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Lowenstein C. "Deaths of despair" over the business cycle: New estimates from a shift-share instrumental variables approach. ECONOMICS AND HUMAN BIOLOGY 2024; 53:101374. [PMID: 38518546 PMCID: PMC11060774 DOI: 10.1016/j.ehb.2024.101374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/31/2024] [Accepted: 03/10/2024] [Indexed: 03/24/2024]
Abstract
This study presents new evidence of the effects of short-term economic fluctuations on suicide, fatal drug overdose, and alcohol-related mortality among working-age adults in the United States from 2003-2017. Using a shift-share instrumental variables approach, I find that a one percentage point increase in the aggregate employment rate decreases current-year non-drug suicides by 1.7 percent. These protective effects are concentrated among working-age men and likely reflect a combination of individual labor market experiences as well as the indirect effects of local economic growth. I find no consistent evidence that short-term business cycle changes affect drug or alcohol-related mortality. While the estimated protective effects are small relative to secular increases in suicide in recent decades, these findings are suggestive of important, short-term economic factors affecting specific causes of death and should be considered alongside the longer-term and multifaceted social, economic, and cultural determinants of America's "despair" epidemic.
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Affiliation(s)
- Christopher Lowenstein
- University of California, Berkeley School of Public Health, Division of Health Policy and Management, 2121 Berkeley Way, Room 5302, Berkeley, CA 94720, United States.
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2
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Keyes KM, Kandula S, Martinez-Ales G, Gimbrone C, Joseph V, Monnat S, Rutherford C, Olfson M, Gould M, Shaman J. Geographic Variation, Economic Activity, and Labor Market Characteristics in Trajectories of Suicide in the United States, 2008-2020. Am J Epidemiol 2024; 193:256-266. [PMID: 37846128 DOI: 10.1093/aje/kwad205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023] Open
Abstract
Suicide rates in the United States have increased over the past 15 years, with substantial geographic variation in these increases; yet there have been few attempts to cluster counties by the magnitude of suicide rate changes according to intercept and slope or to identify the economic precursors of increases. We used vital statistics data and growth mixture models to identify clusters of counties by their magnitude of suicide growth from 2008 to 2020 and examined associations with county economic and labor indices. Our models identified 5 clusters, each differentiated by intercept and slope magnitude, with the highest-rate cluster (4% of counties) being observed mainly in sparsely populated areas in the West and Alaska, starting the time series at 25.4 suicides per 100,000 population, and exhibiting the steepest increase in slope (0.69/100,000/year). There was no cluster for which the suicide rate was stable or declining. Counties in the highest-rate cluster were more likely to have agricultural and service economies and less likely to have urban professional economies. Given the increased burden of suicide, with no clusters of counties improving over time, additional policy and prevention efforts are needed, particularly targeted at rural areas in the West.
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Varin M, Liu L, Gabrys R, Gariepy G, MacEachern KH, Weeks M. Increased alcohol use, heavy episodic drinking, and suicide ideation during the COVID-19 pandemic in Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 114:33-43. [PMID: 36203029 PMCID: PMC9540056 DOI: 10.17269/s41997-022-00689-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/17/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Alcohol use is a known risk factor for suicidality, yet this relationship has not been explored during the pandemic in Canada. As a growing body of evidence demonstrates the negative impact of COVID-19 on alcohol consumption and associated harms in Canada, there is a need to examine this more closely. METHODS Using the Survey on COVID-19 and Mental Health 2020, we compared the prevalence of suicide ideation among: (1) individuals who reported an increase in alcohol consumption vs those who reported a decrease/no change, and (2) individuals who reported past month heavy episodic drinking vs those who did not. We compared overall unadjusted odds ratios and across a number of sociodemographic and mental health variables. All estimates were weighted to ensure they were nationally representative. RESULTS The prevalence and likelihood of suicide ideation were significantly higher among people who reported increased alcohol consumption during the pandemic (4.9% vs 2.0%; OR = 2.6, 95% CI: 1.8, 3.7) and people who reported past month heavy episodic drinking (3.4% vs 2.1%; OR = 1.7, 95% CI: 1.2, 2.3). Males and middle-aged and older-aged individuals had the highest odds ratios for increased alcohol consumption and past month heavy episodic drinking with suicide ideation. CONCLUSION In the Canadian general population during the COVID-19 pandemic, there were significant associations between suicide ideation and increased alcohol use as well as past month heavy episodic drinking across specific sociodemographic subgroups. Future research could explore these associations while adjusting for social determinants of health such as income security, employment, education, social support, stress, and mental health.
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Affiliation(s)
- Melanie Varin
- Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1S 5H4, Canada.
| | - Li Liu
- Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON K1S 5H4 Canada
| | - Robert Gabrys
- Canadian Centre on Substance Use and Addiction, Ottawa, ON Canada
| | - Geneviève Gariepy
- Public Health Agency of Canada, Montreal, QC Canada ,Institut Universitaire en Santé Mentale de Montréal, Research Centre, Montreal, QC Canada
| | | | - Murray Weeks
- Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON K1S 5H4 Canada
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Azcueta R, Pinna M, Manchia M, Simbula S, Tondo L, Baldessarini RJ. Suicidal risks in rural versus urban populations in Sardinia. J Affect Disord 2021; 295:1449-1455. [PMID: 34565595 DOI: 10.1016/j.jad.2021.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 08/30/2021] [Accepted: 09/12/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Rural locations have been associated with suicidal risk; low population density may be a relevant factor. Accordingly, we investigated hypothesized associations between suicidal ideation and behavior with selected geographic and population-related measures and other factors. METHODS Consenting adult patients at a mood disorder center in Cagliari, Sardinia, were assessed for the presence of suicidal ideation and acts and their association with selected demographic and clinical factors as well as indicators of urbanicity and rurality, including distance from the region's main metropolitan area, population density, altitude, and population growth trends. RESULTS Of 5,668 subjects, 27% had an indication of lifetime suicidal behavior or ideation; 8.6% had at least one suicidal act. Low population density, higher altitude and their interaction, distance from the metropolitan center of the main city (Cagliari), and population decline were associated with greater risk of suicidal ideation or behavior. In addition, and as expected, alcohol or substance abuse, diagnosis of mood disorders, higher depression ratings at intake, being younger at illness-onset, family history of suicide or other psychiatric disorder, being female, unmarried, separated or divorced, currently smoking cigarettes, being unemployed, and having experienced sexual abuse all were more likely in subjects with suicidal ideation or behavior. CONCLUSION Suicidal ideation and behavior were associated with indicators of social isolation as well as with previously reported clinical and demographic risk factors.
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Affiliation(s)
- Ramon Azcueta
- Hospital de Emergencias Psiquiátricas Torcuato de Alvear, Buenos Aires, Argentina
| | - Marco Pinna
- Lucio Bini Mood Disorders Centers, Cagliari and Rome, Italy; Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Italy; Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Stefano Simbula
- Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Italy
| | - Leonardo Tondo
- Lucio Bini Mood Disorders Centers, Cagliari and Rome, Italy; McLean Hospital and Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Ross J Baldessarini
- McLean Hospital and Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Capaldi CA, Liu L, Dopko RL. Positive mental health and perceived change in mental health among adults in Canada during the second wave of the COVID-19 pandemic. Health Promot Chronic Dis Prev Can 2021; 41:359-377. [PMID: 34569773 PMCID: PMC8639168 DOI: 10.24095/hpcdp.41.11.05] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Canadian surveys from spring/summer 2020 suggest the prevalence of some positive mental health (PMH) outcomes have declined compared to pre-pandemic levels. However, less is known about the state of PMH during the second wave of the COVID-19 pandemic. METHODS We compared adults' self-rated mental health (SRMH), community belonging and life satisfaction in Fall 2020 versus 2019 in the overall population and across sociodemographic characteristics using cross-sectional data from the Survey on COVID-19 and Mental Health (September-December, 2020) and the 2019 Canadian Community Health Survey. We also conducted regression analyses to examine which sociodemographic factors were associated with reporting in Fall 2020 that one's mental health was about the same or better compared to before the pandemic. RESULTS Fewer adults reported high SRMH in Fall 2020 (59.95%) than in 2019 (66.71%) and fewer reported high community belonging in Fall 2020 (63.64%) than in 2019 (68.42%). Rated from 0 (very dissatisfied) to 10 (very satisfied), average life satisfaction was lower in Fall 2020 (7.19) than in 2019 (8.08). Females, those aged under 65 years, those living in a population centre, and those absent from work due to COVID-19 had lower odds of reporting that their mental health was about the same or better in Fall 2020. CONCLUSION The PMH of adults was lower during the pandemic's second wave. However, the majority of individuals still reported high SRMH and community belonging. The findings identify certain sociodemographic groups whose mental health appears to have been more negatively impacted by the pandemic. Continued surveillance is important in ensuring mental health builds back better and stronger in Canada after the pandemic.
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Affiliation(s)
| | - Li Liu
- Public Health Agency of Canada, Ottawa, Ontario, Canada
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Greene N, Tomedi LE, Cox ME, Mello E, Esser MB. Alcohol testing and alcohol involvement among violent deaths by state, 2014-2016. Prev Med 2021; 148:106527. [PMID: 33745953 PMCID: PMC9159354 DOI: 10.1016/j.ypmed.2021.106527] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/10/2021] [Accepted: 03/16/2021] [Indexed: 11/16/2022]
Abstract
Blood alcohol concentration (BAC) testing rates vary across states, potentially biasing estimates of alcohol involvement in violent deaths. The National Violent Death Reporting System (NVDRS) collects information on violent deaths, including decedents' BACs. This study assessed characteristics of violent deaths by BAC testing status, and the proportion of decedents with a positive BAC or BAC ≥ 0.08 g/dL. NVDRS data from 2014 to 2016 (2014: 18 states; 2015: 27 states; 2016: 32 states) were analyzed to assess BAC testing (tested, not tested, unknown/missing) by state, decedent characteristics, and death investigation system (e.g., state medical examiner, coroners), in 2019. The proportion of violent deaths with a BAC > 0.0 or ≥ 0.08 g/dL was also assessed. Among 95,390 violent death decedents, 57.1% had a BAC test (range: 9.5% in Georgia to 95.8% in Utah), 2.3% were not tested, and 40.6% had an unknown/missing BAC testing status (range: 1.3% in Alaska to 78.0% in Georgia). Decedents who were 21-44 years, American Indian/Alaska Native or Hispanic, died by poisoning, died by undetermined intent, or were investigated by a state medical examiner were most likely to receive BAC testing. Among the violent deaths with a reported BAC, 41.1% had a positive BAC and 27.7% had a BAC ≥ 0.08 g/dL. About 2 in 5 violent deaths were missing data on alcohol testing. Increased testing and reporting of alcohol among violent deaths could inform the development and use of evidence-based prevention strategies (e.g., increasing alcohol taxes, regulating alcohol outlet density) for reducing violent deaths.
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Affiliation(s)
- Naomi Greene
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Laura E Tomedi
- The ECHO Institute, University of New Mexico, Albuquerque, Mexico.
| | - Mary E Cox
- Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC, United States
| | - Elizabeth Mello
- Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, New York City Department of Health and Mental Hygiene, Long Island City, NY, United States; Office of Integrated Surveillance and Informatics Services, Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, United States
| | - Marissa B Esser
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Kwan Y, Choi S, Min S, Ahn JS, Kim H, Kim MH, Lee J. Does personality problems increase youth suicide risk?: A characteristic analysis study of youth who visit the emergency department following suicide attempt. J Affect Disord 2021; 282:539-544. [PMID: 33433383 DOI: 10.1016/j.jad.2020.12.066] [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: 11/29/2020] [Accepted: 12/20/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Youth suicide attempts are a major risk factor for future complete suicides. However, the characteristics of suicide attempters based on the emergency department (ED) have rarely been explored, making it challenging to comprehend the characteristics of youth suicide attempters comprehensively. This study aims to investigate the characteristics of youth suicide attempters who visited the ED. METHODS We examined the youth (age: 12-25 years) and adult (age: 26-65 years) groups of suicide attempters who visited the ED in Wonju-si, Gangwon-do, Korea. Interviews were conducted with attempters and guardians to identify sociodemographic, clinical, and suicide-related variables. Besides, we performed bivariate logistic regression analysis with statistically adjusted gender, educational age, Socioeconomic Status(SES) level, and medical illness. RESULTS Youth were diagnosed more frequently with Personality disorder compared to adults. Besides, youth tended to report interpersonal or abuse as motivations for suicide, whereas adults tended to report medical illness or economic problems. Furthermore, youth attempted suicide more impulsively and repeatedly; however, medical lethality of each attempt tended to be lower than adults. LIMITATION We experienced difficulty in collecting complete information because of poor consciousness or cooperation of patients who visited the ED immediately after suicide attempt. Also, the study cohort was only recruited from one hospital in a region. CONCLUSION Youth suicide attempters are suggested to have relatively serious and persistent problems involving personality or traits than adults. Thus, this study highlights the significance of preventive strategies based on early psychopathological evaluation and treatment.
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Affiliation(s)
- Yunna Kwan
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Ilsan-ro 20, Wonju 26426, Korea; Department of Psychology, Duksung Women's University, 33, Samyang-ro 144-gil, Dobong-gu, 01369 Seoul, Korea
| | - SungWon Choi
- Department of Psychology, Duksung Women's University, 33, Samyang-ro 144-gil, Dobong-gu, 01369 Seoul, Korea
| | - Seongho Min
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Ilsan-ro 20, Wonju 26426, Korea
| | - Joung-Sook Ahn
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Ilsan-ro 20, Wonju 26426, Korea
| | - Huiju Kim
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Ilsan-ro 20, Wonju 26426, Korea
| | - Min-Hyuk Kim
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Ilsan-ro 20, Wonju 26426, Korea.
| | - Jinhee Lee
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Ilsan-ro 20, Wonju 26426, Korea.
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Peters DJ, Monnat SM, Hochstetler AL, Berg MT. The Opioid Hydra: Understanding Overdose Mortality Epidemics and Syndemics Across the Rural-Urban Continuum. RURAL SOCIOLOGY 2020; 85:589-622. [PMID: 33814639 PMCID: PMC8018687 DOI: 10.1111/ruso.12307] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The rapid increase of fatal opioid overdoses over the past two decades is a major U.S. public health problem, especially in non-metropolitan communities. The crisis has transitioned from pharmaceuticals to illicit synthetic opioids and street mixtures, especially in urban areas. Using latent profile analysis, we classify n = 3,079 counties into distinct classes using CDC fatal overdose rates for specific opioids in 2002-2004, 2008-2012, and 2014-2016. We identify three distinct epidemics (prescription opioids, heroin, and prescription-synthetic opioid mixtures) and one syndemic involving all opioids. We find that prescription-related epidemic counties, whether rural or urban, have been "left behind" the rest of the nation. These communities are less populated and more remote, older and mostly white, have a history of drug abuse, and are former farm and factory communities that have been in decline since the 1990s. Overdoses in these places exemplify the "deaths of despair" narrative. By contrast, heroin and opioid syndemic counties tend to be more urban, connected to interstates, ethnically diverse, and in general more economically secure. The urban opioid crisis follows the path of previous drug epidemics, affecting a disadvantaged subpopulation that has been left behind rather than the entire community. County data on opioid epidemic class membership are provided.
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Affiliation(s)
| | - Shannon M Monnat
- Maxwell School of Citizenship and Public Affairs, Syracuse University
| | | | - Mark T Berg
- Department of Sociology and Criminology, University of Iowa
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9
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Kaplan MS, Kerr WC, McFarland BH, Bensley K, Caetano R, Giesbrecht N, Monnat SM, Nolte KB. A Reply to Monteiro et al.'s (2020) 'Alcohol Policy and Coronavirus: An Open Research Agenda'. J Stud Alcohol Drugs 2020; 81:687-688. [PMID: 33028483 PMCID: PMC8076483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024] Open
Affiliation(s)
- Mark S. Kaplan
- Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California
| | - William C. Kerr
- Alcohol Research Group, Public Health Institute, Oakland, California
| | - Bentson H. McFarland
- Professor Emeritus of Psychiatry, Public Health & Preventive Medicine, Oregon Health & Science University, Portland, Oregon
| | - Kara Bensley
- Alcohol Research Group, Public Health Institute, Oakland, California
| | - Raul Caetano
- Prevention Research Center, Berkeley, California
| | | | - Shannon M. Monnat
- Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, New York
| | - Kurt B. Nolte
- University of New Mexico School of Medicine, Albuquerque, New Mexico
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10
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Orpana H, Giesbrecht N, Hajee A, Kaplan MS. Alcohol and other drugs in suicide in Canada: opportunities to support prevention through enhanced monitoring. Inj Prev 2020; 27:194-200. [PMID: 32220934 PMCID: PMC8005800 DOI: 10.1136/injuryprev-2019-043504] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 02/06/2023]
Abstract
The use of alcohol and other drugs has been identified as a significant factor related to suicide through multiple pathways. This paper highlights current understanding of their contributions to suicide in Canada and identifies opportunities for enhancing monitoring and prevention initiatives. Publications from 1998 to 2018 about suicide in Canada and that referred to alcohol or other drugs were identified using PubMed and Google Scholar. A second literature search restricted to articles including results of toxicology testing was conducted by a librarian. We summarised the literature identified on ecological analyses, attributable fractions and deaths, and research including the results of toxicological analyses. Our literature search yielded 5230 publications, and 164 documents were identified for full-text screening. We summarised the findings from 30 articles. Ecological analyses support the association between alcohol sales, annual per capita alcohol consumption and suicide rates. Based on published estimates, approximately a quarter of suicide deaths in Canada are alcohol-attributable, while the estimated attributable fraction for illegal drugs is more variable. Finally, there is a dearth of literature examining the role of acute alcohol and/or drug consumption prior to suicide based on toxicological findings. The proportion of suicide decedents with drugs or alcohol present at the time of death varies widely. While there is evidence on the role of alcohol and drugs in suicide deaths, there is not a large body of research about the acute use of these substances at the time of death among suicide decedents in Canada. Our understanding of the role of alcohol and other drugs in suicide deaths could be enhanced through systematic documentation, which in turn could provide much needed guidance for clinical practice, prevention strategies and policy initiatives.
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Affiliation(s)
- Heather Orpana
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada .,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Norman Giesbrecht
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Aliya Hajee
- Downtown West Clinic, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Mark S Kaplan
- Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California, USA
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Allen K, Goldman-Mellor S. Neighborhood Characteristics and Adolescent Suicidal Behavior: Evidence from a Population-based Study. Suicide Life Threat Behav 2018; 48:677-689. [PMID: 28914968 DOI: 10.1111/sltb.12391] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/09/2017] [Indexed: 11/30/2022]
Abstract
Research on the relationship between neighborhood characteristics and adolescents' risk of nonfatal suicidal behavior is scarce. We used California survey data to examine associations between measures of objective neighborhood quality (levels of violent crime, property crime, and socioeconomic disadvantage) and subjective neighborhood quality (perceptions of neighborhood safety and social cohesion) and adolescents' self-reported suicidal ideation and suicide attempt. Objective measures of neighborhood quality were unrelated to adolescents' risk of suicidal behavior. However, adolescents who perceived their neighborhoods to be less safe and less cohesive were 20%-45% more likely than nonsuicidal peers to report suicidal ideation and attempt.
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12
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Goldman-Mellor S, Allen K, Kaplan MS. Rural/Urban Disparities in Adolescent Nonfatal Suicidal Ideation and Suicide Attempt: A Population-Based Study. Suicide Life Threat Behav 2018; 48:709-719. [PMID: 28940747 DOI: 10.1111/sltb.12390] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 06/15/2017] [Indexed: 11/28/2022]
Abstract
Adolescent suicide rates exhibit stark geographic disparities, with rates highest in rural areas. The causes of this disparity remain unclear. We investigated whether adolescent nonfatal suicidal ideation and attempt-leading risk factors for suicide-demonstrate the same rural/urban disparity. Using adolescent data from the 2011-2014 waves of the population-representative California Health Interview Survey (CHIS; N = 4,616), we estimated associations between residence in a rural area and suicidal ideation and suicide attempt, as well as access to psychological care. Survey-weighted logistic regression models controlled for individual- and family-level covariates. Results showed that rural adolescents were, compared to urban adolescents, substantially less likely to report recent suicidal ideation (OR = 0.25, 95% confidence interval [CI] = 0.10, 0.61) and suicide attempt (OR = 0.17, 95% CI = 0.05, 0.66). Suicidal youths in rural and urban areas were equally likely, however, to report receiving psychological care. In this study, rural adolescents in California reported lower rates of nonfatal suicidal behavior compared to urban peers. This pattern contrasts with rates of adolescent suicide fatality, which are higher in rural areas. Results suggest that reducing geographic disparities in youth suicide may require multifaceted public health approaches, in addition to better identification and treatment for high-risk adolescents.
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Affiliation(s)
- Sidra Goldman-Mellor
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, CA, USA
| | - Kristina Allen
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, CA, USA
| | - Mark S Kaplan
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, CA, USA
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13
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Monnat SM. Factors Associated With County-Level Differences in U.S. Drug-Related Mortality Rates. Am J Prev Med 2018; 54:611-619. [PMID: 29598858 PMCID: PMC6080628 DOI: 10.1016/j.amepre.2018.01.040] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 01/19/2018] [Accepted: 01/30/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Over the past 2 decades, drug-related deaths have grown to be a major U.S. public health problem. County-level differences in drug-related mortality rates are large. The relative contributions of social determinants of health to this variation, including the economic, social, and healthcare environments, are unknown. METHODS Using data from the U.S. Centers for Disease Control and Prevention Multiple-Cause of Death Files (2006-2015, analyzed in 2017); U.S. Census Bureau; U.S. Department of Agriculture Economic Research Service; Agency for Healthcare Research and Quality; and Northeast Regional Center for Rural Development, this paper modeled associations between county-level drug-related mortality rates and economic, social, and healthcare environments. Spatial autoregressive models controlled for state fixed effects and county demographic characteristics. RESULTS The average county-level age-adjusted drug-related mortality rate was 16.6 deaths per 100,000 population (2006-2015), but there were substantial geographic disparities in rates. Controlling for county demographic characteristics, average mortality rates were significantly higher in counties with greater economic and family distress and in counties economically dependent on mining. Average mortality rates were significantly lower in counties with a larger presence of religious establishments, a greater percentage of recent in-migrants, and counties with economies reliant on public (government) sector employment. Healthcare supply factors did not contribute to between-county disparities in mortality rates. CONCLUSIONS Drug-related mortality rates are not randomly distributed across the U.S. Future research should consider the specific pathways through which economic, social, and healthcare environments are associated with drug-related mortality.
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Affiliation(s)
- Shannon M Monnat
- Lerner Center for Public Health Promotion (Center for Policy Research), Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, New York.
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14
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Hoertel N, Faiz H, Airagnes G, Blanco C, Pascal De Raykeer R, Franco S, Ducoutumany G, Lemogne C, Limosin F. A comprehensive model of predictors of suicide attempt in heavy drinkers: Results from a national 3-year longitudinal study. Drug Alcohol Depend 2018; 186:44-52. [PMID: 29547760 DOI: 10.1016/j.drugalcdep.2018.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/04/2017] [Accepted: 01/05/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Heavy drinkers are at high risk for suicide attempt and suicide. Multiple factors, when examined in isolation, have been implicated in the risk of suicide attempt in this population. In this report, we present a comprehensive model of the 3-year risk of suicide attempt in heavy drinkers using a longitudinal nationally representative study, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; wave 1, 2001-2002; wave 2, 2004-2005). METHODS We used structural equation modeling to simultaneously examine effects of four broad groups of clinical factors previously identified as potential predictors of attempted suicides: 1) alcohol use disorder severity, 2) severity of comorbidity, 3) sociodemographic characteristics and 4) help-seeking for alcohol problems. Heavy drinking was defined as drinking 5 or more drinks in a day more than once a week in the month prior to Wave 1. RESULTS About 1.5% of the 1573 heavy drinker participants (i.e., 5.1% of the NESARC sample) attempted suicide during the 3-year follow-up period. After adjusting for all other factors, several factors independently predicted attempted suicides: the alcohol use disorder liability factor measured by DSM-IV-TR criteria for alcohol abuse and dependence and two dimensions of psychopathology, the general psychopathology factor accounting for the shared effects of all comorbid psychiatric disorders and the externalizing dimension accounting for the shared effects of comorbid substance use disorders. No other factor predicted this risk in addition. CONCLUSION This model may help identify individuals with heavy drinking at high risk of suicide and develop more effective suicide prevention strategies.
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Affiliation(s)
- Nicolas Hoertel
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin-Celton Hospital, Department of Psychiatry, 92130, Issy-les-Moulineaux, France; INSERM UMR 894, Psychiatry and Neurosciences Center, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France.
| | - Hadi Faiz
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin-Celton Hospital, Department of Psychiatry, 92130, Issy-les-Moulineaux, France; INSERM UMR 894, Psychiatry and Neurosciences Center, France
| | - Guillaume Airagnes
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin-Celton Hospital, Department of Psychiatry, 92130, Issy-les-Moulineaux, France; Inserm, UMS 011, Population-based Epidemiological Cohorts, Villejuif, France; Inserm UMR 1168, VIMA, Villejuif, France
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Rachel Pascal De Raykeer
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin-Celton Hospital, Department of Psychiatry, 92130, Issy-les-Moulineaux, France; INSERM UMR 894, Psychiatry and Neurosciences Center, France
| | - Silvia Franco
- New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Géraldine Ducoutumany
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin-Celton Hospital, Department of Psychiatry, 92130, Issy-les-Moulineaux, France
| | - Cédric Lemogne
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin-Celton Hospital, Department of Psychiatry, 92130, Issy-les-Moulineaux, France; INSERM UMR 894, Psychiatry and Neurosciences Center, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France
| | - Frédéric Limosin
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin-Celton Hospital, Department of Psychiatry, 92130, Issy-les-Moulineaux, France; INSERM UMR 894, Psychiatry and Neurosciences Center, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France
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15
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Abstract
Purpose
Financial threat is defined as fearful-anxious uncertainty regarding one’s current and future financial situation. The purpose of this paper is to examine predictors and outcomes of financial threat in two samples of students who completed an online questionnaire for course credit. The theoretical model the authors proposed tested the association between personal debt, anxiety, and economic hardship with financial threat, and in turn, financial threat’s relationship with willingness to change financial behavior (e.g. increase income, cut expenses, and reduce debt), job search activity, and psychological distress. Consistent across samples, structural equation modeling (SEM) revealed that the data fit the model and supported all four hypotheses. Debt, economic hardship, and anxiety were all related positively to financial threat, which itself related positively to willingness to change, job search, and psychological distress. Importantly, financial threat mediated the relationship between these economic-situational predictors and affective-behavioral outcomes of financial stain. Theoretical and practical implications of the findings are discussed.
Design/methodology/approach
Using an online questionnaire, participants completed measures of economic hardship, intolerance of uncertainty, job search behavior, financial threat, life satisfaction, general health, perceived stress, and willingness to change to financial behavior. The authors developed and tested a model that explores emotional and cognitive reactions to financial stressors following the recession.
Findings
Results of SEM revealed that the data fit the model and no modification indices were suggested. Examination of parameter estimates indicated that total debt, economic hardship, and anxiety were positively related to financial threat. Financial threat, in turn, positively related to willingness to change one’s financial behaviors, job search, and psychological distress. In addition, economic hardship and anxiety were positively related to psychological distress. That is, individuals who were feeling more threatened by their financial situation were more willing to change their financial situation and were more likely to engage in job search behavior. They were also more likely to report more psychological distress than individuals reporting lower levels of financial threat.
Research limitations/implications
This study was cross-sectional and therefore precludes causal interpretations of the findings. Longitudinal data with repeated assessments of all measures would help determine the direction of causation. Also, the study relied on self-report data, which is prone to bias. For example, it is possible that some participants did not know their exact debt levels, which may have resulted in an under- or overestimation of debt levels. Future research should extend this line of research using objective measures. While the model tested in this study examined the impact of economic factors on perceived threat, behavior, and psychological distress, it did not include social and psychological resources. For example, the authors did not include measures of social support, coping, or personality, which may moderate the impact of economic variables and stress on psychological distress. Although financial knowledge/literacy was not studied here, future research could include it since it has been associated with a variety of financial behaviors such as cash-flow management, credit management, saving, and investing. There is some evidence that financial literacy can decrease emotional stress and anxiety (Vitt et al., 2000).
Practical implications
The current study can help researchers and practitioners understand the concept of financial threat among university students. For example, if students have incurred student loans and debt and begin displaying symptoms of distress, like anxiousness, worry, and irritability, they could be referred to a professional experienced in working with emotional and behavioral disorders related to financial issues. It can also help practitioners gain an understanding and insight into clients’ poor financial decision making. Government could initiate programs that help individuals cope with the negative effects of unemployment. Given that young people are experiencing disproportionately high unemployment that can have a lasting adverse effect on employment prospects and future earnings, the current post-secondary curriculum needs to prepare young people for the world of work, and gain a footing in the labor market. One way to achieve this is through high-quality work experiences (e.g. internships/apprenticeships). Identifying ways to mitigate the effects of debt and economic hardship is also imperative. For example, money and debt advice may improve one’s financial circumstances, which, in turn, may improve their physical and psychological well-being.
Social implications
Future studies could focus on developing models predicting to financial stress using personality, psychological resources, and an objective measure of financial knowledge. Despite these limitations, this research demonstrates how emotional factors need to be included in economic models that also include debt and economic hardship. The study contributes to the economic and psychological literature by documenting how economic hardship and debt influence perceptions of threat, planned behavior, and psychological distress. The authors take a unique approach to describing economic hardship and financial threat as antecedents of distress, job search, and willingness to change. Future research could be directed toward employing the model for predicting behavior that would lessen economic stress and thereby leading to increased psychological well-being.
Originality/value
The study develops and tests an original theoretical model linking financial, emotional, and psychological variable in a comprehensive framework that is then tested empirically. This model is original with this paper.
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Kaplan MS, Caetano R, Giesbrecht N, Huguet N, Kerr WC, McFarland BH, Nolte KB. The National Violent Death Reporting System: Use of the Restricted Access Database and Recommendations for the System's Improvement. Am J Prev Med 2017; 53:130-133. [PMID: 28347589 PMCID: PMC5500302 DOI: 10.1016/j.amepre.2017.01.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/30/2016] [Accepted: 01/27/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Mark S Kaplan
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, California.
| | - Raul Caetano
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California
| | - Norman Giesbrecht
- Social and Epidemiological Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - William C Kerr
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Bentson H McFarland
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - Kurt B Nolte
- Office of the Medical Investigator, University of New Mexico, Albuquerque, New Mexico
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Park CHK, Yoo SH, Lee J, Cho SJ, Shin MS, Kim EY, Kim SH, Ham K, Ahn YM. Impact of acute alcohol consumption on lethality of suicide methods. Compr Psychiatry 2017; 75:27-34. [PMID: 28288368 DOI: 10.1016/j.comppsych.2017.02.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 01/26/2017] [Accepted: 02/26/2017] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The influence of acute alcohol consumption on the factors related to suicide remains understudied. Thus, the present study investigated the relationship between blood alcohol content (BAC) and the lethality of suicide methods. METHODS Autopsy data on 315 South Korean suicide completers with a positive BAC were collected from a nationwide pool between May 2015 and November 2015, and the methods were dichotomised as suicide methods of low lethality (SMLL; drug/chemical overdose and sharp objects, n=67) and suicide methods of high lethality (SMHL; everything else, n=243). BAC at the time of autopsy and various suicide-related factors of these two groups were compared with logistic regression analyses. RESULTS Compared to suicide completers with a BAC in the lowest range of 0.011-0.049%, suicide completers with a BAC in the range of 0.150-0.199% were more likely to use SMHL (odds ratio [OR]: 3.644, 95% confidence interval [CI]: 1.221-10.874). Additionally, the adoption of SMHL was significantly associated with the absence of a psychiatric illness (OR: 0.433, 95% CI: 0.222-0.843) and a younger age; the OR for high BAC among subjects in their 40s was 0.266 (95% CI: 0.083-0.856); in their 50s, 0.183 (95% CI: 0.055-0.615); and in their 60s, 0.057 (95% CI: 0.015-0.216). CONCLUSIONS The relationship between BAC and suicide method lethality was represented by a bell-shaped pattern in which suicide methods of high lethality were more likely to be used by suicide completers with mid-range BAC levels. The increased impulsivity and impairments in particular executive functions, including planning and organization, associated with acute alcohol use may influence the selection of a particular suicide method based on its lethality.
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Affiliation(s)
- C Hyung Keun Park
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Seong Ho Yoo
- Institute of Forensic Medicine and Department of Forensic Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Jaewon Lee
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Sung Joon Cho
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Min-Sup Shin
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Eun Young Kim
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Mental Health Center, Seoul National University Health Care Center, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea.
| | - Se Hyun Kim
- Department of Neuropsychiatry, Dongguk University International Hospital, Dongguk University Medical School, 27 Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 10326, Republic of Korea.
| | - Keunsoo Ham
- Psychological Forensics Division, National Forensic Service, 10 Ipchun-ro, Wonju-si, Gangwon-do 26460, Republic of Korea.
| | - Yong Min Ahn
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
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18
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Kerr WC, Kaplan MS, Huguet N, Caetano R, Giesbrecht N, McFarland BH. Economic Recession, Alcohol, and Suicide Rates: Comparative Effects of Poverty, Foreclosure, and Job Loss. Am J Prev Med 2017; 52:469-475. [PMID: 27856114 PMCID: PMC5362282 DOI: 10.1016/j.amepre.2016.09.021] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/29/2016] [Accepted: 09/12/2016] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Suicide rates and the proportion of alcohol-involved suicides rose during the 2008-2009 recession. Associations between county-level poverty, foreclosures, and unemployment and suicide rates and proportion of alcohol-involved suicides were investigated. METHODS In 2015, National Violent Death Reporting System data from 16 states in 2005-2011 were utilized to calculate suicide rates and a measure of alcohol involvement in suicides at the county level. Panel models with year and state fixed effects included county-level measures of unemployment, foreclosure, and poverty rates. RESULTS Poverty rates were strongly associated with suicide rates for both genders and all age groups, were positively associated with alcohol involvement in suicides for men aged 45-64 years, and negatively associated for men aged 20-44 years. Foreclosure rates were negatively associated with suicide rates for women and those aged ≥65 years but positively related for those aged 45-64 years. Unemployment rate effects on suicide rates were mediated by poverty rates in all groups. CONCLUSIONS Population risk of suicide was most clearly associated with county-level poverty rates, indicating that programs addressing area poverty should be targeted for reducing suicide risk. Poverty rates were also associated with increased alcohol involvement for men aged 45-64 years, indicating a role for alcohol in suicide for this working-aged group. However, negative associations between economic indicators and alcohol involvement were found for four groups, suggesting that non-economic factors or more general economic effects not captured by these indicators may have played a larger role in alcohol-related suicide increases.
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Affiliation(s)
- William C Kerr
- Alcohol Research Group, Public Health Institute, Emeryville, California.
| | - Mark S Kaplan
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, California
| | - Nathalie Huguet
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon
| | - Raul Caetano
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California
| | - Norman Giesbrecht
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Bentson H McFarland
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
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19
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Caetano R, Vaeth PAC, Mills B, Canino G. Employment Status, Depression, Drinking, and Alcohol Use Disorder in Puerto Rico. Alcohol Clin Exp Res 2016; 40:806-15. [PMID: 27038594 DOI: 10.1111/acer.13020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 01/19/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND Our aim was to examine the association between employment status, depression, drinking, binge drinking, and DSM-5 alcohol use disorder in Puerto Rico. METHODS Data are from a 2013 to 2014 household random sample of individuals 18 to 64 years of age in San Juan, Puerto Rico. RESULTS Bivariate analyses showed that depression was 5 times higher among unemployed males than among those employed full time (21% vs. 4%) and 2 times higher among unemployed females compared to those employed part time or full time (18% vs. 7% and 9%). Employment status was not associated with weekly volume of drinking, but nonparticipation in the workforce was protective against drinking (odds ratio [OR] = 2.17; 95% confidence interval [CI]: 1.03 to 4.57; p < 0.05) and binge drinking (OR = 0.62; 95% CI = 0.39 to 0.97; p < 0.05). This association could be due to the fact that those not in the work force may not be working due to sickness or disability. Male gender was a factor of risk for being a current drinker (OR = 2; 95% CI = 1.53 to 2.6; p < 0.001) and binge drinking (OR = 1.69; 95% CI = 1.29 to 2.2; p < 0.001). Male gender was protective against depression (OR = 0.32; 95% CI = 0.14 to 0.73; p < 0.01), but males employed only part time were almost 5 times more likely than females employed full time to be depressed (OR = 4.66; 95% CI = 1.25 to 17.38; p < 0.05). CONCLUSIONS Employment status in Puerto Rico is associated with depression and with current drinking, but not with other alcohol-related outcomes. Perhaps Puerto Rico is a "wet" environment, where drinking is already at a relatively high level that is not affected by employment status. Perhaps the chronic high rate of unemployment in the island has also created familial (e.g., support) and personal level accommodations (e.g., participation in the informal economy) that do not include increased drinking.
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Affiliation(s)
- Raul Caetano
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California
| | - Patrice A C Vaeth
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California
| | - Britain Mills
- Dallas Regional Campus, University of Texas School of Public Health, Dallas, Texas
| | - Glorisa Canino
- Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
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Kaplan MS, Huguet N, Caetano R, Giesbrecht N, Kerr WC, McFarland BH. Heavy Alcohol Use Among Suicide Decedents Relative to a Nonsuicide Comparison Group: Gender-Specific Effects of Economic Contraction. Alcohol Clin Exp Res 2016; 40:1501-6. [PMID: 27187543 DOI: 10.1111/acer.13100] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 04/11/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The primary objective of this gender-stratified study was to assess the rate of heavy alcohol use among suicide decedents relative to a nonsuicide comparison group during the 2008 to 2009 economic crisis. METHODS The National Violent Death Reporting System and the Behavioral Risk Factor Surveillance System were analyzed by gender-stratified multiple logistic regression to test whether change in acute intoxication (blood alcohol content ≥0.08 g/dl) before (2005 to 2007), during (2008 to 2009), and after (2010 to 2011) the Great Recession mirrored change in heavy alcohol use in a living sample. RESULTS Among men, suicide decedents experienced a significantly greater increase (+8%) in heavy alcohol use at the onset of the recession (adjusted ratio of odds ratio = 1.15, 95% confidence interval = 1.10 to 1.20) (relative to the prerecession period) than did men in a nonsuicide comparison group (-2%). Among women, changes in rates of heavy alcohol use were similar in the suicide and nonsuicide comparison groups at the onset and after the recession. CONCLUSIONS Acute alcohol use contributed to suicide among men during the recent economic downturn. Among women who died by suicide, acute alcohol use mirrored consumption in the general population. Women may show resilience (or men, vulnerability) to deleterious interaction of alcohol with financial distress.
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Affiliation(s)
- Mark S Kaplan
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, California
| | - Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Raul Caetano
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California
| | - Norman Giesbrecht
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - William C Kerr
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Bentson H McFarland
- Department of Psychiatry, Oregon Health and Science University, Portland, Oregon
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Martin-Carrasco M, Evans-Lacko S, Dom G, Christodoulou NG, Samochowiec J, González-Fraile E, Bienkowski P, Gómez-Beneyto M, Dos Santos MJH, Wasserman D. EPA guidance on mental health and economic crises in Europe. Eur Arch Psychiatry Clin Neurosci 2016; 266:89-124. [PMID: 26874960 DOI: 10.1007/s00406-016-0681-x] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 01/28/2016] [Indexed: 12/16/2022]
Abstract
This European Psychiatric Association (EPA) guidance paper is a result of the Working Group on Mental Health Consequences of Economic Crises of the EPA Council of National Psychiatric Associations. Its purpose is to identify the impact on mental health in Europe of the economic downturn and the measures that may be taken to respond to it. We performed a review of the existing literature that yields 350 articles on which our conclusions and recommendations are based. Evidence-based tables and recommendations were developed through an expert consensus process. Literature dealing with the consequences of economic turmoil on the health and health behaviours of the population is heterogeneous, and the results are not completely unequivocal. However, there is a broad consensus about the deleterious consequences of economic crises on mental health, particularly on psychological well-being, depression, anxiety disorders, insomnia, alcohol abuse, and suicidal behaviour. Unemployment, indebtedness, precarious working conditions, inequalities, lack of social connectedness, and housing instability emerge as main risk factors. Men at working age could be particularly at risk, together with previous low SES or stigmatized populations. Generalized austerity measures and poor developed welfare systems trend to increase the harmful effects of economic crises on mental health. Although many articles suggest limitations of existing research and provide suggestions for future research, there is relatively little discussion of policy approaches to address the negative impact of economic crises on mental health. The few studies that addressed policy questions suggested that the development of social protection programs such as active labour programs, social support systems, protection for housing instability, and better access to mental health care, particularly at primary care level, is strongly needed.
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Affiliation(s)
- M Martin-Carrasco
- Institute of Psychiatric Research, Mª Josefa Recio Foundation (Hospitaller Sisters), Bilbao, Spain. .,Centro de Investigación en Red Salud Mental (CIBERSAM), Madrid, Spain. .,Clinica Padre Menni, Department of Psychiatry, Joaquin Beunza, 45, 31014, Pamplona, Spain.
| | - S Evans-Lacko
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London, UK.,PSSRU, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - G Dom
- Collaborative Antwerp Psychiatric Research Institute, Antwerp University, 2610, Wilrijk, Belgium
| | | | - J Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Szczecin, Poland
| | - E González-Fraile
- Institute of Psychiatric Research, Mª Josefa Recio Foundation (Hospitaller Sisters), Bilbao, Spain
| | - P Bienkowski
- Department of Pharmacology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - M Gómez-Beneyto
- Centro de Investigación en Red Salud Mental (CIBERSAM), Madrid, Spain.,University of Valencia, Valencia, Spain
| | - M J H Dos Santos
- Portuguese Society of Psychiatry and Mental Health, Beatriz Ângelo Hospital, Lisbon, Portugal
| | - D Wasserman
- National Centre for Suicide Research and Prevention of Mental Health, Karolinska Institute, Stockholm, Sweden
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Margerison-Zilko C, Goldman-Mellor S, Falconi A, Downing J. Health Impacts of the Great Recession: A Critical Review. CURR EPIDEMIOL REP 2016; 3:81-91. [PMID: 27239427 DOI: 10.1007/s40471-016-0068-6] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The severity, sudden onset, and multipronged nature of the Great Recession (2007-2009) provided a unique opportunity to examine the health impacts of macroeconomic downturn. We comprehensively review empirical literature examining the relationship between the Recession and mental and physical health outcomes in developed nations. Overall, studies reported detrimental impacts of the Recession on health, particularly mental health. Macro- and individual-level employment- and housing-related sequelae of the Recession were associated with declining fertility and self-rated health, and increasing morbidity, psychological distress, and suicide, although traffic fatalities and population-level alcohol consumption declined. Health impacts were stronger among men and racial/ethnic minorities. Importantly, strong social safety nets in some European countries appear to have buffered those populations from negative health effects. This literature, however, still faces multiple methodological challenges, and more time may be needed to observe the Recession's full health impact. We conclude with suggestions for future work in this field.
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Affiliation(s)
- Claire Margerison-Zilko
- Department of Epidemiology and Biostatistics, Michigan State University, 909 Fee Rd., Rm 601, East Lansing, MI 48824, Ph: 517-353-8623
| | - Sidra Goldman-Mellor
- Department of Public Health, University of California, Merced, 5200 N. Lake Rd., Merced, CA 95342, Ph: (209) 228-2498
| | - April Falconi
- General Internal Medicine, Stanford University, Palo Alto, CA 94305, Ph: (703) 328-4851
| | - Janelle Downing
- School of Public Health, University of California, Berkeley, 545 University Hall, University of California, Berkeley, CA 94720-7360, Ph: (510) 643-8571
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