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Troya MI, Griffin E, Arensman E, Cassidy E, Mughal F, Lonergan CN, O'Mahony J, Lovejoy S, Ward M, Corcoran P. Hospital-presenting self-harm among older adults living in Ireland: a 13-year trend analysis from the National Self-Harm Registry Ireland. Int Psychogeriatr 2024; 36:396-404. [PMID: 37842766 DOI: 10.1017/s1041610223000856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
OBJECTIVES To examine trends in rates of self-harm among emergency department (ED) presenting older adults in Ireland over a 13-year period. DESIGN Population-based study using data from the National Self-Harm Registry Ireland. SETTING National hospital EDs. PARTICIPANTS Older adults aged 60 years and over presenting with self-harm to hospital EDs in Ireland between January 1, 2007 and December 31, 2019. MEASUREMENTS ED self-harm presentations. RESULTS Between 2007 and 2019, there were 6931 presentations of self-harm in older adults. The average annual self-harm rate was 57.8 per 100,000 among older adults aged 60 years and over. Female rates were 1.1 times higher compared to their male counterparts (61.4 vs 53.9 per 100,000). Throughout the study time frame, females aged 60-69 years had the highest rates (88.1 per 100,000), while females aged 80 years and over had the lowest rates (18.7 per 100,000). Intentional drug overdose was the most commonly used method (75.5%), and alcohol was involved in 30.3% of presentations. Between the austerity and recession years (2007-2012), self-harm presentations were 7% higher compared to 2013-2019 (incidence rate ratio (IRR): 1.07 95% CI 1.02-1.13, p = 0.01). CONCLUSIONS Findings indicate that self-harm in older adults remains a concern with approximately 533 presentations per year in Ireland. While in younger age groups, females report higher rates of self-harm, this gender difference was reversed in the oldest age group (80 years and over), with higher rates of self-harm among males. Austerity/recession years (2007-2012) had significantly higher rates of self-harm compared to subsequent years.
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Affiliation(s)
- M Isabela Troya
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Eve Griffin
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Ella Arensman
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Eugene Cassidy
- Department of Psychiatry and Neurobehavioral Science, University College Cork, Acute Mental Health Unit, Cork University Hospital, Wilton, Ireland
| | | | - Caoimhe Ni Lonergan
- Department of Psychiatry and Neurobehavioral Science, University College Cork, Acute Mental Health Unit, Cork University Hospital, Wilton, Ireland
| | - James O'Mahony
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Sally Lovejoy
- National Clinical Programme for Self-Harm and Suicide-related Ideation, Office of the National Clinical Advisor and Group Lead, Dr. Steevens Hospital, Dublin, Ireland
| | - Mark Ward
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Paul Corcoran
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
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Lambe G, Dempsey P, Bolger M, Bolster F. Self-harm, suicide and brain death: the role of the radiologist. Clin Radiol 2024; 79:239-249. [PMID: 38341342 DOI: 10.1016/j.crad.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 02/12/2024]
Abstract
Suicide is a leading cause of death worldwide and takes many forms, which include hanging, jumping from a height, sharp force trauma, ingestion/poisoning, drowning, and firearm injuries. Self-harm and suicide are associated with particular injuries and patterns of injury. Many of these patterns are apparent on imaging. Self-harm or suicidal intent may be overlooked initially in such cases, particularly when the patient is unconscious or uncooperative. Correct identification of these findings by the radiologist will allow a patient's management to be tailored accordingly and may prevent future suicide attempts. The initial role of the radiologists in these cases is to identify life-threatening injuries that require urgent medical attention. The radiologist can add value by drawing attention to associated injuries, which may have been missed on initial clinical assessment. In many cases of self-harm and suicide, imaging is more reliable than clinical assessment. The radiologist may be able to provide important prognostic information that allows clinicians to manage expectations and plan appropriately. Furthermore, some imaging studies will provide essential forensic information. Unfortunately, many cases of attempted suicide will end in brain death. The radiologist may have a role in these cases in identifying evidence of hypoxic-ischaemic brain injury, confirming a diagnosis of brain death through judicious use of ancillary tests and, finally, in donor screening for organ transplantation. A review is presented to illustrate the imaging features of self-harm, suicide, and brain death, and to highlight the important role of the radiologist in these cases.
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Affiliation(s)
- G Lambe
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
| | - P Dempsey
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - M Bolger
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - F Bolster
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
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Talamonti D, Schneider J, Gibson B, Forshaw M. The impact of national and international financial crises on mental health and well-being: a systematic review. J Ment Health 2023:1-38. [PMID: 37934869 DOI: 10.1080/09638237.2023.2278104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/03/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Evidence suggests that financial crises and poor mental health are reciprocally related, but no systematic review has been conducted to synthesise the existing literature on the impact of national and international financial crises on population-level mental health and well-being. AIMS The aim of this study was to systematically review the available literature on the global impact of financial crises on mental health and well-being outcomes. METHODS After registration on PROSPERO, a systematic search was conducted in PsycINFO, MEDLINE, Wiley, and Web of Science for papers published until 21 November 2022. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement, 98 papers were identified as meeting eligibility criteria. Included studies were assessed using the Mixed Methods Appraisal Tool (MMAT) and results were presented in a formal narrative synthesis. RESULTS Our findings show that financial crises are significantly associated with well-being and occurrence of psychological conditions. Several socio-demographic, cultural, and country-specific characteristics played a crucial role in the prevention of population mental health decline in periods of financial crises. CONCLUSIONS Based on the findings of this review, evidence-based recommendations were developed to guide the design of policy actions that protect population mental health during and after financial crises.
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Affiliation(s)
- Deborah Talamonti
- AXDEV Group Inc, Québec, Canada
- Université de Montréal, Montreal, Canada
| | - Jekaterina Schneider
- Centre for Appearance Research, School of Social Sciences, College of Health, Science and Society, University of the West of England, Bristol, UK
| | - Benjamin Gibson
- Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Mark Forshaw
- Department of Psychology, Edge Hill University, Ormskirk, UK
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Gong AK, Yun JH, Kim IS, Yuh MA, Woo SH, Kim J, Hong S. Factors Affecting Emergency Medical Utilization After Self-harm and Effectiveness of Community-Based Suicide Prevention Provisions in Preventing Self-harm: A Nationwide Registry-Based Study in Korea. Community Ment Health J 2023; 59:942-953. [PMID: 36547814 PMCID: PMC9772591 DOI: 10.1007/s10597-022-01077-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
In order to formulate and implement a community-based suicide prevention program, as well as evaluate the effectiveness of these programs, it is necessary to understand the epidemiological characteristics of self-harm. Clinical data were collected from the National Emergency Department Information System (NEDIS) data panel in Korea for patients seen after self-harm episodes. Socioeconomic factors were collected from Statistics Korea. Variables representing SP provisions (SPPs) were collected from the Korea Foundation for Suicide Prevention. Increasing the number of mental health providers resulted in lower annual emergency department visit rate after self-harm (VRSH) in the entire population, as well as in both the young and elderly populations. An increase in the mental health budget led to a significant reduction in VRSHs. However, the number of suicide prevention centers did not have any significant association with the VRSH. This study also provides substantial evidence that community-based SPPs are effective in preventing self-harm.
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Affiliation(s)
- Ae Kyung Gong
- Department of Emergency Medicine, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Ji Hyun Yun
- Department of Emergency Medicine, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - In Soo Kim
- Department of Emergency Medicine, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Min Ah Yuh
- Department of Emergency Medicine, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Seon Hee Woo
- Department of Emergency Medicine, Incheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Jinwoo Kim
- Department of Emergency Medical Service, Daejeon Health Institute of Science, 21, Chungjeong-Ro, Dong-Gu, Daejeon, 34504, Republic of Korea
| | - Sungyoup Hong
- Department of Emergency Medicine, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea.
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5
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Kelleher E, Geary EH, Tawfik M, Ní Mhuircheartaigh E, Gavin B, Wall M, Lyne JP, Doherty AM, McNicholas F. Consultant psychiatrists' experience of the impact of the COVID-19 pandemic on mental health services. Ir J Psychol Med 2022; 39:373-385. [PMID: 33910665 PMCID: PMC8503055 DOI: 10.1017/ipm.2021.41] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 04/19/2021] [Accepted: 04/26/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The novel coronavirus 2019 (COVID-19) has spread worldwide threatening human health. To reduce transmission, a 'lockdown' was introduced in Ireland between March and May 2020. The aim of this study is to capture the experiences of consultant psychiatrists during lockdown and their perception of it's impact on mental health services. METHODS A questionnaire designed by the Royal College of Psychiatrists was adapted and circulated to consultant members of the College of Psychiatrists of Ireland following the easing of restrictions. The questionnaire assessed the perceived impact on referral rates, mental health act provision, availability of information technology (IT), consultant well-being and availability of personal protective equipment (PPE). Thematic analysis was employed to analyse free-text sections. RESULTS Response rate was 32% (n = 197/623). Consultants reported an initial decrease/significant decrease in referrals in the first month of lockdown (68%, n = 95/140) followed by an increase/significant increase in the second month for both new (83%, n = 100/137) and previously attending patients (65%, n = 88/136). Social isolation and reduced face-to-face mental health supports were among the main reasons identified. The needs of children and older adults were highlighted. Most consultants (76%, n = 98/129) felt their working day was affected and their well-being reduced (52%, n = 61/119). The majority felt IT equipment availability was inadequate (67%, n = 88/132). Main themes identified from free-text sections were service management, relationship between patients and healthcare service and effects on consultants' lives. CONCLUSIONS The COVID-19 pandemic has placed increased pressure on service provision and consultant wellness. This further supports the longstanding need to increase mental health service investment.
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Affiliation(s)
- E. Kelleher
- Liaison Psychiatry Service, Cork University Hospital, Cork, Ireland
- Liaison Psychiatry Service, Mercy University Hospital, Cork, Ireland
- Department of Psychiatry, School of Medicine, University College Cork, Cork, Ireland
| | - E. H. Geary
- St Michael’s Unit, Mercy University Hospital, Cork, Ireland
| | - M. Tawfik
- St Michael’s Unit, Mercy University Hospital, Cork, Ireland
| | | | - B. Gavin
- Department of Child & Adolescent Psychiatry, School Medicine and Medical Science, University College Dublin, Belfield, Dublin, Ireland
| | - M. Wall
- Acute Mental Health Unit, Cork University Hospital, Cork, Ireland
| | - J. P. Lyne
- Wicklow Mental Health Services, Newcastle Hospital, Greystones, Co. Wicklow, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - A. M. Doherty
- Liaison Psychiatry Service, Mater Misericordiae University Hospital, Dublin, Ireland
- Department of Psychiatry, University College Dublin, Dublin, Ireland
| | - F. McNicholas
- Department of Child & Adolescent Psychiatry, School Medicine and Medical Science, University College Dublin, Belfield, Dublin, Ireland
- Lucena Child and Adolescent Mental Health Services, St John of Gods, Rathgar, Dublin, Ireland
- Children’s Health Ireland, Crumlin, Dublin, Ireland
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Asper M, Osika W, Dalman C, Pöllänen E, Simonsson O, Flodin P, Sidorchuk A, Marchetti L, Awil F, Castro R, Niemi ME. Effects of the COVID-19 pandemic and previous pandemics, epidemics and economic crises on mental health: systematic review. BJPsych Open 2022; 8:e181. [PMID: 36214114 PMCID: PMC9551492 DOI: 10.1192/bjo.2022.587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND A rise in mental illness is expected to follow the COVID-19 pandemic, which has also been projected to lead to a deep global economic recession, further adding to risk factors. AIMS The aim of this review was to assess the impact of the COVID-19 pandemic and previous pandemics, epidemics and economic crises on mental health. METHOD Searches were conducted in PubMed, Web of Science, PsycINFO and Sociological Abstracts. We included studies of all populations exposed to the COVID-19 pandemic, and other similar pandemics/epidemics and economic crises, compared with non-exposed time periods or regions. The outcome was mental health. RESULTS The 174 included studies assessed mental health impacts of the COVID-19 pandemic (87 studies), 2008 economic crisis (84 studies) and severe acute respiratory syndrome (SARS) epidemic (three studies). Outcomes were divided into affective disorders, suicides, mental healthcare utilisation and other mental health. COVID-19 pandemic studies were of lesser quality than those for the economic crisis or SARS epidemic. Most studies for all exposures showed increases in affective disorders and other mental health problems. For economic crisis exposure, increases in mental healthcare utilisation and suicides were also found, but these findings were mixed for COVID-19 pandemic exposure. This is probably because of quarantine measures affecting help-seeking and shorter follow-ups of studies of COVID-19 pandemic exposure. CONCLUSIONS Our findings highlight the importance of available, accessible and sustainable mental health services. Also, socioeconomically disadvantaged populations should be particular targets of policy interventions during the COVID-19 pandemic.
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Affiliation(s)
- Michaela Asper
- Department of Global Public Health, Karolinska Institutet, Sweden
| | - Walter Osika
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden; and Stockholm Health Care Services, Region Stockholm, Sweden
| | - Christina Dalman
- Department of Global Public Health, Karolinska Institutet, Sweden
| | - Elin Pöllänen
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Otto Simonsson
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Pär Flodin
- Department of Global Public Health, Karolinska Institutet, Sweden
| | - Anna Sidorchuk
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden; and Stockholm Health Care Services, Region Stockholm, Sweden
| | | | | | - Rosa Castro
- Federation of European Academies of Medicine, Belgium
| | - Maria E Niemi
- Department of Global Public Health, Karolinska Institutet, Sweden
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7
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Oberndorfer M, Dorner TE, Brunnmayr M, Berger K, Dugandzic B, Bach M. Health-related and socio-economic burden of the COVID-19 pandemic in Vienna. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1550-1561. [PMID: 34219320 PMCID: PMC8444637 DOI: 10.1111/hsc.13485] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 05/17/2021] [Accepted: 06/07/2021] [Indexed: 05/07/2023]
Abstract
Previous pandemics have rarely affected everyone equally and, so far, the COVID-19 pandemic is no exception. Emerging evidence has shown that incidence rate, hospitalisation rate, and mortality due to COVID-19 are higher among people in lower socio-economic position (SEP). In addition, first investigations indicate that not everyone is equally affected by this pandemic's collateral public health damage. Using a stratified random sample of 1,004 participants living in Vienna, a Central European city with approximately 1.9 million inhabitants, this study analysed the distribution of 10 adverse health-related and socio-economic outcomes attributable to the COVID-19 pandemic across socio-economic strata. To this end, we estimated differences in the incidence rate of these outcomes by SEP and each of its indicators using zero-inflated Poisson and logistic regression models, adjusted for age and gender. Data were collected during first lockdown measures between 27 April and 17 May 2020. Differences in the incidence rate between the two lowest and two highest SEP groups were clearly visible. Participants in the lowest SEP category had a 32.96% higher incidence rate (IRR = 1.333 [95% CI: 1.079-1.639]), and participants in the second lowest SEP category had a 44.69% higher incidence rate (IRR = 1.447 [95% CI: 1.190-1.760]) compared with participants in the highest SEP category. In sum, 6 out of 10 adverse COVID-19-related outcomes were, to a greater or lesser extent, disproportionately experienced by Viennese residents in lower SEP. Inequalities were most visible between income groups and for the outcomes job loss, worsening of the financial situation, and worse mental health. These results strengthen and extend the current evidence on the unequally distributed burden of the COVID-19 pandemic. In light of effect heterogeneity across SEP indicators, we encourage future investigators to pay increased attention to their operationalisation of SEP. Such awareness will help to correctly identify those in most urgent need of supportive polices.
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Affiliation(s)
- Moritz Oberndorfer
- Department of Social and Preventive MedicineCentre for Public HealthMedical University of ViennaViennaAustria
| | - Thomas E. Dorner
- Department of Social and Preventive MedicineCentre for Public HealthMedical University of ViennaViennaAustria
- Social Insurance Fund for Public Service, Railway and Mining IndustriesGesundheitseinrichtung Sitzenberg‐ReidlingSitzenberg‐ReidlingAustria
| | - Martina Brunnmayr
- Social Insurance Fund for Public Service, Railway and Mining IndustriesTherapiezentrum JustusparkBad HallAustria
| | - Katharina Berger
- Social Insurance Fund for Public Service, Railway and Mining IndustriesTherapiezentrum JustusparkBad HallAustria
| | - Belma Dugandzic
- Social Insurance Fund for Public Service, Railway and Mining IndustriesTherapiezentrum JustusparkBad HallAustria
| | - Michael Bach
- Social Insurance Fund for Public Service, Railway and Mining IndustriesTherapiezentrum JustusparkBad HallAustria
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8
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Yoshioka E, Hanley SJ, Sato Y, Saijo Y. Impact of the COVID-19 pandemic on suicide rates in Japan through December 2021: An interrupted time series analysis. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 24:100480. [PMID: 35655718 PMCID: PMC9150875 DOI: 10.1016/j.lanwpc.2022.100480] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND The COVID-19 pandemic is negatively impacting mental health globally. While increased social cohesion may have initially decreased suicide risk, there are few reports on the long-term impact. We examined the impact of the pandemic on suicide by gender and age through December 2021 in Japan. METHODS We analyzed trends in monthly suicide rates by age and gender from January 2016 to December 2021 using provisional mortality data in an interrupted time series analysis. We also considered linear trends in the pre-pandemic period and seasonal variations. Pandemic onset was defined as from April 2020. Estimated excess deaths by suicide that occurred during the pandemic were calculated. FINDINGS Excess number of suicide deaths during the pandemic period was estimated to be 1208 for men and 1825 for women. While there was no statistically significant increase in suicide rates overall for both men and women during the pandemic compared to the pre-pandemic, age-specific analyses showed a statistically significant increase in men 20-29 and 40-49 years, and in women of all age groups, except those under 20, 40-49 and over 80 years. INTERPRETATION The COVID-19 pandemic has had a negative impact on suicide rates in Japan and the impact is most pronounced in women and younger age groups. Subgroup analyses are needed, with a particular focus on those considered to be vulnerable and at increased suicide risk. FUNDING A Grant-in-Aid for scientific research from the Ministry of Education, Culture, Sports, Science and Technology of Japan (Award Number 21K10462).
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Affiliation(s)
- Eiji Yoshioka
- Department of Social Medicine, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido 078-8510, Japan
| | - Sharon J.B. Hanley
- Hokkaido University Center for Environmental and Health Sciences, Kita 12, Nishi 7, Kita-Ku, Sapporo 060-0812, Japan
| | - Yukihiro Sato
- Department of Social Medicine, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido 078-8510, Japan
| | - Yasuaki Saijo
- Department of Social Medicine, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido 078-8510, Japan
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9
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Abstract
Suicide is a major public health concern in the United States. Between 2000 and 2018, US suicide rates increased by 35%, contributing to the stagnation and subsequent decrease in US life expectancy. During 2019, suicide declined modestly, mostly owing to slight reductions in suicides among Whites. Suicide rates, however, continued to increase or remained stable among all other racial/ethnic groups, and little is known about recent suicide trends among other vulnerable groups. This article (a) summarizes US suicide mortality trends over the twentieth and early twenty-first centuries, (b) reviews potential group-level causes of increased suicide risk among subpopulations characterized by markers of vulnerability to suicide, and (c) advocates for combining recent advances in population-based suicide prevention with a socially conscious perspective that captures the social, economic, and political contexts in which suicide risk unfolds over the life course of vulnerable individuals.
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Affiliation(s)
- Gonzalo Martínez-Alés
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; ,
- Department of Psychiatry, La Paz University Hospital, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Tammy Jiang
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA;
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; ,
| | - Jaimie L Gradus
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA;
- Department of Psychiatry, School of Medicine, Boston University, Boston, Massachusetts, USA;
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Villarroel N, MacFarlane A, Roura M, Basogomba A, Bradley C, LeMaster JW, Hannigan A. The impact of economic recession on the health of migrant fathers over time: results from the Growing up in Ireland longitudinal study. BMC Public Health 2022; 22:166. [PMID: 35073892 PMCID: PMC8788144 DOI: 10.1186/s12889-022-12596-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 01/11/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The relationship between economic conditions and health can depend on both the health outcome measured and the composition of the population. Analysis of outcomes by both ethnicity and country of birth has been recommended. The aim of our study is to explore the impact of recession on self-rated health and depression of migrant fathers in Ireland over time, considering both ethnicity and country of birth.
Methods
Longitudinal data from waves of a population-representative cohort study (Growing up in Ireland, 2008–2013) was used with Wave 1 collected before the recession and Wave 2 collecting information on how the recession affected families. Socio-demographic variables, self-rated health and depression were compared across three groups of fathers classified by self-identified ethnicity and country of birth: White Irish (n = 5628), Other White European (EU-10) (n = 431), and Black African (n = 192) using chi-square tests and logistic regression models. Rates of follow-up were compared across groups at Wave 3.
Results
Prior to the recession, the rate of employment was lowest for African fathers (51% vs 81% for EU-10 fathers and 92% for Irish fathers, p < 0.001). At Wave 2, African families were more likely to have experienced a very significant effect of the recession (40.1% compared to 22.4% for families from EU-10 and 21.3% for Irish families, p < 0.001). However, the impact of the recession on depression and self-rated health was only found in Irish fathers. By Wave 3, rates of follow-up were lower for migrant fathers, particularly for EU-10 fathers.
Conclusions
Understanding the relationship between economic conditions and health is complex and may be related to multiple dimensions of socio-economic advantage and disadvantage. African families were already more likely to be disadvantaged prior to the recession and that pattern persisted during the recession. Further research on attrition rates of migrants in population cohort studies is needed and the development of effective strategies for recruitment, follow-up and analysis.
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11
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Barreto AAM, Souza LEPFD. Unemployment and suicide among the Brazilian population in the crisis of capitalism. CIENCIA & SAUDE COLETIVA 2021; 26:5869-5882. [PMID: 34909980 DOI: 10.1590/1413-812320212612.14672021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/21/2021] [Indexed: 01/09/2023] Open
Abstract
The current crisis of capitalism has multiple economic, financial, social, environmental, cultural and political facets. In Brazil, the severity of the crisis is no different, resulting from the exhaustion of the neo-developmentalist model and its inability to resist global crisis. This study compares suicide mortality rates (MR) among employed and unemployed persons in Brazil prior to and during the economic crisis using death records from the period 2011 to 2016. The findings show that in the period 2011 to 2016 the suicide MR fell from 2.66/100,000 to 2.46 among unemployed persons and increased from 5.52/100,000 to 6.89/100,000 in employed persons. Suicide is a complex, multi-causal phenomenon determined by a diverse range of social factors, including strategies that increase worker exploitation. Indeed, being employed can have a greater negative impact on the mental health of workers than being unemployed.
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Affiliation(s)
- Antonio Angelo Menezes Barreto
- Instituto de Saúde Coletiva, Universidade Federal da Bahia. R. Basílio da Gama s/n, Canela. 40110-040 Salvador BA Brasil.
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12
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Scriven M, Geary E, Kelly BD. Psychiatrists and COVID-19: what is our role during this unprecedented time? Ir J Psychol Med 2021; 38:307-312. [PMID: 32811576 PMCID: PMC7533475 DOI: 10.1017/ipm.2020.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/20/2020] [Accepted: 08/13/2020] [Indexed: 11/06/2022]
Abstract
The declaration of a COVID-19 (Severe Acute Respiratory Syndrome - CoronaVirus2) pandemic by the World Health Organization in March 2020 has vastly changed the landscape in which mental health services function. Consideration is required to adapt services during this unusual time, ensuring continued provision of care for current patients, availability of care for patients with new-onset mental health difficulties and delivery of evidence-based support for healthcare professionals working with affected patients. Lessons can be learned from research carried out during the severe acute respiratory syndrome, Middle East respiratory syndrome and Ebola epidemics to ensure the delivery of efficient and effective mental health services both now and into the future.
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Affiliation(s)
- M. Scriven
- Department of Psychiatry, North Lee Mental Health Services, Mercy University Hospital, Cork, Ireland
| | - E. Geary
- Department of Psychiatry, South Lee Mental Health Services, Cork University Hospital, Cork, Ireland
| | - B. D. Kelly
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin, Ireland
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13
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Bergmans RS, Larson P, Bennion E, Mezuk B, Wozniak MC, Steiner AL, Gronlund CJ. Short-term exposures to atmospheric evergreen, deciduous, grass, and ragweed aeroallergens and the risk of suicide in Ohio, 2007-2015: Exploring disparities by age, gender, and education level. ENVIRONMENTAL RESEARCH 2021; 200:111450. [PMID: 34102161 PMCID: PMC8404218 DOI: 10.1016/j.envres.2021.111450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/27/2021] [Accepted: 05/29/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Seasonal trends in suicide mortality are observed worldwide, potentially aligning with the seasonal release of aeroallergens. However, only a handful of studies have examined whether aeroallergens increase the risk of suicide, with inconclusive results thus far. The goal of this study was to use a time-stratified case-crossover design to test associations of speciated aeroallergens (evergreen, deciduous, grass, and ragweed) with suicide deaths in Ohio, USA (2007-2015). METHODS Residential addresses for 12,646 persons who died by suicide were linked with environmental data at the 4-25 km grid scale including atmospheric aeroallergen concentrations, maximum temperature, sunlight, particulate matter <2.5 μm, and ozone. A case-crossover design was used to examine same-day and 7-day cumulative lag effects on suicide. Analyses were stratified by age group, gender, and educational level. RESULTS In general, associations were null between aeroallergens and suicide. Stratified analyses revealed a relationship between grass pollen and same-day suicide for women (OR = 3.84; 95% CI = 1.44, 10.22) and those with a high school degree or less (OR = 2.03; 95% CI = 1.18, 3.49). CONCLUSIONS While aeroallergens were generally not significantly related to suicide in this sample, these findings provide suggestive evidence for an acute relationship of grass pollen with suicide for women and those with lower education levels. Further research is warranted to determine whether susceptibility to speciated aeroallergens may be driven by underlying biological mechanisms or variation in exposure levels.
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Affiliation(s)
- Rachel S Bergmans
- Institute for Social Research, University of Michigan, Ann Arbor, MI, 48106, USA.
| | - Peter Larson
- Institute for Social Research, University of Michigan, Ann Arbor, MI, 48106, USA
| | - Erica Bennion
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Briana Mezuk
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Matthew C Wozniak
- Department of Climate and Space Sciences and Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Allison L Steiner
- Department of Climate and Space Sciences and Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Carina J Gronlund
- Institute for Social Research, University of Michigan, Ann Arbor, MI, 48106, USA
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14
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Guerra O, Eboreime E. The Impact of Economic Recessions on Depression, Anxiety, and Trauma-Related Disorders and Illness Outcomes-A Scoping Review. Behav Sci (Basel) 2021; 11:119. [PMID: 34562956 PMCID: PMC8464685 DOI: 10.3390/bs11090119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022] Open
Abstract
In the wake of a global economic recession secondary to the COVID-19 pandemic, this scoping review seeks to summarize the current quantitative research on the impact of economic recessions on depression, anxiety, traumatic disorders, self-harm, and suicide. Seven research databases (PsycINFO, MEDLINE, Embase, Web of Science: Core Collection, National Library of Medicine PubMed, PubMed Central, and Google Scholar) were searched for keywords returning 3412 preliminary results published since 2008 in Organisation for Economic Coordination and Development (OECD)nations. These were screened by both authors for inclusion/exclusion criteria resulting in 127 included articles. Articles included were quantitative studies in OECD countries assessing select mental disorders (depression, anxiety, and trauma-/stress-related disorders) and illness outcomes (self-harm and suicide) during periods of economic recession. Articles were limited to publication from 2008 to 2020, available online in English, and utilizing outcome measures specific to the disorders and outcomes specified above. A significant relationship was found between periods of economic recession and increased depressive symptoms, self-harming behaviour, and suicide during and following periods of recession. Results suggest that existing models for mental health support and strategies for suicide prevention may be less effective than they are in non-recession times. It may be prudent to focus public education and medical treatments on raising awareness and access to supports for populations at higher risk, including those vulnerable to the impacts of job or income loss due to low socioeconomic status preceding the recession or high levels of financial strain, those supporting others financially, approaching retirement, and those in countries with limited social safety nets. Policy makers should be aware of the potential protective nature of unemployment safeguards and labour program investment in mitigating these negative impacts. Limited or inconclusive data were found on the relationship with traumatic disorders and symptoms of anxiety. In addition, research has focused primarily on the working-age adult population with limited data available on children, adolescents, and older adults, leaving room for further research in these areas.
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Affiliation(s)
- Olivia Guerra
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada;
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15
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Colombo FR, Alicandro G, La Vecchia C. Area-level indicators of income and total mortality during the COVID-19 pandemic. Eur J Public Health 2021; 31:625-629. [PMID: 33749735 PMCID: PMC8083668 DOI: 10.1093/eurpub/ckab038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND There is mounting evidence that socioeconomic inequalities in mortality have widened during the COVID-19 pandemic. This study aimed at evaluating the relationship between area-level indicators of income and total mortality during the first phase of COVID-19 pandemic in the most hit Italian region. METHODS We conducted an ecological study based on the number of deaths registered in the municipalities of the Lombardy region (Italy) between January 2019 and June 2020. Municipalities were grouped according to quintiles of average income and pension of their resident population. Monthly age-standardized mortality ratios (MRs) between the poorest and the richest municipalities and the corresponding 95% CI were computed to evaluate whether the pre-existing socioeconomic inequalities widened during the pandemic. RESULTS Over the study period, 175 853 deaths were registered. During the pre-pandemic period (January 2019 to February 2020) the MR between the poorest and the richest municipalities ranged between 1.12 (95% CI: 1.00-1.25) and 1.33 (95% CI: 1.20-1.47). In March 2020, when the pandemic began to rapidly spread in the region, it raised up to 1.61 (95% CI: 1.51-1.72) and decreased thereafter, reaching the pre-pandemic values in April 2020. Similar results were observed in the analysis of the mortality at ages 65 and over in municipalities grouped according to average pension, where the MR increased up to 1.82 (95% CI: 1.70-1.94) in March 2020. CONCLUSIONS The socioeconomic inequalities in mortality widened in Lombardy, the Italian region most severely hit during the first phase of the COVID-19 pandemic.
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Affiliation(s)
- Fabio Riccardo Colombo
- Department of Social and Political Sciences, Università degli Studi di Milano, Milan, Italy
| | - Gianfranco Alicandro
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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16
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Cherrie M, Curtis S, Baranyi G, Cunningham N, Dibben C, Bambra C, Pearce J. A data linkage study of the effects of the Great Recession and austerity on antidepressant prescription usage. Eur J Public Health 2021; 31:297-303. [PMID: 33550373 DOI: 10.1093/eurpub/ckaa253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND International literature shows unemployment and income loss during the Great Recession worsened population mental health. This individual-level longitudinal study examines how regional economic trends and austerity related to depression using administrative prescription data for a large and representative population sample. METHODS Records from a sample of the Scottish Longitudinal Study (N=86 500) were linked to monthly primary care antidepressant prescriptions (2009-15). Regional economic trends were characterized by annual full-time employment data (2004-14). Economic impact of austerity was measured via annual income lost per working age adult due to welfare reforms (2010-15). Sequence analysis identified new cases of antidepressant use, and group-based trajectory modelling classified regions into similar economic trajectories. Multi-level logistic regression examined relationships between regional economic trends and new antidepressant prescriptions. Structural equation mediation analysis assessed the contributory role of welfare reforms. RESULTS Employed individuals living in regions not recovering post-recession had the highest risk of beginning a new course of antidepressants (AOR 1.23; 95% CI 1.08-1.38). Individuals living in areas with better recovery trajectories had the lowest risk. Mediation analyses showed that 50% (95% CI 7-61%) of this association was explained by the impact of welfare benefit reforms on average incomes. CONCLUSIONS Following the Great Recession, local labour market decline and austerity measures were associated with growing antidepressant usage, increasing regional inequalities in mental health. The study evidences the impact of austerity on health inequalities and suggests that economic conditions and welfare policies impact on population health. Reducing the burden of mental ill-health primarily requires action on the social determinants.
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Affiliation(s)
- Mark Cherrie
- Centre for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - Sarah Curtis
- Centre for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK.,School of Geography, Durham University, Durham, UK
| | - Gergő Baranyi
- Centre for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - Niall Cunningham
- School of Geography Politics and Sociology, Newcastle University, Newcastle, UK
| | - Chris Dibben
- Centre for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK.,ESRC Administrative Data Research Centre, University of Edinburgh, Newcastle, UK
| | - Clare Bambra
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Jamie Pearce
- Centre for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
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17
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Vandoros S, Kawachi I. Economic uncertainty and suicide in the United States. Eur J Epidemiol 2021; 36:641-647. [PMID: 34114185 PMCID: PMC8191707 DOI: 10.1007/s10654-021-00770-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 06/02/2021] [Indexed: 10/27/2022]
Abstract
Previous studies have found an association between recessions and increased rates of suicide. In the present study we widened the focus to examine the association between economic uncertainty and suicides. We used monthly suicide data from the US at the State level from 2000 to 2017 and combined them with the monthly economic uncertainty index. We followed a panel data econometric approach to study the association between economic uncertainty and suicide, controlling for unemployment and other indicators. Economic uncertainty is positively associated with suicide when controlling for unemployment [coeff: 8.026; 95% CI: 3.692-12.360] or for a wider range of economic and demographic characteristics [coeff: 7.478; 95% CI: 3.333-11.623]. An increase in the uncertainty index by one percent is associated with an additional 11-24.4 additional monthly suicides in the US. Economic uncertainty is likely to act as a trigger, which underlines the impulsive nature of some suicides. This highlights the importance of providing access to suicide prevention interventions (e.g. hotlines) during periods of economic uncertainty.
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Affiliation(s)
- Sotiris Vandoros
- King's College London, Bush House, 30 Aldwych, London, WC2B 4BG, UK. .,Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Ichiro Kawachi
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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18
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Birchall E, Perry IJ, Corcoran P, Daly C, Griffin E. The impact of guidance on the supply of codeine-containing products on their use in intentional drug overdose. Eur J Public Health 2021; 31:853-858. [PMID: 34041521 PMCID: PMC8514187 DOI: 10.1093/eurpub/ckab082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Concerns about the misuse of codeine led to the introduction of guidance restricting the supply of over-the-counter (OTC) codeine-containing products in Ireland in 2010. The aim of this study was to examine the impact of this guidance on the national rate of hospital-presenting self-harm involving codeine-related intentional drug overdose (IDO). Methods Presentations involving IDO to Irish general hospitals between 1 January 2007 and 31 December 2013, as recorded by the National Self-Harm Registry Ireland, were analyzed. Event-based rates per 100 000 were calculated using national population data. Poisson regression models were used to assess rate changes between pre- and post-guidance periods and to calculate excess presentations. Results Between January 2007 and December 2013, a total of 57 759 IDOs were recorded, with 4789 (8.3%) involving a codeine-containing product. The rate of codeine-related IDOs was 20% lower in the period following implementation of the guidance (incidence rate ratio: 0.80; 95% CI: 0.75 to 0.85), representing a total of 509 (95% CI: −624, −387) fewer codeine-related IDOs in that period. Reductions were observed across all ages and were more pronounced for females (0.76, 0.71 to 0.82) than males (0.87, 0.79 to 0.97). The rate of IDOs involving other drugs decreased by 3% in the same period (0.97, 0.95 to 0.98). Conclusion Our findings indicate that the rate of codeine-related IDOs was significantly lower in the period following the implementation of the guidance. There is a large body of evidence supporting the restriction of potentially harmful medication as an effective strategy in suicide prevention.
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Affiliation(s)
- Emma Birchall
- School of Medicine, University College Cork, Cork, Ireland
| | - Ivan J Perry
- School of Public Health, University College Cork, Cork, Ireland
| | - Paul Corcoran
- School of Public Health, University College Cork, Cork, Ireland.,National Suicide Research Foundation, Cork, Ireland
| | | | - Eve Griffin
- School of Public Health, University College Cork, Cork, Ireland.,National Suicide Research Foundation, Cork, Ireland
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19
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Leske S, Kõlves K, Crompton D, Arensman E, de Leo D. Real-time suicide mortality data from police reports in Queensland, Australia, during the COVID-19 pandemic: an interrupted time-series analysis. Lancet Psychiatry 2021; 8:58-63. [PMID: 33212023 PMCID: PMC7836943 DOI: 10.1016/s2215-0366(20)30435-1] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Deaths by suicide can increase during infectious disease outbreaks. This study analysed suspected suicide rates in 2020 relative to 2015-19 to assess any early effects of the COVID-19 pandemic in Queensland, Australia. METHODS We analysed data from the interim Queensland Suicide Register (iQSR), a state-wide real-time suicide surveillance system, using an interrupted time-series design. The data source for the iQSR is the Form 1 police report of a death to a coroner. Two QSR staff independently classed the probability of a death by suicide as possible, probable, or beyond reasonable doubt. The analysis included the probable or beyond reasonable doubt categories as suspected suicides. The primary outcome was the monthly suspected suicide rate. We applied Poisson and negative binomial regressions to assess whether Queensland's Public Health Emergency Declaration on Jan 29, 2020, affected suspected suicides from Feb 1 to Aug 31, 2020. Secondary outcomes included absolute or relative changes in police-reported motives of recent unemployment, financial problems, domestic violence, and relationship breakdown. FINDINGS 3793 suspected suicides were recorded with an unadjusted monthly rate of 14·85 deaths per 100 000 people (from Jan 1, 2015, to Jan 31, 2020) before the declaration, and 443 suspected suicides were recorded with an unadjusted monthly rate of 14·07 deaths per 100 000 people (Feb 1, 2020, onwards) after the declaration. An interrupted time-series Poisson regression model unadjusted (rate ratio [RR] 0·94, 95% CI 0·82-1·06) and adjusted for overdispersion, seasonality, and pre-exposure trends (RR 1·02, 95% CI 0·83-1·25) indicated no evidence of a change in suspected suicide rates. We found no absolute or relative increases in the motives for suspected suicides, including recent unemployment, financial problems, relationship breakdown, or domestic violence from February to August, 2020, compared with the pre-exposure period. INTERPRETATION There does not yet appear to be an overall change in the suspected suicide rate in the 7 months since Queensland declared a public health emergency. Despite this, COVID-19 has contributed to some suspected suicides in Queensland. Ongoing community spread and increasing death rates of COVID-19, and its impact on national economies and mental health, reinforces the need for governments to maintain the monitoring and reporting of suicide mortality in real time. FUNDING None.
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Affiliation(s)
- Stuart Leske
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia.
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - David Crompton
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Ella Arensman
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia; School of Public Health and National Suicide Research Foundation, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Diego de Leo
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia; Slovene Centre for Suicide Research, Andrej MarušiČ Institute, and Department of Psychology, FAMNIT, University of Primorska, Koper, Slovenia
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20
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Bonakdari H, Pelletier JP, Martel-Pelletier J. A continuous data driven translational model to evaluate effectiveness of population-level health interventions: case study, smoking ban in public places on hospital admissions for acute coronary events. J Transl Med 2020; 18:466. [PMID: 33298067 PMCID: PMC7724897 DOI: 10.1186/s12967-020-02628-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/20/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND An important task in developing accurate public health intervention evaluation methods based on historical interrupted time series (ITS) records is to determine the exact lag time between pre- and post-intervention. We propose a novel continuous transitional data-driven hybrid methodology using a non-linear approach based on a combination of stochastic and artificial intelligence methods that facilitate the evaluation of ITS data without knowledge of lag time. Understanding the influence of implemented intervention on outcome(s) is imperative for decision makers in order to manage health systems accurately and in a timely manner. METHODS To validate a developed hybrid model, we used, as an example, a published dataset based on a real health problem on the effects of the Italian smoking ban in public spaces on hospital admissions for acute coronary events. We employed a continuous methodology based on data preprocessing to identify linear and nonlinear components in which autoregressive moving average and generalized structure group method of data handling were combined to model stochastic and nonlinear components of ITS. We analyzed the rate of admission for acute coronary events from January 2002 to November 2006 using this new data-driven hybrid methodology that allowed for long-term outcome prediction. RESULTS Our results showed the Pearson correlation coefficient of the proposed combined transitional data-driven model exhibited an average of 17.74% enhancement from the single stochastic model and 2.05% from the nonlinear model. In addition, data demonstrated that the developed model improved the mean absolute percentage error and correlation coefficient values for which 2.77% and 0.89 were found compared to 4.02% and 0.76, respectively. Importantly, this model does not use any predefined lag time between pre- and post-intervention. CONCLUSIONS Most of the previous studies employed the linear regression and considered a lag time to interpret the impact of intervention on public health outcome. The proposed hybrid methodology improved ITS prediction from conventional methods and could be used as a reliable alternative in public health intervention evaluation.
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Affiliation(s)
- Hossein Bonakdari
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis Street, R11.412, Montreal, QC, H2X 0A9, Canada.,Department of Soil and Agri-Food Engineering, Laval University, 2425 rue de l'Agriculture, Québec, QC, G1V 0A6, Canada
| | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis Street, R11.412, Montreal, QC, H2X 0A9, Canada
| | - Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis Street, R11.412, Montreal, QC, H2X 0A9, Canada.
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21
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Abstract
The global pandemic as a result of the SARS-CoV2 virus has seen over 16 m people infected and over 650,000 deaths, with men at double the risk of both developing the severe form of the disease and mortality. There are both biological (sex) and socio-cultural (gender) factors, compounded by socio-economic factors and ethnicity, that impact on the aftermath of what has occurred over the short time that this novel coronavirus has been circulating the world. The potential life-long morbidity as a result of the infection and as a consequence of highly invasive critical care treatment needs to be factored into the rehabilitation of survivors. There are also many men whose lives will have been severely affected both physically and emotionally by the pandemic without ever contracting the disease, with the widespread disruption to normal existence and its impact on their social world and the economy. The implications of the closure of many healthcare services over the initial lockdown will also have both a shorter- and longer-term impact on other diseases due to missed early diagnosis and disrupted treatment regimes. Getting effective public health messages out to the population is critical and this current pandemic is demonstrating that there needs to be a more focused view on men's health behavior. Without effective public support for preventative action, the more likely the disease will continue its path unabated. This review explores the wider ramifications of the disease both for those men who have survived the disease and those that have been affected by the wider social effects of the pandemic. The pandemic should be a wake-up call for all involved in the planning and delivery of health and social care for the greater attention to the central role of sex and gender.
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Affiliation(s)
- Alan White
- School of Health and Community Studies, Leeds Beckett University, Leeds, West Yorkshire , United Kingdom of Great Britain and Northern Ireland
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22
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Jemberie WB, Stewart Williams J, Eriksson M, Grönlund AS, Ng N, Blom Nilsson M, Padyab M, Priest KC, Sandlund M, Snellman F, McCarty D, Lundgren LM. Substance Use Disorders and COVID-19: Multi-Faceted Problems Which Require Multi-Pronged Solutions. Front Psychiatry 2020; 11:714. [PMID: 32848907 PMCID: PMC7396653 DOI: 10.3389/fpsyt.2020.00714] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/07/2020] [Indexed: 12/21/2022] Open
Abstract
COVID-19 shocked health and economic systems leaving millions of people without employment and safety nets. The pandemic disproportionately affects people with substance use disorders (SUDs) due to the collision between SUDs and COVID-19. Comorbidities and risk environments for SUDs are likely risk factors for COVID-19. The pandemic, in turn, diminishes resources that people with SUD need for their recovery and well-being. This article presents an interdisciplinary and international perspective on how COVID-19 and the related systemic shock impact on individuals with SUDs directly and indirectly. We highlight a need to understand SUDs as biopsychosocial disorders and use evidence-based policies to destigmatize SUDs. We recommend a suite of multi-sectorial actions and strategies to strengthen, modernize and complement addiction care systems which will become resilient and responsive to future systemic shocks similar to the COVID-19 pandemic.
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Affiliation(s)
- Wossenseged Birhane Jemberie
- Department of Social Work, Umeå University, Umeå, Sweden
- Centre for Demography and Ageing Research (CEDAR), Umeå University, Umeå, Sweden
- The Swedish National Graduate School for Competitive Science on Ageing and Health (SWEAH), Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Jennifer Stewart Williams
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden
- Research Centre for Generational Health and Ageing, Faculty of Health, University of Newcastle, Callaghan, NSW, Australia
| | - Malin Eriksson
- Department of Social Work, Umeå University, Umeå, Sweden
| | | | - Nawi Ng
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Mojgan Padyab
- Department of Social Work, Umeå University, Umeå, Sweden
- Centre for Demography and Ageing Research (CEDAR), Umeå University, Umeå, Sweden
| | - Kelsey Caroline Priest
- MD/PhD Program, School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Mikael Sandlund
- Psychiatry Unit, Department of Clinical Science, Umeå University, Umeå, Sweden
| | | | - Dennis McCarty
- Oregon Health & Science University- Portland State University, School of Public Health, Portland, OR, United States
| | - Lena M. Lundgren
- Department of Social Work, Umeå University, Umeå, Sweden
- Cross-National Behavioral Health Laboratory, Graduate School of Social Work, University of Denver, Denver, CO, United States
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Bambra C, Riordan R, Ford J, Matthews F. The COVID-19 pandemic and health inequalities. J Epidemiol Community Health 2020; 74:964-968. [PMID: 32535550 PMCID: PMC7298201 DOI: 10.1136/jech-2020-214401] [Citation(s) in RCA: 632] [Impact Index Per Article: 158.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/18/2020] [Indexed: 11/20/2022]
Abstract
This essay examines the implications of the COVID-19 pandemic for health inequalities. It outlines historical and contemporary evidence of inequalities in pandemics—drawing on international research into the Spanish influenza pandemic of 1918, the H1N1 outbreak of 2009 and the emerging international estimates of socio-economic, ethnic and geographical inequalities in COVID-19 infection and mortality rates. It then examines how these inequalities in COVID-19 are related to existing inequalities in chronic diseases and the social determinants of health, arguing that we are experiencing a syndemicpandemic. It then explores the potential consequences for health inequalities of the lockdown measures implemented internationally as a response to the COVID-19 pandemic, focusing on the likely unequal impacts of the economic crisis. The essay concludes by reflecting on the longer-term public health policy responses needed to ensure that the COVID-19 pandemic does not increase health inequalities for future generations.
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Affiliation(s)
- Clare Bambra
- Population Health Sciences Institute, Newcastle University Institute for Health and Society, Newcastle upon Tyne, UK
| | - Ryan Riordan
- School of Clinical Medicine, Cambridge University, Cambridge, UK
| | - John Ford
- School of Clinical Medicine, Cambridge University, Cambridge, UK
| | - Fiona Matthews
- Population Health Sciences Institute, Newcastle University Institute for Health and Society, Newcastle upon Tyne, UK
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24
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Abstract
The COVID-19 pandemic is a global health emergency, the scale, speed and nature of which is beyond anything most of us have experienced in our lifetimes. The mental health burden associated with this pandemic is also likely to surpass anything we have previously experienced. In this editorial, we seek to anticipate the nature of this additional mental health burden and make recommendations on how to mitigate against and prepare for this significant increase in mental health service demand.
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Abstract
Human disasters come in all shapes and sizes including wars, terrorist violence, natural events, economic recessions and depressions as well as infection. As a species more fragile than we often allow, humans would be expected to adversely react to these types of disasters in terms of mental ill health and possibly suicidal behaviour leading to increased demands on the Mental Health services. This narrative historical paper examines relevant studies into how previous disasters affected mental health and suicidal behaviour. The characteristics of what is known of the current Covid-19 disease are analysed and compared to other types of disasters with a view to gaining some insight into what we might expect. Of all the types of disasters, economic recession appears most toxic. Mitigating the worst effects of recession appears to be protective. Particularly vulnerable groups are identified in whom we might expect an increase in suicidal behaviour.
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26
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Steeg S, Carr MJ, Mok PLH, Pedersen CB, Antonsen S, Ashcroft DM, Kapur N, Erlangsen A, Nordentoft M, Webb RT. Temporal trends in incidence of hospital-treated self-harm among adolescents in Denmark: national register-based study. Soc Psychiatry Psychiatr Epidemiol 2020; 55:415-421. [PMID: 31654088 DOI: 10.1007/s00127-019-01794-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Studies conducted in the UK and in Ireland have reported increased rates of self-harm in adolescent females from around the time of the 2008 economic recession and through periods of subsequent national austerity programme implementation. It is not known if incidence rates have increased similarly in other Western European countries during this period. METHODS Data from interlinked national administrative registers were extracted for individuals born in Denmark during 1981-2006. We estimated gender- and age-specific incidence rates (IRs) per 10,000 person-years at risk for hospital-treated non-fatal self-harm during 2000-2016 at ages 10-19 years. RESULTS Incidence of self-harm peaked in 2007 (IR 25.1) and then decreased consistently year on year to 13.8 in 2016. This pattern was found in all age groups, in both males and females and in each parental income tertile. During the last 6 years of the observation period, 2011-2016, girls aged 13-16 had the highest incidence rates whereas, among boys, incidence was highest among 17-19 year olds throughout. CONCLUSIONS The temporal increases in incidence rates of self-harm among adolescents observed in some Western European countries experiencing major economic recession were not observed in Denmark. Restrictions to sales of analgesics, access to dedicated suicide prevention clinics, higher levels of social spending and a stronger welfare system may have protected potentially vulnerable adolescents from the increases seen in other countries. A better understanding of the specific mechanisms behind the temporal patterns in self-harm incidence in Denmark is needed to help inform suicide prevention in other nations.
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Affiliation(s)
- Sarah Steeg
- Division of Psychology and Mental Health, Centre for Mental Health and Safety, Manchester Academic Health Science Centre, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, England, UK. .,Manchester Academic Health Science Centre (MAHSC), Manchester, UK.
| | - Matthew J Carr
- Division of Psychology and Mental Health, Centre for Mental Health and Safety, Manchester Academic Health Science Centre, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, England, UK.,Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | - Pearl L H Mok
- Division of Psychology and Mental Health, Centre for Mental Health and Safety, Manchester Academic Health Science Centre, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, England, UK.,Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | - Carsten B Pedersen
- Centre for Integrated Register-based Research at Aarhus University, Aarhus, Denmark.,National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Sussie Antonsen
- Centre for Integrated Register-based Research at Aarhus University, Aarhus, Denmark.,National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Darren M Ashcroft
- Division of Pharmacy and Optometry, Centre for Pharmacoepidemiology and Drug Safety, The University of Manchester, Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | - Nav Kapur
- Division of Psychology and Mental Health, Centre for Mental Health and Safety, Manchester Academic Health Science Centre, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, England, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre (MAHSC), Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | - Roger T Webb
- Division of Psychology and Mental Health, Centre for Mental Health and Safety, Manchester Academic Health Science Centre, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, England, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre (MAHSC), Manchester, UK
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27
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Abstract
Scholarly literature claims that health declines in populations when optimism about investing in the future wanes. This claim leads us to describe collective optimism as a predictor of selection in utero. Based on the literature, we argue that the incidence of suicide gauges collective optimism in a population and therefore willingness to invest in the future. Using monthly data from Sweden for the years 1973-2016, we test the hypothesis that the incidence of suicide among women of child-bearing age correlates inversely with male twin births, an indicator of biological investment in high-risk gestations. We find that, as predicted by our theory, the incidence of suicide at month t varies inversely with the ratio of twin to singleton male births at month t + 3. Our results illustrate the likely sensitivity of selection in utero to change in the social environment and so the potential for viewing collective optimism as a component of public health infrastructure.
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28
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Hegerl U, Maxwell M, Harris F, Koburger N, Mergl R, Székely A, Arensman E, Van Audenhove C, Larkin C, Toth MD, Quintão S, Värnik A, Genz A, Sarchiapone M, McDaid D, Schmidtke A, Purebl G, Coyne JC, Gusmão R. Prevention of suicidal behaviour: Results of a controlled community-based intervention study in four European countries. PLoS One 2019; 14:e0224602. [PMID: 31710620 PMCID: PMC6844461 DOI: 10.1371/journal.pone.0224602] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 10/17/2019] [Indexed: 11/18/2022] Open
Abstract
The 'European Alliance Against Depression' community-based intervention approach simultaneously targets depression and suicidal behaviour by a multifaceted community based intervention and has been implemented in more than 115 regions worldwide. The two main aims of the European Union funded project "Optimizing Suicide Prevention Programmes and Their Implementation in Europe" were to optimise this approach and to evaluate its implementation and impact. This paper reports on the primary outcome of the intervention (the number of completed and attempted suicides combined as 'suicidal acts') and on results concerning process evaluation analysis. Interventions were implemented in four European cities in Germany, Hungary, Portugal and Ireland, with matched control sites. The intervention comprised activities with predefined minimal intensity at four levels: training of primary care providers, a public awareness campaign, training of community facilitators, support for patients and their relatives. Changes in frequency of suicidal acts with respect to a one-year baseline in the four intervention regions were compared to those in the four control regions (chi-square tests). The decrease in suicidal acts compared to baseline in the intervention regions (-58 cases, -3.26%) did not differ significantly (χ2 = 0.13; p = 0.72) from the decrease in the control regions (-18 cases, -1.40%). However, intervention effects differed between countries (χ2 = 8.59; p = 0.04), with significant effects on suicidal acts in Portugal (χ2 = 4.82; p = 0.03). The interviews and observations explored local circumstances in each site throughout the study. Hypothesised mechanisms of action for successful implementation were observed and drivers for 'added-value' were identified: local partnership working and 'in-kind' contributions; an approach which valued existing partnership strengths; and synergies operating across intervention levels. It can be assumed that significant events during the implementation phase had a certain impact on the observed outcomes. However, this impact was, of course, not proven.
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Affiliation(s)
- Ulrich Hegerl
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Goethe-Universität Frankfurt, Frankfurt, Germany
| | - Margaret Maxwell
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, Scotland, United Kingdom
| | - Fiona Harris
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, Scotland, United Kingdom
| | - Nicole Koburger
- Department of Research Services, University of Leipzig, Leipzig, Saxonia, Germany
| | - Roland Mergl
- Department of Psychology, Bundeswehr University Munich
| | - András Székely
- Institute of Behavioral Sciences, Semmelweis University Budapest, Budapest, Hungary
| | - Ella Arensman
- National Suicide Research Foundation and School of Public Health, University College Cork, Cork, Ireland
| | - Chantal Van Audenhove
- Center for care research and consultancy at KU Leuven (LUCAS), University of Leuven, Leuven, Belgium
| | - Celine Larkin
- National Suicide Research Foundation and School of Public Health, University College Cork, Cork, Ireland
| | - Mónika Ditta Toth
- Institute of Behavioral Sciences, Semmelweis University Budapest, Budapest, Hungary
| | - Sónia Quintão
- CEDOC, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Airi Värnik
- Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia & Tallinn University, Tallinn, Estonia
| | - Axel Genz
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Otto-von-Guericke University, Magdeburg, Saxonia-Anhalt, Germany
| | - Marco Sarchiapone
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - David McDaid
- London School of Economics and Political Science, London, United Kingdom
| | - Armin Schmidtke
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Wuerzburg, Bavaria, Germany
| | - György Purebl
- Institute of Behavioral Sciences, Semmelweis University Budapest, Budapest, Hungary
| | - James C. Coyne
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Ricardo Gusmão
- CEDOC, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
- ISPUP, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
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29
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Arensman E, Larkin C, McCarthy J, Leitao S, Corcoran P, Williamson E, McAuliffe C, Perry IJ, Griffin E, Cassidy EM, Bradley C, Kapur N, Kinahan J, Cleary A, Foster T, Gallagher J, Malone K, Ramos Costa AP, Greiner BA. Psychosocial, psychiatric and work-related risk factors associated with suicide in Ireland: optimised methodological approach of a case-control psychological autopsy study. BMC Psychiatry 2019; 19:275. [PMID: 31492119 PMCID: PMC6728991 DOI: 10.1186/s12888-019-2249-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 08/20/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Suicide has profound effects on families and communities, but is a statistically rare event. Psychological autopsies using a case-control design allow researchers to examine risk factors for suicide, using a variety of sources to detail the psychological and social characteristics of decedents and to compare them to controls. The Suicide Support and Information System Case Control study (SSIS-ACE) aimed to compare psychosocial, psychiatric and work-related risk factors across three groups of subjects: suicide decedents, patients presenting to hospital with a high-risk self-harm episode, and general practice controls. METHODS The study design includes two inter-related studies; one main case-control study: comparing suicide cases to general practice (GP) controls, and one comparative study: comparing suicide cases to patients presenting with high-risk self-harm. Consecutive cases of suicide and probable suicide are identified through coroners' registration of deaths in the defined region (Cork City and County, Ireland) and are frequency-matched for age group and gender with GP patient controls recruited from the same GP practice as the deceased. Data sources for suicide cases include coroners' records, interviews with health care professionals and proxy informants; data sources for GP controls and for high-risk self-harm controls include interviews with control, with proxy informants and with health care professionals. Interviews are semi-structured and consist of quantitative and qualitative parts. The quantitative parts include a range of validated questionnaires addressing psychiatric, psychosocial and occupational factors. The study adopts several methodological innovations, including accessing multiple data sources for suicide cases and controls simultaneously, recruiting proxy informants to examine consistency across sources. CONCLUSIONS The study allows for the investigation of consistency across different data sources and contributes to the methodological advancement of psychological autopsy research. The study will also inform clinical and public health practice. The comparison between suicide cases and controls will allow investigation of risk and protective factors for suicide more generally, while the comparison with high-risk self-harm patients will help to identify the factors associated specifically with a fatal outcome to a self-harm episode. A further enhancement is the particular focus on specific work-related risk factors for suicide.
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Affiliation(s)
- E. Arensman
- 0000000123318773grid.7872.aNational Suicide Research Foundation and School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
| | - C. Larkin
- 0000 0001 0742 0364grid.168645.8Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, 01655 USA
| | | | - S. Leitao
- 0000 0004 0617 6269grid.411916.aSchool of Public Health, College of Medicine and Health and National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, Cork University Hospital Maternity Hospital, Wilton, Cork, Ireland
| | - P. Corcoran
- 0000000123318773grid.7872.aNational Suicide Research Foundation and School of Public Health, University College Cork, Western Gateway Building, Cork, Ireland
| | - E. Williamson
- 0000000123318773grid.7872.aNational Suicide Research Foundation, University College Cork, Western Gateway Building, Cork, Ireland
| | - C. McAuliffe
- St. Patrick’s Mental Health Services, Cork, Ireland
| | - I. J. Perry
- 0000000123318773grid.7872.aSchool of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
| | - E. Griffin
- 0000000123318773grid.7872.aNational Suicide Research Foundation, University College Cork, Western Gateway Building, Cork, Ireland
| | - E. M. Cassidy
- Department of Psychiatry and Neurobehavioural Science, University College Cork, Liaison Psychiatry Service, Cork University Hospital, Cork, Ireland
| | - C. Bradley
- 0000000123318773grid.7872.aDepartment of General Practice, University College Cork, Western Gateway Building, Cork, Ireland
| | - N. Kapur
- 0000 0004 0430 6955grid.450837.dCentre for Mental Health and Safety, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - J. Kinahan
- 0000 0004 0575 9497grid.411785.eNorth Lee Psychiatric Services, Mercy University Hospital, Cork, Ireland
| | - A. Cleary
- 0000 0001 0768 2743grid.7886.1Geary Institute for Public Policy, University College Dublin, Dublin, Ireland
| | - T. Foster
- Consultant Psychiatrist, Omagh and Fermanagh, Northern Ireland
| | - J. Gallagher
- 0000000123318773grid.7872.aSchool of Public Health, University College Cork, Cork, Ireland
| | - K. Malone
- 0000 0001 0768 2743grid.7886.1School of Medicine, University College Dublin, Dublin, Ireland
| | - A. P. Ramos Costa
- 0000000123318773grid.7872.aSchool of Public Health and National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - B. A. Greiner
- 0000000123318773grid.7872.aSchool of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland
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30
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Barros JM, Melia R, Francis K, Bogue J, O'Sullivan M, Young K, Bernert RA, Rebholz-Schuhmann D, Duggan J. The Validity of Google Trends Search Volumes for Behavioral Forecasting of National Suicide Rates in Ireland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3201. [PMID: 31480718 PMCID: PMC6747463 DOI: 10.3390/ijerph16173201] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/18/2019] [Accepted: 08/27/2019] [Indexed: 11/17/2022]
Abstract
Annual suicide figures are critical in identifying trends and guiding research, yet challenges arising from significant lags in reporting can delay and complicate real-time interventions. In this paper, we utilized Google Trends search volumes for behavioral forecasting of national suicide rates in Ireland between 2004 and 2015. Official suicide rates are recorded by the Central Statistics Office in Ireland. While similar investigations using Google trends data have been carried out in other jurisdictions (e.g., United Kingdom, United Stated of America), such research had not yet been completed in Ireland. We compiled a collection of suicide- and depression-related search terms suggested by Google Trends and manually sourced from the literature. Monthly search rate terms at different lags were compared with suicide occurrences to determine the degree of correlation. Following two approaches based on vector autoregression and neural network autoregression, we achieved mean absolute error values between 4.14 and 9.61 when incorporating search query data, with the highest performance for the neural network approach. The application of this process to United Kingdom suicide and search query data showed similar results, supporting the benefit of Google Trends, neural network approach, and the applied search terms to forecast suicide risk increase. Overall, the combination of societal data and online behavior provide a good indication of societal risks; building on past research, our improvements led to robust models integrating search query and unemployment data for suicide risk forecasting in Ireland.
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Affiliation(s)
- Joana M Barros
- Insight Centre for Data Analytics, NUI Galway, H91 AEX4 Galway, Ireland.
- School of Computer Science, National University of Ireland Galway, Galway, Ireland.
| | - Ruth Melia
- Psychology Department, Health Service Executive MidWest, Ennis, Ireland
| | - Kady Francis
- Psychology Department, Health Service Executive Dublin Mid Leinster, Longford, Ireland
| | - John Bogue
- School of Psychology, National University of Ireland Galway, H91 EV56 Galway, Ireland
| | - Mary O'Sullivan
- Suicide Prevention Resource Office, Health Service Executive West, Galway, Ireland
| | - Karen Young
- School of Computer Science, National University of Ireland Galway, Galway, Ireland
| | - Rebecca A Bernert
- Suicide Prevention Research Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5717, USA
| | | | - Jim Duggan
- School of Computer Science, National University of Ireland Galway, Galway, Ireland
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Curtis S, Norman P, Cookson R, Cherrie M, Pearce J. Recession, local employment trends and change in self-reported health of individuals: A longitudinal study in England and Wales during the ‘great recession’. Health Place 2019; 59:102174. [DOI: 10.1016/j.healthplace.2019.102174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 07/13/2019] [Accepted: 07/18/2019] [Indexed: 12/24/2022]
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32
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Soleymani M, Yip PSF. Assessing the impact of the economic crises in 1997 and 2008 on suicides in Hong Kong, Taiwan and South Korea using a strata-bootstrap algorithm. J Appl Stat 2019; 47:666-684. [DOI: 10.1080/02664763.2019.1650008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Mehdi Soleymani
- Department of Statistics, The University of Auckland, Auckland, New Zealand
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong
| | - Paul S. F. Yip
- Department of Statistics, The University of Auckland, Auckland, New Zealand
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong
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Regional employment and individual worklessness during the Great Recession and the health of the working-age population: Cross-national analysis of 16 European countries. Soc Sci Med 2019; 267:112377. [PMID: 31285070 PMCID: PMC7116502 DOI: 10.1016/j.socscimed.2019.112377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 02/01/2019] [Accepted: 06/20/2019] [Indexed: 11/22/2022]
Abstract
Studies from single countries suggest that local labour market conditions, including rates of employment, tend to be associated with the health of the populations residing in those areas, even after adjustment for individual characteristics including employment status. The aim of this study is to strengthen the cross-national evidence base on the influence of regional employment levels and individual worklessness on health during the period of the Great Recession. We investigate whether higher regional employment levels are associated with better health over and above individual level employment. Individual level data (N = 23,078 aged 15–64 years) were taken from 16 countries (Austria, Belgium, Czech Republic, Denmark, Finland, France, Germany, Hungary, Ireland, Netherlands, Norway, Poland, Portugal, Spain, Sweden and United Kingdom) participating in the 2014 European Social Survey. Regional employment rates were extracted from Eurostat, corresponding with the start (2008) and end (2013) of the Great Recession. Health outcomes included self-reported heart or circulation problems, high blood pressure, diabetes, self-rated health, depression, obesity and allergies (as a falsification test). We calculated multilevel Poisson regression models, which included individuals nested within regions, controlling for potential confounding variables and country fixed effects. After adjustment for individual level socio-demographic factors, higher average regional employment rates (from 2008 to 2013) were associated with better health outcomes. Individual level worklessness was associated with worsened health outcomes, most strongly with poor self-rated health. In models including both individual worklessness and the average regional employment rate, regional employment remained associated with heart and circulation problems, depression and obesity. There was evidence of an interaction between individual worklessness and regional employment for poor self-rated health and depression. The findings suggest that across 16 European countries, for some key outcomes, higher levels of employment in the regional labour market may be beneficial for the health of the local population. Few cross-national studies have examined regional employment and health. High regional employment is related to reduced risk of poor health. Regional employment moderates the impact of individual worklessness on some outcomes.
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Griffin E, Bonner B, Dillon CB, O’Hagan D, Corcoran P. The association between self-harm and area-level characteristics in Northern Ireland: an ecological study. Eur J Public Health 2019; 29:948-953. [DOI: 10.1093/eurpub/ckz021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Factors contributing to suicidal behaviour are complex and multi-faceted. This study took an ecological approach to examine the association between area-level factors and rates of self-harm in Northern Ireland.
Methods
Data on self-harm presentations to emergency departments (EDs) were obtained from the Northern Ireland Self-harm Registry. The study included residents of Northern Ireland aged 16–64 years. Deprivation was measured using the Northern Ireland Multiple Deprivation Measure 2017. Population density and social fragmentation were calculated using measures from the 2011 census. Associations between area-level factors and self-harm rates were explored using negative binomial regression.
Results
Between 2013 and 2015, 14 477 individuals aged 16–64 years presented to EDs in Northern Ireland following self-harm. The rate of self-harm was 472 per 100 000 and was higher for male residents (478 vs. 467). Self-harm rates were highest in urban areas—680 per 100 000 in Belfast City and 751 per 100 000 in Derry City. Rates of self-harm in Northern Ireland were more than four times higher in the most deprived areas. A positive association with rates of self-harm held for the deprivation domains of employment, crime, education, health and income. There was a moderate association with population density. Some gender differences emerged, with associations with male rates of self-harm more pronounced.
Conclusion
These findings indicate that self-harm rates are highest for those residing in highly deprived areas, where unemployment, crime and low level of education are challenges. Community interventions tailored to meet the needs of specific areas may be effective in reducing suicidal behaviour.
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Affiliation(s)
- Eve Griffin
- National Suicide Research Foundation, Cork, Ireland
| | | | | | | | - Paul Corcoran
- National Suicide Research Foundation, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
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35
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The association between economic uncertainty and suicide in the short-run. Soc Sci Med 2019; 220:403-410. [DOI: 10.1016/j.socscimed.2018.11.035] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/03/2018] [Accepted: 11/23/2018] [Indexed: 11/21/2022]
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Availability and use of mental health services in European countries: Influence on national suicide rates. J Affect Disord 2018; 239:66-71. [PMID: 29990664 DOI: 10.1016/j.jad.2018.06.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/13/2018] [Accepted: 06/15/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous research suggests significant increases in suicide mortality rates in European countries following the economic crisis of 2008. However, the relationship between national differences in availability and use of mental health services and suicide rates has not been extensively examined yet. MATERIALS AND METHODS Data on mental health services and socioeconomic variables were derived from Eurostat for the years 2000-2013 for ten European countries. The national health care variables consisted of suicide mortality rate (SMR), average length of hospital stay and number of hospitalizations due to affective disorder or any psychiatric disorder, number of psychiatric beds and number of prescribed antidepressants. Economic variables included the gross domestic product (GDP), the gross domestic product per 1000 inhabitants (Real GDP), the rate of unemployment and the GINI-coefficient as a measurement for the equality of wealth distribution. Mixed models were used to investigate the potential influence of the onset of the economic crisis in 2008 on each of the psychiatric variables. Multivariable regression analyses were used to assess the influence on suicide mortality rates. RESULTS In this study, a significant change in slope starting from 2008 was revealed for the number of psychiatric beds, hospitalizations due to affective disorder or any psychiatric disorder and for prescribed antidepressants. Furthermore, a significant step change for hospitalizations due to affective disorder was observed in 2008. SMR exhibited a significant step change in 2008 for males and females as well as a significant change in slope from 2008 onwards for males only. Contrary to our hypothesis, most variables showed no statistically significant influence on SMR. Only a higher number of available psychiatric beds was significantly associated with higher suicide mortality rates. This effect, however, was only significant for females and did not remain significant after correcting for economic variables. Less than 10% of suicide mortality rate variability could be explained by a model including all variables, further corroborating the multifactorial etiology of suicide. LIMITATIONS Since administrative registry data was used, the results should be interpreted with caution. Results might not be applicable to countries not included. CONCLUSION While significant changes in the psychiatric variables, as well as SMR, were observed, no statistically significant influence on SMR remained after correcting for country, time and economic variables. Our study suggests the necessity of a more comprehensive international data gathering effort. Further research is needed to identify populations at risk of suicide.
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Bohnert ASB, Guy GP, Losby JL. Opioid Prescribing in the United States Before and After the Centers for Disease Control and Prevention's 2016 Opioid Guideline. Ann Intern Med 2018; 169:367-375. [PMID: 30167651 PMCID: PMC6176709 DOI: 10.7326/m18-1243] [Citation(s) in RCA: 285] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND In response to adverse outcomes from prescription opioids, the Centers for Disease Control and Prevention (CDC) released the Guideline for Prescribing Opioids for Chronic Pain in March 2016. OBJECTIVE To test the hypothesis that the CDC guideline release corresponded to declines in specific opioid prescribing practices. DESIGN Interrupted time series analysis of monthly prescribing measures from the IQVIA transactional data warehouse and Real-World Data Longitudinal Prescriptions population-level estimates based on retail pharmacy data. Population size was determined by U.S. Census monthly estimates. SETTING United States, 2012 to 2017. PATIENTS Persons prescribed opioid analgesics. MEASUREMENTS Outcomes included opioid dosage, days supplied, overlapping benzodiazepine prescriptions, and the overall rate of prescribing. RESULTS The rate of high-dosage prescriptions (≥90 morphine equivalent milligrams per day) was 683 per 100 000 persons in January 2012 and declined by 3.56 (95% CI, -3.79 to -3.32) per month before March 2016 and by 8.00 (CI, -8.69 to -7.31) afterward. Likewise, the percentage of patients with overlapping opioid and benzodiazepine prescriptions was 21.04% in January 2012 and declined by 0.02% (CI, -0.04% to -0.01%) per month before the CDC guideline release and by 0.08% (CI, -0.08% to -0.07%) per month afterward. The overall opioid prescribing rate was 6577 per 100 000 persons in January 2012 and declined by 23.48 (CI, -26.18 to -20.78) each month before the guideline release and by 56.74 (CI, -65.96 to -47.53) per month afterward. LIMITATION No control population; inability to determine the appropriateness of opioid prescribing. CONCLUSION Several opioid prescribing practices were decreasing before the CDC guideline, but the time of its release was associated with a greater decline. Guidelines may be effective in changing prescribing practices. PRIMARY FUNDING SOURCE CDC.
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Affiliation(s)
- Amy S B Bohnert
- University of Michigan and Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan (A.S.B.)
| | - Gery P Guy
- Centers for Disease Control and Prevention, Atlanta, Georgia (G.P.G., J.L.L.)
| | - Jan L Losby
- Centers for Disease Control and Prevention, Atlanta, Georgia (G.P.G., J.L.L.)
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38
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Akhter N, Bambra C, Mattheys K, Warren J, Kasim A. Inequalities in mental health and well-being in a time of austerity: Follow-up findings from the Stockton-on-Tees cohort study. SSM Popul Health 2018; 6:75-84. [PMID: 30225337 PMCID: PMC6138882 DOI: 10.1016/j.ssmph.2018.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/16/2018] [Accepted: 08/19/2018] [Indexed: 11/10/2022] Open
Abstract
In response to the 2007/8 financial crisis and the subsequent ‘Great Recession’, the UK government pursued a policy of austerity, characterised by public spending cuts and reductions in working-age welfare benefits. This paper reports on a case study of the effects of this policy on local inequalities in mental health and wellbeing in the local authority of Stockton-on-Tees in the North East of England, an area with very high spatial and socio-economic inequalities. Follow-up findings from a prospective cohort study of the gap in mental health and wellbeing between the most and least deprived neighbourhoods of Stockton-on-Tees is presented. It is the first quantitative study to use primary data to intensively and longitudinally explore local inequalities in mental health and wellbeing during austerity and it also examines any changes in the underpinning social and behavioural determinants of health. Using a stratified random sampling technique, the data was analysed using linear mixed effects model (LMM) that explored any changes in the gap in mental health and wellbeing between people from the most and least deprived areas, alongside any changes in the material, psychosocial and behavioural determinants. The main findings are that the significant gap in mental health between the two areas remained constant over the 18-month study period, whilst there were no changes in the underlying determinants. These results may reflect our relatively short follow-up period or the fact that the cohort sample were older than the general population and pensioners in the UK have largely been protected from austerity. The study therefore potentially provides further empirical evidence to support assertions that social safety nets matter - particularly in times of economic upheaval. First quantitative study to use primary data to intensively and longitudinally explore local inequalities in mental health and wellbeing during austerity. Also examines any changes in the material, psychosocial and behavioural determinants. Finds that the large gap in mental health between the two areas remained constant over the 18-month study period, whilst there were no changes in the underlying determinants. The stability of inequalities in mental health and wellbeing during austerity may have been because the sample was older than the general population and pensioners in the UK have largely been shielded from austerity. Discusses the importance of universal benefits in the context of health inequalities and austerity.
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Affiliation(s)
- N Akhter
- Wolfson Research Institute for Health and Wellbeing, Durham University, United Kingdom.,Fuse - UKCRC Centre for Translational Research in Public Health, United Kingdom
| | - C Bambra
- Fuse - UKCRC Centre for Translational Research in Public Health, United Kingdom.,Institute of Health and Society, Newcastle University, United Kingdom
| | - K Mattheys
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
| | - J Warren
- St Cuthbert's Society, Durham University, United Kingdom
| | - A Kasim
- Wolfson Research Institute for Health and Wellbeing, Durham University, United Kingdom.,Fuse - UKCRC Centre for Translational Research in Public Health, United Kingdom
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39
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Horgan A, Kelly P, Goodwin J, Behan L. Depressive Symptoms and Suicidal Ideation among Irish Undergraduate College Students. Issues Ment Health Nurs 2018; 39:575-584. [PMID: 29465285 DOI: 10.1080/01612840.2017.1422199] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study examined the prevalence of depressive symptoms and suicidal ideation among 220 first year undergraduate university students in Ireland. Data were collected using the Centre for Epidemiological Studies Depression Scale and the Suicidal Behaviours Questionnaire. Findings indicated that 59% of participants experienced depressive symptoms and 28.5% had suicidal ideation. Financial stress and poor relationships with both parents, increased the odds of experiencing depressive symptoms. Sexual orientation, financial stress, and poor relationships with fathers, increased the odds of experiencing suicidal ideation. Suicidal ideation was also higher in those who had sought help in the past from mental health professionals. Nurses need to be aware of the factors associated with mental ill-health in this population.
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Affiliation(s)
- Aine Horgan
- a School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork , Cork , Ireland
| | - Peter Kelly
- b School of Health Sciences, Waterford Institute of Technology , Waterford , Ireland
| | - John Goodwin
- c School of Nursing and Midwifery, University College Cork , Cork , Ireland
| | - Laura Behan
- d School of Applied Psychology, University College Cork , Ireland
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Griffin E, McMahon E, McNicholas F, Corcoran P, Perry IJ, Arensman E. Increasing rates of self-harm among children, adolescents and young adults: a 10-year national registry study 2007-2016. Soc Psychiatry Psychiatr Epidemiol 2018; 53:663-671. [PMID: 29721594 DOI: 10.1007/s00127-018-1522-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/25/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Rates of hospital-treated self-harm are highest among young people. The current study examined trends in rates of self-harm among young people in Ireland over a 10-year period, as well as trends in self-harm methods. METHODS Data from the National Self-Harm Registry Ireland on presentations to hospital emergency departments (EDs) following self-harm by those aged 10-24 years during the period 2007-2016 were included. We calculated annual self-harm rates per 100,000 by age, gender and method of self-harm. Poisson regression models were used to examine trends in rates of self-harm. RESULTS The average person-based rate of self-harm among 10-24-year-olds was 318 per 100,000. Peak rates were observed among 15-19-year-old females (564 per 100,000) and 20-24-year-old males (448 per 100,000). Between 2007 and 2016, rates of self-harm increased by 22%, with increases most pronounced for females and those aged 10-14 years. There were marked increases in specific methods of self-harm, including those associated with high lethality. CONCLUSIONS The findings indicate that the age of onset of self-harm is decreasing. Increasing rates of self-harm, along with increases in highly lethal methods, indicate that targeted interventions in key transition stages for young people are warranted.
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Affiliation(s)
- Eve Griffin
- National Suicide Research Foundation, 4.28 Western Gateway Building, University College Cork, Cork, Ireland.
| | - Elaine McMahon
- National Suicide Research Foundation, 4.28 Western Gateway Building, University College Cork, Cork, Ireland
| | - Fiona McNicholas
- Department of Child and Adolescent Psychiatry, Our Lady's Children's Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland.,Lucena Clinic, Rathgar, Dublin 6, Ireland
| | - Paul Corcoran
- National Suicide Research Foundation, 4.28 Western Gateway Building, University College Cork, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
| | - Ivan J Perry
- School of Public Health, University College Cork, Cork, Ireland
| | - Ella Arensman
- National Suicide Research Foundation, 4.28 Western Gateway Building, University College Cork, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
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Are we finally making progress with suicide and self-harm? An overview of the history, epidemiology and evidence for prevention. Ir J Psychol Med 2018; 35:95-101. [PMID: 30115199 DOI: 10.1017/ipm.2017.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Ireland's suicide rate is falling, but suicide and self-harm remain substantial societal problems. It is not possible to predict suicide at the level of the individual but good primary care, good mental health care and good social care all likely reduce risk. In terms of targeted interventions, public health measures, such as paracetamol pack size regulations, have the best evidence base to support them. Despite increased public and professional discussion, much remains to be done to provide effective, coordinated support to those at risk of suicide and those bereaved. In 2016, there were up to 300 different groups providing support. Clearly, a coordinated, effective and compassionate approach is needed, linking community and state resources meaningfully with each other. Approaches rooted outside of core mental health services will be vital: addressing alcohol problems and other addictions, reducing homelessness, reforming the criminal justice system and improving social care.
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Grace B, Richardson N, Carroll P. ". . . If You're Not Part of the Institution You Fall by the Wayside": Service Providers' Perspectives on Moving Young Men From Disconnection and Isolation to Connection and Belonging. Am J Mens Health 2018; 12:252-264. [PMID: 26921002 PMCID: PMC5818107 DOI: 10.1177/1557988316634088] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
There have been increasing calls for more gender-specific service provision to support young men's (20-29 years) mental health and well-being. In Ireland, young men are the demographic group that are most likely to die by suicide but among the least likely to seek help. This study sought to investigate service providers' perspectives on the factors that support or inhibit young men from engaging in services targeted at supporting their mental/emotional well-being. Qualitative methodologies (focus groups, n = 9; interviews, n = 7) were used for this study. Disconnection from family and community was identified as a key indicator of "at-risk" groups of young men who, more typically, had experienced significant disruption in their lives. The discord between demands and expectations facing young men on one hand, and insufficient life-management and coping skills on the other, left many young men vulnerable and bereft. The desire to save face and preserve one's masculine identity was linked to young men's reluctance to seek help when feeling down. There was a strong consensus that there could be no shortcuts to [re]connecting with young men. While sport, technology, and social media were cited as appropriate media in which to engage young men, the essence of sustained connection revolved around creating safety, trust, rapport, and meaningful relationships. The findings from this study have informed the development of a Train the Trainer program ("Connecting with Young Men"), which is currently being delivered to service providers in Ireland and which may have implications for service provision elsewhere.
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Affiliation(s)
- Billy Grace
- Institute of Technology Carlow, Carlow, Ireland
| | | | - Paula Carroll
- Waterford Institute of Technology, Waterford, Ireland
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43
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Arensman E, Griffin E, Daly C, Corcoran P, Cassidy E, Perry IJ. Recommended next care following hospital-treated self-harm: Patterns and trends over time. PLoS One 2018; 13:e0193587. [PMID: 29494659 PMCID: PMC5832269 DOI: 10.1371/journal.pone.0193587] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/14/2018] [Indexed: 11/22/2022] Open
Abstract
Objective The specific objectives of this study were to examine variation in the care of self-harm patients in hospital settings and to identify the factors that predict recommended next care following self-harm. Methods Data on consecutive presentations to Irish emergency departments (EDs) involving self-harm from the National Self-Harm Registry Ireland from 2004 to 2012 were utilised. Univariate and multivariate regression analyses were performed to assess the associations between patients’ clinical and demographic characteristics, and recommended next care received. Results Across the study period a total 101,904 self-harm presentations were made to hospital EDs, involving 63,457 individuals. Over the course of the study there was a declining number of presentations resulting in patient admission following attendance with self-harm. Recommended next care varied according to hospital location, with general admission rates ranging from 11% to 61% across administrative health regions. Multinomial logistic regression identified that the factor which most strongly affected next care was the presenting hospital. Being male, older age, method, repeat self-harm, time of attendance and residence of the patient were all identified as influencing care received. Psychiatric admission was most common when highly lethal methods of self-harm were used (OR = 4.00, 95% CI, 3.63–4.41). A relatively large proportion of patients left the ED without being seen (15%) and the risk of doing so was highest for self-harm repeaters (1.64, 1.55–1.74 for those with 5+ presentations). Conclusions The extensive hospital variation in recommended next care indicates that management of self-harm patients may be determined more by where they present than by the needs of the patient. The study outcomes underline the need to standardise the clinical management of self-harm patients in general hospital settings.
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Affiliation(s)
- Ella Arensman
- National Suicide Research Foundation, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
- * E-mail:
| | - Eve Griffin
- National Suicide Research Foundation, Cork, Ireland
| | | | - Paul Corcoran
- National Suicide Research Foundation, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Eugene Cassidy
- Department of Psychiatry, University College Cork, Cork, Ireland
- Liaison Psychiatry Service, Cork University Hospital, Cork, Ireland
| | - Ivan J. Perry
- School of Public Health, University College Cork, Cork, Ireland
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44
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O'Neill S, Ennis E, Corry C, Bunting B. Factors Associated with Suicide in Four Age Groups: A Population Based Study. Arch Suicide Res 2018; 22:128-138. [PMID: 28166461 DOI: 10.1080/13811118.2017.1283265] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Life events and circumstances leading to death change throughout the life course. In this study, 4 age groups within those who have died by suicide are compared in terms method of suicide, sex, occupation, mental disorders, prior suicide attempts, and life events prior to death. Analyses were based on a database of deaths by suicide and undetermined intent based on data in the Northern Ireland (NI) coronial files from 2005-2011 (N = 1667). Research determined that hanging is very prominent as a method of death within the under-20 age group. Women who die by suicide are more likely to have a known mental disorder than men, and the proportions increase with age group. Relationship difficulties are associated with many of these deaths and particularly for males aged under 40 years. Physical health and life events were more relevant than mental illness per se, in males aged over 61 years. For a sizeable proportion of the cases included in the current database there was no information on the life events prior to death. Understanding the factors associated with suicide across age groups is essential to informing suicide prevention strategy and programs and the development of more nuanced and effective interventions.
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45
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O'Neill S, Ennis E, McFeeters D, Gallagher L. Financial Sector Workers' Experiences of Managing Suicidal Clients. CRISIS 2017; 39:159-165. [PMID: 29052433 DOI: 10.1027/0227-5910/a000483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Financial sector workers interface with indebted clients, who may be distressed and have heightened vulnerability to suicidality. AIM(S) This study examined the experiences of 10 Irish financial sector workers who had experiences of encountering distressed clients who discuss suicide. METHOD Semistructured interviews (open-ended questions) were used. RESULTS Interpretative phenomenological analysis (IPA) identified four themes, namely: (1) avoidance versus confrontation of reality (management of the debt); (2) role conflict (recovering the debt vs. supporting the client); (3) emotional impact and distancing from clients (coping with concerns for client welfare); (4) desire for support (practical and emotional training and support needs). LIMITATIONS The frequency with which such clients were encountered was not assessed. CONCLUSION These themes demonstrate the need to provide support to this group, and also the difficulties in providing training to manage suicidal clients in a context where the staff member's goal is to recover debt.
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Affiliation(s)
- Siobhan O'Neill
- 1 School of Psychology, Ulster University, L. Derry, Northern Ireland, UK
| | - Edel Ennis
- 1 School of Psychology, Ulster University, L. Derry, Northern Ireland, UK
| | - Danielle McFeeters
- 1 School of Psychology, Ulster University, L. Derry, Northern Ireland, UK
| | - Lia Gallagher
- 1 School of Psychology, Ulster University, L. Derry, Northern Ireland, UK
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46
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Sutherland G, Milner A, Dwyer J, Bugeja L, Woodward A, Robinson J, Pirkis J. Implementation and evaluation of the Victorian Suicide Register. Aust N Z J Public Health 2017; 42:296-302. [DOI: 10.1111/1753-6405.12725] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/01/2017] [Accepted: 08/01/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Georgina Sutherland
- Melbourne School of Population and Global Health; University of Melbourne; Victoria
| | - Allison Milner
- Melbourne School of Population and Global Health; University of Melbourne; Victoria
| | - Jeremy Dwyer
- Coroners Prevention Unit; Coroners Court of Victoria
- Melbourne School of Population and Global Health; University of Melbourne; Victoria
| | - Lyndal Bugeja
- Coroners Prevention Unit; Coroners Court of Victoria
- Department of Forensic Medicine; Monash University; Victoria
| | - Alan Woodward
- Lifeline Research Foundation; Australian Capital Territory
| | - Jo Robinson
- Orygen; The National Centre of Excellence in Youth Mental Health; Victoria
| | - Jane Pirkis
- Melbourne School of Population and Global Health; University of Melbourne; Victoria
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47
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Bonnie Lee C, Liao CM, Lin CM. The impacts of the global financial crisis on hospitalizations due to depressive illnesses in Taiwan: A prospective nationwide population-based study. J Affect Disord 2017. [PMID: 28633047 DOI: 10.1016/j.jad.2017.06.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND In the third quarter of 2008, a major financial crisis hit many developed countries. Taiwan suffered its own share: a rise in unemployment and a severe decline in gross domestic product. This study is to address the health consequences of this crisis on different socioeconomic populations in Taiwan. METHODS A sample of 6,225,766 men and 5,417,651 women, was obtained and their admissions data over 2007-2012 were retrieved. Stratified into three income levels, the sample was examined on the 147,921 episodes of hospitalization due to depressive illnesses (DIs) over that period by an interrupted time series analysis for monthly incidence rates of DI hospitalizations RESULTS: The adjusted incidence rates of hospitalization (AIRH) for DIs among the low income were 10 times that of the high income group. The AIRHs were generally higher in all of three female income groups than they were in the three male income groups. The low income men and women showed increases (of 18.0% and 14.2%, respectively) beginning in April 2008 that sustained for two years. The high income women exhibited a 5.0% monthly rise in the rate of DI hospitalizations. LIMITATIONS Our time series models can control some confounding factors, but the ecological fallacy remained. CONCLUSIONS This study provides evidence that the economic recession resulted in increased rates of DI hospitalization in Taiwan, especially among the low income population. Women of higher incomes may have suffered a more enduring impact.
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Affiliation(s)
- Chiachi Bonnie Lee
- Department of Health Services Administration, College of Public Health, China Medical University, Taichung, Taiwan
| | - Chen-Mao Liao
- Department of Applied Statistics and Information Science, Ming Chuan University, Taoyuan, Taiwan
| | - Chih-Ming Lin
- Department of Healthcare Information and Management, Ming Chuan University, Taoyuan, Taiwan.
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Kearns M, Muldoon OT, Msetfi RM, Surgenor PWG. Darkness into light? Identification with the crowd at a suicide prevention fundraiser promotes well-being amongst participants. EUROPEAN JOURNAL OF SOCIAL PSYCHOLOGY 2017. [DOI: 10.1002/ejsp.2304] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Michelle Kearns
- Centre for Social Issues Research, Department of Psychology; University of Limerick; Limerick Ireland
| | - Orla T. Muldoon
- Centre for Social Issues Research, Department of Psychology; University of Limerick; Limerick Ireland
- Health Research Institute; University of Limerick; Limerick Ireland
| | - Rachel M. Msetfi
- Centre for Social Issues Research, Department of Psychology; University of Limerick; Limerick Ireland
- Health Research Institute; University of Limerick; Limerick Ireland
| | - Paul W. G. Surgenor
- Pieta House; Centre for the Prevention of Suicide and Self-Harm; Dublin Ireland
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49
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Barnes MC, Haase AM, Bard AM, Donovan JL, Davies R, Dursley S, Potokar J, Kapur N, Hawton K, O'Connor RC, Hollingworth W, Metcalfe C, Gunnell D. HOPE: Help fOr People with money, employment, benefit or housing problems: study protocol for a randomised controlled trial. Pilot Feasibility Stud 2017; 3:44. [PMID: 29043091 PMCID: PMC5629806 DOI: 10.1186/s40814-017-0179-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 08/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Self-harm and suicide increase in times of economic recession. Factors including job loss, austerity measures, financial difficulties and house repossession contribute to the risk. Vulnerable individuals commonly experience difficulties in navigating the benefits system and in accessing the available sources of welfare and debt advice, and this contributes to their distress. Our aim is to determine the feasibility and acceptability of a brief psychosocial intervention (the "HOPE" service) for people presenting to hospital emergency departments (ED) following self-harm or in acute distress because of financial, employment, or welfare (benefit) difficulties. METHOD A pilot study including randomisation will be employed to determine whether it is possible to undertake a full-scale trial. Twenty people presenting to the ED who have self-harmed, have suicidal thoughts and depression and/or are in crisis and where financial, employment or benefit problems are cited as contributory factors will be asked to consent to random allocation to the intervention or control arm on a 2:1 basis. People who require secondary mental health follow-up will be excluded. Those randomised to the intervention arm will receive up to six sessions with a mental health worker who will provide practical help with financial and other problems. The mental health worker will use the motivational interviewing method in their interactions with participants. Control participants will receive one session signposting them to existing relevant support organisations. Participants will be followed up after 3 months. Participants and the mental health workers will take part in qualitative interviews to enable refinement of the intervention. The acceptability of outcome measures including the PHQ-9, GAD-7, repeat self-harm, EQ5D-5L and questions about debt, employment and welfare benefits will be explored. DISCUSSION This study will assess whether a full-scale randomised trial of this novel intervention to prevent self-harm among those distressed because of financial difficulties is feasible, including the acceptability of randomisation, potential rate of recruitment and the acceptability of outcome measures. TRIAL REGISTRATION ISRCTN58531248.
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Affiliation(s)
- M C Barnes
- School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS UK
| | - A M Haase
- School of Policy Studies, University of Bristol, Bristol, UK
| | - A M Bard
- School of Veterinary Sciences, University of Bristol, Bristol, UK
| | - J L Donovan
- National Institute for Health Research Collaboration for Leadership in Applied Health Reserach and Care West, UH Bristol NHS Trust, Bristol, UK
| | - R Davies
- Public Patient Involvement, University of the West of England, Bristol, UK
| | - S Dursley
- Psychiatric Liaison Team, UH Bristol NHS Trust, Bristol, UK
| | - J Potokar
- School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS UK
| | - N Kapur
- Centre for Suicide Prevention, University of Manchester, Manchester, UK
| | - K Hawton
- Centre for Suicide Research, University of Oxford, Oxford, UK
| | - R C O'Connor
- Suicidal Behaviour Research Laboratory, University of Glasgow, Glasgow, UK
| | - W Hollingworth
- School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS UK
| | - C Metcalfe
- School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS UK
| | - D Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS UK.,NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
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50
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Strumpf EC, Charters TJ, Harper S, Nandi A. Did the Great Recession affect mortality rates in the metropolitan United States? Effects on mortality by age, gender and cause of death. Soc Sci Med 2017; 189:11-16. [PMID: 28772108 DOI: 10.1016/j.socscimed.2017.07.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 07/04/2017] [Accepted: 07/20/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Mortality rates generally decline during economic recessions in high-income countries, however gaps remain in our understanding of the underlying mechanisms. This study estimates the impacts of increases in unemployment rates on both all-cause and cause-specific mortality across U.S. metropolitan regions during the Great Recession. METHODS We estimate the effects of economic conditions during the recent and severe recessionary period on mortality, including differences by age and gender subgroups, using fixed effects regression models. We identify a plausibly causal effect by isolating the impacts of within-metropolitan area changes in unemployment rates and controlling for common temporal trends. We aggregated vital statistics, population, and unemployment data at the area-month-year-age-gender-race level, yielding 527,040 observations across 366 metropolitan areas, 2005-2010. RESULTS We estimate that a one percentage point increase in the metropolitan area unemployment rate was associated with a decrease in all-cause mortality of 3.95 deaths per 100,000 person years (95%CI -6.80 to -1.10), or 0.5%. Estimated reductions in cardiovascular disease mortality contributed 60% of the overall effect and were more pronounced among women. Motor vehicle accident mortality declined with unemployment increases, especially for men and those under age 65, as did legal intervention and homicide mortality, particularly for men and adults ages 25-64. We find suggestive evidence that increases in metropolitan area unemployment increased accidental drug poisoning deaths for both men and women ages 25-64. CONCLUSIONS Our finding that all-cause mortality decreased during the Great Recession is consistent with previous studies. Some categories of cause-specific mortality, notably cardiovascular disease, also follow this pattern, and are more pronounced for certain gender and age groups. Our study also suggests that the recent recession contributed to the growth in deaths from overdoses of prescription drugs in working-age adults in metropolitan areas. Additional research investigating the mechanisms underlying the health consequences of macroeconomic conditions is warranted.
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Affiliation(s)
- Erin C Strumpf
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC H3A 1A2, Canada; Department of Economics, McGill University, 855 Sherbrooke St. West, Montreal, QC H3A 2T7, Canada; Institute for Health and Social Policy, McGill University, 1130 Pine Avenue West, Montreal, QC H3A 1A2, Canada.
| | - Thomas J Charters
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC H3A 1A2, Canada; Institute for Health and Social Policy, McGill University, 1130 Pine Avenue West, Montreal, QC H3A 1A2, Canada
| | - Sam Harper
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC H3A 1A2, Canada; Institute for Health and Social Policy, McGill University, 1130 Pine Avenue West, Montreal, QC H3A 1A2, Canada
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC H3A 1A2, Canada; Institute for Health and Social Policy, McGill University, 1130 Pine Avenue West, Montreal, QC H3A 1A2, Canada
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