the drugs were unlikely to account for the findings. Overdoses of temazepam and zopiclone/zolpidem are considerably more likely to result in death than overdoses of diazepam. Practitioners need to exercise caution when prescribing these drugs, especially for individuals who may be at risk of self-harm, and also consider non-pharmacological options.
Collapse
Affiliation(s)
| | - Anne Ferrey
- 1 Department of Psychiatry, University of Oxford, UK
| | - Deborah Casey
- 1 Department of Psychiatry, University of Oxford, UK
| | | | - Alice Fuller
- 3 Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Clare Bankhead
- 3 Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - David Gunnell
- 4 School of Social and Community Medicine, University of Bristol, UK
| | - Caroline Clements
- 5 Manchester Academic Health Sciences Centre, University of Manchester, UK
| | - Navneet Kapur
- 5 Manchester Academic Health Sciences Centre, University of Manchester, UK.,6 Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Jennifer Ness
- 7 Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Keith Waters
- 7 Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Keith Hawton
- 1 Department of Psychiatry, University of Oxford, UK
| |
Collapse
|
50
|
Bowden B, John A, Trefan L, Morgan J, Farewell D, Fone D. Risk of suicide following an alcohol-related emergency hospital admission: An electronic cohort study of 2.8 million people. PLoS One 2018; 13:e0194772. [PMID: 29702655 PMCID: PMC5922531 DOI: 10.1371/journal.pone.0194772] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 03/11/2018] [Indexed: 12/03/2022] Open
Abstract
Objective Alcohol misuse is a well-known risk factor for suicide however, the relationship between alcohol-related hospital admission and subsequent risk of death from suicide is unknown. We aimed to determine the risk of death from suicide following emergency admission to hospital with an alcohol-related cause. Methods We established an electronic cohort study of all 2,803,457 residents of Wales, UK, aged from 10 to under 100 years on 1 January 2006 with six years’ follow-up. The outcome event was death from suicide defined as intentional self-harm (ICD-10 X60-84) or undetermined intent (Y10-34). The main exposure was an alcohol-related admission defined as a ‘wholly attributable’ ICD-10 alcohol code in the admission record. Admissions were coded for the presence or absence of co-existing psychiatric morbidity. The analysis was by Cox regression with adjustments for confounding variables within the dataset. Results During the study follow-up period, there were 15,546,355 person years at risk with 28,425 alcohol-related emergency admissions and 1562 suicides. 125 suicides followed an admission (144.6 per 100,000 person years), of which 11 (9%) occurred within 4 weeks of discharge. The overall adjusted hazard ratio (HR) for suicide following admission was 26.8 (95% confidence interval (CI) 18.8 to 38.3), in men HR 9.83 (95% CI 7.91 to 12.2) and women HR 28.5 (95% CI 19.9 to 41.0). The risk of suicide remained substantial in subjects without known co-existing psychiatric morbidity: HR men 8.11 (95% CI 6.30 to 10.4) and women HR 24.0 (95% CI 15.5 to 37.3). The analysis was limited by the absence in datasets of potentially important confounding variables and the lack of information on alcohol-related harm and psychiatric morbidity in subjects not admitted to hospital. Conclusion Emergency alcohol-related hospital admission is associated with an increased risk of suicide. Identifying individuals in hospital provides an opportunity for psychosocial assessment and suicide prevention of a targeted at-risk group before their discharge to the community.
Collapse
Affiliation(s)
- Bethan Bowden
- Public Health Wales NHS Trust, Swansea, United Kingdom
- Swansea University Medical School, Institute of Life Sciences 2, Swansea, United Kingdom
| | - Ann John
- Public Health Wales NHS Trust, Swansea, United Kingdom
- Swansea University Medical School, Institute of Life Sciences 2, Swansea, United Kingdom
| | - Laszlo Trefan
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Jennifer Morgan
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Daniel Farewell
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
- * E-mail:
| | - David Fone
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| |
Collapse
|