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Arnone D, Karmegam SR, Östlundh L, Alkhyeli F, Alhammadi L, Alhammadi S, Alkhoori A, Selvaraj S. Risk of suicidal behavior in patients with major depression and bipolar disorder - A systematic review and meta-analysis of registry-based studies. Neurosci Biobehav Rev 2024; 159:105594. [PMID: 38368970 DOI: 10.1016/j.neubiorev.2024.105594] [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: 11/17/2023] [Revised: 01/29/2024] [Accepted: 02/14/2024] [Indexed: 02/20/2024]
Abstract
Suicide is a health priority and one of the most common causes of death in mood disorders. One of the limitations of this type of research is that studies often establish rates of suicide behaviors in mood disorders by using diverse comparison groups or simply monitoring cohort of patients over a time period. In this registry-based systematic review, national registers were identified through searches in six academic databases, and information about the occurrence of suicide behaviors in mood disorders was systematically extracted. Odds ratios were subsequently calculated comparing rates of death by suicide in mood disorders in comparison with age and period matched rates of death by suicide in the general population obtained from country-wide national registers. The aim was to provide the most recent summary of epidemiological and clinical factors associated to suicide in mood disorders whilst calculating the likelihood of death by suicide in mood disorders in comparison with non-affected individuals according to national databases. The study follows the Preferred Reporting Guidelines for Systematic Reviews and Meta-analyses and was prespecify registered on Prospero (CRD42020186857). Results suggest that patients with mood disorders are at substantially increased risk of attempting and dying by suicide. Several epidemiological, clinical and social factors are reported to be associated with clinical populations at risk of suicide. Meta-analyses of completed deaths by suicide suggest that the likelihood for dying by suicide in mood disorders is 8.62 times higher in major depression and 8.66 times higher in bipolar disorder with higher number of untoward events in women compared to men in both conditions. The likelihood of dying by suicide in major depressive disorders is higher in the first year following discharge. Clinical guidelines might consider longer periods of monitoring following discharge from hospital. Overall, due to the higher risk of suicide in mood disorders, efforts should be made to increase detection and prevention whilst focusing on reducing risk in the most severe forms of illness with appropriate treatment to promote response and remission at the earliest convenience.
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Affiliation(s)
- Danilo Arnone
- Centre for Affective Disorders, Psychological Medicine, King's College London, London, United Kingdom; Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada.
| | - Sendhil Raj Karmegam
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
| | | | - Fatima Alkhyeli
- United Arab Emirates University, Al Ain, United Arab Emirates
| | - Lamia Alhammadi
- United Arab Emirates University, Al Ain, United Arab Emirates
| | - Shama Alhammadi
- United Arab Emirates University, Al Ain, United Arab Emirates
| | - Amal Alkhoori
- United Arab Emirates University, Al Ain, United Arab Emirates
| | - Sudhakar Selvaraj
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA; Intra-Cellular Therapies, Inc, USA
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Alberdi-Páramo Í, Díaz-Marsá M, Saiz González MD, Carrasco Perera JL. Antisocial traits and neuroticism as predictors of suicidal behaviour in borderline personality disorder: A retrospective study. REVISTA COLOMBIANA DE PSIQUIATRÍA (ENGLISH ED.) 2023; 52:11-19. [PMID: 36997367 DOI: 10.1016/j.rcpeng.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/02/2021] [Indexed: 03/30/2023]
Abstract
INTRODUCTION The spectrum of suicidal behaviour (SB) is nuclear in the clinic and management of borderline personality disorder (BPD). The pathological personality traits of BPD intervene as risk factors for SB in confluence with other clinical and sociodemographic variables associated with BPD. The objective of this work is to evaluate the specific personality traits of BPD that are related to SB. METHODS A cross-sectional, observational and retrospective study was carried out on a sample of 134 patients diagnosed with BPD according to DSM-5 criteria. The Millon-II, Zuckerman-Kuhlman and Barrat questionnaires were used to assess different personality parameters. Variable comparisons were made using the χ2 test and the Student's t-test. The association between variables was analysed using multivariate logistic regression. RESULTS Statistically significant differences were observed between SB and related factors and the neuroticism-anxiety dimension in the Zuckerman-Kuhlman test. It is also significantly related to the phobic and antisocial subscale of the Millon-II. Impulsivity measured with the Zuckerman-Kuhlman and Barrat tests does not appear to be related to SB. CONCLUSIONS The results presented raise the role of phobic, antisocial and neuroticism traits as possible personality traits of BPD related to SB, suggesting an even greater importance within the relationship between BPD and SB than that of impulsivity. Looking to the future, longitudinal studies would increase the scientific evidence for the specified findings.
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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.
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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
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Caine ED. Premature deaths have many names. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1145-1146. [PMID: 35244740 DOI: 10.1007/s00127-022-02260-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/18/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Eric D Caine
- University of Rochester Medical Center, 300 Crittenden Blvd., Rochester, NY, 14642, USA.
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Esmaeili ED, Farahbakhsh M, Sarbazi E, Khodamoradi F, Gaffari Fam S, Azizi H. Predictors and incidence rate of suicide re-attempt among suicide attempters: A prospective study. Asian J Psychiatr 2022; 69:102999. [PMID: 34979473 DOI: 10.1016/j.ajp.2021.102999] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/26/2021] [Accepted: 12/28/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Recent investigations and advances include improved understanding of trends, epidemiology, risk and protective factors on suicide. However, predictors of suicide re-attempt are poorly understood in a prospective design, at least in Iran. This prospective study was performed to investigate predictors and epidemiological aspects of suicide re-attempt during a 5-years of follow-up among Suicide Attempters (SAs). METHODS All the 1034 SAs of Malekan County were followed up and interviewed from 2014 to 2018. Cox regression analysis was used to estimate crude and adjusted hazard ratios and 95% confidence intervals for suicide re-attempt risk. RESULTS The overall prevalence of re-attempt was 117 (11.7%) over 5 years period. The overall incidence and person-time incidence rates of re-attempt were 113.15 per 1000 attempters and 7.1 per 100 person-year, respectively. The majority of re-attempts 161 (81.3%) took place within the first-18 months of follow-up while the peak of re-attempt was 6 months after attempts. In the final analysis, age ≤ 25, family income (≥ 10 million Rials), having any psychiatric disorder, poor education, stressful life events, alcohol abuse, and smoking were the most reliable predictors of suicide re-attempt. CONCLUSION Health systems should be informed about the predictors for subsequent SA after any attempt. Appropriate suicide prevention strategies should be tailored to the specific profile of each group for moderating predictors of suicide re-attempt.
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Affiliation(s)
| | - Mostafa Farahbakhsh
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Ehsan Sarbazi
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Farzad Khodamoradi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Saber Gaffari Fam
- School of Nursing of Miyandoab, Urmia University of Medical Sciences, Urmia, Iran.
| | - Hosein Azizi
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Azizi H, Fakhari A, Farahbakhsh M, Esmaeili E. Effective programs on suicide prevention: Combination of review of systematic reviews with expert opinions. Int J Prev Med 2022; 13:39. [PMID: 35529514 PMCID: PMC9069150 DOI: 10.4103/ijpvm.ijpvm_454_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/21/2021] [Indexed: 11/04/2022] Open
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Alberdi-Páramo Í, Díaz-Marsá M, Saiz González MD, Carrasco Perera JL. Antisocial Traits and Neuroticism as Predictors of Suicidal Behaviour in Borderline Personality Disorder: a Retrospective Study. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 52:S0034-7450(21)00045-7. [PMID: 33840500 DOI: 10.1016/j.rcp.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/12/2021] [Accepted: 02/02/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The spectrum of suicidal behaviour (SB) is nuclear in the clinic and management of borderline personality disorder (BPD). The pathological personality traits of BPD intervene as risk factors for SB in confluence with other clinical and sociodemographic variables associated with BPD. The objective of this work is to evaluate the specific personality traits of BPD that are related to SB. METHODS A cross-sectional, observational and retrospective study was carried out on a sample of 134 patients diagnosed with BPD according to DSM-5 criteria. The Millon-II, Zuckerman-Kuhlman and Barrat questionnaires were used to assess different personality parameters. Variable comparisons were made using the χ2 test and the Student's t-test. The association between variables was analysed using multivariate logistic regression. RESULTS Statistically significant differences were observed between SB and related factors and the neuroticism-anxiety dimension in the Zuckerman-Kuhlman test. It is also significantly related to the phobic and antisocial subscale of the Millon-II. Impulsivity measured with the Zuckerman-Kuhlman and Barrat tests does not appear to be related to SB. CONCLUSIONS The results presented raise the role of phobic, antisocial and neuroticism traits as possible personality traits of BPD related to SB, suggesting an even greater importance within the relationship between BPD and SB than that of impulsivity. Looking to the future, longitudinal studies would increase the scientific evidence for the specified findings.
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Affiliation(s)
- Íñigo Alberdi-Páramo
- Instituto de Psiquiatría y Salud Mental, Hospital Clínico San Carlos, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España.
| | - Marina Díaz-Marsá
- Instituto de Psiquiatría y Salud Mental, Hospital Clínico San Carlos, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España; CIBERSAM, Departamento de Psiquiatría, Universidad Complutense de Madrid, Madrid, España
| | - María Dolores Saiz González
- Instituto de Psiquiatría y Salud Mental, Hospital Clínico San Carlos, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - José Luis Carrasco Perera
- Instituto de Psiquiatría y Salud Mental, Hospital Clínico San Carlos, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España; CIBERSAM, Departamento de Psiquiatría, Universidad Complutense de Madrid, Madrid, España
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Girardi P, Schievano E, Fedeli U, Braggion M, Nuti M, Amaddeo F. Causes of mortality in a large population-based cohort of psychiatric patients in Southern Europe. J Psychiatr Res 2021; 136:167-172. [PMID: 33601168 DOI: 10.1016/j.jpsychires.2021.01.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 12/25/2022]
Abstract
The World Health Organization considers excess morbidity and mortality among people with mental disorders as a high public health priority. This study aims to estimate the mortality risk and causes of death among a large population-based cohort of psychiatric patients. All residents in Veneto (Northeastern Italy) aged between 18 and 84 years with a contact with Community Mental Health Centers in 2008 and a psychiatric diagnosis (n = 54,350) were followed-up for 10 years. Standardized Mortality Ratios (SMR) and excess mortality were computed, with the general regional population as a reference. Mortality was more than doubled (males SMR = 2.4; females SMR = 2.2) and the relative increase in mortality was much larger in young and middle-aged adults (18-44 and 45-64 years) across all diagnostic groups. The most frequent causes were circulatory diseases (27%) and neoplasms (26%). Although the risk was increased by about tenfold, deaths from suicide were limited to 6% and 4% of all decedents in males and females, respectively. Patients with schizophrenia showed a very high risk for mortality for diabetes and cardiovascular disorders. A large excess was found also for respiratory diseases and a two-fold increase for lung cancer in males and breast cancer in females. Although chronic physical disorders are known to be the main causes of mortality in such patients, they receive far less attention than suicide or accidents. Our results suggest that there is still a need to plan actions to prevent excess mortality and to improve the quality of life of patients with mental disorders.
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Affiliation(s)
- Paolo Girardi
- Department of Developmental Psychology and Socialization, University of Padua, Via Venezia 8, 35131, Padua, Italy.
| | - Elena Schievano
- Epidemiological Department, Azienda Zero, Veneto Region, Via Jacopo d'Avanzo 35, 35132, Padua, Italy.
| | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Via Jacopo d'Avanzo 35, 35132, Padua, Italy.
| | - Marco Braggion
- Epidemiological Department, Azienda Zero, Veneto Region, Via Jacopo d'Avanzo 35, 35132, Padua, Italy.
| | - Marco Nuti
- Mental Health and Penitentiary Health Care Unit, Veneto Region, Rio Novo, Dorsoduro 3493, 30123, Venice, Italy.
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.
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Armstrong G, Haregu T, Caine ED, Young JT, Spittal MJ, Jorm AF. High prevalence of health and social risk behaviours among men experiencing suicidal thoughts and behaviour: The imperative to undertake holistic assessments. Aust N Z J Psychiatry 2020; 54:797-807. [PMID: 32447979 DOI: 10.1177/0004867420924098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE We aimed to examine whether suicidal thoughts and behaviour were independently associated with a wide range of health and social risk behaviours. METHODS We conducted cross-sectional analyses of data collected from 13,763 adult males who participated in The Australian Longitudinal Study on Male Health. We fit generalised linear models to estimate the relative risk of engaging in a range of health and social risk behaviours across several domains by suicidal thoughts and behaviour status. RESULTS Men with recent suicidal ideation (relative risk range, 1.10-5.25) and lifetime suicide attempts (relative risk range, 1.10-7.65) had a higher risk of engaging in a broad range of health and social risk behaviours. The associations between suicidal thoughts and behaviour and health and social risk behaviours were typically independent of socio-demographics and in many cases were also independent of depressive symptoms. CONCLUSION Suicidal thoughts and behaviour overlaps with increased risk of engagement in a wide range of health and social risk behaviours, indicating the need for an alignment of broader public health interventions within clinical and community-based suicide prevention activities. The experience of suicidality may be an important catalyst for a broader psychosocial conversation and assessment of health and social risk behaviours, some of which may be modifiable. These behaviours may not carry an imminent risk of premature death, such as from suicide, but they carry profound health and social consequences if left unaddressed.
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Affiliation(s)
- Gregory Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Tilahun Haregu
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Eric D Caine
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Jesse T Young
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, VIC, Australia.,School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.,National Drug Research Institute, Curtin University, Perth, WA, Australia
| | - Matthew J Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Anthony F Jorm
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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Suárez-Pinilla P, Pérez-Herrera M, Suárez-Pinilla M, Medina-Blanco R, López-García E, Artal-Simón JÁ, de Santiago-Díaz AI. Recurrence of suicidal thoughts and behaviors during one year of follow-up: An exploratory study. Psychiatry Res 2020; 288:112988. [PMID: 32387919 DOI: 10.1016/j.psychres.2020.112988] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 04/02/2020] [Accepted: 04/04/2020] [Indexed: 11/28/2022]
Abstract
Suicidal thoughts and behaviors (STB) include suicidal ideation (SI), suicide attempt (SA) and completed suicide. We aimed to identify recurrence predictors of any type of STB, and separately for SA and SI, and to analyze the time until event. A 108-subject cohort presenting at Emergencies with STB was followed during one year. Recurrence risk factors were investigated by multiple Cox survival regressions. Within one year, 31.5%, 23.1% and 9.3% patients recurred with any STB, SA, and SI respectively. Most recurrences (~70%) occurred within the first 6 months. Seeking emergency psychiatric assistance for problems other than STB during follow-up was a common predictor for recurrence of any STB, and SA and SI specifically. Previous SA history and contact with psychiatry outpatient units during follow-up predicted both STB in general and SA in particular. A specific predictor for SA was hospitalization at index, while SI recurrence was associated to SI at index. These results highlight the importance of early intervention and multidisciplinary follow-up considering concurrent psychosocial or adaptive problems. A careful exploration at Emergencies is needed to target potential predictors.
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Affiliation(s)
- Paula Suárez-Pinilla
- Department of Psychiatry, University Hospital Marqués de Valdecilla IDIVAL, Santander, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Santander, Spain.
| | - Marina Pérez-Herrera
- Department of Psychiatry, University Hospital Marqués de Valdecilla IDIVAL, Santander, Spain
| | - Marta Suárez-Pinilla
- Department of Neurodegenertive Diseases UCL Queen Square, Institute of Neurology, London, UK
| | - Raquel Medina-Blanco
- Department of Psychiatry, University Hospital Marqués de Valdecilla IDIVAL, Santander, Spain
| | - Enrique López-García
- Department of Psychiatry, University Hospital Marqués de Valdecilla IDIVAL, Santander, Spain
| | - Jesús Ángel Artal-Simón
- Department of Psychiatry, University Hospital Marqués de Valdecilla IDIVAL, Santander, Spain
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Khan A, Fahl Mar K, Gokul S, Brown WA. Mortality during US FDA clinical trials in patients with diabetes, hypertension, depression and schizophrenia. World J Biol Psychiatry 2020; 21:64-71. [PMID: 30246595 DOI: 10.1080/15622975.2018.1514465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objectives: To evaluate the relationship between the mortality rates associated with psychiatric conditions like depression and schizophrenia compared with chronic medical conditions like hypertension and diabetes.Methods: Examined clinical trial safety data from New Drug Approval programmes reviewed by the US Food and Drug Administration and calculated all-cause and suicide/non-suicide mortality rates per 100,000 patient-exposure-years (PEY) for seven diabetes, 12 hypertension, 11 depression, and nine schizophrenia programmes (126,151 patients, 63,106.3 PEY).Results: Depression (894.8 ± 201.2) and schizophrenia (935.3 ± 214.6) had significantly higher all-cause mortality rates than diabetes (462.8 ± 70.8) and hypertension (448.4 ± 123.1). Psychiatric conditions had 1.9-2.1× the medical conditions' mortality (p < 0.001). Non-suicide mortality rates for depression (506.2 ± 151.3), schizophrenia (550.9 ± 164.7), diabetes (457.2 ± 70.4) and hypertension (430.8 ± 120.6) were comparable. Only antidiabetics showed a signal for all-cause mortality (reduction of 37%, p = 0.008).Conclusions: Depression and schizophrenia trial patients had comparable (if not higher) all-cause mortality rates as older populations in diabetes and hypertension trials, even when excluding suicides. While generalizability of the rates themselves is limited, this study can adequately estimate the relational mortality among these conditions because of the high internal consistency of clinical trials. Potential signals for mortality reduction with active treatment should be considered for all investigational medications for chronic conditions with increased mortality, including psychotropics.
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Affiliation(s)
- Arif Khan
- Northwest Clinical Research Center, Bellevue, WA, USA.,Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
| | | | | | - Walter A Brown
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
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Drug-related mortality after discharge from treatment: A record-linkage study of substance abuse clients in Texas, 2006-2012. Drug Alcohol Depend 2019; 204:107473. [PMID: 31520924 DOI: 10.1016/j.drugalcdep.2019.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/23/2019] [Accepted: 05/06/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patients have higher mortality immediately after substance abuse treatment discharge, but there are few data on post-discharge mortality differences across treatment modalities. METHODS A retrospective cohort study examined individuals discharged from substance abuse treatment during 2006-2012 and probabilistically matched treatment records to death records. Logistic regression examined associations between drug-related death (DRD) and demographics; route, frequency, and classes of drugs abused; and treatment. Primary outcome was DRD during post-discharge days 0-28; secondary outcomes examined DRD during days 29-90 and 91-365. RESULTS We examined 178,749 patients discharged from 254,814 treatment episodes. There were 97 DRD during days 0-28 (4.1/1000 person-years), 115 DRD during days 29-90 (2.6/1000 person-years; IRR 0.6 [95% CI 0.5-0.8]), and 293 DRD during days 91-365 (1.9/1000 person-years; IRR 0.5 [0.4-0.6]). Higher 28-day DRD was associated with abuse of opioids (aOR 2.5 [1.4-4.4]), depressants (aOR 2.0 [1.2-3.4]), or alcohol (aOR 1.7 [1.1-2.6]); and opioid injection (aOR 2.2 [1.3-3.7]). Lower DRD was associated with treatment completion (aOR 0.6 [0.4-0.9]), female sex (aOR 0.6 [0.4-0.8]), and employment (aOR 0.5 [0.3-0.9]). Among all patients, DRD rates were higher following residential (IRR 2.6, [1.6-4.2]) and detoxification (IRR 2.9, [1.7-4.9]) treatment compared to outpatient. Patients with prior opioid abuse had higher 28-day DRD after outpatient (6.7/1000 person-years; IRR 4.1 [1.8-9.1]), residential (13.6/1000 person-years; IRR 4.2 [2.2-8.2]), and detoxification (8.8/1000 person-years; IRR 3.2 [1.2, 8.5]) compared to those without. CONCLUSIONS Drug-related mortality is highest during days 0-28 after discharge, especially following residential and detoxification treatment. Opioid abuse is strongly associated with early post-discharge mortality.
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Park S, Rim SJ, Jo M, Lee MG, Kim CE. Comorbidity of Alcohol Use and Other Psychiatric Disorders and Suicide Mortality: Data from the South Korean National Health Insurance Cohort, 2002 to 2013. Alcohol Clin Exp Res 2019; 43:842-849. [PMID: 30779437 DOI: 10.1111/acer.13989] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 02/12/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previous studies have indicated that alcohol use disorder (AUD) and other psychiatric disorders increase the risk of suicide mortality. However, little research has investigated the concomitant effect of comorbid psychiatric disorders on suicide mortality. This study aimed to investigate the effect of comorbid AUD on suicide mortality of individuals with another psychiatric disorder using a national data sample. METHODS We used the National Health Insurance Service-National Sample Cohort data from 2002 to 2013. We selected individuals with specific psychiatric disorders based on the International Classification of Diseases, 10th revision (F10-F48). Overall, the study included 741,601 participants. We utilized a prioritization process to identify the primary diagnosis for those with multiple diagnoses. All-cause mortality rates and suicide rates per 100,000 person-year (days) and the standardized mortality ratio (SMR) were calculated. Then, we compared the suicide-specific SMR of 3 different groups: (i) specific psychiatric disorder versus general public; (ii) specific psychiatric disorder comorbid with AUD versus general public; and (iii) specific psychiatric disorder comorbid with AUD versus specific psychiatric disorder without comorbid AUD. RESULTS Patients with any specific psychiatric disorder showed higher suicide-specific SMR compared to the general population. Being comorbid with AUD further increased the risk of suicide among psychiatric patients. In particular, patients with bipolar affective disorders, organic mental disorders, or depressive disorders comorbid with AUD had about 2 to 4 times higher suicide-specific SMR compared to those without AUD (bipolar affective disorder: SMR = 3.01, 95% confidence interval (CI) [1.49, 4.54]; organic mental disorder: SMR = 3.43, 95% CI [1.05, 5.81]; depressive disorder: SMR = 2.06, 95% CI [1.52, 2.61]). CONCLUSIONS Our data indicate that having a psychiatric disorder increases the risk of committing suicide. More importantly, comorbid AUD further increases this risk of suicidal death for certain psychiatric disorders. This shows the importance of determining whether patients with psychiatric disorders have comorbid AUD to prevent suicide.
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Affiliation(s)
- Subin Park
- Clinical Research Center (SP, SJR, MJ, MGL, CEK), Mental Health Research Institute, National Center for Mental Health, Seoul, Korea
| | - Soo Jung Rim
- Clinical Research Center (SP, SJR, MJ, MGL, CEK), Mental Health Research Institute, National Center for Mental Health, Seoul, Korea.,Department of Psychology (SJR), Seoul National University, Seoul, Korea
| | - MinKyung Jo
- Clinical Research Center (SP, SJR, MJ, MGL, CEK), Mental Health Research Institute, National Center for Mental Health, Seoul, Korea
| | - Min Geu Lee
- Clinical Research Center (SP, SJR, MJ, MGL, CEK), Mental Health Research Institute, National Center for Mental Health, Seoul, Korea
| | - Chul Eung Kim
- Clinical Research Center (SP, SJR, MJ, MGL, CEK), Mental Health Research Institute, National Center for Mental Health, Seoul, Korea
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14
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Irigoyen M, Porras-Segovia A, Galván L, Puigdevall M, Giner L, De Leon S, Baca-García E. Predictors of re-attempt in a cohort of suicide attempters: A survival analysis. J Affect Disord 2019; 247:20-28. [PMID: 30640026 DOI: 10.1016/j.jad.2018.12.050] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/07/2018] [Accepted: 12/16/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Suicide prevention is one of the greatest challenges in mental health policies. Since a previous suicide attempt is the main predictor of future suicidal behaviour, clinical management of suicide attempters is vital for lowering mortality. Psychopharmacological interventions are still nonspecific, and their effectiveness have often been questioned. In this study, we aim to identify predictors of suicide re-attempt in a cohort of suicide attempters, with particular focus on different aspects of psychopharmacological treatment. METHODS This is a prospective study. Adults presenting with a suicide attempt were approached to take part in our study, resulting in a final sample of 371 participants. Participants were followed from inclusion to next suicide attempt, death by other causes, loss of the patient, or after a maximum of two years. We conducted Kaplan-Meier survival analyses and a multivariate Cox regression model for several exposure variables. RESULTS During the study period, 70 participants (18,9%) re-attempted. 60% of re-attempts occurred within the first 6 months. Three factors were independently associated with risk of re-attempt in the Multivariate Cox regression model: diagnosis of a Cluster B personality disorder, good treatment compliance, and at least one previous suicide attempt prior to the index event. LIMITATIONS Indication bias precludes a clear interpretation of our results regarding psychopharmacological treatment. Poor adherence may also be a consequence of relapse rather than just one of its causes. CONCLUSIONS A correct psychopharmacological treatment is insufficient to prevent re-attempts in populations at risk. Strategies to increase compliance should be taken into account as part of prevention programs.
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Affiliation(s)
- María Irigoyen
- Hospital Universitario Santa María de Lleida, Lérida, Spain; Institut de Recerca Biomèdica de Lleida, Lérida, Spain
| | | | - Leonardo Galván
- Hospital Universitario Santa María de Lleida, Lérida, Spain; Psychiatry Department, Universidad de Lleida, Lérida, Spain
| | | | - Lucas Giner
- Psychiatry Department, Universidad de Sevilla, Sevilla, Spain
| | | | - Enrique Baca-García
- Hospital Universitario Fundación Jiménez-Díaz, Madrid, Spain; Psychiatry Department, Autonoma University of Madrid, Madrid, Spain; Department of Psychiatry, University Hospital Rey Juan Carlos, Madrid, Spain; Department of Psychiatry, General Hospital of Villalba, Madrid, Spain; Department of Psychiatry, University Hospital Infanta Elena, Madrid, Spain; CIBERSAM (Centro de Investigación en Salud Mental), Carlos III Institute of Health, Madrid, Spain; Universidad Católica del Maule, Talca, Chile.
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15
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Knorr AC, Ammerman BA, Hamilton AJ, McCloskey MS. Predicting status along the continuum of suicidal thoughts and behavior among those with a history of nonsuicidal self-injury. Psychiatry Res 2019; 273:514-522. [PMID: 30708203 DOI: 10.1016/j.psychres.2019.01.067] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 01/23/2019] [Accepted: 01/23/2019] [Indexed: 12/01/2022]
Abstract
Nonsuicidal self-injury (NSSI) and suicidal thoughts and behavior often co-occur, representing a growing public health concern. Despite extensive research examining suicidal thoughts and behavior among those who engage in NSSI, there is a lack of research investigating factors that, when considered together, can differentiate individuals along the continuum of suicidal thoughts and behavior (no history, suicidal ideation, suicide plan, suicide attempt). This study sought to address this question using a sample of 1178 college students with NSSI history (68.70% female). Discriminant function analysis was conducted including the following predictors: NSSI characteristics, negative affect difficulties, and behavioral and demographic risk factors for suicidal thoughts and behavior. Results suggest that self-disclosure of suicidal ideation, number of lifetime NSSI methods, NSSI frequency, depressive symptoms, and age most parsimoniously differentiate study groups. Those who use a greater number of NSSI methods and acts, paired with higher depressive symptoms and repeated self-disclosure of suicidal ideation are most likely to have a suicide attempt history; decreases in these variables suggest membership within less severe groups. Furthermore, older age may be related to greater suicidality. Findings suggest that the evaluation and co-occurrence of these variables may contribute to a more accurate suicide risk assessment.
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Affiliation(s)
- Anne C Knorr
- Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA 19122, USA.
| | - Brooke A Ammerman
- Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA 19122, USA
| | - Alexander J Hamilton
- Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA 19122, USA
| | - Michael S McCloskey
- Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA 19122, USA
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16
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Levey DF, Polimanti R, Cheng Z, Zhou H, Nuñez YZ, Jain S, He F, Sun X, Ursano RJ, Kessler RC, Smoller JW, Stein MB, Kranzler HR, Gelernter J. Genetic associations with suicide attempt severity and genetic overlap with major depression. Transl Psychiatry 2019; 9:22. [PMID: 30655502 PMCID: PMC6336846 DOI: 10.1038/s41398-018-0340-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 11/13/2018] [Indexed: 11/09/2022] Open
Abstract
In 2015, ~800,000 people died by suicide worldwide. For every death by suicide there are as many as 25 suicide attempts, which can result in serious injury even when not fatal. Despite this large impact on morbidity and mortality, the genetic influences on suicide attempt are poorly understood. We performed a genome-wide association study (GWAS) of severity of suicide attempts to investigate genetic influences. A discovery GWAS was performed in Yale-Penn sample cohorts of European Americans (EAs, n = 2,439) and African Americans (AAs, n = 3,881). We found one genome-wide significant (GWS) signal in EAs near the gene LDHB (rs1677091, p = 1.07 × 10-8) and three GWS associations in AAs: ARNTL2 on chromosome 12 (rs683813, p = 2.07 × 10-8), FAH on chromosome 15 (rs72740082, p = 2.36 × 10-8), and on chromosome 18 (rs11876255, p = 4.61 × 10-8) in the Yale-Penn discovery sample. We conducted a limited replication analysis in the completely independent Army-STARRS cohorts. rs1677091 replicated in Latinos (LAT, p = 6.52 × 10-3). A variant in LD with FAH rs72740082 (rs72740088; r2 = 0.68) was replicated in AAs (STARRS AA p = 5.23 × 10-3; AA meta, 1.51 × 10-9). When combined for a trans-population meta-analysis, the final sample size included n = 20,153 individuals. Finally, we found significant genetic overlap with major depressive disorder (MDD) using polygenic risk scores from a large GWAS (r2 = 0.007, p = 6.42 × 10-5). To our knowledge, this is the first GWAS of suicide attempt severity. We identified GWS associations near genes involved in anaerobic energy production (LDHB), circadian clock regulation (ARNTL2), and catabolism of tyrosine (FAH). These findings provide evidence of genetic risk factors for suicide attempt severity, providing new information regarding the molecular mechanisms involved.
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Affiliation(s)
- Daniel F. Levey
- 0000000419368710grid.47100.32Division of Human Genetics, Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA ,Department of Psychiatry, Veterans Affairs Connecticut Healthcare Center, West Haven, CT USA
| | - Renato Polimanti
- 0000000419368710grid.47100.32Division of Human Genetics, Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA ,Department of Psychiatry, Veterans Affairs Connecticut Healthcare Center, West Haven, CT USA
| | - Zhongshan Cheng
- 0000000419368710grid.47100.32Division of Human Genetics, Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA ,Department of Psychiatry, Veterans Affairs Connecticut Healthcare Center, West Haven, CT USA
| | - Hang Zhou
- 0000000419368710grid.47100.32Division of Human Genetics, Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA ,Department of Psychiatry, Veterans Affairs Connecticut Healthcare Center, West Haven, CT USA
| | - Yaira Z. Nuñez
- 0000000419368710grid.47100.32Division of Human Genetics, Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA ,Department of Psychiatry, Veterans Affairs Connecticut Healthcare Center, West Haven, CT USA
| | - Sonia Jain
- 0000 0001 2107 4242grid.266100.3Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA USA
| | - Feng He
- 0000 0001 2107 4242grid.266100.3Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA USA
| | - Xiaoying Sun
- 0000 0001 2107 4242grid.266100.3Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA USA
| | - Robert J. Ursano
- 0000 0001 0421 5525grid.265436.0Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - Ronald C. Kessler
- 000000041936754Xgrid.38142.3cDepartment of Health Care Policy, Harvard Medical School, Boston, MA USA
| | - Jordan W. Smoller
- 000000041936754Xgrid.38142.3cDepartment of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA ,0000 0004 0386 9924grid.32224.35Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA USA ,grid.66859.34Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA USA
| | - Murray B. Stein
- 0000 0001 2107 4242grid.266100.3Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA USA ,0000 0001 2107 4242grid.266100.3Department of Psychiatry, University of California San Diego, La Jolla, CA USA ,0000 0004 0419 2708grid.410371.0VA San Diego Healthcare System, San Diego, CA USA
| | - Henry R. Kranzler
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA ,0000 0004 0420 350Xgrid.410355.6Veterans Integrated Service Network 4 Mental Illness Research, Education and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, PA USA
| | - Joel Gelernter
- Division of Human Genetics, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. .,Department of Psychiatry, Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA. .,Department of Genetics, Yale University School of Medicine, New Haven, CT, USA. .,Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA.
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17
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Mitchell AJ, Delaffon V, Lord O. Let's get physical: improving the medical care of people with severe mental illness. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.111.009068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryThere is clear evidence of increased medical comorbidity and related mortality in people with severe mental illness, despite numerous guidelines for managing medical conditions in this population. This article assesses inequalities in medical treatment and preventive healthcare received by psychiatric patients compared with the general population. It considers whether the medical care provided is adequate and whether published guidelines improve it. Mental health specialists, general practitioners and hospital specialists appear to deliver poorer than average medical care for this vulnerable population. Implementation of physical healthcare guidelines is incomplete and the guidelines must be matched with resources to address this deficit.
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18
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Parra-Uribe I, Blasco-Fontecilla H, Garcia-Parés G, Martínez-Naval L, Valero-Coppin O, Cebrià-Meca A, Oquendo MA, Palao-Vidal D. Risk of re-attempts and suicide death after a suicide attempt: A survival analysis. BMC Psychiatry 2017; 17:163. [PMID: 28472923 PMCID: PMC5415954 DOI: 10.1186/s12888-017-1317-z] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 04/20/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Suicide is the primary cause of unnatural death in Spain, and suicide re-attempts a major economic burden worldwide. The risk factors for re-attempt and suicide after an index suicide attempt are different. This study aims to investigate risk factors for re-attempt and suicide after an index suicide attempt. METHODS This observational study is part of a one-year telephone management program. We included all first-time suicide attempters evaluated in the emergency department at Parc Taulí-University Hospital (n = 1241) recruited over a five-year period (January 2008 to December 2012). Suicide attempters were evaluated at baseline using standardized instruments. Bivariate logistic regression models were used to identify risk factors. Kaplan-Meier curves were used to compare the time to re-attempt between categorical variables. Comparisons were performed using Log-Rank and Wilcoxon tests. Variables with a p-value lower than 0.2 were included in a multivariate Cox regression model. Bivariate logistic regression models were considered to identify risk factors for suicide. The significance level was set to 0.05. RESULTS Suicide re-attempters were more likely diagnosed with cluster B personality disorders (36.8% vs. 16.6%; p < 0.001), and alcohol use disorders (19.8 vs. 13.9; p = 0.02). Several [1.2% (15/1241)] of them died by suicide. Attempters who suicide were more likely alcohol users (33.3% vs. 17.2%; p = 0.047), and older (50.9 ± 11.9 vs. 40.7 ± 16.0; p = 0.004). CONCLUSIONS Alcohol use, personality disorders and younger age are risk factors for re-attempting. Older age is a risk factor for suicide among suicide attempters. Current prevention programs of suicidal behaviour should be tailored to the specific profile of each group.
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Affiliation(s)
- Isabel Parra-Uribe
- Department of Mental Health, Parc Tauli-University Hospital, Parc Taulí 1, 08208 Sabadell, Barcelone Spain ,grid.7080.fDepartment of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelone, Spain ,0000 0004 1762 4012grid.418264.dCIBERSAM, Madrid, Spain
| | - Hilario Blasco-Fontecilla
- Department of Psychiatry, IDIPHIM-Puerta de Hierro University Hospital, Autonoma University of Madrid, Avenida Manuel de Falla s/n, Madrid, Spain. .,CIBERSAM, Madrid, Spain.
| | - Gemma Garcia-Parés
- Department of Mental Health, Meritxell Hospital, Andorra la Vella, Andorra
| | | | - Oliver Valero-Coppin
- grid.7080.fStatistical Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Annabel Cebrià-Meca
- Department of Mental Health, Parc Tauli-University Hospital, Parc Taulí 1, 08208 Sabadell, Barcelone Spain ,0000 0004 1762 4012grid.418264.dCIBERSAM, Madrid, Spain
| | - Maria A. Oquendo
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, USA
| | - Diego Palao-Vidal
- Department of Mental Health, Parc Tauli-University Hospital, Parc Taulí 1, 08208, Sabadell, Barcelone, Spain. .,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelone, Spain. .,CIBERSAM, Madrid, Spain.
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19
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Knorr AC, Tull MT, Anestis MD, Dixon-Gordon KL, Bennett MF, Gratz KL. The Interactive Effect of Major Depression and Nonsuicidal Self-Injury on Current Suicide Risk and Lifetime Suicide Attempts. Arch Suicide Res 2016; 20:539-52. [PMID: 26953789 PMCID: PMC5072359 DOI: 10.1080/13811118.2016.1158679] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
UNLABELLED This study examined the main and interactive effects of MDD and lifetime nonsuicidal self-injury (NSSI) on current suicide risk and past suicide attempts. We predicted that individuals with a history of NSSI and current MDD would be at greater suicide risk than those with either risk factor alone. An interaction between lifetime MDD and NSSI was hypothesized for past suicide attempts. 204 substance dependent inpatients completed self-report measures and a diagnostic interview. Patients with both a history of NSSI and current MDD, relative to all other groups, had the greatest suicide risk. No support was found for the lifetime MDD by NSSI interaction. CONCLUSION Findings suggest the relevance of both NSSI and MDD in suicide risk.
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Affiliation(s)
- Anne C. Knorr
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Matthew T. Tull
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Michael D. Anestis
- Department of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | | | - Mary F. Bennett
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Kim L. Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA
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20
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Reydel T, Callahan JC, Verley L, Teiten C, Andreotti C, Claessens YE, Missud D, L'Her E, Le Roux G, Lerolle N. Routine biological tests in self-poisoning patients: results from an observational prospective multicenter study. Am J Emerg Med 2016; 34:1383-8. [PMID: 27117657 DOI: 10.1016/j.ajem.2016.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 03/21/2016] [Accepted: 04/01/2016] [Indexed: 12/23/2022] Open
Abstract
CONTEXT Routine biological tests are frequently ordered in self-poisoning patients, but their clinical relevance is poorly studied. MATERIALS AND METHODS This is a prospective multicentric observational study conducted in the emergency departments and intensive care units of 5 university and nonuniversity French hospitals. Adult self-poisoning patients without severely altered vital status on admission were prospectively included. RESULTS Routine biological test (serum electrolytes and creatinine, liver enzymes, bilirubin, blood cell count, prothrombin time) ordering and results were analyzed. A total of 1027 patients were enrolled (age, 40.2 ± 14 years; women, 61.5%); no patient died during the hospital stay. Benzodiazepine was suspected in more than 70% of cases; 65% (range, 48%-80%) of patients had at least 1 routine biological test performed. At least 1 abnormal test was registered in 23% of these patients. Three factors were associated with abnormal test results: age older than 40 years, male sex, and poisoning with a drug known to alter routine tests (ie, acetaminophen, NSAIDs, metformine, lithium). Depending on these factors, abnormal results ranged from 14% to 48%. Unexpected severe life-threatening conditions were recorded in 6 patients. Only 3 patients were referred to the intensive care unit solely because of abnormal test results. CONCLUSION Routine biological tests are commonly prescribed in nonsevere self-poisoning patients. Abnormal results are frequent but their relevance at bedside remains limited.
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Affiliation(s)
- Thomas Reydel
- Angers University, Angers, France; Department of Medical Intensive Care and Hyperbaric Medicine, Angers University Hospital, Angers, France
| | | | - Laurent Verley
- Department of Emergency Medicine, Saint Malo Hospital, Saint Malo, France
| | - Christelle Teiten
- Department of Emergency Medicine, Brest University Hospital, Brest, France
| | - Christophe Andreotti
- Department of Emergency Medicine, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yann Erick Claessens
- Department of Emergency Medicine, Centre Hospitalier Princesse Grace, Principauté de, Monaco
| | - David Missud
- Clinical Research Center, Angers University Hospital, Angers, France
| | - Erwan L'Her
- Department of Emergency Medicine, Brest University Hospital, Brest, France
| | - Gael Le Roux
- Poison Center, Angers University Hospital, Angers, France
| | - Nicolas Lerolle
- Angers University, Angers, France; Department of Medical Intensive Care and Hyperbaric Medicine, Angers University Hospital, Angers, France.
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21
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Burón P, Jimenez-Trevino L, Saiz PA, García-Portilla MP, Corcoran P, Carli V, Fekete S, Hadlaczky G, Hegerl U, Michel K, Sarchiapone M, Temnik S, Värnick A, Verbanck P, Wasserman D, Schmidtke A, Bobes J. Reasons for Attempted Suicide in Europe: Prevalence, Associated Factors, and Risk of Repetition. Arch Suicide Res 2016; 20:45-58. [PMID: 26726966 DOI: 10.1080/13811118.2015.1004481] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
To examine the prevalence of specific reasons for attempted suicide, factors associated with them, and whether reasons for attempted suicide influence risk of repetition. As part of the Monitoring Suicide in Europe (MONSUE) project, data on 4,683 suicide attempters from nine European countries were collected. Independence tests were used to study the influence of age, gender, and other factors on reported reasons. We examined risk of repetition using logistic regression analysis. Interpersonal conflict was common for all patients except those widowed, living alone, or retired. Mental health problems were prevalent among over 45 year-olds, patients unable to work, and patients with a history of at least three suicide attempts. Financial difficulties were cited more often by patients who were 45-64 years old, divorced or separated, living with children only, and unemployed. Close bereavement/serious illness and own physical illness were associated with those over 65 years of age. Two reasons for suicide attempt, interpersonal conflict and mental health problems, were associated with increased risk of repetition independent of other factors. Suicide attempters have a multitude of problems of varying prevalence depending on age, gender, and other factors. They present a range of clinical profiles that require a multidisciplinary response.
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22
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Reininghaus U, Dutta R, Dazzan P, Doody GA, Fearon P, Lappin J, Heslin M, Onyejiaka A, Donoghue K, Lomas B, Kirkbride JB, Murray RM, Croudace T, Morgan C, Jones PB. Mortality in schizophrenia and other psychoses: a 10-year follow-up of the ӔSOP first-episode cohort. Schizophr Bull 2015; 41:664-73. [PMID: 25262443 PMCID: PMC4393685 DOI: 10.1093/schbul/sbu138] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The excess mortality in people with psychotic disorders is a major public health concern, but little is known about the clinical and social risk factors which may predict this health inequality and help inform preventative strategies. We aimed to investigate mortality in a large epidemiologically characterized cohort of individuals with first-episode psychosis compared with the general population and to determine clinical and social risk factors for premature death. All 557 individuals with first-episode psychosis initially identified in 2 areas (Southeast London and Nottinghamshire, United Kingdom) were traced over a 10-year period in the ӔSOP-10 study. Compared with the general population, all-cause (standardized mortality ratio [SMR] 3.6, 95% confidence interval [CI] 2.6-4.9), natural-cause (SMR 1.7, 95% CI 1.0-2.7) and unnatural-cause (SMR 13.3, 95% CI 8.7-20.4) mortality was very high. Illicit drug use was associated with an increased risk of all-cause mortality (adj. rate ratio [RR] 2.31, 95% CI 1.06-5.03). Risk of natural-cause mortality increased with a longer time to first remission (adj. RR 6.61, 95% CI 1.33-32.77). Family involvement at first contact strongly reduced risk of unnatural-cause mortality (adj. RR 0.09, 95% CI 0.01-0.69). Our findings suggest that the mortality gap in people with psychotic disorders remains huge and may be wider for unnatural-cause mortality than previously reported. Efforts should now focus on further understanding and targeting these tractable clinical and social risk factors of excess mortality. Early intervention and dual diagnosis services may play a key role in achieving more rapid remission and carer involvement and addressing substance use problems to reduce excess mortality in psychosis.
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Affiliation(s)
| | - Rina Dutta
- Department of Psychological Medicine, Institute of Psychiatry, King’s College, London, UK
| | - Paola Dazzan
- NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College, London, UK;,Psychosis Studies Department, Institute of Psychiatry, King’s College, London, UK
| | - Gillian A. Doody
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Paul Fearon
- Department of Psychiatry, Trinity College, Dublin, Ireland
| | - Julia Lappin
- NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College, London, UK;,Psychosis Studies Department, Institute of Psychiatry, King’s College, London, UK;,Department of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Margaret Heslin
- Centre for Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK
| | - Adanna Onyejiaka
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK
| | - Kim Donoghue
- Addictions Department, Institute of Psychiatry, King’s College, London, UK
| | - Ben Lomas
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | | | - Robin M. Murray
- NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College, London, UK;,Psychosis Studies Department, Institute of Psychiatry, King’s College, London, UK
| | - Tim Croudace
- Department of Health Sciences, University of York, York, UK
| | - Craig Morgan
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK;,NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College, London, UK
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre and NIHR Collaboration for Leadership in Applied Health Research & Care, Cambridge, UK
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Lewandowski-Romps L, Peterson C, Berglund PA, Collins S, Cox K, Hauret K, Jones B, Kessler RC, Mitchell C, Park N, Schoenbaum M, Stein MB, Ursano RJ, Heeringa SG. Risk factors for accident death in the U.S. Army, 2004-2009. Am J Prev Med 2014; 47:745-53. [PMID: 25441238 PMCID: PMC4254526 DOI: 10.1016/j.amepre.2014.07.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 06/20/2014] [Accepted: 07/29/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Accidents are one of the leading causes of death among U.S. active-duty Army soldiers. Evidence-based approaches to injury prevention could be strengthened by adding person-level characteristics (e.g., demographics) to risk models tested on diverse soldier samples studied over time. PURPOSE To identify person-level risk indicators of accident deaths in Regular Army soldiers during a time frame of intense military operations, and to discriminate risk of not-line-of-duty from line-of-duty accident deaths. METHODS Administrative data acquired from multiple Army/Department of Defense sources for active duty Army soldiers during 2004-2009 were analyzed in 2013. Logistic regression modeling was used to identify person-level sociodemographic, service-related, occupational, and mental health predictors of accident deaths. RESULTS Delayed rank progression or demotion and being male, unmarried, in a combat arms specialty, and of low rank/service length increased odds of accident death for enlisted soldiers. Unique to officers was high risk associated with aviation specialties. Accident death risk decreased over time for currently deployed, enlisted soldiers and increased for those never deployed. Mental health diagnosis was associated with risk only for previous and never-deployed, enlisted soldiers. Models did not discriminate not-line-of-duty from line-of-duty accident deaths. CONCLUSIONS Adding more refined person-level and situational risk indicators to current models could enhance understanding of accident death risk specific to soldier rank and deployment status. Stable predictors could help identify high risk of accident deaths in future cohorts of Regular Army soldiers.
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Affiliation(s)
| | | | | | - Stacey Collins
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Kenneth Cox
- U.S. Army Institute of Public Health, Aberdeen Proving Ground
| | - Keith Hauret
- U.S. Army Institute of Public Health, Aberdeen Proving Ground
| | - Bruce Jones
- U.S. Army Institute of Public Health, Aberdeen Proving Ground
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Colter Mitchell
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Nansook Park
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | - Michael Schoenbaum
- National Institute of Mental Health, Uniformed Services University School of Medicine, Bethesda, Maryland
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Robert J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, Maryland
| | - Steven G Heeringa
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan.
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Psychiatric and psycho-social characteristics of suicide completers: a comprehensive evaluation of psychiatric case records and postmortem findings. Ir J Psychol Med 2014; 32:167-176. [DOI: 10.1017/ipm.2014.47] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
ObjectivesTo explore the demographic, psychosocial and clinical characteristics of individuals known to the mental health services, who died by probable suicide in the West of Ireland.MethodsPostmortem reports between January 2006 and May 2012 detailed 153 individuals who died by probable suicide, 58 of whom attended the mental health services. Relevant socio-demographic and clinical data was extracted from individuals’ lifetime case notes.ResultsRecurrent depressive disorder (44%) was the most common diagnosis and hanging the most common method of death (58%). Of individuals who died by hanging, 79% previously attempted suicide by the same method. For individuals with a documented history of depression, only 32% had antidepressants detected in their toxicology reports. Similarly, only one individual (20%) with schizophrenia had antipsychotics detected in their toxicology report.ConclusionsIndividuals who died by probable suicide, most commonly died by hanging and drowning; with previous attempts of hanging particularly prevalent in the group who subsequently died by hanging. At the time of death, less than one-third of individuals according to toxicology reports were taking the medication that was last prescribed to them by the mental health services suggesting a high rate of treatment non-concordance in individuals who died by probable suicide.
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Chesney E, Goodwin GM, Fazel S. Risks of all-cause and suicide mortality in mental disorders: a meta-review. WORLD PSYCHIATRY : OFFICIAL JOURNAL OF THE WORLD PSYCHIATRIC ASSOCIATION (WPA) 2014. [PMID: 24890068 DOI: 10.1002/wps.20128.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A meta-review, or review of systematic reviews, was conducted to explore the risks of all-cause and suicide mortality in major mental disorders. A systematic search generated 407 relevant reviews, of which 20 reported mortality risks in 20 different mental disorders and included over 1.7 million patients and over a quarter of a million deaths. All disorders had an increased risk of all-cause mortality compared with the general population, and many had mortality risks larger than or comparable to heavy smoking. Those with the highest all-cause mortality ratios were substance use disorders and anorexia nervosa. These higher mortality risks translate into substantial (10-20 years) reductions in life expectancy. Borderline personality disorder, anorexia nervosa, depression and bipolar disorder had the highest suicide risks. Notable gaps were identified in the review literature, and the quality of the included reviews was typically low. The excess risks of mortality and suicide in all mental disorders justify a higher priority for the research, prevention, and treatment of the determinants of premature death in psychiatric patients.
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Affiliation(s)
- Edward Chesney
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
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Chesney E, Goodwin GM, Fazel S. Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry 2014; 13:153-60. [PMID: 24890068 PMCID: PMC4102288 DOI: 10.1002/wps.20128] [Citation(s) in RCA: 1136] [Impact Index Per Article: 113.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
A meta-review, or review of systematic reviews, was conducted to explore the risks of all-cause and suicide mortality in major mental disorders. A systematic search generated 407 relevant reviews, of which 20 reported mortality risks in 20 different mental disorders and included over 1.7 million patients and over a quarter of a million deaths. All disorders had an increased risk of all-cause mortality compared with the general population, and many had mortality risks larger than or comparable to heavy smoking. Those with the highest all-cause mortality ratios were substance use disorders and anorexia nervosa. These higher mortality risks translate into substantial (10-20 years) reductions in life expectancy. Borderline personality disorder, anorexia nervosa, depression and bipolar disorder had the highest suicide risks. Notable gaps were identified in the review literature, and the quality of the included reviews was typically low. The excess risks of mortality and suicide in all mental disorders justify a higher priority for the research, prevention, and treatment of the determinants of premature death in psychiatric patients.
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Affiliation(s)
- Edward Chesney
- Department of Psychiatry; University of Oxford, Warneford Hospital; Oxford OX3 7JX UK
| | - Guy M. Goodwin
- Department of Psychiatry; University of Oxford, Warneford Hospital; Oxford OX3 7JX UK
| | - Seena Fazel
- Department of Psychiatry; University of Oxford, Warneford Hospital; Oxford OX3 7JX UK
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Tin Tin S, Woodward A, Ameratunga S. What influences the association between previous and future crashes among cyclists? A propensity score analysis. PLoS One 2014; 9:e87633. [PMID: 24489945 PMCID: PMC3906177 DOI: 10.1371/journal.pone.0087633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 12/27/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is known that experience of a previous crash is related to incidence of future crashes in a cohort of New Zealand cyclists. This paper investigated if the strength of such association differed by crash involvement propensity and by the need for medical care in the previous crash. METHODS The Taupo Bicycle Study involved 2590 adult cyclists recruited in 2006 and followed over a median period of 4.6 years through linkage to four national databases. The crash involvement propensity was estimated using propensity scores based on the participants' demographic, cycling and residential characteristics. Cox regression modelling for repeated events was performed with multivariate and propensity score adjustments. Analyses were then stratified by quintiles of the propensity score. RESULTS A total of 801 (31.0%) participants reported having experienced at least one bicycle crash in the twelve months prior to the baseline survey. They had a higher risk of experiencing crash events during follow-up (hazard ratio (HR): 1.43; 95% CI: 1.28, 1.60) but in the stratified analysis, this association was significant only in the highest two quintiles of the propensity score where the likelihood of having experienced a crash was more than 33%. The association was stronger for previous crashes that had received medical care (HR 1.63; 95% CI: 1.41, 1.88) compared to those that had not (HR 1.30; 95% CI: 1.14, 1.49). CONCLUSIONS Previous crash experience increased the risk of future crash involvement in high-risk cyclists and the association was stronger for previous crashes attended medically. What distinguishes the high risk group warrants closer investigation, and the findings indicate also that health service providers could play an important role in prevention of bicycle crash injuries.
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Affiliation(s)
- Sandar Tin Tin
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
- * E-mail:
| | - Alistair Woodward
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Shanthi Ameratunga
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
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Abstract
BACKGROUND Little is known about accidental death risks among psychiatric patients. AIMS To examine this issue in the most comprehensive study to date. METHOD National cohort study of all Swedish adults (n = 6 908 922) in 2001-2008. RESULTS There were 22 419 (0.3%) accidental deaths in the total population, including 5933 (0.9%) accidental deaths v. 3731 (0.6%) suicides among psychiatric patients (n = 649 051). Of persons who died from accidents, 26.0% had any psychiatric diagnosis v. 9.4% in the general population. Accidental death risk was four- to sevenfold among personality disorders, six- to sevenfold among dementia, and two- to fourfold among schizophrenia, bipolar disorder, depression or anxiety disorders, and was not fully explained by comorbid substance use. Strong associations were found irrespective of sociodemographic characteristics, and for different types of accidental death (especially poisoning or falls). CONCLUSIONS All mental disorders were strong independent risk factors for accidental death, which was substantially more common than suicide.
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Affiliation(s)
- Casey Crump
- Casey Crump, MD, PhD, Department of Medicine, Stanford University, Stanford, California, USA; Kristina Sundquist, MD, PhD, Center for Primary Health Care Research, Lund University, Malmö, Sweden, and Stanford Prevention Research Center, Stanford University, Stanford, California, USA; Marilyn A. Winkleby, PhD, Stanford Prevention Research Center, Stanford University, Stanford, California, USA; Jan Sundquist, MD, PhD, Center for Primary Health Care Research, Lund University, Malmö, Sweden, and Stanford Prevention Research Center, Stanford University, Stanford, California, USA
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Crump C, Sundquist K, Winkleby MA, Sundquist J. Mental disorders and vulnerability to homicidal death: Swedish nationwide cohort study. BMJ 2013; 346:f557. [PMID: 23462204 PMCID: PMC6364268 DOI: 10.1136/bmj.f557] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the risk of people with mental disorders being victims of homicide. DESIGN National cohort study. SETTING Sweden. PARTICIPANTS Entire adult population (n = 7,253,516). MAIN OUTCOME MEASURES Homicidal death during eight years of follow-up (2001-08); hazard ratios for the association between mental disorders and homicidal death, with adjustment for sociodemographic confounders; potential modifying effect of comorbid substance use. RESULTS 615 homicidal deaths occurred in 54.4 million person years of follow-up. Mortality rates due to homicide (per 100,000 person years) were 2.8 among people with mental disorders compared with 1.1 in the general population. After adjustment for sociodemographic confounders, any mental disorder was associated with a 4.9-fold (95% confidence interval 4.0 to 6.0) risk of homicidal death, relative to people without mental disorders. Strong associations were found irrespective of age, sex, or other sociodemographic characteristics. Although the risk of homicidal death was highest among people with substance use disorders (approximately ninefold), the risk was also increased among those with personality disorders (3.2-fold), depression (2.6-fold), anxiety disorders (2.2-fold), or schizophrenia (1.8-fold) and did not seem to be explained by comorbid substance use. Sociodemographic risk factors included male sex, being unmarried, and low socioeconomic status. CONCLUSIONS In this large cohort study, people with mental disorders, including those with substance use disorders, personality disorders, depression, anxiety disorders, or schizophrenia, had greatly increased risks of homicidal death. Interventions to reduce violent death among people with mental disorders should tackle victimisation and homicidal death in addition to suicide and accidents, which share common risk factors.
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Affiliation(s)
- Casey Crump
- Department of Medicine, Stanford University, 211 Quarry Road, Suite 405, MC 5985, Palo Alto, CA 94304-1426, USA
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Sheerin FK, Curtis E, de Vries J. Accident occurrence and functional health patterns: a pilot study of relationships in a graduate population. Int J Nurs Knowl 2013; 23:96-105. [PMID: 23281885 DOI: 10.1111/j.2047-3095.2012.01207.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE This pilot study sought to examine the relationship between functional health patterns and accident proneness. METHODS A quantitative-descriptive design was employed assessing accident proneness by collecting data on the occurrence of accidents among a sample of university graduates, and examining this in relation to biographical data and information collated using the Functional Health Pattern Assessment Screening Tool (FHPAST). Data were analyzed using descriptive and inferential statistics. FINDINGS One FHPAST factor predicted more frequent sports accidents. Age was also shown to be a significant predictor but in a counterintuitive way, with greater age predicting less accident proneness. CONCLUSION The FHPAST may have a role to play in accident prediction. IMPLICATIONS FOR NURSING PRACTICE Functional health pattern assessment may be useful for predicting accidents.
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Affiliation(s)
- Fintan K Sheerin
- School of Nursing and Midwifery, University of Dublin, Trinity College Dublin, Dublin, Ireland.
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Bergen H, Hawton K, Waters K, Ness J, Cooper J, Steeg S, Kapur N. Premature death after self-harm: a multicentre cohort study. Lancet 2012; 380:1568-74. [PMID: 22995670 DOI: 10.1016/s0140-6736(12)61141-6] [Citation(s) in RCA: 178] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND People who self-harm have an increased risk of premature death. The aim of this study was to investigate cause-specific premature death in individuals who self-harm, including associations with socioeconomic deprivation. METHODS We undertook a cohort study of patients of all ages presenting to emergency departments in Oxford, Manchester, and Derby, UK, after self-poisoning or self-injury between Jan 1, 2000, and Dec 31, 2007. Postcodes of individuals' place of residence were linked to the Index of Multiple Deprivation 2007 in England. Mortality information was supplied by the Medical Research Information Service of the National Health Service. Patients were followed up to the end of 2009. We calculated age-standardised mortality ratios (SMRs) and years of life lost (YLL), and we tested for associations with socioeconomic deprivation. FINDINGS 30 950 individuals presented with self-harm and were followed up for a median of 6·0 years (IQR 3·9-7·9). 1832 (6·1%) patients died before the end of follow-up. Death was more likely in patients than in the general population (SMR 3·6, 95% CI 3·5-3·8), and occurred more in males (4·1, 3·8-4·3) than females (3·2, 2·9-3·4). Deaths due to natural causes were 2-7·5 times more frequent than was expected. For individuals who died of any cause, mean YLL was 31·4 years (95% CI 30·5-32·2) for male patients and 30·7 years (29·5-31·9) for female patients. Mean YLL for natural-cause deaths was 25·9 years (25·7-26·0) for male patients and 25·5 years (25·2-25·8) for female patients, and for external-cause deaths was 40·2 years (40·0-40·3) and 40·0 years (39·7-40·5), respectively. Disease of the circulatory (13·1% in males; 13·0% in females) and digestive (11·7% in males; 17·8% in females) systems were major contributors to YLL from natural causes. All-cause mortality increased with each quartile of socioeconomic deprivation in male patients (χ(2) trend 39·6; p<0·0001), female patients (13·9; p=0·0002), and both sexes combined (55·4; p<0·0001). Socioeconomic deprivation was related to mortality in both sexes combined from natural causes (51·0; p<0·0001) but not from external causes (0·30; p=0·58). Alcohol problems were associated with death from digestive-system disease, drug misuse with mental and behavioural disorders, and physical health problems with circulatory-system disease. INTERPRETATION Physical health and life expectancy are severely compromised in individuals who self-harm compared with the general population. In the management of self-harm, clinicians assessing patients' psychosocial problems should also consider their physical needs. FUNDING Department of Health Policy Research Programme.
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Affiliation(s)
- Helen Bergen
- University of Oxford Centre for Suicide Research, Department of Psychiatry, Warneford Hospital, Headington, Oxford, UK
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Dutta R, Murray RM, Allardyce J, Jones PB, Boydell JE. Mortality in first-contact psychosis patients in the U.K.: a cohort study. Psychol Med 2012; 42:1649-1661. [PMID: 22153300 DOI: 10.1017/s0033291711002807] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The excess mortality following first-contact psychosis is well recognized. However, the causes of death in a complete incidence cohort and mortality patterns over time compared with the general population are unknown. METHOD All 2723 patients who presented for the first time with psychosis in three defined catchment areas of the U.K. in London (1965-2004, n=2056), Nottingham (1997-1999, n=203) and Dumfries and Galloway (1979-1998, n=464) were traced after a mean of 11.5 years follow-up and death certificates were obtained. Data analysis was by indirect standardization. RESULTS The overall standardized mortality ratio (SMR) for first-contact psychosis was 184 [95% confidence interval (CI) 167-202]. Most deaths (84.2%, 374/444) were from natural causes, although suicide had the highest SMR (1165, 95% CI 873-1524). Diseases of the respiratory system and infectious diseases had the highest SMR of the natural causes of death (232, 95% CI 183-291). The risk of death from diseases of the circulatory system was also elevated compared with the general population (SMR 139, 95% CI 117-164) whereas there was no such difference for neoplasms (SMR 111, 95% CI 86-141). There was strong evidence that the mortality gap compared with the general population for all causes of death (p<0.001) and all natural causes (p=0.01) increased over the four decades of the study. There was weak evidence that cardiovascular deaths may be increasing relative to the general population (p=0.07). CONCLUSIONS People with first-contact psychosis have an overall mortality risk that is nearly double that of the general population. Most excess deaths are from natural causes. The widening of the mortality gap over the last four decades should be of concern to all clinicians involved in delivering healthcare.
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Affiliation(s)
- R Dutta
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK.
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Thomson W. Long term follow up of suicide in a clinically depressed community sample. J Affect Disord 2012; 139:52-5. [PMID: 22425433 DOI: 10.1016/j.jad.2012.02.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 02/07/2012] [Accepted: 02/07/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this study was to examine how sex differences in suicide rates unfolded in a long-term follow up of patients who had been diagnosed with major depression. METHOD Patients who were diagnosed with major depression in the Chichester/Salisbury Catchment Area Study were followed for 49 years. Recorded deaths from suicide were compared with rates that were predicted from historical data on suicide mortality rates from 1960 onwards. FINDINGS An overall suicide rate of 3.4% was found in the present sample. Sixteen women and three men died from suicide. Women's suicide rates were significantly higher than the level predicted based on general population trends. Men showed a barely non-significant trend in the same direction. The diagnosis of clinical depression was associated more strongly with increased risk for suicide among women compared with men. Of the female suicides, 13 had been diagnosed with endogenous depression. CONCLUSIONS While suicide rates are significantly higher for men in the general population, and for depressed patients of both sexes, the depression may be a particularly strong predictor of suicide risk among women. LIMITATIONS The dataset does not provide information about processes that mediate the relationship between depression and suicide mortality.
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Affiliation(s)
- Wendy Thomson
- University of Bristol, School of Experimental Psychology, 12 a Priory Road, Bristol BS8 1TN, England.
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Bergen H, Hawton K, Kapur N, Cooper J, Steeg S, Ness J, Waters K. Shared characteristics of suicides and other unnatural deaths following non-fatal self-harm? A multicentre study of risk factors. Psychol Med 2012; 42:727-741. [PMID: 21910932 DOI: 10.1017/s0033291711001747] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Mortality, including suicide and accidents, is elevated in self-harm populations. Although risk factors for suicide following self-harm are often investigated, rarely have those for accidents been studied. Our aim was to compare risk factors for suicide and accidents. METHOD A prospective cohort (n=30 202) from the Multicentre Study of Self-harm in England, 2000-2007, was followed up to 2010 using national death registers. Risk factors for suicide (intentional self-harm and undetermined intent) and accidents (narcotic poisoning, non-narcotic poisoning, and non-poisoning) following the last hospital presentation for self-harm were estimated using Cox models. RESULTS During follow-up, 1833 individuals died, 378 (20.6%) by suicide and 242 (13.2%) by accidents. Independent predictors of both suicide and accidents were: male gender, age 35 years (except accidental narcotic poisoning) and psychiatric treatment (except accidental narcotic poisoning). Factors differentiating suicide from accident risk were previous self-harm, last method of self-harm (twofold increased risks for cutting and violent self-injury versus self-poisoning) and mental health problems. A risk factor specific to accidental narcotic poisoning was recreational/illicit drug problems, and a risk factor specific to accidental non-narcotic poisoning and non-poisoning accidents was alcohol involvement with self-harm. CONCLUSIONS The similarity of risk factors for suicide and accidents indicates common experiences of socio-economic disadvantage, life problems and psychopathology resulting in a variety of self-destructive behaviour. Of factors associated with the accidental death groups, those for non-narcotic poisoning and other accidents were most similar to suicide; differences seemed to be related to criteria coroners use in reaching verdicts. Our findings support the idea of a continuum of premature death.
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Affiliation(s)
- H Bergen
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, UK
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[Recommendations for the prevention and management of suicidal behaviour]. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2012; 5:8-23. [PMID: 22854500 DOI: 10.1016/j.rpsm.2012.01.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 01/05/2012] [Accepted: 01/16/2012] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Suicidal behaviour is a major public health issue. Suicidal behaviour is one of the main causes of years of life lost and it is the third leading cause of death among young adults. This project was initiated by the Spanish Society of Psychiatry and the Spanish Society of Biological Psychiatry with the aim of providing a document containing the main recommendations on the prevention and management of suicidal behaviour; these recommendations should be based on the best available evidence and the experts' opinion. MATERIAL AND METHODS In this article we summarize the review of the available evidence on the epidemiology and impact of suicidal behaviour, risk and protective factors, evaluation tools for the assessment of suicide risk, international and local preventive protocols, educational interventions for health professionals, and potential interventions for at risk populations. RESULTS Based on this review, a panel of psychiatrists summarized and agreed a set of recommendations about the impact, prevention and management of suicidal behaviour. CONCLUSION The recommendations on the prevention and management of suicidal behaviour were summarized in the ten conclusions reported in this article.
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Bennett S, Coggan C, Adams P. Young People's Pathways to Well-being Following a Suicide Attempt. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2012. [DOI: 10.1080/14623730.2002.9721877] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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All-cause mortality after non-fatal self-poisoning: a cohort study. Soc Psychiatry Psychiatr Epidemiol 2011; 46:455-62. [PMID: 20336278 DOI: 10.1007/s00127-010-0213-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Accepted: 03/10/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Suicide has been repeatedly shown to have greatly increased incidence after non-fatal self-harm but far less is known about early death from other causes. The present study's aim was to describe mortality and risk factors concerning all causes of death after non-fatal self-poisoning. METHODS A prospective cohort study of 976 patients who attended the Emergency Department in Nottingham, UK during a 9-month period in 1985-1986. Information on deaths was obtained for 16 years following an episode of self-poisoning, from the records of the Office for National Statistics. RESULTS The observed:expected ratio for all-cause mortality was 2.2. Deaths due to diseases of the digestive and respiratory systems were, respectively, 4.4 and 2.9 times more frequent than expected. The risk for accidents was sixfold and for probable suicides 17-fold when compared with the risk in the general population. The main risk factor for subsequent deaths from natural causes was increasing age. CONCLUSIONS The findings of this study suggest that patients who survive self-poisoning have an increased risk of death from natural and unnatural causes. The findings point towards the need for more effective clinical management and preventive initiatives.
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Norelli LJ, Coates AD, Kovasznay BM. Cancer risk from diagnostic radiology in a deliberate self-harm patient. Acta Psychiatr Scand 2010; 122:427-30. [PMID: 20136800 DOI: 10.1111/j.1600-0447.2010.01538.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Patients who engage in recurrent deliberate self-harm (DSH) behaviours have increased morbidity and mortality and use emergency services more than others. Unrecognized iatrogenic injury may play a role. Specifically, we call attention to the potential danger of cumulative radiation exposure. METHOD Case presentation and discussion. RESULTS A 29-year-old woman with multiple episodes of deliberate foreign body ingestion received over 400 diagnostic radiology examinations during a 12 year period. The patient's calculated total radiation dose reached an average of 20.5 mSv per year, a dose comparable to atomic bomb survivors and nuclear industry workers, populations in which there is a significant excess cancer risk. CONCLUSION Patients with recurrent self-injurious behaviours, frequent users of healthcare services who often undergo repeated medical assessment and treatment, are likely at higher risk for iatrogenic adverse events. Multiple diagnostic radiology examinations have recently come under scrutiny for causing increased lifetime risk of cancer. Healthcare providers, in particular psychiatrists and emergency department physicians, should consider the cumulative risks of radiological procedures when assessing and treating patients with DSH.
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Affiliation(s)
- Lisa J Norelli
- Capital District Psychiatric Center, Albany, NY, USA Albany Medical College, Department of Psychiatry, Albany, NY 12208, USA.
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Lahti M, Räikkönen K, Wahlbeck K, Heinonen K, Forsén T, Kajantie E, Pesonen AK, Osmond C, Barker DJP, Eriksson JG. Prenatal origins of hospitalization for personality disorders: the Helsinki birth cohort study. Psychiatry Res 2010; 179:226-30. [PMID: 20493545 DOI: 10.1016/j.psychres.2009.08.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Revised: 07/03/2009] [Accepted: 08/27/2009] [Indexed: 11/30/2022]
Abstract
Although a suboptimal prenatal environment has been linked with schizophrenia and depression, possible associations with personality disorders remain unclear. The aim of this study was to examine the associations of body size at birth and length of gestation with hospitalization for personality disorders in a cohort study of 6506 men and 5857 women born in Helsinki, Finland, between 1934 and 1944. International Classification of Diseases (-8, -9, -10) diagnoses of personality disorders were extracted from the national Finnish Hospital Discharge Register since 1969. 102 men and 80 women had been hospitalized due to any personality disorder. 41 men and 30 women had dramatic personality disorders. Among men, head circumference showed an inverse J-shaped, nonlinear association with hospitalization for personality disorders. Men with a small head circumference were at increased risk. Also in men, a smaller head-to-length ratio linearly predicted personality disorders. Among women, a smaller placental area predicted increased risk of hospitalization for dramatic personality disorders. Vulnerability to personality disorders may be programmed during fetal life.
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Affiliation(s)
- Marius Lahti
- Department of Psychology, University of Helsinki, Helsinki, Finland.
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Bramsen I, Deeg DJH, van der Ploeg E, Fransman S. Wartime stressors and mental health symptoms as predictors of late-life mortality in World War II survivors. J Affect Disord 2007; 103:121-9. [PMID: 17291593 DOI: 10.1016/j.jad.2007.01.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2006] [Revised: 01/09/2007] [Accepted: 01/09/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pathways through which wartime stress leads to excess mortality have not been examined so far. The current study examines wartime stress in relation to late-life mortality among 1448 World War II survivors, and potential mediating effects of mental health symptoms that were assessed in 1992. METHODS In 1992, a community survey was held. In 2002, vital status was checked. RESULTS The highest hazard rates of mortality were found among military veterans and war survivors who had been seriously wounded. Posttraumatic stress disorder, suicidal thoughts, and, particularly, depression were associated with a higher hazard rate. Depression, anxiety, and somatic complaints appeared to act as mediators between the wartime stressor 'permanent disability or illness' and survival time. LIMITATIONS The results may not be generalizable to all World War II survivors since the sample was restricted to those who survived until 1992. In addition, there was a considerable level of non-response, and the study used self-report data on wartime exposure and psychological symptoms. CONCLUSIONS Exposure to wartime stress as well as mental health symptoms in the long-term aftermath of war and violence are significant predictors of late-life mortality. Wounded survivors and those with a permanent disability or illness are particularly vulnerable.
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Affiliation(s)
- Inge Bramsen
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands.
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Ryb GE, Soderstrom CA, Kufera JA, Dischinger P. Longitudinal Study of Suicide After Traumatic Injury. ACTA ACUST UNITED AC 2006; 61:799-804. [PMID: 17033543 DOI: 10.1097/01.ta.0000196763.14289.4e] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Suicide risk after discharge among trauma patients could be influenced by multiple factors. The aim of this study is to establish whether patients discharged from a trauma center experience an increased suicide rate and whether this can be explained by defined demographic, injury, or alcohol abuse risk factors. METHODS Patients admitted between July 1, 1983, and June 30, 1995, and discharged alive from a Level I trauma center (n = 27,399) were followed for 1.5 to 14.5 years to determine whether they had died. Death determination was made by an epidemiologic support service, which had created a repository of death certificates. Variables used in the analyses included age, gender, race, Injury Severity Score, discharge disposition, mechanism of injury, and alcohol toxicology. General and trauma populations were compared using standard mortality rates. Risk factors for suicide within the trauma population were explored using Pearson's chi2, Mantel-Haenszel chi2, Cox proportional hazards, and Mantel-Cox log-rank methodology. RESULTS Suicide was more common in the trauma than in the general population (standard mortality rate = 1.71). This difference may be attributed primarily to alcohol use problems. Suicide risk in the trauma population increased with age from 25 to 44 years, male gender, Caucasian race, and positive alcohol toxicology. Disability (as measured by discharge disposition), but not injury severity, also seemed to have an influence on suicide rates. CONCLUSION Interventions that address modifiable risk factors for suicide (substance abuse, psychiatric disorders, hopelessness, and social isolation) could benefit trauma patients known to be at higher risk for suicide, particularly those abusing alcohol.
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Affiliation(s)
- Gabriel E Ryb
- National Study Center for Trauma and Emergency Medical Systems, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
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Maxwell JC, Pullum TW, Tannert K. Deaths of clients in methadone treatment in Texas: 1994-2002. Drug Alcohol Depend 2005; 78:73-81. [PMID: 15769560 DOI: 10.1016/j.drugalcdep.2004.09.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2004] [Revised: 09/27/2004] [Accepted: 10/04/2004] [Indexed: 11/19/2022]
Abstract
This study analyzes causes of deaths of 766 patients who died while in methadone treatment in Texas between 1994 and 2002. Compared with deaths in the general population of Texas, deaths of clients in methadone treatment were 4.6 times more likely to be from a drug overdose, 3.4 times more likely to be from liver disease, 1.7 times more likely to be from a respiratory disease, 1.5 times more likely to be from a homicide and 1.4 times more likely to be from AIDS, but less likely to be from suicide, motor vehicle accidents, cardiovascular diseases or cancer. Of the clients, 20% died of liver disease, 18% of cardiovascular disease and 14% of drug overdose. An older cohort had been in treatment longer, had more take-homes, were on higher doses and tended to die of chronic diseases. A younger cohort tended to die from traumas, including drug overdose. Time in treatment was 43.3 months; mean daily dose was 77.3mg; number of days/month dosed in the clinic was 13.9. Given these rates, the scope of services should include on-site treatment for other medical conditions and staff should be educated about and counsel about the risk of death for new patients.
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Affiliation(s)
- Jane Carlisle Maxwell
- School of Social Work, The University of Texas at Austin, 1717 West 6th Street, Suite 335, Austin, TX 78703, USA.
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Thompson AH, Borden K, Belton KL. Intentional and Unintentional Injuries Across Health Regions in Alberta, Canada. CRISIS 2004; 25:156-60. [PMID: 15580850 DOI: 10.1027/0227-5910.25.4.156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The growing practice of including intentional injuries (suicide and interpersonal violence) under the injury control umbrella has produced some controversy. The present study was designed to determine whether or not there might be an empirical basis for this initiative from an ecological point of view by examining the associations among unintentional and intentional injuries across 17 geographically defined health regions. The study was set in the Province of Alberta, Canada, where health services were delivered to a population of 2.96 million persons in 1999 through 17 regional health authorities. The results of a principal components analysis showed that nearly all causes of injury-hospitalization loaded on a single factor. It was not possible to produce separate factors for intentional and unintentional injuries. The strong intercorrelation among all measures suggests that there is an empirical basis for the view that intentional and unintentional injuries belong under the same conceptual umbrella, at least at the ecological level.
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Affiliation(s)
- Angus H Thompson
- Alberta Center for Injury Control and Research, University of Alberta, Edmonton, Canada.
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Abstract
Circumstances over the life-course may contribute to adult social class differences in mortality. However, it is only rarely that the life-course approach has been applied to mortality studies among young adults. The aim of this study is to determine to what extent social class differences in mortality among young Finnish men are explained by living conditions in the parental home and life paths related to transitions in youth. The data for males born in 1956-60 based on the 1990 census records are linked with death records (3184 deaths) by cause of death for 1991-98, and with information on life-course circumstances from the 1970, 1975, 1980, and 1985 censuses. Controlling for living conditions in the parental home-social class, family type, number of siblings, language and region of residence-reduced the high excess mortality of the lower non-manual (RR 1.51, 95% CI: 1.28-1.79), skilled manual (RR 2.94, 2.54-3.40), and unskilled manual class (RR 4.08, 3.51-4.73) by 10% in all-cause mortality. The equivalent reduction for cardiovascular disease was 28% and for alcohol-related causes 16%. The effect of parental home on mortality differences was mainly mediated through its effect on youth paths (pathway model). Educational, marital, and employment paths had a substantial effect-independent of parental home-on social class differences from various causes of death. When all these variables were controlled for adult social class differences in cause specific mortality were reduced by 75-86%. Most of this reduction in mortality differences can be attributed to educational path. However, marital and employment paths had their independent effects, particularly on the excess mortality of unskilled manual workers with disproportionately common exposure to long-term unemployment and living without a partner. In summary, social class differences in total mortality among men in their middle adulthood were only partly determined by parental home but they were mainly attributable to educational, marital, and employment paths in youth.
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Affiliation(s)
- Tiina Pensola
- Department of Sociology, Population Research Unit, University of Helsinki, P.O. Box 18, FIN-00014, Finland.
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Citrome LL, Jaffe AB. Relationship of Atypical Antipsychotics with Development of Diabetes Mellitus. Ann Pharmacother 2003; 37:1849-57. [PMID: 14632602 DOI: 10.1345/aph.1d142] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To review the pharmacoepidemiologic evidence for the link between exposure to atypical antipsychotics and the development of diabetes mellitus. DATA SOURCES A MEDLINE search (1990-March 2003) was conducted. STUDY SELECTION AND DATA EXTRACTION The search was limited to articles that described findings from analyses of large databases and used the words diabetes or hyperglycemia, and antipsychotic or clozapine or olanzapine or risperidone or quetiapine or ziprasidone or aripiprazole in the title or abstract. The odds ratio or relative risk, together with their corresponding confidence interval, was extracted. DATA SYNTHESIS Results are conflicting, and this variability may be due to the different populations studied, different study designs, and the possibility of publication bias related to funding by the pharmaceutical industry. Nevertheless, an increased risk for diabetes mellitus appears to be present for patients receiving atypical antipsychotics. However, differential risk among the atypical antipsychotics is difficult to ascertain. CONCLUSIONS Clinicians are urged to manage risk by regularly monitoring all patients receiving atypical antipsychotics for the emergence of diabetes mellitus. Future studies should carefully control for confounding variables such as age, diagnosis, change in weight, activity level, family history, and ethnicity.
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Affiliation(s)
- Leslie L Citrome
- New York University School of Medicine, New York, NY and Clinical Research and Evaluation Facility, Nathan S Kline Institute for Psychiatric Research, Orangeburg, NY, USA.
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Corcoran P, Keeley HS, O'Sullivan M, Perry IJ. Parasuicide and suicide in the south-west of Ireland. Ir J Med Sci 2003; 172:107-11; discussion 105-6. [PMID: 14700110 DOI: 10.1007/bf02914492] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Suicidal behaviour has become recognised as a major public health problem. AIM To examine hospital-treated parasuicide and suicide in the Southern and Mid-Western Health Boards. METHODS Parasuicide data were derived from independent data collection in general and psychiatric hospitals and prisons between 1995 and 1997. The corresponding suicide data were obtained electronically from the Central Statistics Office. RESULTS Respectively, the annual person-based male, female and total European age-standardised rates were 128.9, 154.3 and 141.3 per 100,000 for parasuicide compared to 22.7, 5.5 and 14.1 per 100,000 for suicide. The parasuicide/suicide ratio varied markedly by age, gender, area and marital status. The majority of suicides were by hanging or drowning whereas drug overdose made up the vast majority of parasuicide acts. Parasuicide was largely a city phenomenon confined to the young of both genders whereas suicide was a significant problem for city and county men, especially young adult men. CONCLUSION There are striking differences between the patterns of fatal and non-fatal suicidal behaviour in Ireland, which should be considered in prevention initiatives.
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Affiliation(s)
- P Corcoran
- National Suicide Research Foundation, Cork, Ireland
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Neeleman J, Ormel J, Bijl RV. The distribution of psychiatric and somatic III health: associations with personality and socioeconomic status. Psychosom Med 2001; 63:239-47. [PMID: 11292271 DOI: 10.1097/00006842-200103000-00007] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Psychiatric and somatic disorders frequently co-occur in the same individuals. We examined whether this happens because these types of morbidity share risk factors or because they are risk factors for each other. METHODS Negative binomial regression was used to examine, in a random sample of Dutch adults (N = 7076), cross-sectional associations of sociodemographic and personality variables like income and neuroticism with the presence, over 1 year, of 30 somatic and 13 psychiatric disorders, with the latter diagnosed by structured interview. We examined to what extent the links of these variables with these two morbidity types were independent of each other. RESULTS This population experienced 5050 somatic and 2438 psychiatric disorders during the preceding year. Subjects reporting more somatic disorders had more psychiatric disorders. Neuroticism, followed closely by low educational attainment, was the strongest correlate of both morbidity types. After adjustment for all other covariates including somatic morbidity, the number of psychiatric diagnoses rose 1.84-fold (95% confidence interval = 1.74-1.94) per standard deviation increase in neuroticism. Likewise, adjusted for all other covariates including psychiatric diagnoses, 1.42 (95% confidence interval = 1.35-1.50) times more somatic disorders were reported per standard deviation increase in neuroticism. CONCLUSIONS Personal features like neuroticism and low educational attainment are linked with psychiatric and with somatic morbidity. These links are largely independent. Although this study was cross-sectional, the results suggest that these different types of morbidity may have overlapping etiologies. Key words: Comorbidity, multimorbidity coefficient, negative binomial regression, epidemiology, neuroticism, social class.
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Affiliation(s)
- J Neeleman
- Department of Social Psychiatry, University of Groningen, The Netherlands.
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