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Hynes DM, Niederhausen M, Chen JI, Shahoumian TA, Rowneki M, Hickok A, Shepherd-Banigan M, Hawkins EJ, Naylor J, Teo A, Govier DJ, Berry K, McCready H, Osborne TF, Wong E, Hebert PL, Smith VA, Bowling CB, Boyko EJ, Ioannou GN, Iwashyna TJ, Maciejewski ML, O'Hare AM, Viglianti EM, Bohnert ASB. Risk of Suicide-Related Outcomes After SARS-COV-2 Infection: Results from a Nationwide Observational Matched Cohort of US Veterans. J Gen Intern Med 2024; 39:626-635. [PMID: 37884839 PMCID: PMC10973286 DOI: 10.1007/s11606-023-08440-9] [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: 06/05/2023] [Accepted: 09/18/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Negative mental health-related effects of SARS-COV-2 infection are increasingly evident. However, the impact on suicide-related outcomes is poorly understood, especially among populations at elevated risk. OBJECTIVE To determine risk of suicide attempts and other self-directed violence (SDV) after SARS-COV-2 infection in a high-risk population. DESIGN We employed an observational design supported by comprehensive electronic health records from the Veterans Health Administration (VHA) to examine the association of SARS-COV-2 infection with suicide attempts and other SDV within one year of infection. Veterans with SARS-COV-2 infections were matched 1:5 with non-infected comparators each month. Three periods after index were evaluated: days 1-30, days 31-365, and days 1-365. PARTICIPANTS VHA patients infected with SARS-COV-2 between March 1, 2020 and March 31, 2021 and matched non-infected Veteran comparators. MAIN MEASURES Suicide attempt and other SDV events for the COVID-19 and non-infected comparator groups were analyzed using incidence rates per 100,000 person years and hazard ratios from Cox regressions modeling time from matched index date to first event. Subgroups were also examined. KEY RESULTS 198,938 veterans with SARS-COV-2 (COVID-19 group) and 992,036 comparators were included. Unadjusted one-year incidence per 100,000 for suicide attempt and other SDV was higher among the COVID-19 group: 355 vs 250 and 327 vs 235, respectively. The COVID-19 group had higher risk than comparators for suicide attempts: days 1-30 hazard ratio (HR) = 2.54 (CI:2.05, 3.15), days 31-365 HR = 1.30 (CI:1.19, 1.43) and days 1-365 HR = 1.41 (CI:1.30, 1.54), and for other SDV: days 1-30 HR = 1.94 (CI:1.51, 2.49), days 31-365 HR = 1.32 (CI:1.20, 1.45) and days 1-365 HR = 1.38 (CI:1.26, 1.51). CONCLUSIONS COVID-19 patients had higher risks of both suicide attempts and other forms of SDV compared to uninfected comparators, which persisted for at least one year after infection. Results support suicide risk screening of those infected with SARS-COV-2 to identify opportunities to prevent self-harm.
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Affiliation(s)
- Denise M Hynes
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA.
- College of Health, and Center for Quantitative Life Sciences, Oregon State University, Corvallis, OR, USA.
- School of Nursing, Oregon Health & Science University (OHSU), Portland, OR, USA.
| | - Meike Niederhausen
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
- OHSU-Portland State University School of Public Health, OHSU, Portland, OR, USA
| | - Jason I Chen
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
- Department of Psychiatry, OHSU, Portland, OR, USA
| | | | - Mazhgan Rowneki
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
| | - Alex Hickok
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
| | - Megan Shepherd-Banigan
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA HCS, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Eric J Hawkins
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound HCS, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Jennifer Naylor
- School of Medicine, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Education and Clinical Center, VISN 6 Mental Illness Research, Durham, NC, USA
- Durham VA HCS, Durham, NC, USA
| | - Alan Teo
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
- Department of Psychiatry, OHSU, Portland, OR, USA
| | - Diana J Govier
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
- OHSU-Portland State University School of Public Health, OHSU, Portland, OR, USA
| | - Kristin Berry
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
| | - Holly McCready
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
- Department of Psychiatry, OHSU, Portland, OR, USA
| | - Thomas F Osborne
- VA Palo Alto HCS, Palo Alto, CA, USA
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Edwin Wong
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
| | - Paul L Hebert
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
| | - Valerie A Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA HCS, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
| | - C Barrett Bowling
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA HCS, Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
- Durham VA Geriatric Research Education and Clinical Center, Durham VA HCS, Durham, NC, USA
| | - Edward J Boyko
- Seattle Epidemiologic Research Information Center, VA Puget Sound HCS, Seattle, WA, USA
| | - George N Ioannou
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Theodore J Iwashyna
- Departments of Medicine and Health Policy and Management, Johns Hopkins University, Baltimore, MD, USA
- Center for Clinical Management Research, VA Ann Arbor HCS, Ann Arbor, MI, USA
| | - Matthew L Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA HCS, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Ann M O'Hare
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
- Hospital and Specialty Medicine Service, VA Puget Sound HCS, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - Elizabeth M Viglianti
- Center for Clinical Management Research, VA Ann Arbor HCS, Ann Arbor, MI, USA
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Amy S-B Bohnert
- Center for Clinical Management Research, VA Ann Arbor HCS, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
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2
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Rockett IRH, Ali B, Caine ED, Shepard DS, Banerjee A, Nolte KB, Connery HS, Larkin GL, Stack S, White FMM, Jia H, Cossman JS, Feinberg J, Stover AN, Miller TR. Escalating costs of self-injury mortality in the 21st century United States: an interstate observational study. BMC Public Health 2023; 23:285. [PMID: 36755229 PMCID: PMC9906586 DOI: 10.1186/s12889-023-15188-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 02/02/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Estimating the economic costs of self-injury mortality (SIM) can inform health planning and clinical and public health interventions, serve as a basis for their evaluation, and provide the foundation for broadly disseminating evidence-based policies and practices. SIM is operationalized as a composite of all registered suicides at any age, and 80% of drug overdose (intoxication) deaths medicolegally classified as 'accidents,' and 90% of corresponding undetermined (intent) deaths in the age group 15 years and older. It is the long-term practice of the United States (US) Centers for Disease Control and Prevention (CDC) to subsume poisoning (drug and nondrug) deaths under the injury rubric. This study aimed to estimate magnitude and change in SIM and suicide costs in 2019 dollars for the United States (US), including the 50 states and the District of Columbia. METHODS Cost estimates were generated from underlying cause-of-death data for 1999/2000 and 2018/2019 from the US Centers for Disease Control and Prevention's (CDC's) Wide-ranging ONline Data for Epidemiologic Research (WONDER). Estimation utilized the updated version of Medical and Work Loss Cost Estimation Methods for CDC's Web-based Injury Statistics Query and Reporting System (WISQARS). Exposures were medical expenditures, lost work productivity, and future quality of life loss. Main outcome measures were disaggregated, annual-averaged total and per capita costs of SIM and suicide for the nation and states in 1999/2000 and 2018/2019. RESULTS 40,834 annual-averaged self-injury deaths in 1999/2000 and 101,325 in 2018/2019 were identified. Estimated national costs of SIM rose by 143% from $0.46 trillion to $1.12 trillion. Ratios of quality of life and work losses to medical spending in 2019 US dollars in 2018/2019 were 1,476 and 526, respectively, versus 1,419 and 526 in 1999/2000. Total national suicide costs increased 58%-from $318.6 billion to $502.7 billion. National per capita costs of SIM doubled from $1,638 to $3,413 over the observation period; costs of the suicide component rose from $1,137 to $1,534. States in the top quintile for per capita SIM, those whose cost increases exceeded 152%, concentrated in the Great Lakes, Southeast, Mideast and New England. States in the bottom quintile, those with per capita cost increases below 70%, were located in the Far West, Southwest, Plains, and Rocky Mountain regions. West Virginia exhibited the largest increase at 263% and Nevada the smallest at 22%. Percentage per capita cost increases for suicide were smaller than for SIM. Only the Far West, Southwest and Mideast were not represented in the top quintile, which comprised states with increases of 50% or greater. The bottom quintile comprised states with per capita suicide cost increases below 24%. Regions represented were the Far West, Southeast, Mideast and New England. North Dakota and Nevada occupied the extremes on the cost change continuum at 75% and - 1%, respectively. CONCLUSION The scale and surge in the economic costs of SIM to society are large. Federal and state prevention and intervention programs should be financed with a clear understanding of the total costs-fiscal, social, and personal-incurred by deaths due to self-injurious behaviors.
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Affiliation(s)
- Ian R H Rockett
- Department of Epidemiology and Biostatistics, West Virginia University School of Public Health, One Medical Center Drive, Morgantown, WV, 26506-9190, USA.
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY, 14642, USA.
| | - Bina Ali
- Pacific Institute for Research and Evaluation, 4061 Powder Mill Rd, Beltsville, MD, 20705, USA
| | - Eric D Caine
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY, 14642, USA
| | - Donald S Shepard
- Cost and Value Group, Heller School for Social Policy and Management, Brandeis University, 415 South St, Waltham, MA, 02453, USA
| | - Aniruddha Banerjee
- Department of Geography, Indiana University-Purdue University at Indianapolis, Cavanaugh Hall 441, 425 University Blvd., Indianapolis, IN, 46202, USA
| | - Kurt B Nolte
- Department of Pathology, University of New Mexico School of Medicine, MSC08-4640, Albuquerque, NM, 87131, USA
| | - Hilary S Connery
- McLean Hospital, 115 Mill Street, Mail Stop 222, Belmont, MA, 02478-1064, USA
- Department of Psychiatry, Harvard Medical School, 2 West, Room 305, 401 Park Drive, Boston, MA, 02215, USA
| | - G Luke Larkin
- Northeast Ohio Medical University, 4209 St. Rt. 44, PO Box 95, Rootstown, OH, 44272, USA
| | - Steven Stack
- Department of Criminology and Criminal Justice, Wayne State University, 3293 Faculty/Administration Building (FAB) 656 W. Kirby St, Detroit, MI, 48202, USA
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Tolan Park Medical Building, 3901 Chrysler Service Drive, Detroit, MI, 48201-2167, USA
| | - Franklin M M White
- Department of Community Health and Epidemiology, Dalhousie University, 5790 University Ave, Halifax, NS, B3H 1V7, Canada
| | - Haomiao Jia
- Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
- School of Nursing, Columbia University, 560 W 168th St, New York, NY, 10032, USA
| | - Jeralynn S Cossman
- College for Health, Community and Policy, University of Texas-San Antonio, One UTSA Circle, San Antonio, TX, 78249-3209, USA
| | - Judith Feinberg
- Departments of Behavioral Medicine and Psychiatry and Medicine, Infectious Diseases, West Virginia University School of Medicine, 30 Chestnut Ridge Rd, Morgantown, WV, 26506, USA
| | - Amanda N Stover
- Eshelman School of Pharmacy, University of North Carolina at Asheville, One University Heights, 2214 Kerr Hall, Asheville, NC, 28804, USA
| | - Ted R Miller
- Pacific Institute for Research and Evaluation, 4061 Powder Mill Rd, Beltsville, MD, 20705, USA
- Centre for Population Health Research, Curtin University, 208 Kent St, Bentley, WA, 6102, Australia
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Pikala M, Burzyńska M. The Burden of Suicide Mortality in Poland: A 20-Year Register-Based Study (2000-2019). Int J Public Health 2023; 68:1605621. [PMID: 36816833 PMCID: PMC9931732 DOI: 10.3389/ijph.2023.1605621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
Objectives: The aim of the study was to assess mortality trends due to suicide in Poland in the years 2000-2019 with the use of joinpoint regression. Methods: The study analysed all suicide deaths in Poland in the years 2000-2019 (N = 113,355). Age-standardised death rates (SDRs), the annual percentage change (APC) and the average annual percentage change (AAPC) were determined. Results: In the male group, SDR was 29.3 in 2000 and 21.6 in 2019, in the female group, SDR decreased from 5.2 to 3.0. In 2019, the highest SDR values were noted in the group aged between 45 and 64 years. The most common method of suicide was hanging. In 2019, odds ratios (OR) of death due to suicide for age groups 15-24 years vs. 65 years or above were 51.47 among men and 181.89 among women. With regards to primary vs. tertiary education, OR values were 1.08 and 0.25, respectively; for single vs. widowed individuals 8.22 and 12.35; while for rural vs. urban residents 1.60 and 1.15. Conclusion: There is a need to implement educational programmes, primarily designed for young people.
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Affiliation(s)
- Małgorzata Pikala
- Department of Epidemiology and Biostatistics, Social and Preventive Medicine, Medical University of Lodz, Łódź, Poland
| | - Monika Burzyńska
- Department of Epidemiology and Biostatistics, Social and Preventive Medicine, Medical University of Lodz, Łódź, Poland
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4
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Choi NG, Marti CN, Choi BY. Job loss, financial strain, and housing problems as suicide precipitants: Associations with other life stressors. SSM Popul Health 2022; 19:101243. [PMID: 36203475 PMCID: PMC9530609 DOI: 10.1016/j.ssmph.2022.101243] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 09/23/2022] [Accepted: 09/25/2022] [Indexed: 11/17/2022] Open
Abstract
Previous research has shown that job loss, financial strain, and/or loss of housing (JFH) in midlife elevate suicide risk. In this study based on the 2017–2019 National Violent Death Reporting System, we examined other suicide precipitants and contributors of decedents whose suicide was in part precipitated by JFH and the circumstances under which they died. First, we examined all adult decedents (N = 94,454; 74,042 males [78.4%] and 20,412 females [21.6%]) and then focused on decedents age 45–64 (N = 34,208; 25,640 males [75%] and 8568 females [25.0%]). The 45–64 age group had the highest rate of JFH (22.0% for males and 15.1% for females) as a suicide precipitant. The results of generalized linear models for all adult suicide decedents of both sexes showed that the 45–64 age group (IRR = 2.02, 95% CI = 1.89–2.16), compared to 65+ age group, and relationship problems, mental disorders, and alcohol problems were associated with significantly higher risk of JFH-precipitated suicide. In male decedents age 45–64, JFH was positively associated with depressed mood (IRR = 1.95, 95% CI = 1.85–2.06), alcohol problems (IRR = 1.14, 95% CI = 1.07–1.21), and number of crises (IRR = 1.48, 95% CI = 1.43–1.53). In female decedents age 45–64, JFH was positively associated with relationship problems (IRR = 1.19, 95% CI = 1.05–1.35), legal problems (IRR = 1.27, 95% CI = 1.06–1.54), depressed mood (IRR = 1.78, 95% CI = 1.59–1.99), and number of crises (IRR = 1.58, 95% CI = 1.48–1.68). In both sexes, the risk of JFH was also positively associated with a college education. In female decedents, JFH risk was higher among divorced or never-married individuals. Coroner/medical examiner and law enforcement agency reports show that some experienced depression and started misusing alcohol and/or other substances following a job loss, but others had these problems throughout life, which caused/contributed to JFH. These findings show the significance of suicide prevention approaches at both systemic (generous unemployment insurance, housing subsidies) and individual (treatment of depression and alcohol/substance misuse problems and social support/connection) levels. 16.2% of male and 13.0% of female suicide decedents age 18+ in 2017–2019 had job/finance/housing problems (JFH). Among decedents age 45–64, 22.0% of male and 15.1% of female had JFH. JFH was positively associated with number of crises, depressed mood, and relationship and alcohol problems in both sexes. Suicide prevention approaches are needed at both systemic and individual levels.
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Affiliation(s)
- Namkee G. Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, 78712, USA
- Corresponding author. UT Steve Hicks School of Social Work, 1925 San Jacinto Blvd, Austin, TX 78712, USA.
| | - C. Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, 78712, USA
| | - Bryan Y. Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine and BayHealth, Dover, DE, 19901, USA
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Alpert HR, Slater ME, Yoon YH, Chen CM, Winstanley N, Esser MB. Alcohol Consumption and 15 Causes of Fatal Injuries: A Systematic Review and Meta-Analysis. Am J Prev Med 2022; 63:286-300. [PMID: 35581102 PMCID: PMC9347063 DOI: 10.1016/j.amepre.2022.03.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION The proportion of fatal nontraffic injuries that involve high levels of alcohol use or alcohol intoxication was assessed by cause of injury to generate alcohol-attributable fractions. Updated alcohol-attributable fractions can contribute to improved estimates of the public health impact of excessive alcohol use. METHODS Peer-reviewed and gray literature for 1995-2019 on 15 causes of fatal nontraffic injuries in the U.S., Canada, or Mexico were systematically reviewed, and state data systems were queried for available estimates of fatalities with recorded blood alcohol concentration levels and proportions of decedents with blood alcohol concentrations ≥0.10 g/dL by cause of injury. For each injury cause, alcohol-attributable fractions across studies were synthesized by meta-analysis of single proportions using generalized linear mixed models. RESULTS In total, 60 published studies and 40 additional population-level data points from 6 state data systems were included. The meta-analyzed alcohol-attributable fractions by cause of injury are as follows: air-space transport (0.03), aspiration (0.24), child maltreatment (0.09), drowning (0.31), fall injuries (0.37), fire injuries (0.34), firearm injuries (0.24), homicide (0.29), hypothermia (0.29), motor vehicle nontraffic crashes (0.42), occupational and machine injuries (0.08), other road vehicle crashes (railroad trespasser injuries) (0.63), poisoning (not alcohol) (0.20), suicide (0.21), and water transport (0.27), yielding an overall median alcohol-attributable fraction of 0.27. DISCUSSION Excessive alcohol use is associated with substantial proportions of violent and nonviolent injury deaths. These findings can improve the data used for estimating alcohol-attributable injury deaths and inform the planning and implementation of evidence-based strategies (e.g., increasing alcohol taxes, regulating alcohol outlet density) to prevent them.
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Affiliation(s)
| | | | | | | | | | - 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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6
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Rahman N, Mozer R, McHugh RK, Rockett IRH, Chow CM, Vaughan G. Using natural language processing to improve suicide classification requires consideration of race. Suicide Life Threat Behav 2022; 52:782-791. [PMID: 35384040 DOI: 10.1111/sltb.12862] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/25/2022] [Accepted: 03/22/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To improve the accuracy of classification of deaths of undetermined intent and to examine racial differences in misclassification. METHODS We used natural language processing and statistical text analysis on restricted-access case narratives of suicides, homicides, and undetermined deaths in 37 states collected from the National Violent Death Reporting System (NVDRS) (2017). We fit separate race-specific classification models to predict suicide among undetermined cases using data from known homicide cases (true negatives) and known suicide cases (true positives). RESULTS A classifier trained on an all-race dataset predicts less than half of these cases as suicide. Importantly, our analysis yields an estimated suicide rate for the Black population comparable with the typical detection rate for the White population, indicating that misclassification excess is endemic for Black suicide. This problem may be mitigated by using race-specific data. Our findings, based on the statistical text analysis, also reveal systematic differences in the phrases identified as most predictive of suicide. CONCLUSIONS This study highlights the need to understand the reasons underlying suicide rate differences and for further testing of strategies to reduce misclassification, particularly among people of color.
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Affiliation(s)
- Nusrat Rahman
- Department of Natural and Applied Sciences, Bentley University, Waltham, Massachusetts, USA.,Health Thought Leadership Network, Bentley University, Waltham, Massachusetts, USA
| | - Reagan Mozer
- Department of Mathematical Sciences, Bentley University, Waltham, Massachusetts, USA
| | - R Kathryn McHugh
- Division of Alcohol, Drugs and Addiction, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Ian R H Rockett
- Department of Epidemiology and Biostatistics, West Virginia University, Morgantown, West Virginia, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Clifton M Chow
- Department of Mathematical Sciences, Bentley University, Waltham, Massachusetts, USA.,Academic Technology Center, Bentley University, Waltham, Massachusetts, USA
| | - Gregory Vaughan
- Department of Mathematical Sciences, Bentley University, Waltham, Massachusetts, USA
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7
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Perry SW, Rainey JC, Allison S, Bastiampillai T, Wong ML, Licinio J, Sharfstein SS, Wilcox HC. Achieving health equity in US suicides: a narrative review and commentary. BMC Public Health 2022; 22:1360. [PMID: 35840968 PMCID: PMC9284959 DOI: 10.1186/s12889-022-13596-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 06/07/2022] [Indexed: 11/16/2022] Open
Abstract
Suicide rates in the United States (US) reached a peak in 2018 and declined in 2019 and 2020, with substantial and often growing disparities by age, sex, race/ethnicity, geography, veteran status, sexual minority status, socioeconomic status, and method employed (means disparity). In this narrative review and commentary, we highlight these many disparities in US suicide deaths, then examine the possible causes and potential solutions, with the overarching goal of reducing suicide death disparities to achieve health equity.The data implicate untreated, undertreated, or unidentified depression or other mental illness, and access to firearms, as two modifiable risk factors for suicide across all groups. The data also reveal firearm suicides increasing sharply and linearly with increasing county rurality, while suicide rates by falls (e.g., from tall structures) decrease linearly by increasing rurality, and suicide rates by other means remain fairly constant regardless of relative county urbanization. In addition, for all geographies, gun suicides are significantly higher in males than females, and highest in ages 51-85 + years old for both sexes. Of all US suicides from 1999-2019, 55% of male suicides and 29% of female suicides were by gun in metropolitan (metro) areas, versus 65% (Male) and 42% (Female) suicides by gun in non-metro areas. Guns accounted for 89% of suicides in non-metro males aged 71-85 + years old. Guns (i.e., employment of more lethal means) are also thought to be a major reason why males have, on average, 2-4 times higher suicide rates than women, despite having only 1/4-1/2 as many suicide attempts as women. Overall the literature and data strongly implicate firearm access as a risk factor for suicide across all populations, and even more so for male, rural, and older populations.To achieve the most significant results in suicide prevention across all groups, we need 1) more emphasis on policies and universal programs to reduce suicidal behaviors, and 2) enhanced population-based strategies for ameliorating the two most prominent modifiable targets for suicide prevention: depression and firearms.
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Affiliation(s)
- Seth W Perry
- Department of Psychiatry and Behavioral Sciences, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA.
- Department of Neuroscience & Physiology, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA.
- Department of Neurosurgery, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA.
- Department of Public Health and Preventive Medicine, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA.
| | - Jacob C Rainey
- Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Stephen Allison
- Department of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Tarun Bastiampillai
- Department of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Mind and Brain Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
- Department of Psychiatry, Monash University, Clayton, Australia
| | - Ma-Li Wong
- Department of Psychiatry and Behavioral Sciences, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA
- Department of Neuroscience & Physiology, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA
- Department of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Julio Licinio
- Department of Psychiatry and Behavioral Sciences, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA
- Department of Neuroscience & Physiology, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA
- Department of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Department of Medicine, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA
- Department of Pharmacology, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA
| | - Steven S Sharfstein
- Sheppard Pratt Health System, Baltimore, MD, USA
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Holly C Wilcox
- Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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8
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Larson PS, Bergmans RS. Impact of the COVID-19 pandemic on temporal patterns of mental health and substance abuse related mortality in Michigan: An interrupted time series analysis. LANCET REGIONAL HEALTH. AMERICAS 2022; 10:100218. [PMID: 35284903 PMCID: PMC8898171 DOI: 10.1016/j.lana.2022.100218] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background The emergence of SARS-CoV2 (COVID-19) had wide impacts to health and mortality and prompted unprecedented containment efforts. The full impact of the COVID-19 pandemic and resulting responses on mental health and substance abuse related mortality are unknown. Methods We obtained records for deaths from suicide, alcohol related liver failure, and overdose from the Michigan Department of Health and Human Services (MDHHS) for 2006 to 2020. We compared mortality within sex, age, marital, racial and urban/rural groups using basic statistical methods. We compared standardized mean daily mortality incidence before and after the onset of the pandemic using t-tests. We used an interrupted time series approach, using generalized additive Poisson regression models with smoothed components for time to assess differences in mortality trends before and after the onset of the pandemic within demographic groups. Findings There were 19,365 suicides, 8,790 deaths from alcohol related liver failure, and 21,778 fatal drug overdoses. Compared with 2019, suicides in 2020 declined by 17.6%, overdose mortality declined by 22.5%—while alcohol deaths increased by 12.4%. Crude comparisons suggested that there were significant declines in suicides for white people, people 18 to 65 and increases for rural decedents, overdoses increased for Black people, females and married/widowed people, and alcohol mortality increased for nearly all groups. ITS models, however, suggested increased suicide mortality for rural residents, significantly increased alcohol related mortality for people ≥65 and increased overdose mortality in men. Interpretation The onset of the pandemic was associated with mixed patterns of mortality between suicide, alcohol and overdose deaths. Patterns varied within demographic groups, suggesting that impacts varied among different groups, particularly racial and marital groups. Funding This work was supported by the United States National Institute of Environmental Health Sciences [K99/R00ES026198] and their Michigan Center on Lifestage Environmental Exposures and Disease [grant number P30ES017885]; and the Institute for Global Biological Change at the University of Michigan.
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Affiliation(s)
- Peter S Larson
- Survey Research Center, Social Environment and Health Program, University of Michigan Institute for Social Research, 426 Thompson, Ann Arbor, MI 48104, USA.,Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Rachel S Bergmans
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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9
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Dmetrichuk JM, Rosenthal JS, Man J, Cullip M, Wells RA. Retrospective study of non-natural manners of death in Ontario: Effects of the COVID-19 pandemic and related public health measures. LANCET REGIONAL HEALTH. AMERICAS 2022; 7:100130. [PMID: 34927128 PMCID: PMC8671724 DOI: 10.1016/j.lana.2021.100130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND The effects of the COVID-19 pandemic on non-natural manners of death in Ontario is not known. Understanding the indirect consequences of the pandemic and related public health measures (i.e. lockdown) fills a vital need to inform best practice in public health and guide policy decisions. METHODS The Office of the Chief Coroner and the Ontario Forensic Pathology Service (OCC-OFPS) investigate sudden and unexpected deaths in the province of Ontario. The number of homicides, suicides, and accidental deaths (non-natural deaths=77,655) were extracted from the centralized Coroner's Information System database (total deaths=197,966), across four provincially defined stages of lockdown related to the COVID-19 pandemic (March 17 to December 31, 2020), and crude rates (per 100,000 people) were compared to the previous eleven years. FINDINGS There was no major change to the rate of homicides during 2020 compared to 2009-2019 (RR 1⋅1, 95% CI 0⋅95-1⋅2; p=0⋅19; estimated annual effect=21 more deaths in 2020). The rate of suicides also did not show an overall major change in 2020 (RR 1⋅02, 95% CI 0⋅96-1⋅1; p=0⋅50; estimated annual effect=27 more deaths in 2020). However, during the first stage of lockdown (Stage 0), there was a decrease in the rate of suicides compared to all combinations of recent years from 2013 onwards (RRs 0⋅82-0⋅86, combined 95% CI 0⋅69-0⋅99; max p=0⋅039; estimated effect of 30 less deaths in Stage 0). There was an excess of over 1,500 accidental drug-related deaths that occurred during 2020 (RR 2⋅5, 95% CI 2⋅4-2⋅7; p<0⋅001). This finding held up to 'interrupted time series' robustness testing, indicating that 2020 had substantially more drug-related deaths, even when accounting for the linear increasing trend over time. Although motor vehicle collision associated fatalities appeared to decrease slightly in 2020 (RR 0⋅89, 95% CI 0⋅81-0⋅96; p=0⋅0039; estimated annual effect of 78 less deaths), we could not conclude any lockdown-associated effect, particularly when compared to 2019 (RR 0⋅26, 95% CI 0⋅75-1⋅1; p=0⋅26). INTERPRETATION In Ontario, the short-term effects of the COVID-19 pandemic did not greatly increase homicide or suicide rates, nor decrease motor vehicle collision fatality rates; however, the longer-term impact of the pandemic remains to be elucidated and ongoing vigilance is warranted in the event that other trends emerge. Accidental drug-related fatalities substantially increased during all stages of the lockdown, marking an urgent need for consideration in policy. These results highlight the vital role of death investigation systems in providing high quality and timely data to inform public health recommendations.
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Affiliation(s)
- Jennifer M Dmetrichuk
- Provincial Forensic Pathology Unit, Ontario Forensic Pathology Service, Forensic Services and Coroner's Complex, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey S Rosenthal
- Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Julia Man
- Office of the Chief Coroner, Forensic Services and Coroner's Complex, Toronto, Ontario, Canada
| | - Mackenzie Cullip
- Provincial Forensic Pathology Unit, Ontario Forensic Pathology Service, Forensic Services and Coroner's Complex, Toronto, Ontario, Canada
| | - Richard A Wells
- Office of the Chief Coroner, Forensic Services and Coroner's Complex, Toronto, Ontario, Canada
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10
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Rockett IRH, Jia H, Ali B, Banerjee A, Connery HS, Nolte KB, Miller T, White FMM, DiGregorio BD, Larkin GL, Stack S, Kõlves K, McHugh RK, Lulla VO, Cossman J, De Leo D, Hendricks B, Nestadt PS, Berry JH, D’Onofrio G, Caine ED. Association of State Social and Environmental Factors With Rates of Self-injury Mortality and Suicide in the United States. JAMA Netw Open 2022; 5:e2146591. [PMID: 35138401 PMCID: PMC8829661 DOI: 10.1001/jamanetworkopen.2021.46591] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Self-injury mortality (SIM) combines suicides and the preponderance of drug misuse-related overdose fatalities. Identifying social and environmental factors associated with SIM and suicide may inform etiologic understanding and intervention design. OBJECTIVE To identify factors associated with interstate SIM and suicide rate variation and to assess potential for differential suicide misclassification. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used a partial panel time series with underlying cause-of-death data from 50 US states and the District of Columbia for 1999-2000, 2007-2008, 2013-2014 and 2018-2019. Applying data from the Centers for Disease Control and Prevention, SIM includes all suicides and the preponderance of unintentional and undetermined drug intoxication deaths, reflecting self-harm behaviors. Data were analyzed from February to June 2021. EXPOSURES Exposures included inequity, isolation, demographic characteristics, injury mechanism, health care access, and medicolegal death investigation system type. MAIN OUTCOMES AND MEASURES The main outcome, SIM, was assessed using unstandardized regression coefficients of interstate variation associations, identified by the least absolute shrinkage and selection operator; ratios of crude SIM to suicide rates per 100 000 population were assessed for potential differential suicide misclassification. RESULTS A total of 101 325 SIMs were identified, including 74 506 (73.5%) among males and 26 819 (26.5%) among females. SIM to suicide rate ratios trended upwards, with an accelerating increase in overdose fatalities classified as unintentional or undetermined (SIM to suicide rate ratio, 1999-2000: 1.39; 95% CI, 1.38-1.41; 2018-2019: 2.12; 95% CI, 2.11-2.14). Eight states recorded a SIM to suicide rate ratio less than 1.50 in 2018-2019 vs 39 states in 1999-2000. Northeastern states concentrated in the highest category (range, 2.10-6.00); only the West remained unrepresented. Least absolute shrinkage and selection operator identified 8 factors associated with the SIM rate in 2018-2019: centralized medical examiner system (β = 4.362), labor underutilization rate (β = 0.728), manufacturing employment (β = -0.056), homelessness rate (β = -0.125), percentage nonreligious (β = 0.041), non-Hispanic White race and ethnicity (β = 0.087), prescribed opioids for 30 days or more (β = 0.117), and percentage without health insurance (β = -0.013) and 5 factors associated with the suicide rate: percentage male (β = 1.046), military veteran (β = 0.747), rural (β = 0.031), firearm ownership (β = 0.030), and pain reliever misuse (β = 1.131). CONCLUSIONS AND RELEVANCE These findings suggest that SIM rates were associated with modifiable, upstream factors. Although embedded in SIM, suicide unexpectedly deviated in proposed social and environmental determinants. Heterogeneity in medicolegal death investigation processes and data assurance needs further characterization, with the goal of providing the highest-quality reports for developing and tracking public health policies and practices.
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Affiliation(s)
- Ian R. H. Rockett
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Haomiao Jia
- Department of Biostatistics, Mailman School of Public Health and School of Nursing, Columbia University, New York, New York
| | - Bina Ali
- Pacific Institute for Research and Evaluation, Calverton, Maryland
| | - Aniruddha Banerjee
- Department of Geography, Indiana University–Purdue University at Indianapolis
| | - Hilary S. Connery
- McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Kurt B. Nolte
- Departments of Pathology and Radiology, University of New Mexico School of Medicine, Albuquerque
- Departments of Pathology and Radiology, University of New Mexico School of Medicine, Albuquerque
| | - Ted Miller
- Pacific Institute for Research and Evaluation, Calverton, Maryland
- Centre for Population Health Research, Curtin University, Perth, Australia
| | - Franklin M. M. White
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | | | | | - Steven Stack
- Departments of Criminal Justice and Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, Mount Gravatt, Australia
- WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Mount Gravatt, Australia
| | - R. Kathryn McHugh
- McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Vijay O. Lulla
- Department of Geography, Indiana University–Purdue University at Indianapolis
| | - Jeralynn Cossman
- College for Health, Community and Policy, University of Texas, San Antonio
| | - Diego De Leo
- Slovene Centre for Suicide Research and Department of Psychology, University of Primorska, Koper, Slovenia
| | - Brian Hendricks
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown
| | - Paul S. Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - James H. Berry
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown
| | - Gail D’Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Eric D. Caine
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
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11
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Sinyor M, Tran US, Garcia D, Till B, Voracek M, Niederkrotenthaler T. Suicide mortality in the United States following the suicides of Kate Spade and Anthony Bourdain. Aust N Z J Psychiatry 2021; 55:613-619. [PMID: 33300363 DOI: 10.1177/0004867420976844] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The suicides of Kate Spade and Anthony Bourdain, two major American icons, in a span of days in June 2018 represent a unique and tragic natural experiment to characterize associations with actual suicides in the aftermath of celebrity suicides. The aim of this study was to identify changes in suicide counts after their deaths. METHODS Suicide data were obtained from the United States' Centers for Disease Control and Prevention's public-use mortality file. A time-series analysis was performed, examining monthly suicide data by age group (⩽19, 20-44, 45-64 and ⩾65 years), for both men and women, for all suicide methods and for hanging versus non-hanging methods, from January 1999 to December 2018. Seasonal autoregressive integrated moving-average models were fitted to the pre-June 2018 period, estimating suicides in subsequent months and identifying deviations from expected values. The volume of Twitter posts about Kate Spade and Anthony Bourdain was used as a proxy of societal attention. RESULTS Tweets about the celebrities were mainly concentrated in June 2018 and faded quickly in July. Total suicides exceeded the 95% confidence interval for June and approximated the upper limit of the 95% confidence interval in July. Over this 2-month span, there were 418 (95% confidence interval = [184, 652]) more suicides than expected, including 275 (95% confidence interval = [79, 471]) excess suicides in men and 182 (95% confidence interval = [93, 271]) in women. These equate to 4.8%, 4.1% and 9.1% increases above expected counts. There were 392 (95% confidence interval = [271, 514]) excess suicides by hanging, a 14.5% increase, with no significant increase in all other methods combined. CONCLUSION AND RELEVANCE These findings demonstrate that mortality following celebrity suicides can occur at a similar magnitude to that observed for other public health emergencies. They underscore the urgency for interventions to mitigate imitation effects after celebrity suicide reporting.
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Affiliation(s)
- Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Ulrich S Tran
- School of Psychology, Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria.,Wiener Werkstaette for Suicide Research, Vienna, Austria
| | - David Garcia
- Complexity Science Hub Vienna, Vienna, Austria.,Section for Science of Complex Systems, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.,Institute of Interactive Systems and Data Science, Faculty of Computer Science and Biomedical Engineering, TU Graz, Graz, Austria
| | - Benedikt Till
- Wiener Werkstaette for Suicide Research, Vienna, Austria.,Unit Suicide Research & Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Martin Voracek
- School of Psychology, Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria.,Wiener Werkstaette for Suicide Research, Vienna, Austria
| | - Thomas Niederkrotenthaler
- Wiener Werkstaette for Suicide Research, Vienna, Austria.,Unit Suicide Research & Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
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12
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Wu ZH, Yong Q, Walker JM, Grady JJ, Laurencin CT. Fentanyl, Heroin, and Cocaine Overdose Fatalities are Shifting to the Black Community: An Analysis of the State of Connecticut. J Racial Ethn Health Disparities 2021; 9:722-730. [PMID: 33977509 DOI: 10.1007/s40615-021-01007-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/04/2021] [Accepted: 02/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Historically, Blacks and Hispanics have had lower opioid-involved overdose death rates in Connecticut (CT). We examined if a shift has taken place where rates of Black fatal overdoses have now surpassed Whites in the state. METHODS Drug overdose fatality rates were calculated by number of deaths per year per 100,000 population from 2012 to 2019 in Connecticut. Measures were by race (White, Hispanic, Black, and Asian or Pacific Islander), age groups, and types of drugs, including fentanyl, heroin, cocaine, and other opioids. Poisson regression was used to test the interactions (race × age); joinpoint regression analysis was used to evaluate trend lines of fatality rate by racial/ethnic group within each age group with a significance level of p < 0.05. RESULTS Drug overdose fatality rates in CT from 2012 to 2019 showed a significant increase for all races combined, estimated 3.6 deaths per 100,000 population per year. For Whites, overdose deaths were 4.6 per year from 2012 to 2017 with no change from 2017 to 2019. The overdose fatality rate for Hispanics was 3.0 and for Asian or Pacific Islanders 0.6 per year from 2012 to 2019. For Blacks, the death rates were statistically flat between 2012 and 2014; however, from 2015 to 2019, this group saw the largest average increase of 6.0 overdose deaths per 100,000 population each year. By 2019, the overdose fatality rate was higher in Blacks than in Whites, (39 vs. 38 per 100,000, respectively). Further, Blacks ages 50 years and over reported the highest overdose fatality rates among all race/age groups, an increase of 8.5 deaths per 100,000 population since 2014. CONCLUSIONS AND RELEVANCE Connecticut is a microcosm of the opioid overdose trend in the New England region of our country. The majority of overdose deaths in CT involved illicit drugs, fentanyl, heroin, and cocaine, rather than prescription drugs. Blacks 50-years-old and over showed the fastest growing overdose death rates. Opioid deaths are now shifting to the Black community, creating an urgent public health crisis.
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Affiliation(s)
- Z Helen Wu
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT, 06030, USA.,Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, 06030, USA
| | - Qiao Yong
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT, 06030, USA.,Department of Statistics, University of Connecticut, Storrs, CT, 06269, USA
| | - Joanne M Walker
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT, 06030, USA
| | - James J Grady
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT, 06030, USA.,Department of Population Health Science, University of Connecticut Health Center, Farmington, CT, 06030, USA
| | - Cato T Laurencin
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT, 06030, USA. .,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, Farmington, CT, USA. .,Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT, USA. .,Department of Materials Science & Engineering, University of Connecticut, Storrs, CT, USA. .,Department of Biomedical Engineering, University of Connecticut, Storrs, CT, USA. .,Department of Chemical & Biomolecular Engineering, University of Connecticut, Storrs, CT, USA.
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13
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Rockett IR, Caine ED, Banerjee A, Ali B, Miller T, Connery HS, Lulla VO, Nolte KB, Larkin GL, Stack S, Hendricks B, McHugh RK, White FM, Greenfield SF, Bohnert AS, Cossman JS, D'Onofrio G, Nelson LS, Nestadt PS, Berry JH, Jia H. Fatal self-injury in the United States, 1999-2018: Unmasking a national mental health crisis. EClinicalMedicine 2021; 32:100741. [PMID: 33681743 PMCID: PMC7910714 DOI: 10.1016/j.eclinm.2021.100741] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Suicides by any method, plus 'nonsuicide' fatalities from drug self-intoxication (estimated from selected forensically undetermined and 'accidental' deaths), together represent self-injury mortality (SIM)-fatalities due to mental disorders or distress. SIM is especially important to examine given frequent undercounting of suicides amongst drug overdose deaths. We report suicide and SIM trends in the United States of America (US) during 1999-2018, portray interstate rate trends, and examine spatiotemporal (spacetime) diffusion or spread of the drug self-intoxication component of SIM, with attention to potential for differential suicide misclassification. METHODS For this state-based, cross-sectional, panel time series, we used de-identified manner and underlying cause-of-death data for the 50 states and District of Columbia (DC) from CDC's Wide-ranging Online Data for Epidemiologic Research. Procedures comprised joinpoint regression to describe national trends; Spearman's rank-order correlation coefficient to assess interstate SIM and suicide rate congruence; and spacetime hierarchical modelling of the 'nonsuicide' SIM component. FINDINGS The national annual average percentage change over the observation period in the SIM rate was 4.3% (95% CI: 3.3%, 5.4%; p<0.001) versus 1.8% (95% CI: 1.6%, 2.0%; p<0.001) for the suicide rate. By 2017/2018, all states except Nebraska (19.9) posted a SIM rate of at least 21.0 deaths per 100,000 population-the floor of the rate range for the top 5 ranking states in 1999/2000. The rank-order correlation coefficient for SIM and suicide rates was 0.82 (p<0.001) in 1999/2000 versus 0.34 (p = 0.02) by 2017/2018. Seven states in the West posted a ≥ 5.0% reduction in their standardised mortality ratios of 'nonsuicide' drug fatalities, relative to the national ratio, and 6 states from the other 3 major regions a >6.0% increase (p<0.05). INTERPRETATION Depiction of rising SIM trends across states and major regions unmasks a burgeoning national mental health crisis. Geographic variation is plausibly a partial product of local heterogeneity in toxic drug availability and the quality of medicolegal death investigations. Like COVID-19, the nation will only be able to prevent SIM by responding with collective, comprehensive, systemic approaches. Injury surveillance and prevention, mental health, and societal well-being are poorly served by the continuing segregation of substance use disorders from other mental disorders in clinical medicine and public health practice. FUNDING This study was partially funded by the National Centre for Injury Prevention and Control, US Centers for Disease Control and Prevention (R49CE002093) and the US National Institute on Drug Abuse (1UM1DA049412-01; 1R21DA046521-01A1).
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Affiliation(s)
- Ian R.H. Rockett
- Department of Epidemiology, West Virginia University School of Public Health, Morgantown, WV, United States
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, United States
| | - Eric D. Caine
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, United States
| | - Aniruddha Banerjee
- Department of Geography, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana, United States
| | - Bina Ali
- Pacific Institute for Research and Evaluation, Calverton, Maryland, United States
| | - Ted Miller
- Pacific Institute for Research and Evaluation, Calverton, Maryland, United States
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Hilary S. Connery
- McLean Hospital, Belmont, Massachusetts, United States
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States
| | - Vijay O. Lulla
- Department of Geography, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana, United States
| | - Kurt B. Nolte
- Department of Pathology and Radiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
| | - G. Luke Larkin
- Northeast Ohio Medical University, Rootstown, Ohio, United States
| | - Steven Stack
- Department of Criminal Justice, Wayne State University, Detroit, Michigan, United States
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan, United States
| | - Brian Hendricks
- Department of Epidemiology, West Virginia University School of Public Health, Morgantown, WV, United States
| | - R. Kathryn McHugh
- McLean Hospital, Belmont, Massachusetts, United States
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States
| | - Franklin M.M. White
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shelly F. Greenfield
- McLean Hospital, Belmont, Massachusetts, United States
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States
| | - Amy S.B. Bohnert
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, United States
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, United States
| | - Jeralynn S. Cossman
- College for Health, Community and Policy, University of Texas-San Antonio, San Antonio, Texas, United States
| | - Gail D'Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, United States
| | - Lewis S. Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States
| | - Paul S. Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - James H. Berry
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - Haomiao Jia
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, United States
- School of Nursing, Columbia University, New York, New York, United States
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14
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McClure RJ. Injury prevention: maturation of the field. Inj Prev 2020; 26:403. [PMID: 32958565 DOI: 10.1136/injuryprev-2020-043979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Roderick J McClure
- School of Rural Medicine, University of New England, Armidale, Maine, Australia
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15
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Rockett IRH, Caine ED, Connery HS, Nolte KB. Overcoming the limitations of 'accident' as a manner of death for drug overdose mortality: case for a death certificate checkbox. Inj Prev 2020; 27:375-378. [PMID: 32917742 DOI: 10.1136/injuryprev-2020-043830] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/23/2020] [Accepted: 07/25/2020] [Indexed: 01/21/2023]
Abstract
Collectively, the epidemic increases in the United States of opioid-related deaths and suicides during the first two decades of the 21st century have exposed shortcomings in current forensic and epidemiological approaches for determining and codifying manner of death-a vital function fulfilled by medical examiners, coroners and nosologists-the foundation for the National Violent Death Reporting System (NVDRS), an incident-based surveillance system providing individual-level information on decedent characteristics, manner, cause and circumstances of suicide, homicide and other violent injury deaths. Drug intoxication deaths are generally classified as 'accidents' or unintentional, a fundamental mischaracterisation; most arose from repetitive self-harm behaviours related to substance acquisition and misuse. Moreover, given the burden of affirmative evidence required to determine suicide, many of these 'accidents' likely reflected unrecognised intentional acts-that is, suicides. Addition of a simple checkbox for self-injury mortality on the death certificate would enrich the National Death Index and NVDRS, and in turn, inform prevention and clinical research, and enhance the evaluation of prevention programmes and therapeutic regimens.
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Affiliation(s)
- Ian R H Rockett
- Epidemiology, West Virginia University, Morgantown, West Virginia, USA .,Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Eric D Caine
- Injury Control Research Center for Suicide Prevention, University of Rochester Medical Center, Rochester, New York, USA.,Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Hilary S Connery
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts, USA.,Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Kurt B Nolte
- Pathology and Radiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
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Li F, Yip PSF. How to make adjustments of underreporting of suicide by place, gender, and age in China? Soc Psychiatry Psychiatr Epidemiol 2020; 55:1133-1143. [PMID: 32221643 DOI: 10.1007/s00127-020-01856-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 02/28/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Underreporting of suicide is a worldwide problem. In particular, the national suicide rates published by the Chinese Ministry of Health ("MOH") could be severely underreported. Validity of the assumption of evenly underreported of suicide by place (city/rural), gender, and age in China has been evaluated and some possible adjustments to the underreporting have been suggested. METHODS Mortality rates from the MOH from 2002 to 2016 were extracted. Due to zero undetermined deaths, accidental deaths (weighted by causes of death) were used to evaluate underreported suicides. 53% of drownings, 11% of falls, 11% of poisonings, and 7% of other accidents were assumed as underreported suicides. Negative binomial regressions were used to calculate the rate ratios of the underreported suicides compared to suicides. Negative binomial regressions were also used to calculate the annual percentage changes of different mortality rates. RESULTS Suicides of rural males could most likely be underreported (49%; 95% CI 39-61%), but suicides of rural females would least likely (30%; 95% CI 24-38%). Suicides of people aged 15-24 years and 75 years and above could more likely to be underreported than other ages. After adding the underreported suicides, declining trends of the national suicide rates had been eased. CONCLUSIONS People who lack social connection could have a high possibility of underreporting suicide. However, when rural females died of unnatural causes, their parents or even the whole village tended to quest for their intents, thus rural females had a lower possibility of underreporting suicide.
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Affiliation(s)
- Feng Li
- Social Work and Social Administration Department, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Paul S F Yip
- Social Work and Social Administration Department, The University of Hong Kong, Pokfulam, Hong Kong SAR, China. .,Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong SAR, China.
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Nestadt PS, Bohnert ASB. Clinical Perspective on Opioids in the Context of Suicide Risk. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 18:100-105. [PMID: 33162847 PMCID: PMC7587892 DOI: 10.1176/appi.focus.20200003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Psychiatrists are on the front lines of two simultaneous public health crises: the increasing rates of suicide and opioid-related deaths. In this review, the authors discuss ways in which these two classes of preventable deaths may be linked, with an emphasis on identifying and preventing both outcomes through increased understanding of their shared risk factors. As clinicians, it is crucial to maintain awareness of the ways in which opioid use may contribute to depression and suicidality, as well as how mood disorders may complicate opioid use. In light of this interplay, interventions which target risk factors for both suicide and overdose are key. Interventions include early treatment of substance dependence and depression, as well as harm reduction measures, such as provision of naloxone, medication-assisted treatments for dependency, and multidisciplinary approaches to chronic pain that do not rely solely on escalating opioid doses. It is also important to address social determinants of health, which may increase risk for both accidental and intentional overdose. The roads to overdose and suicide overlap considerably and cannot be considered separately.
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Affiliation(s)
- Paul S Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, and Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Nestadt); Department of Psychiatry, University of Michigan, and U.S. Department of Veterans Affairs, Ann Arbor, Michigan (Bohnert)
| | - Amy S B Bohnert
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, and Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Nestadt); Department of Psychiatry, University of Michigan, and U.S. Department of Veterans Affairs, Ann Arbor, Michigan (Bohnert)
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