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Safiri S, Mousavi SE, Nejadghaderi SA, Noori M, Sullman MJM, Kolahi AA, Shekarriz-Foumani R. The burden of major depressive disorder in the Middle East and North Africa region, 1990-2019. Acta Neuropsychiatr 2024; 36:139-152. [PMID: 37690795 DOI: 10.1017/neu.2023.42] [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: 09/12/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) is one of the leading causes of disability. We aimed to report the MDD-attributable prevalence, incidence and years lived with disability (YLDs) in the Middle East and North Africa (MENA) region from 1990 to 2019 by age, sex and socio-demographic index (SDI). METHODS Publicly available data on the burden of MDD were retrieved from the Global Burden of Disease (GBD) study 2019 for the 21 countries in MENA. The counts and age-standardised rates (per 100,000) were presented, along with their corresponding 95% uncertainty intervals. RESULTS In 2019, MDD had an age-standardised point prevalence of 3322.1 and an incidence rate of 4921.7 per 100,000 population in MENA. Furthermore, there were 4.1 million YLDs in 2019. However, there were no substantial changes in the MDD burden over the period 1990-2019. In 2019, Palestine had the highest burden of MDD. The highest prevalence, incidence and YLDs attributable to MDD were found in the 35-39 age group. In 2019, the YLD rate in MENA was higher than the global rate for almost all age groups. Furthermore, there was a broadly negative association between the YLD rate and SDI. CONCLUSION The study highlights the need to prevent the disorder using a multidisciplinary approach and for the provision of cost-effective treatments for those affected, in order to increase their quality of life.
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Affiliation(s)
- Saeid Safiri
- Clinical Research Development Unit of Tabriz Valiasr Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Ehsan Mousavi
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Aria Nejadghaderi
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Maryam Noori
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mark J M Sullman
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
- Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Shekarriz-Foumani
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Oya Y, Ishihara K, Shiko Y, Kawasaki Y, Iwase H. A Descriptive Study of the Characteristics of Homicide-Suicide in Forensic Autopsy Cases. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:1473-1495. [PMID: 37887432 DOI: 10.1177/08862605231207616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Homicide followed by suicide (HS) is a tragic event with varied characteristics across countries and regions. Compared to Western countries, there are limited studies on HS in Asian countries. Therefore, this study aimed to clarify the characteristics of recent HS cases by examining forensic autopsy records from 2008 to 2020 collected from the Department of Legal Medicine, Chiba University, in Japan. A total of 77 HS cases were identified, involving 77 perpetrators (52 completed suicides, 25 attempted suicides), with 28 perpetrator and 89 victim autopsies. Our findings showed that older adults accounted for nearly half of the victims; victims were mostly females, whereas most perpetrators were male. The most common HS relationship was that between a parent and a child. Autopsy findings showed that the most common cause of death was strangulation, and illegal drugs were detected only in a few cases; however, psychotropic drugs were detected in child victims. No obvious evidence of past child physical abuse by caregivers was found. In contrast, intimate partner violence (IPV) was present, with a history of IPV found in half of HS cases involving adult intimate partner relationships. Notably, gender differences in age and relationship to the victim were identified. Likewise, some perpetrators may have expressed their plans and intentions for HS before the event, which may represent an important sign for HS prevention. However, to accurately reveal the course of HS, nationwide integrated statistics, forensic autopsies, including toxicological analyses of the deceased; and forensic psychiatric perspectives, including psychological autopsy, are required.
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Affiliation(s)
| | | | | | - Yohei Kawasaki
- Japanese Red Cross College of Nursing, Shibuya-ku, Tokyo, Japan
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Bowersox NW, Smith CM, Austin K, Bradford DW, Browne J, Nelson SM, Szymanski BR, Glynn SM. Mortality and suicidality in veterans health administration patients with newly-identified early episode psychosis. Schizophr Res 2024; 264:362-369. [PMID: 38219412 DOI: 10.1016/j.schres.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/15/2023] [Accepted: 01/01/2024] [Indexed: 01/16/2024]
Abstract
Within the Veterans Affairs (VA), management of self-harm is a major clinical priority. However, there is limited information on risks for self-harm among VA patients with emerging psychotic disorders relative to VA patients with other emerging mental health conditions. Using information from fiscal years 2010 through 2018, a national cohort of VA patients 30 or younger was classified based on mental health diagnoses into three groups: 1) early episode psychosis (EEP), 2) non-early episode psychosis mental health (non-EEP MH), or 3) no mental health (no MH). Analyses focused on cohort members' risk for all-cause mortality, suicide mortality, and non-fatal suicide attempts (NFSA) during the year following initial diagnosis of mental health conditions (or first year of VA care, for the no MH group). In unadjusted analyses, the EEP group had elevated rates of all-cause mortality, suicide mortality, and NFSA relative to the non-EEP MH and no MH groups and the non-EEP MH had elevated rates of all-cause mortality, suicide mortality, and NFSA relative to the no MH group. After adjusting for demographics and care receipt, EEP status was unrelated to all-cause mortality but associated with increased suicide mortality risk and NFSA. Non-EEP MH status was associated with reduced risk of all-cause mortality but increased risk for NFSA. In the year following first diagnosis, VA patients with EEP are at increased risk for suicide mortality and self-harm even after accounting for other risk factors. Clinical services targeting this crucial time can help promote safety for this vulnerable group.
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Affiliation(s)
- Nicholas W Bowersox
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington, DC, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Colin M Smith
- Duke Hubert-Yeargan Center for Global Health, Durham, NC, USA
| | - Karen Austin
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington, DC, USA
| | - Daniel W Bradford
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington, DC, USA; Duke University Medical Center, Durham, NC, USA
| | - Julia Browne
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Sharon M Nelson
- Center for Evaluation and Implementation Resources, VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA; Psychology Department, Pennsylvania State University, University Park, PA, USA
| | - Benjamin R Szymanski
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington, DC, USA
| | - Shirley M Glynn
- VA Greater Los Angeles Healthcare System at West Los Angeles, Los Angeles, CA, USA; Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
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Chen D, Ejlskov L, Laustsen LM, Weye N, Sørensen CLB, Momen NC, Dreier JW, Zheng Y, Damgaard AJ, McGrath JJ, Sørensen HT, Plana-Ripoll O. The Role of Socioeconomic Position in the Association Between Mental Disorders and Mortality: A Systematic Review and Meta-Analysis. JAMA Psychiatry 2024; 81:125-134. [PMID: 37966825 PMCID: PMC10652216 DOI: 10.1001/jamapsychiatry.2023.4316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/14/2023] [Indexed: 11/16/2023]
Abstract
Importance Studies are lacking summarizing how the association between mental disorders and mortality varies by socioeconomic position (SEP), particularly considering different aspects of SEP, specific types of mental disorders, and causes of death. Objective To investigate the role of SEP in the association between mental disorders and mortality and the association between SEP and mortality among people with mental disorders. Data Sources MEDLINE, Embase, PsycINFO, and Web of Science were searched from January 1, 1980, through April 3, 2023, and a snowball search of reference and citation lists was conducted. Study Selection Inclusion criteria were observational studies estimating the associations between different types of mental disorders and mortality, stratified by SEP and between SEP and mortality in people with mental disorders. Data Extraction and Synthesis Pairs of reviewers independently extracted data using a predefined data extraction form and assessed the risk of bias using the adapted Newcastle-Ottawa scale. Graphical analyses of the dose-response associations and random-effects meta-analyses were performed. Heterogeneity was explored through meta-regressions and sensitivity analyses. Main Outcomes and Measures All-cause and cause-specific mortality. Results Of 28 274 articles screened, 71 including more than 4 million people with mental disorders met the inclusion criteria (most of which were conducted in high-income countries). The relative associations between mental disorders and mortality were similar across SEP levels. Among people with mental disorders, belonging to the highest rather than the lowest SEP group was associated with lower all-cause mortality (pooled relative risk [RR], 0.79; 95% CI, 0.73-0.86) and mortality from natural causes (RR, 0.73; 95% CI, 0.62-0.85) and higher mortality from external causes (RR, 1.18; 95% CI, 0.99-1.41). Heterogeneity was high (I2 = 83% to 99%). Results from subgroup, sensitivity, and meta-regression analyses were consistent with those from the main analyses. Evidence on absolute scales, specific diagnoses, and specific causes of death was scarce. Conclusion and Relevance This study did not find a sufficient body of evidence that SEP moderated the relative association between mental disorders and mortality, but the underlying mortality rates may differ by SEP group, despite having scarcely been reported. This information gap, together with our findings related to SEP and a possible differential risk between natural and external causes of death in individuals with specific types of mental disorders, warrants further research.
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Affiliation(s)
- Danni Chen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Linda Ejlskov
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Lisbeth Mølgaard Laustsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Nanna Weye
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
- Department of Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
| | | | - Natalie C. Momen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | | | - Yan Zheng
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Astrid Jensen Damgaard
- Master Program in Health Science, Rehabilitation and Prevention, Aarhus University, Aarhus, Denmark
| | - John J. McGrath
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Queensland Centre for Mental Health Research, University of Queensland, Wacol, Queensland, Australia
- Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Oleguer Plana-Ripoll
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
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Penney SR, Lam AA, Kolla N, Martin K, Belfry K, Simpson AIF. Homicide in the context of psychosis: analysis of prior service utilisation and age at onset of illness and violence. BJPsych Open 2023; 9:e171. [PMID: 37724335 PMCID: PMC10594185 DOI: 10.1192/bjo.2023.567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/01/2023] [Accepted: 08/18/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Public stigma and fear are heightened in cases of extreme violence perpetrated by persons with serious mental illness (SMI). Prevention efforts require understanding of illness patterns and treatment needs prior to these events unfolding. AIMS To examine mental health service utilisation by persons who committed homicide and entered into forensic care, to investigate the adequacy of mental healthcare preceding these offences. METHOD Forensic patients across two mental health hospitals in Ontario with an admitting offence of homicide between 2011 and 2021 were identified (n = 112). Sociodemographic, clinical and offence-related variables were coded from the health record and reports prepared for the forensic tribunal. RESULTS Most patients (75.7%) had mental health contacts preceding the homicide, with 28.4% having a psychiatric in-patient admission in the year prior. For those with service contacts in the year preceding, 50.9% had had only sporadic contact and 70.7% were non-adherent with prescribed medications. Victims were commonly known to the individual (35.7%) and were often family members in care-providing roles (55.4%). Examination of age at onset of illness and offending patterns suggested that most persons admitted to forensic care for homicide act in the context of illness and exhibit a low frequency of pre-homicide offending. CONCLUSIONS Many individuals admitted to forensic care for homicide have had inadequate mental healthcare leading up to this point. Effective responses to reduce and manage risk should encompass services that proactively address illness-related (e.g. earlier access and better maintenance in care) and criminogenic (e.g. substance use treatment, employment and psychosocial supports) domains.
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Affiliation(s)
- Stephanie R. Penney
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Austin A. Lam
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Kolla
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; and Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
| | - Krystle Martin
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
| | - Kimberly Belfry
- Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
| | - Alexander I. F. Simpson
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Li Y, Huang X, Yuan M, Chang J, Zhang T, Wang G, Su P. Childhood maltreatment and homicidal ideation among Chinese early adolescents: The serial mediating role of borderline personality features and aggression. Aggress Behav 2023; 49:536-546. [PMID: 37243977 DOI: 10.1002/ab.22091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/29/2023]
Abstract
A large body of evidence linked childhood maltreatment (CM) to juvenile violence and delinquent behavior. However, little is known about the association between CM and homicidal ideation in early adolescents. This study aimed to examine that relationship and to explore the serial mediating role of borderline personality features (BPF) and aggression in that relationship in a large sample of early adolescents. A total of 5724 early adolescents (mean age: 13.5 years) were recruited from three middle schools in Anhui Province, China. The participants were invited to complete self-report questionnaires regarding their history of CM, BPF, aggression, and homicidal ideation. Mediation analyses were evaluated using structural equation modeling. A total of 669 participants (11.7%) reported homicidal ideation in the past 6 months. CM victimization was positively associated with homicidal ideation after adjusting for covariates. Furthermore, the serial mediation analysis showed a significant indirect effect of CM on homicidal ideation through BPF and subsequent aggression. Exposure to maltreatment in childhood is likely to manifest BPF and subsequently higher levels of aggression, which in turn are related to increased homicidal ideation. These findings suggest the need for early intervention for BPF and aggression in early adolescents exposed to CM to prevent the development of homicidal ideation.
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Affiliation(s)
- Yonghan Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Xiaoman Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China
- Hefei City Maternal and Child Health & Family Planning Service Center, Hefei, People's Republic of China
| | - Mengyuan Yuan
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Junjie Chang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Tingting Zhang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Gengfu Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, Anhui, People's Republic of China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, Anhui, People's Republic of China
| | - Puyu Su
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, Anhui, People's Republic of China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, Anhui, People's Republic of China
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Mortality in Schizophrenia-Spectrum Disorders: Recent Advances in Understanding and Management. Healthcare (Basel) 2022; 10:healthcare10122366. [PMID: 36553890 PMCID: PMC9777663 DOI: 10.3390/healthcare10122366] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022] Open
Abstract
Schizophrenia is a life-shortening disease and life expectancy in patients may be 15-20 years shorter than in the general population, with increasing longevity gap over time. Premature mortality in schizophrenia-spectrum disorders is mainly due to preventable natural causes, such as cardio-vascular disease, infections, respiratory tract diseases and cancer, alongside suicide, homicide and accidents. There is a complex interplay of factors that act synergistically and cause physical morbidity to patients and subsequent mortality. Smoking, alcohol/substance abuse and sedentary life style, alongside disease-related factors, such as metabolic abnormalities and accelerating aging contribute to physical morbidity. Moreover, the symptomatology of psychosis and stigma may limit patients' access to quality medical care. Interventions to promote physical health in those patients should be multifaceted, and should target all patient-related modifiable factors, but also should address service-related healthcare disparities. Long-term antipsychotic use (including clozapine and long-acting injectables) is associated with substantially decreased all-cause mortality, including suicide and cardiovascular mortality, in patients with schizophrenia despite the well-known cardiometabolic adverse effects of second-generation agents. Integrated care may involve co-location of physical and mental health services, liaison services, shared protocols and information sharing systems, and has emerged as a way to address the physical health needs of those patients. Interventions to address mortality in schizophrenia and related syndromes should take place as early as possible in the course of the patients' treatment, and could be an integral component of care delivered by specialized early intervention services.
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Jiang T, Nagy D, Rosellini AJ, Horváth-Puhó E, Keyes KM, Lash TL, Galea S, Sørensen HT, Gradus JL. The Joint Effects of Depression and Comorbid Psychiatric Disorders on Suicide Deaths: Competing Antagonism as an Explanation for Subadditivity. Epidemiology 2022; 33:295-305. [PMID: 34860728 DOI: 10.1097/ede.0000000000001449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous studies of the effect of interaction between psychiatric disorders on suicide have reported mixed results. We investigated the joint effect of depression and various comorbid psychiatric disorders on suicide. METHODS We conducted a population-based case-cohort study with all suicide deaths occurring between 1 January 1995 and 31 December 2015 in Denmark (n = 14,103) and a comparison subcohort comprised of a 5% random sample of the source population at baseline (n = 265,183). We quantified the joint effect of pairwise combinations of depression and major psychiatric disorders (e.g., organic disorders, substance use disorders, schizophrenia, bipolar disorder, neurotic disorders, eating disorders, personality disorders, intellectual disabilities, developmental disorders, and behavioral disorders) on suicide using marginal structural models and calculated the relative excess risk due to interaction. We assessed for the presence of competing antagonism for negative relative excess risk due to interactions. RESULTS All combinations of depression and comorbid psychiatric disorders were associated with increased suicide risk. For example, the rate of suicide among men with depression and neurotic disorders was 20 times (95% CI = 15, 26) the rate in men with neither disorder. Most disorder combinations were associated with subadditive suicide risk, and there was evidence of competing antagonism in most of these cases. CONCLUSIONS Subadditivity may be explained by competing antagonism. When both depression and a comorbid psychiatric disorder are present, they may compete to cause the outcome such that having 2 disorders may be no worse than having a single disorder with respect to suicide risk.
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Affiliation(s)
- Tammy Jiang
- From the Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Dávid Nagy
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Anthony J Rosellini
- Center for Anxiety and Related Disorders, Department of Psychological and Brain Sciences, Boston University, Boston, MA
| | | | - Katherine M Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Timothy L Lash
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Sandro Galea
- From the Department of Epidemiology, Boston University School of Public Health, Boston, MA
- Department of Family Medicine, Boston University School of Medicine, Boston, MA
| | - Henrik T Sørensen
- From the Department of Epidemiology, Boston University School of Public Health, Boston, MA
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jaimie L Gradus
- From the Department of Epidemiology, Boston University School of Public Health, Boston, MA
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
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Hodgins S. Could Expanding and Investing in First-Episode Psychosis Services Prevent Aggressive Behaviour and Violent Crime? Front Psychiatry 2022; 13:821760. [PMID: 35242064 PMCID: PMC8885584 DOI: 10.3389/fpsyt.2022.821760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/21/2022] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Some persons developing, or presenting, schizophrenia engage in aggressive behaviour (AB) and/or criminal offending. Most of these individuals display AB prior to a first episode of psychosis (FEP). In fact, approximately one-third of FEP patients have a history of AB, some additionally display other antisocial behaviours (A+AB). The large majority of these individuals have presented conduct problems since childhood, benefit from clozapine, have extensive treatment needs, and are unlikely to comply with treatment. A smaller sub-group begin to engage in AB as illness onsets. A+AB persists, often for many years in spite of treatment-as-usual, until a victim is seriously harmed. This article proposes providing multi-component treatment programs at FEP in order to prevent aggressive and antisocial behaviours of persons with schizophrenia. METHOD Non-systematic reviews of epidemiological studies of AB among persons with schizophrenia, of the defining characteristics of sub-types of persons with schizophrenia who engage in AB and their responses to treatment, and of FEP service outcomes. RESULTS Studies have shown that mental health services that simultaneously target schizophrenia and aggressive behaviour are most effective both in reducing psychotic symptoms and aggressive behaviour. Evidence, although not abundant, suggests that a multi-component treatment program that would include the components recommended to treat schizophrenia and cognitive-behavioural interventions to reduce A+AB, and the other factors promoting A+AB such as substance misuse, victimisation, and poor recognition of emotions in the faces of others has the potential to effectively treat schizophrenia and reduce A+AB. Patients with a recent onset of AB would require few components of treatment, while those with prior conduct disorder would require all. Such a program of treatment would be long and intense. CONCLUSIONS Trials are needed to test the effectiveness of multi-component treatment programs targeting schizophrenia and A+AB at FEP. Studies are also necessary to determine whether providing such programs in hospitals and/or prisons, with long-term community after-care, and in some cases with court orders to participate in treatment, would enhance effectiveness. Whether investing at FEP would be cost-effective requires investigation.
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Affiliation(s)
- Sheilagh Hodgins
- Département de Psychiatrie et Addictologie, Université de Montréal et Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada.,Haina Institute of Forensic Psychiatry, Haina, Germany
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O’Neill M, Buajitti E, Donnelly PD, Kornas K, Rosella L. Characterising mental health and addictions and assault-related health care use in the year prior to death: a population-based linked cohort study of homicide victims. Int J Popul Data Sci 2021; 6:1410. [PMID: 34095544 PMCID: PMC8142946 DOI: 10.23889/ijpds.v6i1.1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Homicide is an important cause of death for older youth and adult Canadians; however, little is known about health care use prior to death among this population. OBJECTIVES To characterise health care use for mental health and addictions (MHA) and serious assault (herein referred to assault) one year prior to death among individuals who died by homicide in Ontario, Canada using linked mortality and health care utilisation data. METHODS We report rates of health care use for MHA and assault in the year prior to death among all individuals 16 years and older in Ontario, Canada, who died by homicide from April 2003 to December 2012 (N = 1,541). Health care use for MHA included inpatient stays, emergency department (ED) visits and outpatient visits, whereas health care use for assault included only hospital-based care (ED visits and inpatient stays). Sociodemographic characteristics and health care utilisation were examined across homicide deaths, stratified by sex. RESULTS Overall, 28.5% and 5.9% of homicide victims sought MHA and assault care in the year prior to death, respectively. A greater proportion of females accessed care for MHA, whereas a greater proportion of males accessed assault-related health care. Males were more likely to be hospitalised following an ED visit for a MHA or assault related reason, in comparison to females. The most common reason for a MHA hospital visit was for substance-related disorders. We found an increase over time for hospital-based visits for assault prior to death, a trend that was not observed for MHA-related visits. CONCLUSIONS A large proportion of homicide victims interacted with the health care system for MHA or assault in the year prior to death. An increase in hospital-based visits for assault-related reasons prior to death was observed. These trends may offer insight into avenues for support and prevention for victims of homicide.
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Kouppis E, Björkenstam C, Gerdin B, Ekselius L, Björkenstam E. Childbearing and mortality among women with personality disorders: nationwide registered-based cohort study. BJPsych Open 2020; 6:e95. [PMID: 32838831 PMCID: PMC7488311 DOI: 10.1192/bjo.2020.77] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND People with a personality disorder have a higher mortality and reduced life expectancy than the general population. Childbearing is thought to have a protective effect on morbidity and mortality. Yet, there are no studies on whether childbearing is related to a lower mortality among women with personality disorder. AIMS This study examined associations between childbearing and mortality among women with personality disorder. Our hypothesis was that parity would be associated with lower mortality. METHOD This register-based cohort study included 27 412 women treated for personality disorder in in-patient or specialised out-patient care between 1990 and 2015. We used nationwide population-based registers to obtain information on sociodemographics, child delivery, healthcare use and mortality. Mortality risk estimates were calculated as hazard ratios (HRs) with 95% CIs using Cox regression. Adjustments were made for year of birth, educational level, age at diagnosis, comorbidity and severity of personality disorder. RESULTS Nulliparous women had a nearly twofold increased mortality risk (adjusted HR = 1.78, 95% CI 1.50-2.12) compared with parous women and over twofold mortality risk (adjusted HR = 2.29, 95% CI 1.72-3.04) compared with those giving birth after their first personality disorder diagnosis. Those giving birth before their first personality disorder diagnosis had a 1.5-fold higher risk of mortality than those giving birth after their first personality disorder diagnosis (adjusted HR = 1.48, 95% CI 1.06-2.07). There was a threefold risk of suicide in nulliparous women compared with those giving birth after their first personality disorder diagnosis (adjusted HR = 2.90, 95% CI 1.97-4.26). CONCLUSIONS Childbearing history should be an integral part of the clinical evaluation of women with personality disorder.
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Affiliation(s)
| | | | - Bengt Gerdin
- Department of Surgical Sciences, Uppsala University, Sweden
| | - Lisa Ekselius
- Department of Neuroscience, Uppsala University, Sweden
| | - Emma Björkenstam
- Department of Neuroscience, Uppsala University, Sweden; and Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
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Bhavsar V, Sanyal J, Patel R, Shetty H, Velupillai S, Stewart R, Broadbent M, MacCabe JH, Das-Munshi J, Howard LM. The association between neighbourhood characteristics and physical victimisation in men and women with mental disorders. BJPsych Open 2020; 6:e73. [PMID: 32669154 PMCID: PMC7443921 DOI: 10.1192/bjo.2020.52] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/15/2020] [Accepted: 06/02/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND How neighbourhood characteristics affect the physical safety of people with mental illness is unclear. AIMS To examine neighbourhood effects on physical victimisation towards people using mental health services. METHOD We developed and evaluated a machine-learning-derived free-text-based natural language processing (NLP) algorithm to ascertain clinical text referring to physical victimisation. This was applied to records on all patients attending National Health Service mental health services in Southeast London. Sociodemographic and clinical data, and diagnostic information on use of acute hospital care (from Hospital Episode Statistics, linked to Clinical Record Interactive Search), were collected in this group, defined as 'cases' and concurrently sampled controls. Multilevel logistic regression models estimated associations (odds ratios, ORs) between neighbourhood-level fragmentation, crime, income deprivation, and population density and physical victimisation. RESULTS Based on a human-rated gold standard, the NLP algorithm had a positive predictive value of 0.92 and sensitivity of 0.98 for (clinically recorded) physical victimisation. A 1 s.d. increase in neighbourhood crime was accompanied by a 7% increase in odds of physical victimisation in women and an 13% increase in men (adjusted OR (aOR) for women: 1.07, 95% CI 1.01-1.14, aOR for men: 1.13, 95% CI 1.06-1.21, P for gender interaction, 0.218). Although small, adjusted associations for neighbourhood fragmentation appeared greater in magnitude for women (aOR = 1.05, 95% CI 1.01-1.11) than men, where this association was not statistically significant (aOR = 1.00, 95% CI 0.95-1.04, P for gender interaction, 0.096). Neighbourhood income deprivation was associated with victimisation in men and women with similar magnitudes of association. CONCLUSIONS Neighbourhood factors influencing safety, as well as individual characteristics including gender, may be relevant to understanding pathways to physical victimisation towards people with mental illness.
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Affiliation(s)
- Vishal Bhavsar
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Jyoti Sanyal
- Clinical Informatics, BRC Nucleus, South London and Maudsley NHS Foundation Trust, UK
| | - Rashmi Patel
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Hitesh Shetty
- Clinical Informatics, BRC Nucleus, South London and Maudsley NHS Foundation Trust, UK
| | | | - Robert Stewart
- BRC Nucleus, South London and Maudsley NHS Foundation Trust, UK
| | - Matthew Broadbent
- Clinical Informatics, BRC Nucleus, South London and Maudsley NHS Foundation Trust, UK
| | | | - Jayati Das-Munshi
- Department of Health Services and Population Research, King's College London, UK
| | - Louise M. Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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Kouppis E, Ekselius L. Validity of the personality disorder diagnosis in the Swedish National Patient Register. Acta Psychiatr Scand 2020; 141:432-438. [PMID: 32092153 DOI: 10.1111/acps.13166] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/11/2020] [Accepted: 02/19/2020] [Indexed: 12/28/2022]
Abstract
AIMS The Swedish National Patient Register (NPR) is an exceptional source of information in clinical epidemiological research. The register is, however, not validated for the diagnosis of personality disorder (PD). We therefore assessed its validity in this patient group, and the group with emotionally unstable PD (EUPD)/borderline personality disorder (BPD). METHODS Records from 100 random adult patients (aged 15-65 years) diagnosed with any PD in the NPR between 1987 and 2015 were analysed using a protocol based on general diagnostic criteria for PD, as well as specific criteria for EUPD/BPD in both ICD and DSM classification systems. RESULTS Of the 100 patients, 27 had been given a diagnosis of EUPD, 23 another specific PD and 50 an unspecified PD. Using ICD criteria, 88 of 95 evaluable patients could be confirmed to have a PD, that is an agreement rate of 93%. Using DSM criteria, the agreement was lower (77 patients or 81%). Of 26 evaluable patients with a diagnosis of EUPD/BPD, the diagnosis was confirmed in all cases when using the ICD criteria, but in only 20 when using the DSM criteria. CONCLUSIONS The NPR is a valid source of data for the diagnosis of PD per se and also of EUPD in women.
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Affiliation(s)
- E Kouppis
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - L Ekselius
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
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Sariaslan A, Arseneault L, Larsson H, Lichtenstein P, Fazel S. Risk of Subjection to Violence and Perpetration of Violence in Persons With Psychiatric Disorders in Sweden. JAMA Psychiatry 2020; 77:359-367. [PMID: 31940015 PMCID: PMC6990843 DOI: 10.1001/jamapsychiatry.2019.4275] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
IMPORTANCE Key outcomes for persons with psychiatric disorders include subjection to violence and perpetration of violence. The occurrence of these outcomes and their associations with psychiatric disorders need to be clarified. OBJECTIVE To estimate the associations of a wide range of psychiatric disorders with the risks of subjection to violence and perpetration of violence. DESIGN, SETTING, AND PARTICIPANTS A total of 250 419 individuals born between January 1, 1973, and December 31, 1993, were identified to have psychiatric disorders using Swedish nationwide registers. Premorbid subjection to violence was measured since birth. The patients were matched by age and sex to individuals in the general population (n = 2 504 190) and to their full biological siblings without psychiatric disorders (n = 194 788). The start date for the patients and control groups was defined as the discharge date of the first psychiatric episode. The participants were censored either when they migrated, died, experienced the outcome of interest, or reached the end of the study period on December 31, 2013. Data were analyzed from January 15 to September 14, 2019. EXPOSURES Patients with common psychiatric disorders (eg, schizophrenia, bipolar disorder, depression, and anxiety) were differentiated using a hierarchical approach. Patients with personality disorders and substance use disorders were also included. MAIN OUTCOMES AND MEASURES Subjection to violence was defined as an outpatient visit (excluding a primary care visit), inpatient episode, or death associated with any diagnosis of an injury that was purposefully inflicted by other persons. Perpetration of violence was defined as a violent crime conviction. Stratified Cox regression models were fitted to account for the time at risk, a range of sociodemographic factors, a history of violence, and unmeasured familial confounders (via sibling comparisons). RESULTS Among 250 419 patients (55.4% women), the median (interquartile range) age at first diagnosis ranged from 20.0 (17.4-24.0) years for alcohol use disorder to 23.7 (19.9-28.8) years for anxiety disorder. Compared with 2 504 190 matched individuals without psychiatric disorders from the general population, patients with psychiatric disorders were more likely to be subjected to violence (7.1 [95% CI, 6.9-7.2] vs 1.0 [95% CI, 0.9-1.0] per 1000 person-years) and to perpetrate violence (7.5 [95% CI, 7.4-7.6] vs 0.7 [95% CI, 0.7-0.7] per 1000 person-years). In the fully adjusted models, patients with psychiatric disorders were 3 to 4 times more likely than their siblings without psychiatric disorders to be either subjected to violence (adjusted hazard ratio [aHR], 3.4 [95% CI, 3.2-3.6]) or to perpetrate violence (aHR, 4.2 [95% CI, 3.9-4.4]). Diagnosis with any of the specific disorders was associated with higher rates of violent outcomes, with the sole exception of schizophrenia, which was not associated with the risk of subjection to violence. CONCLUSIONS AND RELEVANCE In this study, persons with psychiatric disorders were 3 to 4 times more likely than their siblings without psychiatric disorders to have been subjected to violence or to have perpetrated violence after the onset of their conditions. The risks of both outcomes varied by specific psychiatric diagnosis, history of violence, and familial risks. Clinical interventions may benefit from targeted approaches for the assessment and management of risk of violence in people with psychiatric disorders.
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Affiliation(s)
- Amir Sariaslan
- Warneford Hospital, Department of Psychiatry, University of Oxford, Oxford, United Kingdom,Social and Public Policy Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Louise Arseneault
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Orebro University School of Medical Sciences, Orebro, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Seena Fazel
- Warneford Hospital, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Wilson R, Hepgul N, Higginson IJ, Gao W. End-of-life care and place of death in adults with serious mental illness: A systematic review and narrative synthesis. Palliat Med 2020; 34:49-68. [PMID: 31608768 DOI: 10.1177/0269216319867847] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND People with serious mental illness have greater mortality risk than the general population. They experience health care inequalities throughout life; it is not clear if this persists to end of life. AIM Assess the empirical evidence describing end-of-life care and place of death for people with serious mental illness. DESIGN A systematic review of original, peer-reviewed research, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were analysed using a narrative synthesis approach. DATA SOURCES Five online databases (Embase, PsycArticles, PsycINFO, Medline, PubMed) and additional sources were searched (without time restriction) for primary research reporting health care utilisation in the last year of life or place of death in adults with serious mental illness. RESULTS After full-text screening, 23 studies were included. We found studies reporting hospital admissions, emergency department care, palliative care, and general practitioner (GP) visits at end of life. We found conflicting evidence for the association between serious mental illness and end-of-life care, although different patient groups, settings and measures were used across studies. People with serious mental illness were more likely to die in care homes than the general population. There were no patterns for other places of death. CONCLUSIONS The evidence was sparse and heterogeneous, demonstrating variability in patterns and reporting of health care use and with little consensus on where people with serious mental illness are likely to die. Given that people with serious mental illness have increased mortality risk, this gap in the knowledge around end-of-life care outcomes is concerning; this area of research needs further development.
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Affiliation(s)
- Rebecca Wilson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Nilay Hepgul
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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Zhang GB, Wang GF, Han AZ, Xu N, Xie GD, Chen LR, Su PY. Association between different stages of precollege school bullying and murder-related psychological behaviors among college students in Anhui Province, China. Psychiatry Res 2019; 282:112593. [PMID: 31630040 DOI: 10.1016/j.psychres.2019.112593] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 09/29/2019] [Accepted: 09/29/2019] [Indexed: 12/31/2022]
Abstract
Little is known about the relationship between precollege school bullying and murder-related psychological behaviors. The present study aims to examine that relationship in Chinese college students using a cross-sectional study. Self-report data were collected from 4034 college students in Anhui Province using a proportional stratified cluster sampling method. Four types of school bullying (i.e., physical, verbal, relational, and cyber) with bullies and victims and two periods (i.e., primary and secondary) were measured. The prevalence rates of murderous ideation, plans, preparation, and attempts were 6.9%, 2.5%, 1.8%, 1.4%, respectively. Different stages of precollege cyber bullying were associated with murder-related psychological behaviors for both bullies (primary: AORs = 2.78 to 15.67; secondary: AORs = 2.43 to 9.99; both periods: AORs = 2.26 to 14.04) and victims (primary: AORs = 2.87 to 16.57; secondary: AORs = 1.89 to 4.49; both periods: AORs = 3.68 to 21.48). A dose-response relationship was found, such that college students with a bullying perpetration index of two types and more were more likely to have murder-related psychological behaviors than those who were not bullied. Notably, both primary and secondary school bullying, especially cyber forms, were more likely to be associated with murder-related psychological behaviors. Therefore, it is necessary to develop school bullying preventive measures beginning in primary school.
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Affiliation(s)
- Guo-Bao Zhang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Geng-Fu Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - A-Zhu Han
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Nuo Xu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Guo-Die Xie
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Li-Ru Chen
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China
| | - Pu-Yu Su
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei, 230032, Anhui, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei 230032, Anhui, China.
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17
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Walter F, Carr MJ, Mok PLH, Antonsen S, Pedersen CB, Appleby L, Fazel S, Shaw J, Webb RT. Multiple adverse outcomes following first discharge from inpatient psychiatric care: a national cohort study. Lancet Psychiatry 2019; 6:582-589. [PMID: 31171451 PMCID: PMC6586943 DOI: 10.1016/s2215-0366(19)30180-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/28/2019] [Accepted: 04/12/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Discharged psychiatric inpatients are at elevated risk of serious adverse outcomes, but no previous study has comprehensively examined an array of multiple risks in a single cohort. METHODS We used data from the Danish Civil Registration System to delineate a cohort of all individuals born in Denmark in 1967-2000, who were alive and residing in Denmark on their 15th birthday, and who had been discharged from their first inpatient psychiatric episode at age 15 years or older. Each individual in the discharged cohort was matched on age and sex with 25 comparators without a history of psychiatric admission. Data linked to each individual were also obtained from the Psychiatric Central Research Register, Register of Causes of Death, National Patient Register, and the National Crime Register. We used survival analysis techniques to estimate absolute and relative risks of all-cause mortality, suicide, accidental death, homicide victimisation, homicide perpetration, non-fatal self-harm, violent criminality, and hospitalisation following violence, until Dec 31, 2015. FINDINGS We included 62 922 individuals in the discharged cohort, and 1 573 050 matched comparators. Risks for each of all eight outcomes examined were markedly elevated in the discharged cohort relative to the comparators. Within 10 years of first discharge, the cumulative incidence of death, self-harm, committing a violent crime, or hospitalisation due to interpersonal violence was 32·0% (95% CI 31·6-32·5) in the discharged cohort (37·1% [36·5-37·8] in men and 27·2% [26·7-27·8] in women). Absolute risk of at least one adverse outcome occurring within this timeframe were highest in people diagnosed with a psychoactive substance use disorder at first discharge (cumulative incidence 49·4% [48·4-50·4]), and lowest in those diagnosed with a mood disorder (24·4% [23·6-25·2]). For suicide and non-fatal self-harm, risks were especially high during the first 3 months post-discharge, whereas risks for accidental death, violent criminality, and hospitalisation due to violence were more constant throughout the 10-year follow-up. INTERPRETATION People discharged from inpatient psychiatric care are at higher risk than the rest of the population for a range of serious fatal and non-fatal adverse outcomes. Improved inter-agency liaison, intensive follow-up immediately after discharge, and longer-term social support are indicated. FUNDING Medical Research Council, European Research Council, and Wellcome Trust.
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Affiliation(s)
- Florian Walter
- Centre for Mental Health & Safety, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
| | - Matthew J Carr
- Centre for Mental Health & Safety, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
| | - Pearl L H Mok
- Centre for Mental Health & Safety, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
| | - Sussie Antonsen
- National Centre for Register-based Research and Centre for Integrated Register-based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Carsten B Pedersen
- National Centre for Register-based Research and Centre for Integrated Register-based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Louis Appleby
- Centre for Mental Health & Safety, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
| | - Seena Fazel
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Warneford Hospital, Oxford, UK
| | - Jenny Shaw
- Centre for Mental Health & Safety, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
| | - Roger T Webb
- Centre for Mental Health & Safety, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK; National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Manchester, UK.
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18
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Walter F, Carr MJ, Mok PL, Antonsen S, Pedersen CB, Shaw J, Webb RT. Suicide Methods and Specific Types of Accidental Death and Fatal Poisoning Among Discharged Psychiatric Patients: A National Cohort Study. J Clin Psychiatry 2018; 79:17m11809. [PMID: 30289629 PMCID: PMC6193537 DOI: 10.4088/jcp.17m11809] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 04/05/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Persons discharged from inpatient psychiatric units are at greatly elevated risk of dying unnaturally. We conducted a comprehensive examination of specific causes of unnatural death post-discharge in a national register-based cohort. METHOD A cohort of 1,683,645 Danish residents born 1967-1996 was followed from their 15th birthday until death, emigration, or December 31, 2011, whichever came first. Survival analysis techniques were used to estimate incidence rate ratios (IRRs) comparing risk for persons with and without psychiatric admission history in relation to (a) suicide method, (b) accidental death type, (c) fatal poisoning type, and (d) homicide. RESULTS More than half (52.5%, n = 711) of all unnatural deaths post-discharge were fatal poisonings, compared with less than a fifth (17.0%, n = 1,012) among persons in the general population not admitted. Just 6.8% (n = 92) of all unnatural deaths post-discharge were due to transport accidents-the most common unnatural death type in the general population (53.4%, n = 3,184). Suicide risk was 32 times higher among discharged patients (IRR 32.3; 95% CI, 29.2-35.8) and was even higher during the first year post-discharge (IRR 70.4; 95% CI, 59.7-83.0). Among the suicide methods examined, relative risk values were significantly larger for intentional self-poisoning (IRR 40.8; 95% CI, 33.9-49.1) than for "violent" suicide methods (IRR 29.4; 95% CI, 26.1-33.2). The greatest relative risk observed was for fatal poisoning (irrespective of intent) by psychotropic medication (IRR 93.7; 95% CI, 62.5-140.5). The highest post-discharge mortality rate was for accidental self-poisoning among persons diagnosed with a psychoactive substance abuse disorder: 290.1 per 100,000 person-years. CONCLUSIONS Closer liaison between inpatient services and community care, more effective early treatment for comorbid substance abuse, enhanced psychosocial assessment following self-harm, and tighter medication surveillance could decrease risk of unnatural death post-discharge.
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Affiliation(s)
| | | | | | - Sussie Antonsen
- Centre for Integrated Register-Based Research and National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Carsten B Pedersen
- Centre for Integrated Register-Based Research and National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Jenny Shaw
- Centre for Mental Health & Safety, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Roger T Webb
- Centre for Mental Health & Safety, The University of Manchester and Manchester Academic Health Sciences Centre (MAHSC), Jean McFarlane Bldg, Oxford Rd, Manchester, UK M13 9PL. .,Centre for Mental Health & Safety, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Manchester, United Kingdom
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Apostolopoulos A, Michopoulos I, Zachos I, Rizos E, Tzeferakos G, Manthou V, Papageorgiou C, Douzenis A. Association of Schizoid and Schizotypal Personality disorder with violent crimes and homicides in Greek prisons. Ann Gen Psychiatry 2018; 17:35. [PMID: 30116288 PMCID: PMC6086037 DOI: 10.1186/s12991-018-0204-4] [Citation(s) in RCA: 3] [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] [Received: 05/07/2018] [Accepted: 07/31/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Personality disorders (PDs) have been associated with both violent crimes and homicides in many studies. The proportion of PDs among prisoners reaches up to 80%. For male prisoners, the most common PD in the literature is antisocial PD. The aim of this study was to investigate the association between PDs and violent crimes/homicides of male prisoners in Greece. METHODS A sample of 308 subjects was randomly selected from a population of 1300 male prisoners incarcerated in two Greek prisons, one urban and one rural. The presence of PDs was assessed using the Mini International Neuropsychiatric Interview (MINI) and the Personality Diagnostic Questionnaire-4 (PDQ-4). Using logistic regression models PD types and PD "Clusters" (independent variables) were associated with "violent/non-violent crimes" and "homicides/non homicides" (dependent variables). RESULTS "Cluster A" PDs (Paranoid, Schizoid, and Schizotypal) were diagnosed in 16.2%, "Cluster B" (Antisocial, Borderline, Histrionic, Narcissistic) in 66.9% and "Cluster C" (Obsessive-Compulsive, Dependent, Avoidant) in 2.9% of the studied population. Violent crimes and homicides were found significantly associated with "Cluster A" PDs (p = 0.022, p = 0.020). The odds ratio of committing violent crimes was 2.86 times higher for patients with "Cluster A" PDs than the ones without PDs. In addition, the odds ratio of committing homicides was 4.25 times higher for patients with "Cluster A" PDs. In separate analyses, the commitment of violent crimes as well as homicides, was significantly associated with Schizoid (p = 0.043, p = 0.020) and Schizotypal PD (p = 0.017, p = 0.030). CONCLUSIONS The majority of prisoners was found to suffer from a PD, mainly the Antisocial "Cluster B", but the commitment of violent crimes and homicides was significantly associated only with "Cluster A" PDs and specifically with Schizoid and Schizotypal PD.
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Affiliation(s)
| | - Ioannis Michopoulos
- 2nd Psychiatric Department of the University of Athens, Attikon Hospital, Athens, Greece
| | | | - Emmanouil Rizos
- 2nd Psychiatric Department of the University of Athens, Attikon Hospital, Athens, Greece
| | - Georgios Tzeferakos
- 2nd Psychiatric Department of the University of Athens, Attikon Hospital, Athens, Greece
| | | | | | - Athanasios Douzenis
- 2nd Psychiatric Department of the University of Athens, Attikon Hospital, Athens, Greece
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Abstract
PURPOSE OF REVIEW The contribution of people with psychosis to homicide statistics is small, but there is a statistically significantly higher rate of homicide among them than in the general population. Legal authorities and the wider public call for more information. Our aim was a narrative synthesis of empirical literature generated by systematic searches for the five complete years 2013-2017. RECENT FINDINGS One article showed that people with psychosis are five times more likely to be homicide victims than those without, but focus remains on perpetrators. Consensus is that although psychotic symptoms contribute to homicidal acts, so do many of the variables that increase homicide risk more generally - including substance use, trauma histories and access to weapons; thus, both the epidemiology of homicide and some details, like method, may be country specific. In 2013-2017, variation in service provision as a risk factor for homicide has emerged more clearly but, overall, research made few homicide-specific advances. SUMMARY Criminal homicide is, fortunately, uncommon in most countries. Homicides by people with psychosis are so rare that they do not rate mention in the 2013 United Nations Global Survey of Homicide. This may account for the limitations to much research for this group. Despite some homicide-specific evidence of advantage for early intervention for psychosis, impact of improving treatment - the most promising way forward - will generally have to be inferred from the not entirely satisfactory surrogate of effects of treatment on violent offending more generally.
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Barber S, Thornicroft G. Reducing the Mortality Gap in People With Severe Mental Disorders: The Role of Lifestyle Psychosocial Interventions. Front Psychiatry 2018; 9:463. [PMID: 30323773 PMCID: PMC6172296 DOI: 10.3389/fpsyt.2018.00463] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/06/2018] [Indexed: 11/22/2022] Open
Abstract
This mini-review considers the mortality gap in persons with severe mental disorder (SMD) globally. Current estimates of 10-20 years of potential life lost may be too conservative, both in high (HIC) and low and middle-income countries (LMICs). There is an emerging consensus that natural causes account for the majority of deaths in persons with SMD in both resource settings. In HICs, cardiovascular causes predominate, and can be attributed to individual, health-system and societal level risk factors. Psychosocial lifestyle interventions target behavior specific risk factors for physical ill-health. There is good evidence for tailored weight-loss programmes, but mixed evidence for smoking cessation, substance misuse and risky sexual behavior. In terms of supporting persons with SMD, nurse-led services and the utilization of peer-support are showing promise. Future research efforts must focus on effective interventions and health system models for both high and low resource settings to address this startling health inequality.
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Affiliation(s)
- Sarah Barber
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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22
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Roberts LW, Louie AK, Guerrero APS, Balon R, Beresin EV, Brenner A, Coverdale J. Premature Mortality Among People with Mental Illness: Advocacy in Academic Psychiatry. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2017; 41:441-446. [PMID: 28585124 DOI: 10.1007/s40596-017-0738-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 05/17/2017] [Indexed: 06/07/2023]
Affiliation(s)
| | | | | | | | | | - Adam Brenner
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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23
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Liu NH, Daumit GL, Dua T, Aquila R, Charlson F, Cuijpers P, Druss B, Dudek K, Freeman M, Fujii C, Gaebel W, Hegerl U, Levav I, Munk Laursen T, Ma H, Maj M, Elena Medina‐Mora M, Nordentoft M, Prabhakaran D, Pratt K, Prince M, Rangaswamy T, Shiers D, Susser E, Thornicroft G, Wahlbeck K, Fekadu Wassie A, Whiteford H, Saxena S. Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas. World Psychiatry 2017; 16:30-40. [PMID: 28127922 PMCID: PMC5269481 DOI: 10.1002/wps.20384] [Citation(s) in RCA: 409] [Impact Index Per Article: 58.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Excess mortality in persons with severe mental disorders (SMD) is a major public health challenge that warrants action. The number and scope of truly tested interventions in this area remain limited, and strategies for implementation and scaling up of programmes with a strong evidence base are scarce. Furthermore, the majority of available interventions focus on a single or an otherwise limited number of risk factors. Here we present a multilevel model highlighting risk factors for excess mortality in persons with SMD at the individual, health system and socio-environmental levels. Informed by that model, we describe a comprehensive framework that may be useful for designing, implementing and evaluating interventions and programmes to reduce excess mortality in persons with SMD. This framework includes individual-focused, health system-focused, and community level and policy-focused interventions. Incorporating lessons learned from the multilevel model of risk and the comprehensive intervention framework, we identify priorities for clinical practice, policy and research agendas.
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Affiliation(s)
- Nancy H. Liu
- World Health OrganizationGenevaSwitzerland,University of CaliforniaBerkeleyCAUSA
| | | | - Tarun Dua
- World Health OrganizationGenevaSwitzerland
| | | | - Fiona Charlson
- Queensland Centre for Mental Health ResearchWacolQLDAustralia
| | - Pim Cuijpers
- Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | | | | | | | - Chiyo Fujii
- National Institute of Mental HealthTokyoJapan
| | | | | | | | | | - Hong Ma
- Institute of Mental HealthBeijingP.R. China
| | - Mario Maj
- Department of PsychiatryUniversity of Naples SUNNaplesItaly
| | | | | | | | | | - Martin Prince
- Institute of Psychiatry, King's College LondonLondonUK
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Lahey BB, Krueger RF, Rathouz PJ, Waldman ID, Zald DH. A hierarchical causal taxonomy of psychopathology across the life span. Psychol Bull 2017; 143:142-186. [PMID: 28004947 PMCID: PMC5269437 DOI: 10.1037/bul0000069] [Citation(s) in RCA: 249] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We propose a taxonomy of psychopathology based on patterns of shared causal influences identified in a review of multivariate behavior genetic studies that distinguish genetic and environmental influences that are either common to multiple dimensions of psychopathology or unique to each dimension. At the phenotypic level, first-order dimensions are defined by correlations among symptoms; correlations among first-order dimensions similarly define higher-order domains (e.g., internalizing or externalizing psychopathology). We hypothesize that the robust phenotypic correlations among first-order dimensions reflect a hierarchy of increasingly specific etiologic influences. Some nonspecific etiologic factors increase risk for all first-order dimensions of psychopathology to varying degrees through a general factor of psychopathology. Other nonspecific etiologic factors increase risk only for all first-order dimensions within a more specific higher-order domain. Furthermore, each first-order dimension has its own unique causal influences. Genetic and environmental influences common to family members tend to be nonspecific, whereas environmental influences unique to each individual are more dimension-specific. We posit that these causal influences on psychopathology are moderated by sex and developmental processes. This causal taxonomy also provides a novel framework for understanding the heterogeneity of each first-order dimension: Different persons exhibiting similar symptoms may be influenced by different combinations of etiologic influences from each of the 3 levels of the etiologic hierarchy. Furthermore, we relate the proposed causal taxonomy to transdimensional psychobiological processes, which also impact the heterogeneity of each psychopathology dimension. This causal taxonomy implies the need for changes in strategies for studying the etiology, psychobiology, prevention, and treatment of psychopathology. (PsycINFO Database Record
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Affiliation(s)
| | | | - Paul J Rathouz
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine
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25
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Aihio N, Frings D, Wilcock R, Burrell P. Crime Victims' Demographics Inconsistently Relate to Self-Reported Vulnerability. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2016; 24:379-391. [PMID: 31983962 PMCID: PMC6818235 DOI: 10.1080/13218719.2016.1247418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Previous research has found a discrepancy between the number of individuals who self-report as being vulnerable and official prevalence estimations. Both this discrepancy and victims' views about their vulnerability need addressing in order to identify further training needs for criminal justice system agencies and to that ensure victims receive the appropriate support. Using data from the Metropolitan Police Service (MPS) User Satisfaction Survey (USS) (n = 47,560), the present study explores 1) crime victims' self-reported vulnerability and its association with demographics; 2) police identification of vulnerability; and 3) whether the needs of vulnerable victims are catered for. The results indicate that 38% of the sample self-identified as being vulnerable, a considerably higher percentage than estimated in previous literature. Although associations have been found between vulnerability and demographics, these have been negligible or have had weak effect sizes. The findings are discussed in relation to the current definition of a vulnerable victim, and the role of personal circumstances in self-identification are highlighted.
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Affiliation(s)
- Nelli Aihio
- School of Applied Sciences, Division of Psychology, London South Bank University, UK
| | - Daniel Frings
- School of Applied Sciences, Division of Psychology, London South Bank University, UK
| | - Rachel Wilcock
- Department of Psychology, The University of Winchester, Winchester,UK
| | - Phillip Burrell
- School of Engineering, Division of Computer Science and Informatics,London South Bank University, UK
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26
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Meier SM, Mattheisen M, Mors O, Mortensen PB, Laursen TM, Penninx BW. Increased mortality among people with anxiety disorders: total population study. Br J Psychiatry 2016; 209:216-21. [PMID: 27388572 PMCID: PMC5082973 DOI: 10.1192/bjp.bp.115.171975] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 02/27/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Anxiety disorders and depression are the most common mental disorders worldwide and have a striking impact on global disease burden. Although depression has consistently been found to increase mortality; the role of anxiety disorders in predicting mortality risk is unclear. AIMS To assess mortality risk in people with anxiety disorders. METHOD We used nationwide Danish register data to conduct a prospective cohort study with over 30 million person-years of follow-up. RESULTS In total, 1066 (2.1%) people with anxiety disorders died during an average follow-up of 9.7 years. The risk of death by natural and unnatural causes was significantly higher among individuals with anxiety disorders (natural mortality rate ratio (MRR) = 1.39, 95% CI 1.28-1.51; unnatural MRR = 2.46, 95% CI 2.20-2.73) compared with the general population. Of those who died from unnatural causes, 16.5% had comorbid diagnoses of depression (MRR = 11.72, 95% CI 10.11-13.51). CONCLUSIONS Anxiety disorders significantly increased mortality risk. Comorbidity of anxiety disorders and depression played an important part in the increased mortality.
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Affiliation(s)
- Sandra M. Meier
- National Centre for Register-Based Research, Aarhus University, Aarhus, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, and Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region, Denmark
| | - Manuel Mattheisen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, and Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Ole Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, and Research Department P, Aarhus University Hospital, Risskov, Denmark
| | - Preben B. Mortensen
- National Centre for Register-Based Research, Aarhus University, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Thomas M. Laursen
- National Centre for Register-Based Research, Aarhus University, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Brenda W. Penninx
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands
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27
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Reavey P, Wilcock R, Brown SD, Batty R, Fuller S. Legal professionals and witness statements from people with a suspected mental health diagnosis. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2016; 46:94-102. [PMID: 27210578 DOI: 10.1016/j.ijlp.2016.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Individuals with mental health problems are considered to be part of a group labeled 'vulnerable' in forensic psychology literature and the legal system more generally. In producing witness statements, there are numerous guidelines in the UK, designed to facilitate the production of reliable and valid accounts by those deemed to be vulnerable witnesses. And yet, it is not entirely clear how mental health impacts on reliability and validity within the judicial system, partly due to the diversity of those who present with mental health difficulties. In this paper, we set out to explore how legal professionals operating in the UK understand the impact of mental distress on the practical production of witness testimonies. Twenty legal professionals, including police officers, judges, magistrates and detectives were involved in a semi-structured interview to examine their knowledge and experience of working with mental health problems, and how they approached and worked with this group. A thematic analysis was conducted on the data and specific themes relevant to the overall research question are presented. These include a) dilemmas and deficiencies in knowledge of mental health, b) the abandonment of diagnosis and c) barriers to knowledge: time restrictions, silence, professional identity and fear. Finally, we explore some of the implications of these barriers, with regard to professional practice.
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Affiliation(s)
- Paula Reavey
- Department of Psychology, London South Bank University, 103 Borough Road, London SE1 OAA, United Kingdom.
| | - Rachel Wilcock
- University of Winchester, Sparkford Road, Winchester Hampshire SO22 4NR, United Kingdom
| | - Steven D Brown
- University of Leicester, Leicester, LE11 5HR, United Kingdom
| | - Richard Batty
- Department of Psychology, London South Bank University, 103 Borough Road, London SE1 OAA, United Kingdom
| | - Serina Fuller
- Department of Psychology, London South Bank University, 103 Borough Road, London SE1 OAA, United Kingdom
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28
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Meier SM, Mattheisen M, Mors O, Schendel DE, Mortensen PB, Plessen KJ. Mortality Among Persons With Obsessive-Compulsive Disorder in Denmark. JAMA Psychiatry 2016; 73:268-274. [PMID: 26818216 PMCID: PMC5082974 DOI: 10.1001/jamapsychiatry.2015.3105] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
IMPORTANCE Several mental disorders have consistently been found to be associated with decreased life expectancy, but little is known about whether this is also the case for obsessive-compulsive disorder (OCD). OBJECTIVE To determine whether persons who receive a diagnosis of OCD are at increased risk of death. DESIGN, SETTING, AND PARTICIPANTS Using data from Danish registers, we conducted a nationwide prospective cohort study with 30 million person-years of follow-up. The data were collected from Danish longitudinal registers. A total of 3 million people born between 1955 and 2006 were followed up from January 1, 2002, through December 31, 2011. During this period, 27,236 people died. The data were analyzed primarily in June 2015. MAIN OUTCOMES AND MEASURES We estimated mortality rate ratios (MRRs), adjusted for calendar year, age, sex, maternal and paternal age, place of residence at birth, and somatic comorbidities, to compare persons with OCT with persons without OCD. RESULTS Of 10,155 persons with OCD (5935 women and 4220 men with a mean [SD] age of 29.1 [11.3] years who contributed a total of 54,937 person-years of observation), 110 (1.1%) died during the average follow-up of 9.7 years. The risk of death by natural or unnatural causes was significantly higher among persons with OCD (MRR, 1.68 [95% CI, 1.31-2.12] for natural causes; MRR, 2.61 [95% CI, 1.91-3.47] for unnatural causes) than among the general population. After the exclusion of persons with comorbid anxiety disorders, depression, or substance use disorders, OCD was still associated with increased mortality risk (MRR, 1.88 [95% CI, 1.27-2.67]). CONCLUSIONS AND RELEVANCE The presence of OCD was associated with a significantly increased mortality risk. Comorbid anxiety disorders, depression, or substance use disorders further increased the risk. However, after adjusting for these and somatic comorbidities, we found that the mortality risk remained significantly increased among persons with OCD.
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Affiliation(s)
- Sandra M. Meier
- National Centre for Register-Based Research, Aarhus University, Aarhus V, Denmark2Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark3Child and Adolescent Mental Health Centre–Mental Health Services Capital Region, Copenhagen, Denmark
| | - Manuel Mattheisen
- Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark4Department of Biomedicine, Aarhus University, Aarhus C, Denmark
| | - Ole Mors
- Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark5Research Department P, Aarhus University Hospital, Risskov, Aarhus, Denmark
| | - Diana E. Schendel
- National Centre for Register-Based Research, Aarhus University, Aarhus V, Denmark2Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark6Department of Public Health, Section of Epidemiology, Aarhus University, Aarhus C, Denmark
| | - Preben B. Mortensen
- National Centre for Register-Based Research, Aarhus University, Aarhus V, Denmark2Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark7Centre for Integrated Register-Based Research, Aarhus University, Aarhus C, Denmark
| | - Kerstin J. Plessen
- Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark3Child and Adolescent Mental Health Centre–Mental Health Services Capital Region, Copenhagen, Denmark
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Björkenstam E, Björkenstam C, Holm H, Gerdin B, Ekselius L. Excess cause-specific mortality in in-patient-treated individuals with personality disorder: 25-year nationwide population-based study. Br J Psychiatry 2015; 207:339-45. [PMID: 26159601 DOI: 10.1192/bjp.bp.114.149583] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 11/27/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although personality disorders are associated with increased overall mortality, less is known about cause of death and personality type. AIMS To determine causes of mortality in ICD personality disorders. METHOD Based on data from Swedish nationwide registers, individuals admitted to hospital with a primary diagnosis of personality disorder between 1987 and 2011 were followed with respect to mortality until 31 December 2011. Standardised mortality ratios (SMRs) with 95% confidence intervals and underlying causes of death were calculated. RESULTS All-cause SMRs were increased, overall and in all clusters, for natural as well as unnatural causes of death. The overall SMR was 6.1 in women and 5.0 in men, as high as previously reported for anorexia nervosa, with higher rates in cluster B and mixed/other personality disorders. The SMR for suicide was 34.5 in women and 16.0 in men for cluster B disorders. Somatic and psychiatric comorbidity increased SMRs. CONCLUSIONS The SMR was substantially increased for all personality disorder clusters. Thus, there was an increased premature mortality risk for all personality disorders, irrespective of category.
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Affiliation(s)
- Emma Björkenstam
- Emma Björkenstam, PhD, Department of Public Health Sciences, Karolinska Institutet, Stockholm and the Department of Evaluation, and Analysis, Epidemiology and Methodological Support Unit, National Board of Health and Welfare, Stockholm, Sweden; Charlotte Björkenstam, PhD, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Herman Holm, MD, Department of Psychiatry, Skåne University Hospital, Malmö, Sweden; Bengt Gerdin, MD, PhD, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Lisa Ekselius, MD, PhD, Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Charlotte Björkenstam
- Emma Björkenstam, PhD, Department of Public Health Sciences, Karolinska Institutet, Stockholm and the Department of Evaluation, and Analysis, Epidemiology and Methodological Support Unit, National Board of Health and Welfare, Stockholm, Sweden; Charlotte Björkenstam, PhD, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Herman Holm, MD, Department of Psychiatry, Skåne University Hospital, Malmö, Sweden; Bengt Gerdin, MD, PhD, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Lisa Ekselius, MD, PhD, Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Herman Holm
- Emma Björkenstam, PhD, Department of Public Health Sciences, Karolinska Institutet, Stockholm and the Department of Evaluation, and Analysis, Epidemiology and Methodological Support Unit, National Board of Health and Welfare, Stockholm, Sweden; Charlotte Björkenstam, PhD, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Herman Holm, MD, Department of Psychiatry, Skåne University Hospital, Malmö, Sweden; Bengt Gerdin, MD, PhD, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Lisa Ekselius, MD, PhD, Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Bengt Gerdin
- Emma Björkenstam, PhD, Department of Public Health Sciences, Karolinska Institutet, Stockholm and the Department of Evaluation, and Analysis, Epidemiology and Methodological Support Unit, National Board of Health and Welfare, Stockholm, Sweden; Charlotte Björkenstam, PhD, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Herman Holm, MD, Department of Psychiatry, Skåne University Hospital, Malmö, Sweden; Bengt Gerdin, MD, PhD, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Lisa Ekselius, MD, PhD, Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Lisa Ekselius
- Emma Björkenstam, PhD, Department of Public Health Sciences, Karolinska Institutet, Stockholm and the Department of Evaluation, and Analysis, Epidemiology and Methodological Support Unit, National Board of Health and Welfare, Stockholm, Sweden; Charlotte Björkenstam, PhD, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Herman Holm, MD, Department of Psychiatry, Skåne University Hospital, Malmö, Sweden; Bengt Gerdin, MD, PhD, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Lisa Ekselius, MD, PhD, Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
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Pierce M, Bird SM, Hickman M, Millar T. National record linkage study of mortality for a large cohort of opioid users ascertained by drug treatment or criminal justice sources in England, 2005-2009. Drug Alcohol Depend 2015; 146:17-23. [PMID: 25454405 PMCID: PMC4294586 DOI: 10.1016/j.drugalcdep.2014.09.782] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 09/22/2014] [Accepted: 09/26/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Globally, opioid drug use is an important cause of premature mortality. In many countries, opioid using populations are ageing. The current study investigates mortality in a large cohort of opioid users; with a focus on testing whether excess mortality changes with age. METHODS 198,247 opioid users in England were identified from drug treatment and criminal justice sources (April, 2005 to March, 2009) and linked to mortality records. Mortality rates and standardised mortality ratios (SMRs) were calculated by age-group and gender. RESULTS There were 3974 deaths from all causes (SMR 5.7, 95% Confidence Interval: 5.5 to 5.9). Drug-related poisonings (1715) accounted for 43% of deaths. Relative to gender-and-age-appropriate expectation, mortality was elevated for a range of major causes including: infectious, respiratory, circulatory, liver disease, suicide, and homicide. Drug-related poisoning mortality risk continued to increase beyond 45 years and there were age-related increases in SMRs for specific causes of death (infectious, cancer, liver cirrhosis, and homicide). A gender by age-group interaction revealed that whilst men have a greater drug-related poisoning mortality risk than women at younger ages, the difference narrows with increasing age. CONCLUSION Opioid users' excess mortality persists into old age and for some causes is exacerbated. This study highlights the importance of managing the complex health needs of older opioid users.
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Affiliation(s)
- Matthias Pierce
- Institute of Brain Behaviour & Mental Health, Faculty of Medical and Human Sciences, University of Manchester
| | - Sheila M Bird
- Medical Research Council, Cambridge; University of Strathclyde
| | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol
| | - Tim Millar
- Institute of Brain Behaviour & Mental Health, Faculty of Medical and Human Sciences, University of Manchester.
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31
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Latalova K, Kamaradova D, Prasko J. Violent victimization of adult patients with severe mental illness: a systematic review. Neuropsychiatr Dis Treat 2014; 10:1925-39. [PMID: 25336958 PMCID: PMC4200170 DOI: 10.2147/ndt.s68321] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The aims of this paper are to review data on the prevalence and correlates of violent victimization of persons with severe mental illness, to critically evaluate the literature, and to explore possible approaches for future research. PubMed/MEDLINE and PsycINFO databases were searched using several terms related to severe mental illness in successive combinations with terms describing victimization. The searches identified 34 studies. Nine epidemiological studies indicate that patients with severe mental illness are more likely to be violently victimized than other community members. Young age, comorbid substance use, and homelessness are risk factors for victimization. Victimized patients are more likely to engage in violent behavior than other members of the community. Violent victimization of persons with severe mental illness has long-term adverse consequences for the course of their illness, and further impairs the quality of lives of patients and their families. Victimization of persons with severe mental illness is a serious medical and social problem. Prevention and management of victimization should become a part of routine clinical care for patients with severe mental illness.
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Affiliation(s)
- Klara Latalova
- Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
- Department of Psychiatry, University Hospital Olomouc, Olomouc, Czech Republic
| | - Dana Kamaradova
- Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
- Department of Psychiatry, University Hospital Olomouc, Olomouc, Czech Republic
| | - Jan Prasko
- Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
- Department of Psychiatry, University Hospital Olomouc, Olomouc, Czech Republic
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32
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Rheingold AA. Understanding risk of homicide among mental health patients. Lancet Psychiatry 2014; 1:97-8. [PMID: 26360556 DOI: 10.1016/s2215-0366(14)70272-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Alyssa A Rheingold
- National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.
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Rodway C, Flynn S, While D, Rahman MS, Kapur N, Appleby L, Shaw J. Patients with mental illness as victims of homicide: a national consecutive case series. Lancet Psychiatry 2014; 1:129-34. [PMID: 26360576 DOI: 10.1016/s2215-0366(14)70221-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The media attention received by homicides committed by patients with mental illness is thought to increase stigma. However, people with mental illness can also be victims of violence. We aimed to assess how often victims of homicide are current mental health patients and their relationship to the perpetrators. METHODS In a national consecutive case-series study, we obtained data for victims and perpetrators of all confirmed homicides between Jan 1, 2003, and Dec 31, 2005, in England and Wales. We requested information about contact with mental health services in the 12 months before the homicide for all victims and perpetrators. For victims and perpetrators who had contact with mental health services in the 12 months before homicide, we sent questionnaires to the clinician responsible for the patient's care. FINDINGS 1496 victims of confirmed homicide died between Jan 1, 2003, and Dec 31, 2005, in England and Wales. Patients with mental illness were more likely to die by homicide than were people in the general population (incidence rate ratio 2·6, 95% CI 1·9-3·4). 90 homicide victims (6%) had contact with mental health services in the 12 months before their death. 213 patients with mental illness were convicted of homicide in the same 3 year period. 29 of 90 patient victims were killed by another patient with mental illness. In 23 of these 29 cases, the victim and perpetrator were known to each other, and in 21 of these cases, the victims and perpetrators were undergoing treatment at the same National Health Service Trust. In these 29 cases in which patient victims were killed by another patient with mental illness, alcohol and drug misuse (19 victims [66%], 27 perpetrators [93%]) and previous violence (7 victims [24%], 7 perpetrators [24%]) were common in both victims and, particularly, perpetrators. In seven of the 29 cases in which the victim was killed by another patient with mental illness, both victim and perpetrator were diagnosed with schizophrenia. INTERPRETATION The high risk of patients with mental illness being victims of homicide is an important antistigma message, although this risk partly comes from other patients with mental illness; overall, the risk of patients committing homicide is greater than the risk of being a victim of homicide. Identification and safeguarding of patients at risk of violence should be prominent in clinical risk assessment. FUNDING Healthcare Quality Improvement Partnership.
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Affiliation(s)
- Cathryn Rodway
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK.
| | - Sandra Flynn
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - David While
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - Mohammed S Rahman
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - Navneet Kapur
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - Louis Appleby
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - Jenny Shaw
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK
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Excess mortality after disability retirement due to mental disorders: variations by socio-demographic factors and causes of death. Soc Psychiatry Psychiatr Epidemiol 2014; 49:639-49. [PMID: 23925530 DOI: 10.1007/s00127-013-0747-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 07/22/2013] [Indexed: 01/07/2023]
Abstract
PURPOSE Mental disorders are the key causes of disability retirement and are associated with a high risk of mortality. Social variations in excess mortality after disability retirement are nevertheless poorly understood. We examined socio-demographic differences in all-cause and cause-specific mortality after disability retirement due to depression and other mental disorders. METHODS The data comprised a nationally representative sample of the Finnish population aged 25-64 in 1996 with no prior disability retirement due to mental disorders (N = 392,985). We used Cox regression analysis with disability retirement due to mental disorders as a time-varying covariate and mortality between 1997 and 2007 as the outcome variable. RESULTS We found excess mortality after disability retirement due to mental disorders as compared to those with no such retirement in all specific causes of death, in particular alcohol-related causes, suicide, and other unnatural causes. Excess suicide mortality was particularly large after depression-based disability retirement. Younger age groups, non-manual classes, and those living with a partner and children had largest excess mortality, especially from unnatural and alcohol-related causes. However, the absolute number of excess deaths was not always largest in these socio-demographic groups. CONCLUSIONS In young adulthood, disability retirement due to depression signifies severe health and other social disadvantages that lead to particularly large excess mortality, especially due to unnatural causes. The protective effects of a high socioeconomic position and family ties against unnatural and alcohol-related deaths are limited among those who have already developed depression or other mental disorders that have led to disability retirement.
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Fleischhacker WW, Arango C, Arteel P, Barnes TRE, Carpenter W, Duckworth K, Galderisi S, Halpern L, Knapp M, Marder SR, Moller M, Sartorius N, Woodruff P. Schizophrenia--time to commit to policy change. Schizophr Bull 2014; 40 Suppl 3:S165-94. [PMID: 24778411 PMCID: PMC4002061 DOI: 10.1093/schbul/sbu006] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Care and outcomes for people with schizophrenia have improved in recent years, but further progress is needed to help more individuals achieve an independent and fulfilled life. This report sets out the current need, informs policy makers and all relevant stakeholders who influence care quality, and supports their commitment to creating a better future. The authors recommend the following policy actions, based on research evidence, stakeholder consultation, and examples of best practice worldwide. (1) Provide an evidence-based, integrated care package for people with schizophrenia that addresses their mental and physical health needs. (2) Provide support for people with schizophrenia to enter and to remain in their community, and develop mechanisms to help guide them through the complex benefit and employment systems. (3) Provide concrete support, information, and educational programs to families and carers on how to enhance care for an individual living with schizophrenia in a manner that entails minimal disruption to their lives. (4) All stakeholders, including organizations that support people living with schizophrenia, should be consulted to regularly revise, update, and improve policy on the management of schizophrenia. (5) Provide support, which is proportionate to the impact of the disease, for research and development of new treatments. (6) Establish adequately funded, ongoing, and regular awareness-raising campaigns that form an integral part of routine plans of action. Implementation of the above recommendations will require engagement by every stakeholder, but with commitment from all, change can be achieved.
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Affiliation(s)
- W. Wolfgang Fleischhacker
- Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria;,*To whom correspondence should be addressed; Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria; tel: +43-512-504-23669, fax: +43-512-504-25267, e-mail:
| | - Celso Arango
- Hospital General Universitario Gregorio Marañón, CIBERSAM, Madrid, Spain
| | | | - Thomas R. E. Barnes
- Imperial College Centre for Mental Health, Faculty of Medicine, Imperial College London and West London Mental Health NHS Trust, London, UK
| | - William Carpenter
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | | | - Silvana Galderisi
- Department of Psychiatry, Second University of Naples, Naples, Italy
| | | | - Martin Knapp
- London School of Economics and the Institute of Psychiatry, King’s College London, London, UK
| | - Stephen R. Marder
- Semel Institute, UCLA, VA Desert Pacific Mental Illness Research Education and Clinical Center, Los Angeles, CA
| | - Mary Moller
- Past President, American Psychiatric Nurses Association, Yale School of Nursing, New Haven, CT
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
| | - Peter Woodruff
- Academic Faculty, Royal College of Psychiatrists, London, UK
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Crump C, Ioannidis JPA, Sundquist K, Winkleby MA, Sundquist J. Mortality in persons with mental disorders is substantially overestimated using inpatient psychiatric diagnoses. J Psychiatr Res 2013; 47:1298-303. [PMID: 23806577 PMCID: PMC3746500 DOI: 10.1016/j.jpsychires.2013.05.034] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 04/27/2013] [Accepted: 05/31/2013] [Indexed: 10/26/2022]
Abstract
Mental disorders are associated with premature mortality, and the magnitudes of risk have commonly been estimated using hospital data. However, psychiatric patients who are hospitalized have more severe illness and do not adequately represent mental disorders in the general population. We conducted a national cohort study using outpatient and inpatient diagnoses for the entire Swedish adult population (N = 7,253,516) to examine the extent to which mortality risks are overestimated using inpatient diagnoses only. Outcomes were all-cause and suicide mortality during 8 years of follow-up (2001-2008). There were 377,339 (5.2%) persons with any inpatient psychiatric diagnosis, vs. 680,596 (9.4%) with any inpatient or outpatient diagnosis, hence 44.6% of diagnoses were missed using inpatient data only. When including and accounting for prevalent psychiatric cases, all-cause mortality risk among persons with any mental disorder was overestimated by 15.3% using only inpatient diagnoses (adjusted hazard ratio [aHR], 5.89; 95% CI, 5.85-5.92) vs. both inpatient and outpatient diagnoses (aHR, 5.11; 95% CI, 5.08-5.14). Suicide risk was overestimated by 18.5% (aHRs, 23.91 vs. 20.18), but this varied widely by specific disorders, from 4.4% for substance use to 49.1% for anxiety disorders. The sole use of inpatient diagnoses resulted in even greater overestimation of all-cause or suicide mortality risks when prevalent cases were unidentified (~20-30%) or excluded (~25-40%). However, different methods for handling prevalent cases resulted in only modest variation in risk estimates when using both inpatient and outpatient diagnoses. These findings have important implications for the interpretation of hospital-based studies and the design of future studies.
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Affiliation(s)
- Casey Crump
- Stanford University, Department of Medicine, Palo Alto, CA 94304-1426, USA.
| | - John P. A. Ioannidis
- Stanford University, Stanford Prevention Research Center, Medical School Office Building, 251 Campus Drive, Room X306, Stanford, California USA 94305-5411
| | - Kristina Sundquist
- Lund University, Center for Primary Health Care Research, Clinical Research Centre (CRC), building 28, floor 11, Jan Waldenströms gata 35, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Marilyn A. Winkleby
- Stanford University, Stanford Prevention Research Center, Medical School Office Building, 251 Campus Drive, Room X318, Stanford, California USA 94305-5411
| | - Jan Sundquist
- Lund University, Center for Primary Health Care Research, Clinical Research Centre (CRC), building 28, floor 11, Jan Waldenströms gata 35, Skåne University Hospital, SE-205 02 Malmö, Sweden
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