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Alothman D, Lewis S, Fogarty AW, Card T, Tyrrell E. Primary care consultation patterns before suicide: a nationally representative case-control study. Br J Gen Pract 2024; 74:e426-e433. [PMID: 38331442 PMCID: PMC11157587 DOI: 10.3399/bjgp.2023.0509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/01/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Consultation with primary healthcare professionals may provide an opportunity to identify patients at higher suicide risk. AIM To explore primary care consultation patterns in the 5 years before suicide to identify suicide high-risk groups and common reasons for consulting. DESIGN AND SETTING This was a case-control study using electronic health records from England, 2001 to 2019. METHOD An analysis was undertaken of 14 515 patients aged ≥15 years who died by suicide and up to 40 matched live controls per person who died by suicide (n = 580 159), (N = 594 674). RESULTS Frequent consultations (>1 per month in the final year) were associated with increased suicide risk (age- and sex -adjusted odds ratio [OR] 5.88, 95% confidence interval [CI] = 5.47 to 6.32). The associated rise in suicide risk was seen across all sociodemographic groups as well as in those with and without psychiatric comorbidities. However, specific groups were more influenced by the effect of high-frequency consultation (>1 per month in the final year) demonstrating higher suicide risk compared with their counterparts who consulted once: females (adjusted OR 9.50, 95% CI = 7.82 to 11.54), patients aged 15-<45 years (adjusted OR 8.08, 95% CI = 7.29 to 8.96), patients experiencing less socioeconomic deprivation (adjusted OR 6.56, 95% CI = 5.77 to 7.46), and those with psychiatric conditions (adjusted OR 4.57, 95% CI = 4.12 to 5.06). Medication review, depression, and pain were the most common reasons for which patients who died by suicide consulted in the year before death. CONCLUSION Escalating or more than monthly consultations are associated with increased suicide risk regardless of patients' sociodemographic characteristics and regardless of the presence (or absence) of known psychiatric illnesses.
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Affiliation(s)
- Danah Alothman
- School of Medicine, University of Nottingham, Nottingham
| | - Sarah Lewis
- School of Medicine, University of Nottingham, Nottingham
| | | | - Timothy Card
- School of Medicine, University of Nottingham, Nottingham
| | - Edward Tyrrell
- School of Medicine, University of Nottingham, Nottingham
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2
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Saini P, Hunt A, Blaney P, Murray A. Recognising and Responding to Suicide-Risk Factors in Primary Care: A Scoping Review. JOURNAL OF PREVENTION (2022) 2024:10.1007/s10935-024-00783-1. [PMID: 38801507 DOI: 10.1007/s10935-024-00783-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
The cost of one suicide is estimated to be £1.67 million (2 million euros) to the UK economy. Most people who die by suicide have seen a primary care practitioner (PCP) in the year prior to death. PCPs could aim to intervene before suicidal behaviours arise by addressing suicide-risk factors noted in primary care consultations, thereby preventing suicide and promoting health and wellbeing. This study aimed to conduct a rapid, systematic scoping review to explore how PCPs can effectively recognise and respond to suicide-risk factors. MedLine, CINAHL, PsycINFO, Web of Science and Cochrane Library databases were searched for three key concepts: suicide prevention, mental health and primary care. Two reviewers screened titles, abstracts and full papers independently against the eligibility criteria. Data synthesis was achieved by extracting and analysing study characteristics and findings. Forty-two studies met the eligibility criteria and were cited in this scoping review. Studies were published between 1990 and 2020 and were of good methodological quality. Six themes regarding suicide risk assessment in primary care were identified: Primary care consultations prior to suicide; Reasons for non-disclosure of suicidal behaviour; Screening for suicide risk; Training for primary care staff; Use of language by primary care staff; and, Difference in referral pathways from general practitioners or primary care practitioners. This review focused on better recognition and response to specific suicide-risk factors more widely such as poor mental health, substance misuse and long-term physical health conditions. Primary care is well placed to address the range of suicide-risk factors including biological, physical-health, psychological and socio-economic factors and therefore these findings could inform the development of person-centred approaches to be used in primary care.
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Affiliation(s)
- Pooja Saini
- School of Psychology, Faculty of Health, Suicide and Self-Harm Prevention, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK.
| | - Anna Hunt
- School of Psychology, Faculty of Health, Suicide and Self-Harm Prevention, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | - Peter Blaney
- School of Psychology, Faculty of Health, Suicide and Self-Harm Prevention, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | - Annie Murray
- Department of Health and Social Care, Office for Health Improvement and Disparities, Piccadilly Place 3, Manchester, M1 3BN, UK
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3
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Jack RH, Joseph RM, Coupland CA, Hall CL, Hollis C. Impact of the COVID-19 pandemic on incidence of tics in children and young people: a population-based cohort study. EClinicalMedicine 2023; 57:101857. [PMID: 36820099 PMCID: PMC9932691 DOI: 10.1016/j.eclinm.2023.101857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Since the onset of the coronavirus (COVID-19) pandemic, clinicians have reported an increase in presentations of sudden and new onset tics particularly affecting teenage girls. This population-based study aimed to describe and compare the incidence of tics in children and young people in primary care before and during the COVID-19 pandemic in England. METHODS We used information from the UK Clinical Practice Research Datalink (CPRD) Aurum dataset and included males and females aged 4-11 years and 12-18 years between Jan 1, 2015, and Dec 31, 2021. We grouped the pre-pandemic period (2015-2019) and presented the pandemic years (2020, 2021) separately. We described the characteristics of children and young people with a first record of a motor or vocal tic in each time period. Incidence rates of tics by age-sex groups in 2015-2019, 2020, and 2021 were calculated. Negative binomial regression models were used to calculate incidence rate ratios. FINDINGS We included 3,867,709 males and females aged 4-18 years. Over 14,734,062 person-years of follow-up, 11,245 people had a first tic record during the whole study period. The characteristics of people with tics differed over time, with the proportion of females aged 12-18 years and the proportion with mental health conditions including anxiety increasing during the pandemic. Tic incidence rates per 10,000 person-years were highest for 4-11-year-old males in all three time periods (13.4 [95% confidence interval 13.0-13.8] in 2015-2019; 13.2 [12.3-14.1] in 2020; 15.1 [14.1-16.1] in 2021) but increased markedly during the pandemic in 12-18-year-old females, from 2.5 (2.3-2.7) in 2015-2019, to 10.3 (9.5-11.3) in 2020 and 13.1 (12.1-14.1) in 2021. There were smaller increases in incidence rates in 12-18-year-old males (4.6 [4.4-4.9] in 2015-2019; 4.7 [4.1-5.3] in 2020; 6.2 [5.5-6.9] in 2021) and 4-11-year-old females (4.9 [4.7-5.2] in 2015-2019; 5.7 [5.1-6.4] in 2020; 7.6 [6.9-8.3] in 2021). Incidence rate ratios comparing 2020 and 2021 with 2015-2019 were highest in the 12-18-year-old female subgroup (4.2 [3.6-4.8] in 2020; 5.3 [4.7-6.0] in 2021). INTERPRETATION The incidence of tics in children and young people increased across all age and sex groups during the COVID-19 pandemic, with a differentially large effect in teenage girls (a greater than four-fold increase). Furthermore, in those with tic symptoms, proportions with mental health disorders including anxiety increased during the pandemic. Further research is required on the social and contextual factors underpinning this rise in onset of tics in teenage girls. FUNDING National Institute for Health Research Nottingham Biomedical Research Centre.
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Affiliation(s)
- Ruth H. Jack
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Rebecca M. Joseph
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Carol A.C. Coupland
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Charlotte L. Hall
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Innovation Park, Triumph Road, Nottingham, UK
| | - Chris Hollis
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Innovation Park, Triumph Road, Nottingham, UK
- Corresponding author. National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Institute of Mental Health, School of Medicine, University of Nottingham, Innovation Park, Triumph Road, Nottingham, UK.
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4
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Cybulski L, Ashcroft DM, Carr MJ, Garg S, Chew-Graham CA, Kapur N, Webb RT. Risk factors for nonfatal self-harm and suicide among adolescents: two nested case-control studies conducted in the UK Clinical Practice Research Datalink. J Child Psychol Psychiatry 2022; 63:1078-1088. [PMID: 34862981 DOI: 10.1111/jcpp.13552] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The characteristics of adolescents who die by suicide have hitherto been examined in uncontrolled study designs, thereby precluding examination of risk factors. The degree to which antecedents of nonfatal self-harm and suicide at young age differ remains unknown. METHOD We delineated two nested case-control studies of patients aged 10-19 years using the Clinical Practice Research Datalink with interlinked hospital and national mortality records. Cases were adolescents who between 1st January 2003 and 31st December 2018 had died from suicide (N = 324) - study 1; experienced their first self-harm episode (N = 56,008) - study 2. In both studies, cases were matched on sex, age and practice-level deprivation quintile to 25 controls. By fitting conditional logistic regression, we examined how risks varied according to psychiatric diagnoses, prescribed psychotropic medication, patterns of clinical contact and area-level deprivation. RESULTS Suicides occurred more often among boys (66%), but self-harm was more common in girls (68%). Most individuals who self-harmed or died from suicide presented to their GP at least once in the preceding year (85% and 75% respectively). Only a third of cases had one of the examined diagnostic categories recorded. Depression was most strongly associated with elevated risks for both outcomes (self-harm: OR 7.9; 95% CI 7.8-8.2; suicide: OR 7.4; 95% CI 5.5-9.9). Except for autism spectrum disorder, all other diagnostic categories were linked with similar risk elevations for self-harm as for suicide. Whilst self-harm risk rose incrementally with increasing levels of area-level deprivation, suicide risks did not. CONCLUSIONS We observed few marked differences in risk factor profiles for nonfatal self-harm versus suicide. As most adolescents who had harmed themselves or died by suicide were known to services in the preceding year, their underlying pathology may not be adequately identified and treated. Our findings highlight the need for a multiagency approach to treatment and prevention.
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Affiliation(s)
- Lukasz Cybulski
- Division of Psychology & Mental Health, Faculty of Biology, Medicine, and Health, School of Health Sciences, Centre for Mental Health & Safety, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Darren M Ashcroft
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Division of Pharmacy & Optometry, Faculty of Biology, Medicine and Health, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Matthew J Carr
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Division of Pharmacy & Optometry, Faculty of Biology, Medicine and Health, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Shruti Garg
- Division of Neuroscience & Experimental Psychology, Faculty of Biology, Medicine and Health, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre (MAHSC), Manchester, UK.,Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation, Manchester, UK
| | - Carolyn A Chew-Graham
- Faculty of Medicine and Health Sciences, School of Primary, Community and Social Care, Keele University, Staffs, UK
| | - Nav Kapur
- Division of Psychology & Mental Health, Faculty of Biology, Medicine, and Health, School of Health Sciences, Centre for Mental Health & Safety, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Roger T Webb
- Division of Psychology & Mental Health, Faculty of Biology, Medicine, and Health, School of Health Sciences, Centre for Mental Health & Safety, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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5
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Petrova N. The problem of suicide in depression in the modern world. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:43-48. [DOI: 10.17116/jnevro202212206243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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6
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Kapur N, Gorman LS, Quinlivan L, Webb RT. Mental health services: quality, safety and suicide. BMJ Qual Saf 2021; 31:419-422. [PMID: 34607913 DOI: 10.1136/bmjqs-2021-013532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Nav Kapur
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK, Manchester, UK .,Centre for Mental Health and Safety, University of Manchester, Manchester, UK, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Louise S Gorman
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK, Manchester, UK.,Centre for Mental Health and Safety, University of Manchester, Manchester, UK, The University of Manchester, Manchester, UK
| | - Leah Quinlivan
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK, Manchester, UK.,Centre for Mental Health and Safety, University of Manchester, Manchester, UK, The University of Manchester, Manchester, UK
| | - Roger T Webb
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK, Manchester, UK.,Centre for Mental Health and Safety, University of Manchester, Manchester, UK, The University of Manchester, Manchester, UK
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7
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Elzinga E, de Beurs D, Beekman A, Berkelmans G, Gilissen R. Who didn't consult the doctor? Understanding sociodemographic factors in relation to health care uptake before suicide. J Affect Disord 2021; 287:158-164. [PMID: 33799033 DOI: 10.1016/j.jad.2021.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study aimed to establish differences between suicide decedents and a reference population across various health care settings. METHODS This population-wide registration study combined death statistics, sociodemographic data and health care data from Statistics Netherlands. From 2010 to 2016, 12,015 suicide cases and a random reference group of 132,504 were included and assigned to one of the three health care settings; mental health (MH) care, primary care or no care. Logistic regression analyses were performed to determine differences in suicide risk factors across settings. RESULTS In the 1-2 year period before suicide, 52% of the suicide decedents received MH care, 41% received GP care only and 7% received neither. Although sociodemographic factors showed significant differences across settings, the suicide risk profiles were not profoundly distinctive. A decreasing trend in suicide risk across health care settings became apparent for male gender, income level and being in a one-person or one-parent household, whereas for other factors (middle and older age, non-Western migration background, couples without children and people living in more sparsely populated areas), risk of suicide increased when health care setting became more specialized. LIMITATIONS Because of the data structure, 18 months of suicide decedents' health care use were compared with two years health care use of the reference group, which likely led to an underestimation of the reported differences. CONCLUSION Although there are differences between suicide decedents and a reference group across health care settings, these are not sufficiently distinctive to advocate for a setting-specific approach to suicide prevention.
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Affiliation(s)
- Elke Elzinga
- Research department, 113 Suicide Prevention, Amsterdam, Netherlands; Psychiatry, Amsterdam Public Health (research institute), Amsterdam UMC VU University, Amsterdam, Netherlands.
| | - Derek de Beurs
- Department of epidemiology, Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, Netherlands
| | - Aartjan Beekman
- Department of Research & Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands; Psychiatry, Amsterdam Public Health (research institute), Amsterdam UMC VU University, Amsterdam, Netherlands
| | - Guus Berkelmans
- Research department, 113 Suicide Prevention, Amsterdam, Netherlands; National research institute for mathematics and computer science, Centrum Wiskunde & Informatica; CWI, Amsterdam, Netherlands
| | - Renske Gilissen
- Research department, 113 Suicide Prevention, Amsterdam, Netherlands
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8
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Onyeka IN, O'Reilly D, Maguire A. The association between self-reported mental health, medication record and suicide risk: A population wide study. SSM Popul Health 2021; 13:100749. [PMID: 33665331 PMCID: PMC7901032 DOI: 10.1016/j.ssmph.2021.100749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 01/13/2023] Open
Abstract
Suicide mortality and mental ill health are increasing globally. Mental ill health can be measured in multiple ways. It is unclear which measure is most associated with suicide risk. This study explored the association between self-rated mental health and medication record and death by suicide. The 2011 Northern Ireland Census records of adults aged 18-74 years (n=1,098,967) were linked to a centralised database of dispensed prescription medication and death registrations until the end of 2015. Mental health status was ascertained through both a single-item self-reported question in the Census and receipt of psychotropic medication. Logistic regression models examined the association between indicators of mental ill health and likelihood of suicide mortality. Of the 1,098,967 cohort members, 857 died by suicide during the study period. Just over half of these deaths (n=429, 50.1%) occurred in individuals with neither indicator of mental ill health. Cohort members with both self-reported mental ill health and receipt of psychotropic medication had the highest risk of suicide (OR=6.13, 95%CI: 4.94–7.61), followed by those with psychotropic medication record only (OR=4.00, 95%CI: 3.28–4.88) and self-report only (OR=2.88, 95%CI: 2.16–3.84). Individuals who report mental ill health and have a history of psychotropic medication use are at a high risk of suicide mortality. However, neither measure is particularly sensitive, as both failed to signal over half of subsequent suicides. Some individuals who report poor mental health but are not in receipt of psychotropic medication are at increased risk of suicide, indicating possible unmet treatment need. The combination of the two indicators offers more precision for identifying those most at risk for targeted interventions. Mental ill health is associated with an increased risk of suicide, but measuring population mental health is difficult. The suicide risk associated with both subjective and objective indicators of mental ill health have not been examined. Most individuals who die by suicide have no indicator of mental ill health. Having both self-reported poor mental health and psychotropic medication record carried the highest risk of suicide death. Increased risk of suicide in individuals who report poor mental health but are not on medication may indicate unmet need.
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Affiliation(s)
- Ifeoma N Onyeka
- Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK.,Administrative Data Research Centre Northern Ireland, Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK.,Administrative Data Research Centre Northern Ireland, Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
| | - Aideen Maguire
- Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
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9
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Living alone, loneliness and lack of emotional support as predictors of suicide and self-harm: A nine-year follow up of the UK Biobank cohort. J Affect Disord 2021; 279:316-323. [PMID: 33096330 PMCID: PMC7758739 DOI: 10.1016/j.jad.2020.10.026] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/27/2020] [Accepted: 10/11/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND The association between loneliness and suicide is poorly understood. We investigated how living alone, loneliness and emotional support were related to suicide and self-harm in a longitudinal design. METHODS Between 2006 and 2010 UK Biobank recruited and assessed in detail over 0.5 million people in middle age. Data were linked to prospective hospital admission and mortality records. Adjusted Cox regression models were used to investigate relationships between living arrangements, loneliness and emotional support, and both suicide and self-harm as outcomes. RESULTS For men, both living alone (Hazard Ratio (HR) 2.16, 95%CI 1.51-3.09) and living with non-partners (HR 1.80, 95%CI 1.08-3.00) were associated with death by suicide, independently of loneliness, which had a modest relationship with suicide (HR 1.43, 95%CI 0.1.01-2.03). For women, there was no evidence that living arrangements, loneliness or emotional support were associated with death by suicide. Associations between living alone and self-harm were explained by health for women, and by health, loneliness and emotional support for men. In fully adjusted models, loneliness was associated with hospital admissions for self-harm in both women (HR 1.89, 95%CI 1.57-2.28) and men (HR 1.74, 95%CI 1.40-2.16). LIMITATIONS Loneliness and emotional support were operationalized using single item measures. CONCLUSIONS For men - but not for women - living alone or living with a non-partner increased the risk of suicide, a finding not explained by subjective loneliness. Overall, loneliness may be more important as a risk factor for self-harm than for suicide. Loneliness also appears to lessen the protective associations of cohabitation.
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10
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Corke M, Mullin K, Angel-Scott H, Xia S, Large M. Meta-analysis of the strength of exploratory suicide prediction models; from clinicians to computers. BJPsych Open 2021; 7:e26. [PMID: 33407984 PMCID: PMC8058929 DOI: 10.1192/bjo.2020.162] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Suicide prediction models have been formulated in a variety of ways and are heterogeneous in the strength of their predictions. Machine learning has been a proposed as a way of improving suicide predictions by incorporating more suicide risk factors. AIMS To determine whether machine learning and the number of suicide risk factors included in suicide prediction models are associated with the strength of the resulting predictions. METHOD Random-effect meta-analysis of exploratory suicide prediction models constructed by combining two or more suicide risk factors or using clinical judgement (Prospero Registration CRD42017059665). Studies were located by searching for papers indexed in PubMed before 15 August 2020 with the term suicid* in the title. RESULTS In total, 86 papers reported 102 suicide prediction models and included 20 210 411 people and 106 902 suicides. The pooled odds ratio was 7.7 (95% CI 6.7-8.8) with high between-study heterogeneity (I2 = 99.5). Machine learning was associated with a non-significantly higher odds ratio of 11.6 (95% CI 6.0-22.3) and clinical judgement with a non-significantly lower odds ratio of 4.7 (95% CI 2.1-10.9). Models including a larger number of suicide risk factors had a higher odds ratio when machine-learning studies were included (P = 0.02). Among non-machine-learning studies, suicide prediction models including fewer risk factors performed just as well as those including more risk factors. CONCLUSIONS Machine learning might have the potential to improve the performance of suicide prediction models by increasing the number of included suicide risk factors but its superiority over other methods is unproven.
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Affiliation(s)
- Michelle Corke
- School of Psychiatry, University of New South Wales, Australia
| | - Katherine Mullin
- South Eastern Sydney Local Health District and School of Medicine, University of Notre Dame, Australia
| | | | - Shelley Xia
- South Eastern Sydney Local Health District, Australia
| | - Matthew Large
- South Eastern Sydney Local Health District, Australia; and School of Medicine, University of Notre Dame, Australia
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11
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Hoile R, Tabet N, Smith H, Bremner S, Cassell J, Ford E. Are symptoms of insomnia in primary care associated with subsequent onset of dementia? A matched retrospective case-control study. Aging Ment Health 2020; 24:1466-1471. [PMID: 31791142 DOI: 10.1080/13607863.2019.1695737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objective: There is evidence from neuroimaging studies of an association between insomnia and early dementia biomarkers, but observational studies have so far failed to show a clear association between insomnia and the later development of dementia. We investigated the association between dementia diagnosis and recording of insomnia symptoms 5-10 years earlier in primary care.Method: A case-control study using data from the Clinical Practice Research Datalink. 15,209 cases with dementia (either Alzheimer's, vascular, mixed or non-specific subtypes) at least 65 years old at time of diagnosis, were matched with the same number of controls on year of birth and gender. We ascertained the presence of insomnia symptoms during a five-year period starting 10 years before the index date. Odds ratios for developing dementia were estimated using logistic regression after controlling for hypnotic exposure and physical and mental health comorbidities.Results: The adjusted odds ratio for dementia in those with previous insomnia was 1.34 (95% CI = 1.20-1.50).Conclusion: There is an association between dementia and previous insomnia. It may be possible to incorporate insomnia into predictive tools for dementia.
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Affiliation(s)
- Richard Hoile
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, UK.,Memory Assessment Service, Grove House, Crowborough, UK
| | - Naji Tabet
- Centre for Dementia Studies, Trafford Centre, University of Sussex, Falmer, UK
| | - Helen Smith
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Stephen Bremner
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, UK
| | - Jackie Cassell
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, UK
| | - Elizabeth Ford
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, UK
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12
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van Mens K, Elzinga E, Nielen M, Lokkerbol J, Poortvliet R, Donker G, Heins M, Korevaar J, Dückers M, Aussems C, Helbich M, Tiemens B, Gilissen R, Beekman A, de Beurs D. Applying machine learning on health record data from general practitioners to predict suicidality. Internet Interv 2020; 21:100337. [PMID: 32944503 PMCID: PMC7481555 DOI: 10.1016/j.invent.2020.100337] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/29/2020] [Accepted: 07/20/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Suicidal behaviour is difficult to detect in the general practice. Machine learning (ML) algorithms using routinely collected data might support General Practitioners (GPs) in the detection of suicidal behaviour. In this paper, we applied machine learning techniques to support GPs recognizing suicidal behaviour in primary care patients using routinely collected general practice data. METHODS This case-control study used data from a national representative primary care database including over 1.5 million patients (Nivel Primary Care Database). Patients with a suicide (attempt) in 2017 were selected as cases (N = 574) and an at risk control group (N = 207,308) was selected from patients with psychological vulnerability but without a suicide attempt in 2017. RandomForest was trained on a small subsample of the data (training set), and evaluated on unseen data (test set). RESULTS Almost two-third (65%) of the cases visited their GP within the last 30 days before the suicide (attempt). RandomForest showed a positive predictive value (PPV) of 0.05 (0.04-0.06), with a sensitivity of 0.39 (0.32-0.47) and area under the curve (AUC) of 0.85 (0.81-0.88). Almost all controls were accurately labeled as controls (specificity = 0.98 (0.97-0.98)). Among a sample of 650 at-risk primary care patients, the algorithm would label 20 patients as high-risk. Of those, one would be an actual case and additionally, one case would be missed. CONCLUSION In this study, we applied machine learning to predict suicidal behaviour using general practice data. Our results showed that these techniques can be used as a complementary step in the identification and stratification of patients at risk of suicidal behaviour. The results are encouraging and provide a first step to use automated screening directly in clinical practice. Additional data from different social domains, such as employment and education, might improve accuracy.
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Affiliation(s)
- Kasper van Mens
- Altrecht Mental Healthcare, Utrecht, the Netherlands
- Trimbos Institute (Netherlands Institute of Mental Health), Utrecht, the Netherlands
| | - Elke Elzinga
- 113 Suicide Prevention, Amsterdam, the Netherlands
| | - Mark Nielen
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Joran Lokkerbol
- Trimbos Institute (Netherlands Institute of Mental Health), Utrecht, the Netherlands
| | - Rune Poortvliet
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Gé Donker
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Marianne Heins
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Joke Korevaar
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Michel Dückers
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Claire Aussems
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Marco Helbich
- Human Geography and Spatial Planning, Utrecht University, Utrecht, the Netherlands
| | - Bea Tiemens
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | | | - Aartjan Beekman
- Psychiatry, Amsterdam Public Health (research institute), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Derek de Beurs
- Trimbos Institute (Netherlands Institute of Mental Health), Utrecht, the Netherlands
- Clinical Psychology, Amsterdam Public Health, Vrije Universiteit Amsterdam, the Netherlands
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Jacobs R, Aylott L, Dare C, Doran T, Gilbody S, Goddard M, Gravelle H, Gutacker N, Kasteridis P, Kendrick T, Mason A, Rice N, Ride J, Siddiqi N, Williams R. The association between primary care quality and health-care use, costs and outcomes for people with serious mental illness: a retrospective observational study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background
Serious mental illness, including schizophrenia, bipolar disorder and other psychoses, is linked with high disease burden, poor outcomes, high treatment costs and lower life expectancy. In the UK, most people with serious mental illness are treated in primary care by general practitioners, who are financially incentivised to meet quality targets for patients with chronic conditions, including serious mental illness, under the Quality and Outcomes Framework. The Quality and Outcomes Framework, however, omits important aspects of quality.
Objectives
We examined whether or not better quality of primary care for people with serious mental illness improved a range of outcomes.
Design and setting
We used administrative data from English primary care practices that contribute to the Clinical Practice Research Datalink GOLD database, linked to Hospital Episode Statistics, accident and emergency attendances, Office for National Statistics mortality data and community mental health records in the Mental Health Minimum Data Set. We used survival analysis to estimate whether or not selected quality indicators affect the time until patients experience an outcome.
Participants
Four cohorts of people with serious mental illness, depending on the outcomes examined and inclusion criteria.
Interventions
Quality of care was measured with (1) Quality and Outcomes Framework indicators (care plans and annual physical reviews) and (2) non-Quality and Outcomes Framework indicators identified through a systematic review (antipsychotic polypharmacy and continuity of care provided by general practitioners).
Main outcome measures
Several outcomes were examined: emergency admissions for serious mental illness and ambulatory care sensitive conditions; all unplanned admissions; accident and emergency attendances; mortality; re-entry into specialist mental health services; and costs attributed to primary, secondary and community mental health care.
Results
Care plans were associated with lower risk of accident and emergency attendance (hazard ratio 0.74, 95% confidence interval 0.69 to 0.80), serious mental illness admission (hazard ratio 0.67, 95% confidence interval 0.59 to 0.75), ambulatory care sensitive condition admission (hazard ratio 0.73, 95% confidence interval 0.64 to 0.83), and lower overall health-care (£53), primary care (£9), hospital (£26) and mental health-care costs (£12). Annual reviews were associated with reduced risk of accident and emergency attendance (hazard ratio 0.80, 95% confidence interval 0.76 to 0.85), serious mental illness admission (hazard ratio 0.75, 95% confidence interval 0.67 to 0.84), ambulatory care sensitive condition admission (hazard ratio 0.76, 95% confidence interval 0.67 to 0.87), and lower overall health-care (£34), primary care (£9) and mental health-care costs (£30). Higher general practitioner continuity was associated with lower risk of accident and emergency presentation (hazard ratio 0.89, 95% confidence interval 0.83 to 0.97) and ambulatory care sensitive condition admission (hazard ratio 0.77, 95% confidence interval 0.65 to 0.92), but not with serious mental illness admission. High continuity was associated with lower primary care costs (£3). Antipsychotic polypharmacy was not statistically significantly associated with the risk of unplanned admission, death or accident and emergency presentation. None of the quality measures was statistically significantly associated with risk of re-entry into specialist mental health care.
Limitations
There is risk of bias from unobserved factors. To mitigate this, we controlled for observed patient characteristics at baseline and adjusted for the influence of time-invariant unobserved patient differences.
Conclusions
Better performance on Quality and Outcomes Framework measures and continuity of care are associated with better outcomes and lower resource utilisation, and could generate moderate cost savings.
Future work
Future research should examine the impact of primary care quality on measures that capture broader aspects of health and functioning.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 25. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rowena Jacobs
- Centre for Health Economics, University of York, York, UK
| | - Lauren Aylott
- Expert by experience
- Hull York Medical School, York, UK
| | | | | | - Simon Gilbody
- Hull York Medical School, York, UK
- Department of Health Sciences, University of York, York, UK
| | - Maria Goddard
- Centre for Health Economics, University of York, York, UK
| | - Hugh Gravelle
- Centre for Health Economics, University of York, York, UK
| | - Nils Gutacker
- Centre for Health Economics, University of York, York, UK
| | | | - Tony Kendrick
- Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - Anne Mason
- Centre for Health Economics, University of York, York, UK
| | - Nigel Rice
- Centre for Health Economics, University of York, York, UK
| | - Jemimah Ride
- Centre for Health Economics, University of York, York, UK
| | - Najma Siddiqi
- Hull York Medical School, York, UK
- Department of Health Sciences, University of York, York, UK
- Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Rachael Williams
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK
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14
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Polek E, Neufeld SAS, Wilkinson P, Goodyer I, St Clair M, Prabhu G, Dolan R, Bullmore ET, Fonagy P, Stochl J, Jones PB. How do the prevalence and relative risk of non-suicidal self-injury and suicidal thoughts vary across the population distribution of common mental distress (the p factor)? Observational analyses replicated in two independent UK cohorts of young people. BMJ Open 2020; 10:e032494. [PMID: 32398331 PMCID: PMC7223145 DOI: 10.1136/bmjopen-2019-032494] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES To inform suicide prevention policies and responses to youths at risk by investigating whether suicide risk is predicted by a summary measure of common mental distress (CMD (the p factor)) as well as by conventional psychopathological domains; to define the distribution of suicide risks over the population range of CMD; to test whether such distress mediates the medium-term persistence of suicide risks. DESIGN Two independent population-based cohorts. SETTING Population based in two UK centres. PARTICIPANTS Volunteers aged 14-24 years recruited from primary healthcare registers, schools and colleges, with advertisements to complete quotas in age-sex-strata. Cohort 1 is the Neuroscience in Psychiatry Network (n=2403); cohort 2 is the ROOTS sample (n=1074). PRIMARY OUTCOME MEASURES Suicidal thoughts (ST) and non-suicidal self-injury (NSSI). RESULTS We calculated a CMD score using confirmatory bifactor analysis and then used logistic regressions to determine adjusted associations between risks and CMD; curve fitting was used to examine the relative prevalence of STs and NSSI over the population distribution of CMD. We found a dose-response relationship between levels of CMD and risk of suicide. The majority of all subjects experiencing ST and NSSI (78% and 76% in cohort 1, and 66% and 71% in cohort 2) had CMD scores no more than 2 SDs above the population mean; higher scores indicated the highest risk but were, by definition, infrequent. Pathway mediation models showed that CMD mediated the longitudinal course of both ST and NSSI. CONCLUSIONS NSSI and ST in youths reflect CMD that also mediates their persistence. Universal prevention strategies reducing levels of CMD in the whole population without recourse to screening or measurement may prevent more suicides than approaches targeting youths with the most severe distress or with psychiatric disorders.
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Affiliation(s)
- Ela Polek
- Psychiatry, University of Cambridge, Cambridge, Cambridgeshire, UK
- Psychology, University College Dublin, Dublin, Ireland
| | | | - Paul Wilkinson
- Psychiatry, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Ian Goodyer
- Psychiatry, University of Cambridge, Cambridge, Cambridgeshire, UK
| | | | - Gita Prabhu
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, University College, London, UK
| | - Ray Dolan
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, University College, London, UK
| | | | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Jan Stochl
- Psychiatry, University of Cambridge, Cambridge, Cambridgeshire, UK
- NIHR Applied Research Collaboration East of England, Cambridge, Cambridgeshire, UK
| | - Peter B Jones
- Psychiatry, University of Cambridge, Cambridge, Cambridgeshire, UK
- NIHR Applied Research Collaboration East of England, Cambridge, Cambridgeshire, UK
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15
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Cohen LJ, Wilman-Depena S, Barzilay S, Hawes M, Yaseen Z, Galynker I. Correlates of Chronic Suicidal Ideation Among Community-Based Minor-Attracted Persons. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2020; 32:273-300. [PMID: 30678527 DOI: 10.1177/1079063219825868] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Elevated suicidal risk has been documented in adults who are sexually attracted to minors but the topic has not been adequately investigated, particularly outside the context of the criminal justice system. In this study, risk factors for chronic suicidal ideation were assessed in 333 community-based minor-attracted persons (95% male) via an online survey. Chronic suicidal ideation was endorsed by 38.1% of the participants but was associated neither to history of sexually engaging with a child nor to prior contact with the criminal justice system. In bivariate logistic regression analyses, significant unadjusted correlates included young age, less education, prior mental health treatment, weaker attraction to adult women, history of sexual abuse in the participants' own childhood, and the psychosocial effect of perceived stigma against pedophilia. In multivariable analysis, all these factors except education were uniquely associated with suicidal ideation. These results identify meaningful clinical risk factors and treatment targets in this population.
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Affiliation(s)
- Lisa J Cohen
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Beth Israel, New York, NY, USA
| | | | | | | | - Zimri Yaseen
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Beth Israel, New York, NY, USA
| | - Igor Galynker
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Beth Israel, New York, NY, USA
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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.
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17
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Variation in patterns of health care before suicide: A population case-control study. Prev Med 2019; 127:105796. [PMID: 31400374 PMCID: PMC6744956 DOI: 10.1016/j.ypmed.2019.105796] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 07/29/2019] [Accepted: 08/07/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND The United States has experienced a significant rise in suicide. As decision makers identify how to address this national concern, healthcare systems have been identified as an optimal location for prevention. OBJECTIVE To compare variation in patterns of healthcare use, by health setting, between individuals who died by suicide and the general population. DESIGN Case-Control Study. SETTING Eight healthcare systems across the United States. PARTICIPANTS 2674 individuals who died by suicide between 2000 and 2013 along with 267,400 individuals matched on time-period of health plan membership and health system affiliation. MEASUREMENTS Healthcare use in the emergency room, inpatient hospital, primary care, and outpatient specialty setting measured using electronic health record data during the 7-, 30-, 60-, 90-, 180-, and 365-day time periods before suicide and matched index date for controls. RESULTS Healthcare use was more common across all healthcare settings for individuals who died by suicide. Nearly 30% of individuals had a healthcare visit in the 7-days before suicide (6.5% emergency, 16.3% outpatient specialty, and 9.5% primary care), over half within 30 days, and >90% within 365 days. Those who died by suicide averaged 16.7 healthcare visits during the year. The relative risk of suicide was greatest for individuals who received care in the inpatient setting (aOR = 6.23). There was both a large relative risk (aOR = 3.08) and absolute utilization rate (43.8%) in the emergency room before suicide. LIMITATIONS Participant race/ethnicity was not available. The sample did not include uninsured individuals. CONCLUSIONS This study provides important data about how care utilization differs for those who die by suicide compared to the general population and can inform decision makers on targeting of suicide prevention activities within health systems.
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Kasteridis P, Ride J, Gutacker N, Aylott L, Dare C, Doran T, Gilbody S, Goddard M, Gravelle H, Kendrick T, Mason A, Rice N, Siddiqi N, Williams R, Jacobs R. Association Between Antipsychotic Polypharmacy and Outcomes for People With Serious Mental Illness in England. Psychiatr Serv 2019; 70:650-656. [PMID: 31109263 PMCID: PMC6890489 DOI: 10.1176/appi.ps.201800504] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Although U.K. and international guidelines recommend monotherapy, antipsychotic polypharmacy among patients with serious mental illness is common in clinical practice. However, empirical evidence on its effectiveness is scarce. Therefore, the authors estimated the effectiveness of antipsychotic polypharmacy relative to monotherapy in terms of health care utilization and mortality. METHODS Primary care data from Clinical Practice Research Datalink, hospital data from Hospital Episode Statistics, and mortality data from the Office of National Statistics were linked to compile a cohort of patients with serious mental illness in England from 2000 to 2014. The antipsychotic prescribing profile of 17,255 adults who had at least one antipsychotic drug record during the period of observation was constructed from primary care medication records. Survival analysis models were estimated to identify the effect of antipsychotic polypharmacy on the time to first occurrence of each of three outcomes: unplanned hospital admissions (all cause), emergency department (ED) visits, and mortality. RESULTS Relative to monotherapy, antipsychotic polypharmacy was not associated with increased risk of unplanned hospital admission (hazard ratio [HR]=1.14; 95% confidence interval [CI]=0.98-1.32), ED visit (HR=0.95; 95% CI=0.80-1.14), or death (HR=1.02; 95% CI=0.76-1.37). Relative to not receiving antipsychotic medication, monotherapy was associated with a reduced hazard of unplanned admissions to the hospital and ED visits, but it had no effect on mortality. CONCLUSIONS The study results support current guidelines for antipsychotic monotherapy in routine clinical practice. However, they also suggest that when clinicians have deemed antipsychotic polypharmacy necessary, health care utilization and mortality are not affected.
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Affiliation(s)
- Panagiotis Kasteridis
- Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare)
| | - Jemimah Ride
- Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare)
| | - Nils Gutacker
- Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare)
| | - Lauren Aylott
- Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare)
| | - Ceri Dare
- Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare)
| | - Tim Doran
- Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare)
| | - Simon Gilbody
- Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare)
| | - Maria Goddard
- Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare)
| | - Hugh Gravelle
- Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare)
| | - Tony Kendrick
- Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare)
| | - Anne Mason
- Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare)
| | - Nigel Rice
- Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare)
| | - Najma Siddiqi
- Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare)
| | - Rachael Williams
- Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare)
| | - Rowena Jacobs
- Centre for Health Economics (Kasteridis, Ride, Gutacker, Goddard, Gravelle, Mason, Rice, Jacobs) and Department of Health Sciences (Doran, Gilbody, Siddiqi), University of York, York, England; Hull York Medical School, York, England (Aylott, Gilbody, Siddiqi); Primary Care and Population Sciences, University of Southampton, Southampton, England (Kendrick); Clinical Practice Research Datalink-Medicines and Healthcare Products Regulatory Agency, London (Williams). Mental health services consultant, York, United Kingdom (Dare)
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Reneflot A, Kaspersen SL, Hauge LJ, Kalseth J. Use of prescription medication prior to suicide in Norway. BMC Health Serv Res 2019; 19:215. [PMID: 30947722 PMCID: PMC6449972 DOI: 10.1186/s12913-019-4009-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 03/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of psychotropic medications in relation to mental disorders is considered central to preventing suicide. However, few studies have addressed prescription patterns at different time points within the last year prior to suicide and compared these with those of the general population. METHODS We use data covering the period from 2010 to 2011 from the Norwegian Cause of Death Registry and the Norwegian Prescription Database to examine dispensing patterns of prescription medication within 12 months and within 30 days of suicide. Our data includes all registered suicides in Norway among individuals aged 15 years and older in 2011 (n = 594), 434 men and 160 women. Dispensing of prescription medication in the general population (n ≈ 4 million) are used for comparison. RESULTS Dispensing of any prescription medication were high and varied from 95.6% for females and 83.2% for males within 12 months of suicide, to 64.4% for females and 47.2% for males within 30 days of suicide, respectively. The percentages with dispensed prescription medication increased with age. A similar sex and age pattern was observed for the dispensing of psychotropic medications. Within the last 30 days, close to one in two were dispensed psychotropic medications. The dispensing of antidepressants, hypnotics and sedatives was more common than the dispensing of other categories of psychotropics. The percentages with dispensed prescription medication among the population controls were considerably lower, in particular the dispensing of psychotropics. CONCLUSION Dispensing of prescription medications, including psychotropic medications, is common prior to suicide. The percentage with dispensed prescription medication increases with age and are higher for females than for males.
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Affiliation(s)
- Anne Reneflot
- Mental and Physical Health, Norwegian Institute of Public Health, PO Box 222, 0213 Skøyen, Oslo Norway
| | - Silje L. Kaspersen
- SINTEF Digital, Department of Health, The Norwegian University of Science and Technology, Trondheim, Norway
- Department of Public Health and Nursing, The Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Johan Hauge
- Mental and Physical Health, Norwegian Institute of Public Health, PO Box 222, 0213 Skøyen, Oslo Norway
| | - Jorid Kalseth
- SINTEF Digital, Department of Health, The Norwegian University of Science and Technology, Trondheim, Norway
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Chang OD, Batra MM, Premkumar V, Chang EC, Hirsch JK. Future orientation, depression, suicidality, and interpersonal needs in primary care outpatients. DEATH STUDIES 2018; 44:98-104. [PMID: 30541418 DOI: 10.1080/07481187.2018.1522389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Based on past research findings with college students, we tested whether perceived burdensomeness and thwarted belongingness represent important mediators of the association between future orientation and suicide risk (namely, depression and suicidality) in primary care patients. We conducted a multiple mediator test in a sample of 97 primary care patients. Our results indicated that perceived burdensomeness and thwarted belongingness accounted for the negative associations present between future orientation and measures of suicide risk. These findings provide evidence for perceived burdensomeness and thwarted belongingness as mechanisms accounting for the association between future orientation and suicide risk in primary care patients.
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Affiliation(s)
- Olivia D Chang
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Madeleine M Batra
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Vidhya Premkumar
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Edward C Chang
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jameson K Hirsch
- Department of Psychology, East Tennessee State University, Johnson City, Tennessee, USA
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21
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Risk factors for self-harm in people with epilepsy. J Neurol 2018; 265:3009-3016. [PMID: 30357466 PMCID: PMC6244650 DOI: 10.1007/s00415-018-9094-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To estimate the risk of self-harm in people with epilepsy and identify factors which influence this risk. METHODS We identified people with incident epilepsy in the Clinical Practice Research Datalink, linked to hospitalization and mortality data, in England (01/01/1998-03/31/2014). In Phase 1, we estimated risk of self-harm among people with epilepsy, versus those without, in a matched cohort study using a stratified Cox proportional hazards model. In Phase 2, we delineated a nested case-control study from the incident epilepsy cohort. People who had self-harmed (cases) were matched with up to 20 controls. From conditional logistic regression models, we estimated relative risk of self-harm associated with mental and physical illness comorbidity, contact with healthcare services and antiepileptic drug (AED) use. RESULTS Phase 1 included 11,690 people with epilepsy and 215,569 individuals without. We observed an adjusted hazard ratio of 5.31 (95% CI 4.08-6.89) for self-harm in the first year following epilepsy diagnosis and 3.31 (95% CI 2.85-3.84) in subsequent years. In Phase 2, there were 273 cases and 3790 controls. Elevated self-harm risk was associated with mental illness (OR 4.08, 95% CI 3.06-5.42), multiple general practitioner consultations, treatment with two AEDs versus monotherapy (OR 1.84, 95% CI 1.33-2.55) and AED treatment augmentation (OR 2.12, 95% CI 1.38-3.26). CONCLUSION People with epilepsy have elevated self-harm risk, especially in the first year following diagnosis. Clinicians should adequately monitor these individuals and be especially vigilant to self-harm risk in people with epilepsy and comorbid mental illness, frequent healthcare service contact, those taking multiple AEDs and during treatment augmentation.
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22
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Treatment seeking by employment characteristics among Australian males: a longitudinal study from the Ten to Men study. Public Health 2018; 165:34-41. [PMID: 30359784 DOI: 10.1016/j.puhe.2018.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/06/2018] [Accepted: 09/05/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Men are less likely to seek treatment for mental health problems than women; however, the structural employment-related factors influencing this relationship are unknown. STUDY DESIGN This is a prospective cohort study. METHODS Using the Australian Ten to Men cohort (N = 6447), we examined the relationship between being in a male-dominated occupation and treatment seeking from a mental health professional compared to being in a gender-equal occupation. Models were fit using logistic regression. RESULTS There was some evidence of a stepwise gradient between male-dominated occupations and treatment seeking for mental health problems. However, results were only significant for the most male-dominated occupations after adjustment (odds ratio [OR] 0.70, 95% confidence interval [CI] 0.52 to 0.94, P = 0.017). We also found evidence that individuals who more strongly adhered to masculine norms had a lower likelihood of treatment seeking (OR = 0.97, 95% CI 0.95 to 0.99, P = 0.004). CONCLUSIONS This supports the idea that occupational-related factors influence male treatment seeking for mental health problems.
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Grigoroglou C, Munford L, Webb RT, Kapur N, Doran T, Ashcroft DM, Kontopantelis E. Association between a national primary care pay-for-performance scheme and suicide rates in England: spatial cohort study. Br J Psychiatry 2018; 213:600-608. [PMID: 30058517 DOI: 10.1192/bjp.2018.143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pay-for-performance policies aim to improve population health by incentivising improvements in quality of care.AimsTo assess the relationship between general practice performance on severe mental illness (SMI) and depression indicators under a national incentivisation scheme and suicide risk in England for the period 2006-2014. METHOD Longitudinal spatial analysis for 32 844 small-area geographical units (lower super output areas, LSOAs), using population-structure adjusted numbers of suicide as the outcome variable. Negative binomial models were fitted to investigate the relationship between spatially estimated recorded quality of care and suicide risk at the LSOA level. Incidence rate ratios (IRRs) were adjusted for deprivation, social fragmentation, prevalence of depression and SMI as well as other 2011 Census variables. RESULTS No association was found between practice performance on the mental health indicators and suicide incidence in practice localities (IRR=1.000, 95% CI 0.998-1.002). IRRs indicated elevated suicide risks linked with area-level social fragmentation (1.030; 95% CI 1.027-1.034), deprivation (1.013, 95% CI 1.012-1.014) and rurality (1.059, 95% CI 1.027-1.092). CONCLUSIONS Primary care has an important role to play in suicide prevention, but we did not observe a link between practices' higher reported quality of care on incentivised mental health activities and lower suicide rates in the local population. It is likely that effective suicide prevention needs a more concerted, multiagency approach. Better training in suicide prevention for general practitioners is also essential. These findings pertain to the UK but have relevance to other countries considering similar programmes.Declaration of interestNone.
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Affiliation(s)
- Christos Grigoroglou
- NIHR School for Primary Care Research,Centre for Primary Care,Division of Population Health, Health Services Research and Primary Care,University of Manchester, Manchester Academic Health Sciences Centre (MAHSC),UK
| | - Luke Munford
- Research Fellow in Health Economics,Centre for Health Economics,Division of Population Health, Health Services Research and Primary Care,University of Manchester, Manchester Academic Health Sciences Centre (MAHSC),UK
| | - Roger T Webb
- Professor in Mental Health Epidemiology,Centre for Mental Health and Safety,University of Manchester, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC),UK
| | - Nav Kapur
- Professor of Psychiatry and Population Health,Centre for Suicide Prevention,University of Manchester, Greater Manchester Mental Health Trust and NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC),UK
| | - Tim Doran
- Professor of Health Policy,Department of Health Sciences,University of York,UK
| | - Darren M Ashcroft
- Professor of Pharmacoepidemiology,Centre for Pharmacoepidemiology and Drug Safety,School of Health Sciences,Faculty of Biology, Medicine and Health,University of Manchester, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC),UK
| | - Evangelos Kontopantelis
- Professor of Data Science and Health Services Research,Faculty of Biology, Medicine and Health,University of Manchester, Manchester Academic Health Sciences Centre (MAHSC),UK
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Positive Expectancies for the Future as Potential Protective Factors of Suicide Risk in Adults: Does Optimism and Hope Predict Suicidal Behaviors in Primary Care Patients? Int J Ment Health Addict 2018. [DOI: 10.1007/s11469-018-9922-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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