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Suicide versus homicide firearm injury patterns on trauma systems in a study of the National Trauma Data Bank (NTDB). Sci Rep 2022; 12:15672. [PMID: 36123380 PMCID: PMC9485125 DOI: 10.1038/s41598-022-17280-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/22/2022] [Indexed: 11/24/2022] Open
Abstract
Firearm related mortality in the USA surpassed all other developed countries. This study hypothesizes that injury patterns, weapon type, and mortality differ between suicide groups as opposed to homicide. The American College of Surgeons National Trauma Database was queried from January 2017 to December 2019. All firearm related injuries were included, and weapon type was abstracted. Differences between homicide and suicide groups by sex, age, race, and injury severity were compared using a Mann–Whitney test for numerical data and Fisher’s exact test for categorical data. The association between weapon type and mortality relative to suicide as opposed to homicide was assessed in Fisher’s exact tests. Significance was defined as p < 0.05. There were 100,031 homicide and 11,714 suicide subjects that met inclusion criteria. Homicides were mostly assault victims (97.6%), male (88%), African–American (62%), had less severe injury (mean (ISS) 12.07) and a median age of 20 years old (IQR: 14, 30, p < 0.01). Suicides were mostly male (83%), white (79%), had more severe injury (mean ISS 20.73), and a median age of 36 years old (IQR: 19, 54, p < 0.01). Suicide group had higher odds of head/neck (OR = 13.6) or face (OR = 5.7) injuries, with lower odds of injury to chest (OR = 0.55), abdominal or pelvic contents (OR = 0.25), extremities or pelvic girdle (OR = 0.15), or superficial soft tissue (OR = 0.32). Mortality rate was higher for suicide group (44.8%; 95% confidence interval (CI) 43.9%, 45.7%) compared to the homicide group (11.5%; 95% CI 11.3%, 11.7%). Suicide had higher mortality, more severe injuries, and more head/neck/facial injuries than homicide. Majority of suicides were with handguns.
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Kim HJ, Kweon YS, Hong HJ. Characteristics of Korean students advised to seek psychiatric treatment before death by suicide. Front Psychiatry 2022; 13:950514. [PMID: 36147983 PMCID: PMC9485467 DOI: 10.3389/fpsyt.2022.950514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Suicide is the leading cause of death among adolescents in Korea. Psychiatric disorders are well-known risk factors for suicide, but the proportion of children and adolescents who died by suicide and who had received psychiatric treatment is low. This study aims to examine how many school students who died by suicide were advised by their school to seek psychiatric treatment before their death and to characterize their clinical characteristics. METHODS We analyzed data collected by the Ministry of Education of Korea for all students who died by suicide between 2016 and 2020. Students were grouped according to whether or not they were advised to seek psychiatric treatment by their school-based on mental health screening and teachers' judgments. Sociodemographic characteristics (sex, educational stage, family structure, and socioeconomic status), suicide-related characteristics (place of suicide, suicide method, suicide note, previous self-harm, and previous suicide attempt), emotional and behavioral status, school life and personal, and family problems were compared between the two groups. RESULTS Analysis was conducted for 544 students, 110 (20.2%) of whom were advised to seek psychiatric treatment by their school before their death. This group had a higher proportion of girls; poorer attendance; higher frequency of depression, anxiety, impulsivity, and social problems; personal problems (appearance, friend-related, and mental and physical health problems); family problems (mental health problems of family, bad relationship with parents, and conflict of parents); and higher incidence of self-harm or suicide attempts (P < 0.001) than the other group. CONCLUSION Teachers seem to advise psychiatric treatment when mental health problems are revealed at school. It showed distinctive clinical characteristics between the two groups. Preventing suicide among students requires the attention and effort not only of schools, but also of families, communities, and mental health professionals.
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Affiliation(s)
- Hee Jin Kim
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Yong-Sil Kweon
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, South Korea
| | - Hyun Ju Hong
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, South Korea.,Suicide and School Mental Health Institute, Anyang, South Korea
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Van Bulck L, Goossens E, Luyckx K, Apers S, Oechslin E, Thomet C, Budts W, Enomoto J, Sluman MA, Lu CW, Jackson JL, Khairy P, Cook SC, Chidambarathanu S, Alday L, Eriksen K, Dellborg M, Berghammer M, Johansson B, Mackie AS, Menahem S, Caruana M, Veldtman G, Soufi A, Fernandes SM, White K, Callus E, Kutty S, Moons P. Healthcare system inputs and patient-reported outcomes: a study in adults with congenital heart defect from 15 countries. BMC Health Serv Res 2020; 20:496. [PMID: 32493367 PMCID: PMC7268498 DOI: 10.1186/s12913-020-05361-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 05/25/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The relationship between healthcare system inputs (e.g., human resources and infrastructure) and mortality has been extensively studied. However, the association between healthcare system inputs and patient-reported outcomes remains unclear. Hence, we explored the predictive value of human resources and infrastructures of the countries' healthcare system on patient-reported outcomes in adults with congenital heart disease. METHODS This cross-sectional study included 3588 patients with congenital heart disease (median age = 31y; IQR = 16.0; 52% women; 26% simple, 49% moderate, and 25% complex defects) from 15 countries. The following patient-reported outcomes were measured: perceived physical and mental health, psychological distress, health behaviors, and quality of life. The assessed inputs of the healthcare system were: (i) human resources (i.e., density of physicians and nurses, both per 1000 people) and (ii) infrastructure (i.e., density of hospital beds per 10,000 people). Univariable, multivariable, and sensitivity analyses using general linear mixed models were conducted, adjusting for patient-specific variables and unmeasured country differences. RESULTS Sensitivity analyses showed that higher density of physicians was significantly associated with better self-reported physical and mental health, less psychological distress, and better quality of life. A greater number of nurses was significantly associated with better self-reported physical health, less psychological distress, and less risky health behavior. No associations between a higher density of hospital beds and patient-reported outcomes were observed. CONCLUSIONS This explorative study suggests that density of human resources for health, measured on country level, are associated with patient-reported outcomes in adults with congenital heart disease. More research needs to be conducted before firm conclusions about the relationships observed can be drawn. TRIAL REGISTRATION ClinicalTrials.gov: NCT02150603. Registered 30 May 2014.
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Affiliation(s)
- Liesbet Van Bulck
- KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Kapucijnenvoer 35, Box 7001, B-3000, Leuven, Belgium.,Research Foundation Flanders (FWO), Brussels, Belgium
| | - Eva Goossens
- KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Kapucijnenvoer 35, Box 7001, B-3000, Leuven, Belgium.,Research Foundation Flanders (FWO), Brussels, Belgium.,Division of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, University of Antwerp, Antwerp, Belgium
| | - Koen Luyckx
- KU Leuven School Psychology and Development in Context, KU Leuven - University of Leuven, Leuven, Belgium.,UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Silke Apers
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Erwin Oechslin
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Corina Thomet
- Center for Congenital Heart Disease, Inselspital - Bern University Hospital, University of Bern, Bern, Switzerland
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium.,KU Leuven Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Junko Enomoto
- Department of Adult Congenital Heart Disease, Chiba Cardiovascular Center, Chiba, Japan
| | - Maayke A Sluman
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Chun-Wei Lu
- National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Jamie L Jackson
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA
| | - Paul Khairy
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Stephen C Cook
- Adult Congenital Heart Disease Center, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
| | - Shanthi Chidambarathanu
- Pediatric Cardiology, Frontier Lifeline Hospital (Dr. K. M. Cherian Heart Foundation), Chennai, India
| | - Luis Alday
- Division of Cardiology, Hospital de Niños, Córdoba, Argentina
| | - Katrine Eriksen
- Adult Congenital Heart Disease Center, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Mikael Dellborg
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Adult Congenital Heart Unit, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.,Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Malin Berghammer
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Department of Health Sciences, University West, Trollhättan, Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Canada
| | - Samuel Menahem
- Monash Heart, Monash Medical Centre, Monash University, Melbourne, Australia
| | - Maryanne Caruana
- Department of Cardiology, Mater Dei Hospital, Birkirkara Bypass, Msida, Malta
| | - Gruschen Veldtman
- Adult Congenital Heart Disease Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Alexandra Soufi
- Department of Congenital Heart Disease, Louis Pradel Hospital, Hospices civils de Lyon, Lyon, France
| | - Susan M Fernandes
- Adult Congenital Heart Disease Program at Stanford, Lucile Packard Children's Hospital and Stanford Health Care, Palo Alto, CA, USA
| | - Kamila White
- Adult Congenital Heart Disease Center, Washington University and Barnes Jewish Heart & Vascular Center, University of Missouri, Saint Louis, MO, USA
| | - Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Shelby Kutty
- Adult Congenital Heart Disease Center University of Nebraska Medical Center/ Children's Hospital and Medical Center, Omaha, NE, USA
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Kapucijnenvoer 35, Box 7001, B-3000, Leuven, Belgium. .,Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden. .,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
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Atkinson JA, Page A, Heffernan M, McDonnell G, Prodan A, Campos B, Meadows G, Hickie IB. The impact of strengthening mental health services to prevent suicidal behaviour. Aust N Z J Psychiatry 2019; 53:642-650. [PMID: 30541332 DOI: 10.1177/0004867418817381] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Successive suicide prevention frameworks and action plans in Australia and internationally have called for improvements to mental health services and enhancement of workforce capacity. However, there is debate regarding the priorities for resource allocation and the optimal combination of mental health services to best prevent suicidal behaviour. This study investigates the potential impacts of service capacity improvements on the incidence of suicidal behaviour in the Australian context. METHODS A system dynamics model was developed to investigate the optimal combination of (1) secondary (acute) mental health service capacity, (2) non-secondary (non-acute) mental health service capacity and (3) resources to re-engage those lost to services on the incidence of suicidal behaviour over the period 2018-2028 for the Greater Western Sydney (Australia) population catchment. The model captured population and behavioural dynamics and mental health service referral pathways and was validated using population survey and administrative data, evidence syntheses and an expert stakeholder group. RESULTS Findings suggest that 28% of attempted suicide and 29% of suicides could be averted over the forecast period based on a combination of increases in (1) hospital staffing (with training in trauma-informed care), (2) non-secondary health service capacity, (3) expansion of mental health assessment capacity and (4) re-engagement of at least 45% of individuals lost to services. Reduction in the number of available psychiatric beds by 15% had no substantial impact on the incidence of attempted suicide and suicide over the forecast period. CONCLUSION This study suggests that more than one-quarter of suicides and attempted suicides in the Greater Western Sydney population catchment could potentially be averted with a combination of increases to hospital staffing and non-secondary (non-acute) mental health care. Reductions in tertiary care services (e.g. psychiatric hospital beds) in combination with these increases would not adversely affect subsequent incidence of suicidal behaviour.
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Affiliation(s)
- Jo-An Atkinson
- 1 Decision Analytics, Sax Institute, Haymarket, NSW, Australia.,2 Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia.,3 Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Andrew Page
- 2 Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | | | - Geoff McDonnell
- 1 Decision Analytics, Sax Institute, Haymarket, NSW, Australia
| | - Ante Prodan
- 5 School of Computing, Engineering and Mathematics, Western Sydney University, Penrith, NSW, Australia
| | - Bill Campos
- 6 Western Sydney Primary Health Network, WentWest, Blacktown, NSW, Australia
| | - Graham Meadows
- 7 Department of Psychiatry, Monash University, Dandenong, VIC, Australia.,8 Adult Mental Health Services, Monash Health, Dandenong, VIC, Australia
| | - Ian B Hickie
- 9 Brain and Mind Centre, Camperdown, NSW, Australia
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5
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Bachmann S. Epidemiology of Suicide and the Psychiatric Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1425. [PMID: 29986446 PMCID: PMC6068947 DOI: 10.3390/ijerph15071425] [Citation(s) in RCA: 658] [Impact Index Per Article: 109.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 06/28/2018] [Accepted: 07/01/2018] [Indexed: 12/12/2022]
Abstract
Suicide is a worldwide phenomenon. This review is based on a literature search of the World Health Organization (WHO) databases and PubMed. According to the WHO, in 2015, about 800,000 suicides were documented worldwide, and globally 78% of all completed suicides occur in low- and middle-income countries. Overall, suicides account for 1.4% of premature deaths worldwide. Differences arise between regions and countries with respect to the age, gender, and socioeconomic status of the individual and the respective country, method of suicide, and access to health care. During the second and third decades of life, suicide is the second leading cause of death. Completed suicides are three times more common in males than females; for suicide attempts, an inverse ratio can be found. Suicide attempts are up to 30 times more common compared to suicides; they are however important predictors of repeated attempts as well as completed suicides. Overall, suicide rates vary among the sexes and across lifetimes, whereas methods differ according to countries. The most commonly used methods are hanging, self-poisoning with pesticides, and use of firearms. The majority of suicides worldwide are related to psychiatric diseases. Among those, depression, substance use, and psychosis constitute the most relevant risk factors, but also anxiety, personality-, eating- and trauma-related disorders as well as organic mental disorders significantly add to unnatural causes of death compared to the general population. Overall, the matter at hand is relatively complex and a significant amount of underreporting is likely to be present. Nevertheless, suicides can, at least partially, be prevented by restricting access to means of suicide, by training primary care physicians and health workers to identify people at risk as well as to assess and manage respective crises, provide adequate follow-up care and address the way this is reported by the media. Suicidality represents a major societal and health care problem; it thus should be given a high priority in many realms.
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Affiliation(s)
- Silke Bachmann
- Clienia Littenheid AG, Hauptstrasse 130, 9573 Littenheid, Switzerland.
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, University Halle (Saale), Julius-Kühn-Strasse 7, 6112 Halle (Saale), Germany.
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Abstract
Late life suicide is characterized by less warning, higher lethality, and greater prevalence of depression and physical illness than suicide earlier in the lifespan. Suicidal older adults are more likely to seek help from a physician than through mental health channels, and suicide risk often remains undetected. Hopelessness is a prominent feature in older adult suicide. Traditional suicide hotlines receive few calls from older adults, and staff lack training in working with this age group. Despite the difficulties in preventing older adult suicide, however, opportunities exist. Psychotherapeutic and psychopharmacological treatments for depression may be effective in suicidal older adults, although they have not yet been widely tested. Community agencies with specialized programs for older adults show promise. Results are presented from the evaluation of one such agency, the Center for Elderly Suicide Prevention. After receiving agency services, hopelessness improved among clients but not in a comparison group. There were no significant changes in depressive symptoms or life satisfaction. Recommendations for future preventive efforts include: use of medical contacts to screen for depression and suicide; assessment of suicide risk with even small elevations in depressive symptoms; consideration of physical health status and level of hopelessness in assessing suicide risk; research on effective psychotherapies with suicidal older adults; and support of innovative community outreach and intervention programs.
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Affiliation(s)
| | - Patrick Arbore
- Center for Elderly Suicide Prevention and Grief Related Services Goldman Institute on Aging, San Francisco, California
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7
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Kawaguchi H, Koike S. Association between the Density of Physicians and Suicide Rates in Japan: Nationwide Ecological Study Using a Spatial Bayesian Model. PLoS One 2016; 11:e0148288. [PMID: 26840389 PMCID: PMC4740411 DOI: 10.1371/journal.pone.0148288] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 01/15/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Regional disparity in suicide rates is a serious problem worldwide. One possible cause is unequal distribution of the health workforce, especially psychiatrists. Research about the association between regional physician numbers and suicide rates is therefore important but studies are rare. The objective of this study was to evaluate the association between physician numbers and suicide rates in Japan, by municipality. METHODS The study included all the municipalities in Japan (n = 1,896). We estimated smoothed standardized mortality ratios of suicide rates for each municipality and evaluated the association between health workforce and suicide rates using a hierarchical Bayesian model accounting for spatially correlated random effects, a conditional autoregressive model. We assumed a Poisson distribution for the observed number of suicides and set the expected number of suicides as the offset variable. The explanatory variables were numbers of physicians, a binary variable for the presence of psychiatrists, and social covariates. RESULTS After adjustment for socioeconomic factors, suicide rates in municipalities that had at least one psychiatrist were lower than those in the other municipalities. There was, however, a positive and statistically significant association between the number of physicians and suicide rates. CONCLUSIONS Suicide rates in municipalities that had at least one psychiatrist were lower than those in other municipalities, but the number of physicians was positively and significantly related with suicide rates. To improve the regional disparity in suicide rates, the government should encourage psychiatrists to participate in community-based suicide prevention programs and to settle in municipalities that currently have no psychiatrists. The government and other stakeholders should also construct better networks between psychiatrists and non-psychiatrists to support sharing of information for suicide prevention.
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Affiliation(s)
- Hideaki Kawaguchi
- Department of Medical Informatics and Economics, The University of Tokyo, Tokyo, Japan
| | - Soichi Koike
- Division of Health Policy and Management, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
- Department of Health Management and Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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8
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Korosec Jagodic H, Rokavec T, Agius M, Pregelj P. Availability of mental health service providers and suicide rates in Slovenia: a nationwide ecological study. Croat Med J 2014; 54:444-52. [PMID: 24170723 PMCID: PMC3816558 DOI: 10.3325/cmj.2013.54.444] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM To investigate the influence of socioeconomic factors, mental health service availability, and prevalence of mental disorders on regional differences in the suicide rate in Slovenia. METHODS The effects of different socioeconomic factors, mental health service availability, and mental disorders factors on suicide rates from 2000-2009 were analyzed using a general linear mixed model (GLMM). Pearson correlations were used to explore the direction and magnitude of associations. RESULTS Among socioeconomic factors, unemployment rate ranked as the most powerful predictor of suicide and an increase of one unit in the unemployment rate increased regional suicide rate by 2.21 (β=2.21, 95% confidence intervals [CI]=1.87-2.54, P<0.001). On the other hand, higher marriage/divorce ratio was negatively related to the suicide rate and an increase of one unit in marriage/divorce ratio reduced regional suicide rate by 1.16 (β=-1.16, 95% CI=-2.20 to -0.13, P<0.031). The most influential mental health service availability parameter was higher psychiatrist availability (4 psychiatrists and more working at outpatient clinics per 100 000 inhabitants), which was negatively correlated with the suicide rate and reduced regional suicide rate by 2.95 (β=-2.95, 95% CI=-4.60 to -1.31, P=0.002). Another negatively correlated factor was the antidepressant/anxiolytic ratio higher than 0.5, which reduced the regional suicide rate by 2.32 (β=-2.32, 95% CI=-3.75 to -0.89, P=0.003). Among mental health disorders, only the prevalence of alcohol use disorders was significantly related to the regional suicide rates and an increase of one unit in the prevalence of alcohol use disorders per 1000 inhabitants increased the regional suicide rate by 0.02 (β=0.02, 95% CI=0.01- 0.03, P=0.008). CONCLUSIONS Besides unemployment, which was a very strong predictor of suicide rates, unequal availability of mental health services and quality of depressive disorder treatment may contribute to variations in suicide rates in different regions.
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Affiliation(s)
- Helena Korosec Jagodic
- Peter Pregelj, University of Ljubljana, Faculty of Medicine, Department of psychiatry, Vrazov trg 2, 1104 Ljubljana, Slovenia,
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Balint L, Dome P, Daroczi G, Gonda X, Rihmer Z. Investigation of the marked and long-standing spatial inhomogeneity of the Hungarian suicide rate: a spatial regression approach. J Affect Disord 2014; 155:180-5. [PMID: 24238954 DOI: 10.1016/j.jad.2013.10.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 10/24/2013] [Accepted: 10/25/2013] [Indexed: 01/16/2023]
Abstract
BACKGROUND In the last century Hungary had astonishingly high suicide rates characterized by marked regional within-country inequalities, a spatial pattern which has been quite stable over time. AIMS To explain the above phenomenon at the level of micro-regions (n=175) in the period between 2005 and 2011. METHODS Our dependent variable was the age and gender standardized mortality ratio (SMR) for suicide while explanatory variables were factors which are supposed to influence suicide risk, such as measures of religious and political integration, travel time accessibility of psychiatric services, alcohol consumption, unemployment and disability pensionery. When applying the ordinary least squared regression model, the residuals were found to be spatially autocorrelated, which indicates the violation of the assumption on the independence of error terms and - accordingly - the necessity of application of a spatial autoregressive (SAR) model to handle this problem. According to our calculations the SARlag model was a better way (versus the SARerr model) of addressing the problem of spatial autocorrelation, furthermore its substantive meaning is more convenient. RESULTS SMR was significantly associated with the "political integration" variable in a negative and with "lack of religious integration" and "disability pensionery" variables in a positive manner. Associations were not significant for the remaining explanatory variables. LIMITATIONS Several important psychiatric variables were not available at the level of micro-regions. We conducted our analysis on aggregate data. CONCLUSION Our results may draw attention to the relevance and abiding validity of the classic Durkheimian suicide risk factors - such as lack of social integration - apropos of the spatial pattern of Hungarian suicides.
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Affiliation(s)
- Lajos Balint
- Demographic Research Institute of the Hungarian Central Statistical Office, Buday Laszlo u. 1-3, 1204 Budapest, Hungary.
| | - Peter Dome
- Department of Clinical and Theoretical Mental Health, Semmelweis University, Faculty of Medicine, Kutvolgyi ut 4, 1125 Budapest, Hungary; National Institute of Psychiatry and Addictions, Laboratory for Suicide Research and Prevention, Lehel u. 59, 1135 Budapest, Hungary
| | - Gergely Daroczi
- Rapporter.net, Easystats Ltd., 145-157 St John Street, EC1V 4PW London, United Kingdom
| | - Xenia Gonda
- Department of Clinical and Theoretical Mental Health, Semmelweis University, Faculty of Medicine, Kutvolgyi ut 4, 1125 Budapest, Hungary; National Institute of Psychiatry and Addictions, Laboratory for Suicide Research and Prevention, Lehel u. 59, 1135 Budapest, Hungary
| | - Zoltan Rihmer
- Department of Clinical and Theoretical Mental Health, Semmelweis University, Faculty of Medicine, Kutvolgyi ut 4, 1125 Budapest, Hungary; National Institute of Psychiatry and Addictions, Laboratory for Suicide Research and Prevention, Lehel u. 59, 1135 Budapest, Hungary
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Rihmer Z, Gonda X, Kapitany B, Dome P. Suicide in Hungary-epidemiological and clinical perspectives. Ann Gen Psychiatry 2013; 12:21. [PMID: 23803500 PMCID: PMC3698008 DOI: 10.1186/1744-859x-12-21] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 06/17/2013] [Indexed: 11/21/2022] Open
Abstract
Annual suicide rates of Hungary were unexpectedly high in the previous century. In our narrative review, we try to depict, with presentation of the raw data, the main descriptive epidemiological features of the Hungarian suicide scene of the past decades. Accordingly, we present the annual suicide rates of the period mentioned and also data on how they varied by gender, age, urban vs. rural living, seasons, marital status, etc. Furthermore, the overview of trends of other factors that may have influenced suicidal behavior (e.g., alcohol and tobacco consumption, antidepressant prescription, unemployment rate) in the past decades is appended as well. Based on raw data and also on results of the relevant papers of Hungarian suicidology we tried to explain the observable trends of the Hungarian suicide rate. Eventually, we discuss the results, the possibilities, and the future tasks of suicide prevention in Hungary.
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Affiliation(s)
- Zoltan Rihmer
- Department of Clinical and Theoretical Mental Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
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11
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Tsai JF, Cho W. The secular trend of suicide rate and the socio-economic, media, and climatic factors in Taiwan, 1976-2009: a population-based study. J Affect Disord 2011; 129:270-4. [PMID: 20833432 DOI: 10.1016/j.jad.2010.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 08/10/2010] [Accepted: 08/10/2010] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The purpose of the present study was to explore the relationship between the secular trend of the suicide rate and the socio-economic, media, and climatic factors in Taiwan during 1976-2009. METHODS The yearly suicide death rate, socio-economic (spouseless population, aged population, labor participation rate, unemployment rate, and gross national production), media (newspapers, television sets, and personal computer) densities, and climatic (temperature, rainfall, and sunshine) factors were gathered. Pearson's correlation coefficients between variables were calculated, and stepwise multiple regression analysis was conducted. RESULTS Percentage of the spouseless and elderly population, labor participation rate, unemployment rate, and densities of newspapers and personal computer were significantly associated with suicide rate. Multiple regression chose spouseless population, labor participation rate, and unemployment rate to explain 96.1% of the variance of the suicide rate (F((3,22))=178.996, p=0.000). CONCLUSIONS Socio-economic factors are important for the secular trend of suicide, while medium densities also play some roles.
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Affiliation(s)
- Jui-Feng Tsai
- Department of Psychiatry, Buddhist Tzu Chi Taichung General Hospital, Taichung, Taiwan.
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Sebestyen B, Rihmer Z, Balint L, Szokontor N, Gonda X, Gyarmati B, Bodecs T, Sandor J. Gender differences in antidepressant use-related seasonality change in suicide mortality in Hungary, 1998-2006. World J Biol Psychiatry 2010; 11:579-85. [PMID: 20218927 DOI: 10.3109/15622970903397722] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Studies show that the seasonality of suicide (spring/early summer peak, winter low) is mainly the consequence of the seasonal incidence of depression-related suicides. The aim of the present study was to analyse the relationship between increasing antidepressant utilization and national suicide rate of Hungary between 1998 and 2006, with particular regard to seasonal patterns and gender differences. METHODS Time trend analysis (ARIMA) had been applied to investigate the correlation between the trend of antidepressant prescription and both of suicide rates and seasonality index. RESULTS During the 9 years of the study period there was a significant (P<0.001) correlation between the steadily increasing antidepressant prescription (113%) and continuous decline in total national suicide rate (23%) as well as both in females and males (21 and 23%, respectively), but this relationship was 8-fold stronger in males. Increasing antidepressant utilization was associated with significantly decreased seasonality of suicides only among males. CONCLUSIONS The results suggest that decreasing seasonality of suicides could be a good marker of lowering rate of depression-related suicides in the population particularly among males.
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Affiliation(s)
- Beata Sebestyen
- National Center for Healthcare Audit and Inspection, Budapest, Hungary
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Innamorati M, Tamburello A, Lester D, Amore M, Girardi P, Tatarelli R, Pompili M. Inequalities in suicide rates in the European Union's elderly: trends and impact of macro-socioeconomic factors between 1980 and 2006. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2010; 55:229-38. [PMID: 20416146 DOI: 10.1177/070674371005500406] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To study suicide rates in elderly people in the former European Community, known as the European Union (EU) since late 1993, to identify differences between early members (admitted to the EU before 2004) and new members (admitted after 2004), and to evaluate the association between macro-socioeconomic variables and suicide rates. METHOD We explored temporal trends in age-adjusted suicide rates for people aged 65 years and older residing in the EU from 1980 to 2006. RESULTS In the years examined in the study, there has been a general decrease in suicide rates in new and early members of the EU, although more slowly for elderly men than for women. The decrease in suicide rates of citizens aged 65 years and older was associated with a small but significant difference between new and early members of the EU (RR = 1.04, 95% CI 1.03 to 1.05; z = 11.95, P < 0.001). The macro-socioeconomic indices were strongly associated with age-adjusted suicide rates in EU senior citizens, except unemployment rates. CONCLUSIONS Deaths by suicide in elderly people are declining in all EU nations, but inequalities in the suicide rates of men and women remain, especially in new EU members.
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Abstract
Completed suicide is associated with marital status; being unmarried is associated with a higher suicide rate as compared with being married or living with a partner. Moreover, the region of origin may be particularly important when trying to explain major inequalities in suicide rates across a country. Data were obtained from the Italian Database on Mortality, collected by the Italian Census Bureau (ISTAT) and processed by the Italian National Institute of Health-Statistics Unit. The Italian population in the last Italian census (October 2001) was used to estimate age-standardized mortality rates from suicide by marital status (ICD-9 revision: E950-959) and "natural" causes (ICD-9 revision: 0-280; 320-799). Rate Ratios and 95% confidence intervals were calculated using married individuals as a reference. All analyses were conducted separately for men and women for 2000-2002, the most recent years with data available. Logistic regression analysis was used to compare differences by marital status for suicide versus death from natural causes. There are major inequalities in suicide rates in Italy. The North region has the highest suicide rates both for married and non-married individuals. Sardinia Island has the highest male suicide rate in Italy-23.07 per 100,000 per year-compared with the average national male suicide rate of 13.80, a difference which is significantly higher by 67% (RR: 1.67; 95%CI = 1.40-1.99). In contrast, Sardinia has one of the lowest female suicide rates among the Italian regions, close to that of the South and the Center regions. The North-East is the only region where the suicide rate among divorced men is significantly higher than that of married men. In the South, widowers have the highest suicide rate, with a rate 6-times that of married men (RR = 5.66; 95%CI = 4.46-7.18). Major inequalities in suicide rates by region may derive from different socio-cultural backgrounds, confirming the notion that suicide is a multifaceted phenomenon. The results of the present study indicate that suicide prevention must take into account the social and cultural characteristics of different communities. Moreover, these findings support the notion that marital status may play a central role in influencing suicide.
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Pompili M, Serafini G, Del Casale A, Rigucci S, Innamorati M, Girardi P, Tatarelli R, Lester D. Improving adherence in mood disorders: the struggle against relapse, recurrence and suicide risk. Expert Rev Neurother 2009; 9:985-1004. [PMID: 19589049 DOI: 10.1586/ern.09.62] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Medication nonadherence is a major obstacle to translating treatment efficacy from research settings into effectiveness in clinical practice for patients with affective disorders. Adherence to beneficial drug therapy is associated with lower mortality compared with poor adherence. Reduced adherence is associated with increased suicide risk, especially when lithium is discontinued. The aim of this paper is to review the prevalence, predictors and methods for improving medication adherence in unipolar and bipolar affective disorders. Studies were identified through Medline and PsycInfo searches of English language publications between 1976 and 2009. This was supplemented by a hand search and the inclusion of selected descriptive articles on good clinical practice. Estimates of medication nonadherence for unipolar and bipolar disorders range from 10 to 60% (median: 40%). This prevalence has not changed significantly with the introduction of new medications. There is evidence that attitudes and beliefs are at least as important as side effects in predicting adherence. The limited number of empirical studies on reducing nonadherence indicate that, if recognized, the problem may be overcome. Clinical data highlight the importance of extended courses of medication in improving the long-term prognosis of patients with affective disorders.
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Affiliation(s)
- Maurizio Pompili
- Department of Psychiatry, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Roma, Italy.
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Pompili M, Rihmer Z, Innamorati M, Lester D, Girardi P, Tatarelli R. Assessment and treatment of suicide risk in bipolar disorders. Expert Rev Neurother 2009; 9:109-36. [PMID: 19102673 DOI: 10.1586/14737175.9.1.109] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Completed suicide and suicide attempts are major issues in the management of bipolar disorders. There is evidence that suicide rates among these patients are more than 20-fold higher than the general population and, furthermore, suicidal behavior is much more lethal in bipolar disorder than in the general population. Patients with mood disorders may sometimes exhibit highly perturbed mixed states, which usually increase the risk of suicide. Such states are particularly frequent in bipolar II patients, especially if patients are treated with antidepressant monotherapy (unprotected by mood stabilizers), when depression switches into mania (or vice versa), or when depression lifts and functioning approaches normality. Researchers worldwide agree that treatment involving lithium is the best way to protect patients from suicide risk. Psychosocial activities, including psychoeducation, can protect bipolar patients either directly or, more probably, indirectly by increasing adherence to treatment and helping in daily difficulties that otherwise may lead to demoralization or hopelessness. An extensive understanding of the psychosocial circumstances and the psychopathology of bipolar patients (including temperament) may help clinicians describe the clinical picture accurately and prevent suicidal behavior in these patients.
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Lecrubier Y. False beliefs: the current treatment of patients with depression. Curr Psychiatry Rep 2003; 5:419-22. [PMID: 14609496 DOI: 10.1007/s11920-003-0078-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Yves Lecrubier
- Unité Inserm 302, Hôpital de la Salpétrière, 47 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France.
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Swanson SP, Roberts LJ, Chapman MD. Are anaesthetists prone to suicide? A review of rates and risk factors. Anaesth Intensive Care 2003; 31:434-45. [PMID: 12973968 DOI: 10.1177/0310057x0303100413] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Suicide represents a major source of mortality in Western countries. There is an emerging literature about suicide and the medical profession. The suicide of an anaesthetist represents a catastrophic event, with painful consequences for family, colleagues and the community at large. This review will examine the literature regarding suicide amongst anaesthetists and trainees in the field. It is presented in three sections. First, it provides an overview of existing epidemiological data, comparing rates in the general population, the medical profession, in general, and in anaesthesia, in particular. Second, risk factors that may account for differences in rates will be discussed. Finally, a series of recommendations has been formulated.
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Affiliation(s)
- S P Swanson
- Department of Anaesthesia, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, W.A. 6009
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Osvath P, Michel K, Fekete S. Contacts of suicide attempters with healthcare services in Pecs and Bern in the WHO/EURO Multicentre Study on Parasuicide. Int J Psychiatry Clin Pract 2003; 7:3-8. [PMID: 24937235 DOI: 10.1080/13651500310001004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aim of this study was to compare patterns of contact made by patients with GPs and other healthcare professionals in two European cities prior to attempting suicide. The objective was to determine whether differences between a public and a private healthcare system could be a possible factor influencing the help-seeking behaviour of suicide attempters. Within the frame of the WHO/EURO Multicentre Study on Parasuicide, structured interviews were conducted with suicide attempters in Pecs, Hungary (n=101) and Bern, Switzerland (n=66). In Bern, slightly more patients visited their GPs throughout the year. However, within the last week before the suicide attempt, twice as many Hungarian patients went to see a GP compared with the Bern sample. Almost the same proportion of the patients had suicidal ideation, but in Pecs more than a quarter of them and in Bern half of them talked about their suicidal thoughts. In the Hungarian sample, more patients were prescribed medication and almost half of them used these drugs for self-poisoning compared to over a quarter in Bern. The differences in help-seeking behaviour between the two samples may be related to the higher number of practising GPs and a more consistent patient-doctor relationship in Bern. It is likely that a consistent and personal relationship with a medical helper or system (e.g. GP as gatekeeper) facilitates the communication of suicidal ideation.
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Abstract
BACKGROUND The lifetime risk of suicide in affective disorders is commonly quoted as 15%. This stems from hospital populations of affective disorders. AIMS To model the lifetime prevalence of suicide using data on completed suicides from one English Health District and community-based rates of prevalence of affective disorders. METHODS A secondary analysis of a primary data set based on 212 suicides in North Staffordshire was undertaken. The population rates of psychiatric morbidity were obtained from the National Comorbidity Survey. RESULTS The model suggests a lifetime prevalence rate of suicide for any affective disorder at 2.4%, with a rate for those uncomplicated by substance abuse, personality disorder or non-affective psychosis at 2.4%, and a rate for uncomplicated cases who had no mental health service contact at 1.1%. CONCLUSIONS Lifetime prevalence rates of suicide in subgroups of affective disorders may be lower than the traditional rates cited for hospital depression. This has implications for primary care projects designed to investigate the occurrence of and the prevention of suicide.
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Affiliation(s)
- A P Boardman
- Health Services Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 9AF, England
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Abstract
Depression, the major cause of suicide, is prevalent but an under-detected, underdiagnosed and, under-treated illness and it is particularly true for depressed suicide victims. However, several studies consistently show that successful treatment of depression not only relieves depressive symptoms, but also decreases and makes suicidality vanish. If the rate of treated depressions in the population increases gradually, at a given point it will appear in the decline of the suicide rates. Although absolute evidence is lacking at present, recent reports from some European countries strongly suggest that increasing utilisation of antidepressants is one of the most important contributing factors in the decrease in suicide rates.
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Affiliation(s)
- Z Rihmer
- Department of Psychiatry No. XIII, National Institute for Psychiatry and Neurology, Budapest 27, Pf. 1. 1281, Hungary
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Baldessarini RJ, Tondo L, Hennen J. Treating the suicidal patient with bipolar disorder. Reducing suicide risk with lithium. Ann N Y Acad Sci 2001; 932:24-38; discussion 39-43. [PMID: 11411189 DOI: 10.1111/j.1749-6632.2001.tb05796.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Bipolar disorder is associated with increased mortality because of complications of commonly comorbid substance use and stress-sensitive medical disorders as well as accidents and very high rates of suicide. Long-term lithium treatment may be associated with reduced suicidal risk. We review and summarize findings that help to quantify relationships between the presence versus the absence of lithium maintenance and suicides or attempts in patients with bipolar or other major affective disorders. Results from 33 studies (1970-2000) yielded 13-fold lower rates of suicide and reported attempts during long-term lithium treatment than without it or after it was discontinued. Although greatly reduced, these rates remain above those estimated for the general population. Evidence for substantial, if incomplete, protection against suicide with lithium is supported by more compelling evidence than that for any other treatment provided for patients with mood disorders. Studies of commonly used, but incompletely evaluated, alternative treatments are required, and further protection against premature mortality can be anticipated with better protection against bipolar depression.
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Affiliation(s)
- R J Baldessarini
- Department of Psychiatry & Neuroscience Program, Harvard Medical School, and Bipolar & Psychotic Disorders Program, Mailman Research Center, McLean Division of Massachusetts General Hospital, Belmont, Massachusetts 02478, USA.
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Rutz W, Wålinder J, Von Knorring L, Rihmer Z, Pihlgren H. Prevention of depression and suicide by education and medication: impact on male suicidality. An update from the Gotland study. Int J Psychiatry Clin Pract 1997; 1:39-46. [PMID: 24926980 DOI: 10.3109/13651509709069204] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Depression is an endemic disease with high morbidity, and a high mortality in depression-related suicide. Suicidal tendencies, especially among males, are increasing today in East European countries. General practitioners are considered to have a very important role in the prevention and treatment of depression. Matters of depression are more openly discussed in society. Patients showing up in primary care are nowadays less reluctant to see depression as a causative factor behind their symptoms. Taboos concerning the stigma of depression and suicidality are weaker. In spite of this, important problems still exist regarding poor diagnostic and treatment routines in primary care and the inability of depressive and suicidal men to seek for help or to be recognized. In the years 1983-1984, the Swedish Committee for Prevention and Treatment of Depression (PTD) offered an educational programme to all general practitioners (GPs) on the Swedish island of Gotland. During the 1980s this education was shown to lead to a significant decrease in inpatient care, morbidity, suicide, mortality and costs of depressive illness on the island. The use of anxiolytic and sedative medication decreased and that of antidepressant medication increased. This all showed that an educational programme in primary care on depression and suicide was effective. However, the effects faded and, unexpectedly, the number of male suicides was almost unaffected by the educational programme and by the GPs' ability to diagnose and treat depression. Repeated educational activities during the 1990s again led to a decrease in suicides, mainly in females. Also, the increase in antidepressant prescriptions following GP education in the 1990s was mostly in the treatment of female patients. One of the reasons was that few suicidal males are known to the medical services although many of these people are known to the police and social welfare services. The reasons why depressed and suicidal men do not show up in the medical services are discussed, and found to lie in the differences between the male and the female depressive syndrome, leading to difficulties in reaching, diagnosing and treating these patients. Strategies for finding and treating suicidal depressives are discussed. One conclusion is that males are as often depressed as females, but in different ways, and that one of the reasons behind the dramatic over-representation of males amongst suicide victims may be found in the low rate of diagnosis and treatment of the male depressive syndrome, (hit J Psych Clin Pract 1997; 1: 39-46).
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Affiliation(s)
- W Rutz
- Psychiatric Department, Vishy Hospital, Gotland, Sweden
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Rihmer Z. Recognition of depression and prevention of suicide: the role of general practitioners and general physicians. Int J Psychiatry Clin Pract 1997; 1:131-4. [PMID: 24936667 DOI: 10.3109/13651509709024714] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Suicide is a major health problem throughout the world. After briefly describing the risk factors for suicide, the author focuses on depression, which is the major cause of suicide. Depression is a common illness, treatable not only in psychiatric settings, but also in primary care and general medicine. Consequently, physicians other than psychiatrists (primarily general practitioners) have an important role in suicide prevention.
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Affiliation(s)
- Z Rihmer
- National Institute for Psychiatry and Neurology, Budapest, Hungary
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