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Hielscher E, Hay K, Chang I, McGrath M, Poulton K, Giebels E, Blake J, Batterham PJ, Scott JG, Lawrence D. Australian Youth Self-Harm Atlas: spatial modelling and mapping of self-harm prevalence and related risk and protective factors to inform youth suicide prevention strategies. Epidemiol Psychiatr Sci 2024; 33:e34. [PMID: 39247944 DOI: 10.1017/s2045796024000301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2024] Open
Abstract
AIMS Suicide prevention strategies have shifted in many countries, from a national approach to one that is regionally tailored and responsive to local community needs. Previous Australian studies support this approach. However, most studies have focused on suicide deaths which may not fully capture a complete understanding of prevention needs, and few have focused on the priority population of youth. This was the first nationwide study to examine regional variability of self-harm prevalence and related factors in Australian young people. METHODS A random sample of Australian adolescents (12-17-year-olds) were recruited as part of the Young Minds Matter (YMM) survey. Participants completed self-report questions on self-harm (i.e., non-suicidal self-harm and suicide attempts) in the previous 12 months. Using mixed effects regressions, an area-level model was built with YMM and Census data to produce out-of-sample small area predictions for self-harm prevalence. Spatial unit of analysis was Statistical Area Level 1 (average population 400 people), and all prevalence estimates were updated to 2019. RESULTS Across Australia, there was large variability in youth self-harm prevalence estimates. Northern Territory, Western Australia, and South Australia had the highest estimated state prevalence. Psychological distress and depression were factors which best predicted self-harm at an individual level. At an area-level, the strongest predictor was a high percentage of single unemployed parents, while being in an area where ≥30% of parents were born overseas was associated with reduced odds of self-harm. CONCLUSIONS This study identified characteristics of regions with lower and higher youth self-harm risk. These findings should assist governments and communities with developing and implementing regionally appropriate youth suicide prevention interventions and initiatives.
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Affiliation(s)
- E Hielscher
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Flourish Australia, Sydney Olympic Park, NSW, Australia
| | - K Hay
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - I Chang
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - M McGrath
- Roses in the Ocean, Brisbane, Australia
| | - K Poulton
- Roses in the Ocean, Brisbane, Australia
| | - E Giebels
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - J Blake
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - P J Batterham
- Centre for Mental Health Research, The Australian National University, Canberra, ACT, Australia
| | - J G Scott
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
- Child and Youth Mental Health Service, Children's Health Queensland, Brisbane, QLD, Australia
| | - D Lawrence
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
- School of Population Health, Curtin University, Perth, WA, Australia
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Hartnett Y, Thekiso TB, Kowalska-Beda P, Maher T, McLoughlin DM, Kennedy N. Predictors of inpatient suicide in an Irish psychiatric service, a longitudinal case-control study. Suicide Life Threat Behav 2024; 54:620-631. [PMID: 38517159 DOI: 10.1111/sltb.13073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 10/01/2023] [Accepted: 02/23/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE Inpatient suicide remains difficult to predict. This study aimed to identify individual patient predictors to help identify those at greater risk. METHODS This case-control study was undertaken in an independent mental health service in Ireland. Cases were drawn from all admissions to the service between March 2004 and February 2019. Controls were matched for date of admission. Univariate and multivariate analyses were conducted. RESULTS Thirty-three cases of inpatient suicide were compared to 132 controls. The inpatient suicide rate was 76.2 per 100,000 admissions. The rate of inpatient suicide fell in line with national rates despite less restrictive practices being implemented in the service. Males accounted for 66% of cases. Hanging was the most common method of suicide overall and among male patients, and drowning was the most common among females. Male gender, tertiary referral, an adverse psychosocial event during admission, a period of absence without leave and expressing hopelessness were identified as independent risk factors for inpatient suicide. Substance use, involuntary detention, family history of suicide, and number of previous admissions were not significant. CONCLUSIONS While not highly sensitive, a period of absence without leave, tertiary referral and hopelessness are important predictors of inpatient suicide risk that treating teams should consider in care planning.
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Affiliation(s)
| | | | | | - Tom Maher
- St Patrick's University Hospital, Dublin, Ireland
| | - Declan M McLoughlin
- St Patrick's University Hospital, Dublin, Ireland
- Department of Psychiatry and Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Noel Kennedy
- St Patrick's University Hospital, Dublin, Ireland
- Highfield Healthcare, Dublin, Ireland
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Peng S, Zhang W, Yang T, Cottrell RR, Rockett IRH. Contextual influences on deliberate self-harm among Chinese university undergraduates: A representative nationwide study. J Affect Disord 2023; 335:371-376. [PMID: 37169084 DOI: 10.1016/j.jad.2023.05.010] [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: 11/08/2022] [Revised: 04/29/2023] [Accepted: 05/05/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Numerous studies have identified factors associated with deliberate self-harm (DSH), but environmental influences have largely been neglected. This study explored regional and university contextual factors that impact DSH among undergraduate students in China. METHODS Subjects in this observational cross-sectional study totaled 5016 undergraduate students, who were identified through multistage survey sampling in 22 Chinese universities. Individual-level data were obtained through a self-administered questionnaire, and environmental variables were extracted from the National Bureau of Statistics database. Multilevel logistic regression models were used to examine regional correlates of DSH. RESULTS The overall prevalence of self-reported DSH in the study sample was 7.5 % (95 % CI: 4.1 %, 10.9 %). The full multilevel logistic model showed university rank and city size were inversely associated with DSH prevalence (Adjusted Odds Ratio (AOR): 0.24 and 0.55). Regional unemployment rates were positively associated with DSH prevalence (AOR: 1.98, 95 % CI: 1.48, 2.65). DISCUSSION Contextual disparities appear to contribute to DSH among Chinese undergraduates. Preventive initiatives must focus on redressing imbalances in the allocation of social and economic resources across universities and regions.
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Affiliation(s)
- Sihui Peng
- School of Medicine, Jinan University, Guangzhou 510632, China
| | - Weifang Zhang
- The Stomatology Hospital, Zhejiang University School of Medicine, 310006, China
| | - Tingzhong Yang
- Department of Social Medicine/Center for Tobacco Control Research, Zhejiang University School of Medicine, Hangzhou 310058, China; Injury Control Research Center, West Virginia University, Morgantown, WV 26506-9190, USA.
| | - Randall R Cottrell
- Public Health Studies Program, School of Health and Applied Human Sciences, University of North Carolina, Wilmington, NC 28403, USA.
| | - Ian R H Rockett
- Department of Epidemiology, School of Public Health/Injury Control Research Center, West Virginia University, Morgantown, WV 26506-9190, USA.
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A Systematic Review of the Effects of Urban Living on Suicidality and Self-Harm in the UK and Ireland. J Urban Health 2022; 99:385-408. [PMID: 35378716 PMCID: PMC8979150 DOI: 10.1007/s11524-022-00611-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 12/17/2022]
Abstract
We conducted a systematic review to answer the following: (a) Is there any evidence to support increased prevalence of suicidality and self-harm (i.e. self-harm or suicidality) in urban versus rural environments? (b) What aspects of the urban environment pose risk for suicidality and self-harm? Thirty-five studies met our criteria. Our findings reflect a mixed picture, but with a tendency for urban living to be associated with an increased risk of suicidality and self-harm over rural living, particularly for those living in deprived areas. Further research should focus on the clustering and additive effects of risk and protective factors for suicidality and self-harm in urban environments.
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Affiliation(s)
- Katrina Witt
- 1 Orygen, the National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, University of Melbourne, VIC, Australia.,2 Turning Point, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jo Robinson
- 1 Orygen, the National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, University of Melbourne, VIC, Australia
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Griffin E, Bonner B, Dillon CB, O’Hagan D, Corcoran P. The association between self-harm and area-level characteristics in Northern Ireland: an ecological study. Eur J Public Health 2019; 29:948-953. [DOI: 10.1093/eurpub/ckz021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Factors contributing to suicidal behaviour are complex and multi-faceted. This study took an ecological approach to examine the association between area-level factors and rates of self-harm in Northern Ireland.
Methods
Data on self-harm presentations to emergency departments (EDs) were obtained from the Northern Ireland Self-harm Registry. The study included residents of Northern Ireland aged 16–64 years. Deprivation was measured using the Northern Ireland Multiple Deprivation Measure 2017. Population density and social fragmentation were calculated using measures from the 2011 census. Associations between area-level factors and self-harm rates were explored using negative binomial regression.
Results
Between 2013 and 2015, 14 477 individuals aged 16–64 years presented to EDs in Northern Ireland following self-harm. The rate of self-harm was 472 per 100 000 and was higher for male residents (478 vs. 467). Self-harm rates were highest in urban areas—680 per 100 000 in Belfast City and 751 per 100 000 in Derry City. Rates of self-harm in Northern Ireland were more than four times higher in the most deprived areas. A positive association with rates of self-harm held for the deprivation domains of employment, crime, education, health and income. There was a moderate association with population density. Some gender differences emerged, with associations with male rates of self-harm more pronounced.
Conclusion
These findings indicate that self-harm rates are highest for those residing in highly deprived areas, where unemployment, crime and low level of education are challenges. Community interventions tailored to meet the needs of specific areas may be effective in reducing suicidal behaviour.
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Affiliation(s)
- Eve Griffin
- National Suicide Research Foundation, Cork, Ireland
| | | | | | | | - Paul Corcoran
- National Suicide Research Foundation, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
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Grigoroglou C, Munford L, Webb RT, Kapur N, Ashcroft DM, Kontopantelis E. Spatial distribution and temporal trends in social fragmentation in England, 2001-2011: a national study. BMJ Open 2019; 9:e025881. [PMID: 30679299 PMCID: PMC6347895 DOI: 10.1136/bmjopen-2018-025881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Social fragmentation is commonly examined in epidemiological studies of mental illness as high levels of social fragmentation are often found in areas with high prevalence of mental illness. In this study, we examine spatial and temporal patterns of social fragmentation and its underlying indicators in England over time. SETTING Data for social fragmentation and its underlying indicators were analysed over the decennial Censuses (2001-2011) at a small area geographical level (mean of 1500 people). Degrees of social fragmentation and temporal changes were spatially visualised for the whole of England and its 10 administrative regions. Spatial clustering was quantified using Moran's I; changes in correlations over time were quantified using Spearman's ranking correlation. RESULTS Between 2001 and 2011, we observed a strong persistence for social fragmentation nationally (Spearman's r=0.93). At the regional level, modest changes were observed over time, but marked increases were observed for two of the four social fragmentation underlying indicators, namely single people and those in private renting. Results supported our hypothesis of increasing spatial clustering over time. Moderate regional variability was observed in social fragmentation, its underlying indicators and their clustering over time. CONCLUSION Patterns of social fragmentation and its underlying indicators persisted in England which seem to be driven by the large increases in single people and those in private renting. Policies to improve social cohesion may have an impact on the lives of persons who experience mental illness. The spatial aspect of social fragmentation can inform the targeting of health and social care interventions, particularly in areas with strong social fragmentation clustering.
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Affiliation(s)
- Christos Grigoroglou
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
- Manchester Academic Health Sciences Centre [MAHSC], Manchester, UK
| | - Luke Munford
- Manchester Academic Health Sciences Centre [MAHSC], Manchester, UK
- Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Roger T Webb
- Manchester Academic Health Sciences Centre [MAHSC], Manchester, UK
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Nav Kapur
- Manchester Academic Health Sciences Centre [MAHSC], Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- Centre for Suicide Prevention, Division of Psychology and Mental Health, University of Manchester, Manchester, Greater Manchester, UK
- Greater Manchester Mental Health Trust, Manchester, UK
| | - Darren M Ashcroft
- Manchester Academic Health Sciences Centre [MAHSC], Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Evangelos Kontopantelis
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
- Manchester Academic Health Sciences Centre [MAHSC], Manchester, UK
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Polling C, Bakolis I, Hotopf M, Hatch SL. Spatial patterning of self-harm rates within urban areas. Soc Psychiatry Psychiatr Epidemiol 2019; 54:69-79. [PMID: 30259055 PMCID: PMC6336929 DOI: 10.1007/s00127-018-1601-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 09/18/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Urban areas are usually found to have higher rates of self-harm, with deprivation the strongest predictor at area-level. We use a disease mapping approach to examine how self-harm is patterned within an urban area and its associations with deprivation, urbanness and ethnicity. METHODS Data from clinical records on individuals admitted for self-harm for 725 small areas in South East London were included. Bayesian hierarchical models explored the spatio-temporal patterns of self-harm admission rates and potential associations with proximity to city centre, population density, percentage greenspace and non-white ethnic-minority populations. All models were adjusted for area-level deprivation, social fragmentation and hospital of admission. RESULTS There were 8327 first admissions for self-harm during the study period. Self-harm admission rates varied fourfold across the study area, with lower rates close to the city centre [adjusted standardised admission ratio, closest versus furthest quartile 0.71(95% CrI 0.54-0.96)]. Deprivation was associated with self-harm but partially masked rather than explained the spatial pattern, which strengthened after adjustment. After adjustment for deprivation, hospital of admission and social fragmentation, greenspace, population density and ethnicity were not associated with self-harm rates. CONCLUSION Proximity to the city centre was associated with lower rates of self-harm, but the usual operationalisations of urbanness, population density and greenspace, were not. Deprivation did not explain the spatial patterning, nor did ethnicity. While nationally self-harm rates are higher in urban and deprived areas, this cannot be extrapolated to mean that within cities the inner-city is the highest risk area nor that risk will be principally patterned according to deprivation.
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Affiliation(s)
- Catherine Polling
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ioannis Bakolis
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Stephani L. Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Cairns JM, Graham E, Bambra C. Area-level socioeconomic disadvantage and suicidal behaviour in Europe: A systematic review. Soc Sci Med 2017; 192:102-111. [DOI: 10.1016/j.socscimed.2017.09.034] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 06/21/2017] [Accepted: 09/20/2017] [Indexed: 11/16/2022]
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O'Farrell IB, Corcoran P, Perry IJ. The area level association between suicide, deprivation, social fragmentation and population density in the Republic of Ireland: a national study. Soc Psychiatry Psychiatr Epidemiol 2016; 51:839-47. [PMID: 27059662 DOI: 10.1007/s00127-016-1205-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 03/16/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE Numerous studies have examined the ecological relationship between suicide and area level determinants such as deprivation and social fragmentation. In Ireland, there is considerable geographic variation in the rates of suicide. However, there is a dearth of Irish studies investigating the geographic variability of suicide. METHODS The Irish Central Statistics Office (CSO) provided data relating to all deaths by suicide and deaths of undetermined intent that occurred from 2009 to 2011. Negative binomial regression was used to examine the relationship between area level suicide rates and measures of deprivation, social fragmentation and population density that were taken from the 2011 National Census. RESULTS Overall deprivation had the strongest independent effect on small-area rates of suicide, with the most deprived areas showing the greatest risk of suicide (risk ratio = 2.1; 95 % CI 1.70-2.52). Low population density (rurality) was associated with an increased risk suicide in males across both age groups and among females in the older 40-64-year age group. Conversely, a weak association between high population density (urbanicity) and increased suicide risk was found among females in the 15-39-year age group. Associations with social fragmentation only became apparent in the sub group analysis. Social fragmentation was associated with an elevated risk of suicide in the older 40-64 age group, with this effect being most pronounced among females. CONCLUSION The findings of this study demonstrate marked geographical inequalities in the distribution of suicide in Ireland and highlight the importance of targeting suicide prevention resources in the most deprived areas.
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Affiliation(s)
- I B O'Farrell
- Department of Epidemiology and Public Health, Western Gateway Building, University College Cork, Cork, Republic of Ireland.
| | - P Corcoran
- Department of Epidemiology and Public Health, Western Gateway Building, University College Cork, Cork, Republic of Ireland.,National Suicide Research Foundation, Western Gateway Building, University College Cork, Cork, Republic of Ireland.,Department of Obstetrics and Gynaecology, 5th Floor, Cork University Maternity Hospital, Wilton, Cork, Republic of Ireland
| | - I J Perry
- Department of Epidemiology and Public Health, Western Gateway Building, University College Cork, Cork, Republic of Ireland
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Olfson M, Wang S, Blanco C. National trends in hospital-treated self-harm events among middle-aged adults. Gen Hosp Psychiatry 2015; 37:613-9. [PMID: 26380873 DOI: 10.1016/j.genhosppsych.2015.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 08/19/2015] [Accepted: 08/20/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess national trends in hospital-treated self-harm events focusing on adults aged 45-64years. METHOD Healthcare Cost and Utilization Project data from 2001 (N=7,452,727) to 2011 (N=7,893,587) were used to assess national trends in hospital stays for suicide and self-inflicted injury among youth (0-24years), young adults (35-44years), middle-aged adults (45-64years) and older adults (≥65years). RESULTS Among middle-aged adults, hospital-treated self-harm events increased from 5.1 (2001) to 7.1 (2011) per 10,000 population (OR=1.4, 95% CI=1.2, 1.6). This increase was larger than corresponding changes among youth (5.2-4.9) (interaction P=.0003), young adults (10.0-10.6) (interaction P=.006) or older adults (2.2-2.4) (interaction P=.07). Among middle-aged adults, hospital-treated self-harm events per 100 hospital discharges significantly increased (OR=1.4, 95% CI=1.3, 1.6), but there was not a significant increase in self-harm discharges per 100 mental disorder discharges (OR=1.2, 95% CI=1.0, 1.4). CONCLUSIONS Between 2001 and 2011, there was a disproportionate national increase in hospital-treated self-harm events among middle-aged adults that mirrored national trends in suicide. Because the increase was largely accounted for by an overall increase in mental health hospitalizations of middle-aged adults, the rising rate of hospital-treated self-harm events may reflect broader population-based mental health challenges facing US middle-aged adults.
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Affiliation(s)
- Mark Olfson
- New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA
| | - Shuai Wang
- New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA
| | - Carlos Blanco
- New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA
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Ngamini Ngui A, Vasiliadis HM, Préville M. Individual and area-level factors correlated with death by suicide in older adults. Prev Med 2015; 75:44-8. [PMID: 25819059 DOI: 10.1016/j.ypmed.2015.03.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 01/05/2015] [Accepted: 03/18/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine the influence of individual and area-level characteristics associated with suicide in older adults. METHOD This study used two complementary data sources. The first used administrative data from the Quebec Coroner's office and included information on suicide deaths in older adults aged 65years and over who died by suicide between 2000 and 2005 (n=903 persons). The second data source, which was used to identify the control group, came from a longitudinal study on seniors' health that was conducted in Quebec between 2004 and 2005 (n=2493 persons). Logistic regression analyses were used to test for associations between suicide and individual and area-level level characteristics. RESULTS Suicide was associated with male gender, age, the presence of a physical and mental disorder and the use of health services. At the area-level level, suicide was associated with a higher population density, concentration of men, lower rates of education and higher rate of unemployment. Gender specific analyses also showed different patterns of associations on suicide risk. CONCLUSIONS Suicide in older adults is associated with area-level and individual characteristics. This suggests that policies targeting only one level of risk factors are less likely to significantly influence suicide among this population.
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Affiliation(s)
- André Ngamini Ngui
- Centre de réadaptation en dépendance de Montréal - Institut Universitaire, Canada; Hôpital Charles LeMoyne Research Centre, Longueuil, QC, Canada; Centre for Research and Intervention on Suicide and Euthanasia (CRISE), UQÀM, Montréal, QC, Canada.
| | - Helen-Maria Vasiliadis
- Hôpital Charles LeMoyne Research Centre, Longueuil, QC, Canada; Department of Community Health Sciences, Université de Sherbrooke, QC, Canada.
| | - Michel Préville
- Hôpital Charles LeMoyne Research Centre, Longueuil, QC, Canada; Department of Community Health Sciences, Université de Sherbrooke, QC, Canada.
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Abstract
Background: The Northern Ireland Registry of Deliberate Self-Harm was established as an outcome of the Northern Ireland Suicide Prevention Strategy and Action Plan - Protect Life, beginning in the Western Health and Social Care Trust area. Aims: The study aimed to establish the incidence of hospital-treated deliberate self-harm in the Western Area of Northern Ireland, and to explore the profile of such presentations. Method: Deliberate self-harm presentations made to the three hospital emergency departments operating in the area during the period 2007-2012 were recorded. Results: There were 8,175 deliberate self-harm presentations by 4,733 individuals. Respectively, the total, male, and female age-standardized incidence rate was 342, 320, and 366 per 100,000 population. City council residents had a far higher self-harm rate. The peak rate for women was among 15-19-year-olds (837 per 100,000) and for men was among 20-24-year-olds (809 per 100,000). Risk of repetition was higher in 35-44-year-old patients if self-cutting was involved, but was most strongly associated with the number of previous self-harm presentations. Conclusion: The incidence of hospital-treated self-harm in Northern Ireland is far higher than in the Republic of Ireland and more comparable to that in England.
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O'Farrell IB, Corcoran P, Perry IJ. Characteristics of small areas with high rates of hospital-treated self-harm: deprived, fragmented and urban or just close to hospital? A national registry study. J Epidemiol Community Health 2014; 69:162-7. [DOI: 10.1136/jech-2014-204587] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kinyanda E, Weiss HA, Mungherera M, Onyango-Mangen P, Ngabirano E, Kajungu R, Kagugube J, Muhwezi W, Muron J, Patel V. Prevalence and risk factors of attempted suicide in adult war-affected population of eastern Uganda. CRISIS 2014; 34:314-23. [PMID: 23608229 DOI: 10.1027/0227-5910/a000196] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is conflicting evidence on the relationship between war trauma and suicidal behavior. Some studies point to an increased risk of suicidal behavior while others do not, with a paucity of such data from sub-Saharan Africa. AIMS To investigate the prevalence and risk factors of attempted suicide in war-affected Eastern Uganda. METHOD A cross-sectional survey was carried out in two districts of Eastern Uganda where 1,560 respondents (15 years and older) were interviewed. Multivariable logistic regression was used to assess risk factors of attempted suicide in this population. RESULTS Lifetime attempted suicide was 9.2% (n = 142; 95% CI, 7.8%-10.8%), and 12-month attempted suicide was 2.6% (n = 41; 95% CI, 1.9-3.5%). Lifetime attempted suicide was significantly higher among females 101 (11.1%) than among males 43 (6.5%; OR = 1.80, 95% CI 1.21-2.65). Factors independently associated with lifetime rate of attempted suicide among females were subcounty, being a victim of intimate partner violence, having reproductive health complaints, and having major depressive disorder. Among males these were belonging to a war-vulnerable group, having a surgical complaint, and having a major depressive disorder. CONCLUSIONS In both sexes, the lifetime rate of attempted suicide was not independently directly related to experiences of war trauma. It was, however, indirectly related to war trauma through its association with psychological, somatic, and psychosocial sequelae of war.
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Affiliation(s)
- Eugene Kinyanda
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda/Senior EDCTP Fellowship, Cape Town, South Africa.
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Omer S, Kirkbride JB, Pringle DG, Russell V, O'Callaghan E, Waddington JL. Neighbourhood-level socio-environmental factors and incidence of first episode psychosis by place at onset in rural Ireland: the Cavan-Monaghan First Episode Psychosis Study [CAMFEPS]. Schizophr Res 2014; 152:152-7. [PMID: 24342585 PMCID: PMC3906531 DOI: 10.1016/j.schres.2013.11.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 10/31/2013] [Accepted: 11/12/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Little is known about associations between the social environment and risk for psychosis within rural settings. This study sought to investigate whether such associations exist within a rural context using a prospective dataset of unusual epidemiological completeness. METHOD Using the Cavan-Monaghan First Episode Psychosis Study database of people aged 16 years and older, both ecological analyses and multilevel modelling were applied to investigate associations between incidence of psychosis by place at onset and socio-environmental risk factors of material deprivation, social fragmentation and urban-rural classification across electoral divisions. RESULTS The primary finding was an association between more deprived social contexts and higher rates of psychotic disorder, after adjustment for age and sex [all psychoses: incidence rate ratio (IRR)=1.12, 95% CI (1.03-1.23)]. CONCLUSIONS These findings support an association between adverse socio-environmental factors and increase in risk for psychosis by place at onset within a predominantly rural environment. This study suggests that social environmental characteristics may have an impact on risk across the urban-rural gradient.
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Affiliation(s)
- Sami Omer
- Department of Psychiatry, College of Medicine, University of Dammam, Saudi Arabia; Cavan-Monaghan Mental Health Service, Cavan Hospital, Cavan, Ireland; Molecular & Cellular Therapeutics and 3U Partnership, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | | | - Dennis G. Pringle
- Department of Geography and 3U Partnership, National University of Ireland Maynooth, Maynooth, Ireland
| | - Vincent Russell
- Cavan–Monaghan Mental Health Service, Cavan Hospital, Cavan, Ireland,Department of Psychiatry and 3U Partnership, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | | | - John L. Waddington
- Cavan–Monaghan Mental Health Service, Cavan Hospital, Cavan, Ireland,Molecular & Cellular Therapeutics and 3U Partnership, Royal College of Surgeons in Ireland, Dublin, Ireland
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Fadum EA, Stanley B, Rossow I, Mork E, Törmoen AJ, Mehlum L. Use of health services following self-harm in urban versus suburban and rural areas: a national cross-sectional study. BMJ Open 2013; 3:e002570. [PMID: 23892421 PMCID: PMC3731709 DOI: 10.1136/bmjopen-2013-002570] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 05/20/2013] [Accepted: 06/21/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES This study examines whether there is a difference between urban versus suburban and rural adolescents in their use of health services following two types of self-harm distinguished as self-harm with or without suicide intent. SETTING A nationwide cross-sectional school survey of 11 406 Norwegian adolescents aged 13-19 years in 73 Norwegian junior and senior high schools. PARTICIPANTS Adolescents who reported self-harm and provided valid responses to a follow-up question about having received subsequent help or treatment (n=959) were included in the study. Adolescents were divided into urban versus suburban and rural depending on: (1) the location of municipalities where they attended school and (2) the place of residence. Associations between urban versus suburban and rural areas and the use of health services following self-harm were assessed in those who self-harmed with and without suicide intent. PRIMARY OUTCOME MEASURE Use of health services following self-harm. RESULTS 1 in 4 adolescents reported using health services following self-harm. Adolescents reporting self-harm with suicide intent were more likely to use health services than those who self-harmed without suicide intent. Following self-harm without suicide intent, adolescents in urban areas were four times more likely to use health services than adolescents in suburban and rural areas. There was no statistically significant area difference in the use of health services following self-harm with suicide intent. CONCLUSIONS This study found a geographical variation in the use of health services following self-harm without suicide intent, but not following self-harm with suicide intent. Differences in perception of self-harm and help-seeking behaviour between areas and different accessibility to services are suggested as possible explanations. There is a need to better understand how the interplay between individual characteristics and accessibility to services influences adolescents' use of health services following self-harm. We suggest that multilevel models are a valuable approach to achieve this goal.
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Affiliation(s)
- Elin Anita Fadum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Barbara Stanley
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Ingeborg Rossow
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Norwegian Institute for Alcohol and Drug Research, Oslo, Norway
| | - Erlend Mork
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anita J Törmoen
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Assessing the impact of socioeconomic variables on small area variations in suicide outcomes in England. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 10:158-77. [PMID: 23271304 PMCID: PMC3564135 DOI: 10.3390/ijerph10010158] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 12/14/2012] [Accepted: 12/20/2012] [Indexed: 11/25/2022]
Abstract
Ecological studies of suicide and self-harm have established the importance of area variables (e.g., deprivation, social fragmentation) in explaining variations in suicide risk. However, there are likely to be unobserved influences on risk, typically spatially clustered, which can be modeled as random effects. Regression impacts may be biased if no account is taken of spatially structured influences on risk. Furthermore a default assumption of linear effects of area variables may also misstate or understate their impact. This paper considers variations in suicide outcomes for small areas across England, and investigates the impact on them of area socio-economic variables, while also investigating potential nonlinearity in their impact and allowing for spatially clustered unobserved factors. The outcomes are self-harm hospitalisations and suicide mortality over 6,781 Middle Level Super Output Areas.
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Jimenez-Trevino L, Saiz PA, Corcoran P, Garcia-Portilla MP, Buron P, Garrido M, Diaz-Mesa E, Al-Halabi S, Bobes J. The Incidence of Hospital-Treated Attempted Suicide in Oviedo, Spain. CRISIS 2012; 33:46-53. [DOI: 10.1027/0227-5910/a000094] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: The incidence of hospital-treated attempted suicide has not been well established in Spain. Aims: To determine the incidence of suicide attempters presenting to a hospital in Oviedo, Spain, to describe the nature of the suicidal behavior, and to identify sociodemographic subgroups of the population with high rates. Methods: All admitted to the Hospital Universitario Central de Asturias, Oviedo, during the period 1 May 2008 to 30 April 2009 were examined and those meeting the internationally-recognized case definition were identified. Results: A total of 308 suicide attempt presentations (39% male, 61% female) were made by 279 individuals. Almost 90% of the suicide attempts involved a drug overdose. The age-adjusted total, male, and female attempted suicide rates were 83, 66, and 99 per 100,000, respectively. The highest rate was among 35–44-year-olds for men and women (141.1 and 191.8 per 100,000, respectively). Incidence rates varied widely by sociodemographic characteristics with especially high rates among separated/divorced men (2.4%) and women (1.1%). Conclusions: The reported incidence of hospital-treated attempted suicide is below average in the European context but higher than that reported by previous Spanish studies. Persons separated or divorced constitute a high-risk group.
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Affiliation(s)
| | - Pilar A. Saiz
- Department of Psychiatry, University of Oviedo, CIBERSAM, Oviedo, Spain
| | - Paul Corcoran
- Department of Psychiatry, University of Oviedo, CIBERSAM, Oviedo, Spain
| | | | - Patricia Buron
- Department of Psychiatry, University of Oviedo, CIBERSAM, Oviedo, Spain
| | - Marlen Garrido
- Department of Psychiatry, University of Oviedo, CIBERSAM, Oviedo, Spain
| | - Eva Diaz-Mesa
- Department of Psychiatry, University of Oviedo, CIBERSAM, Oviedo, Spain
| | - Susana Al-Halabi
- Department of Psychiatry, University of Oviedo, CIBERSAM, Oviedo, Spain
| | - Julio Bobes
- Department of Psychiatry, University of Oviedo, CIBERSAM, Oviedo, Spain
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Kinyanda E, Kizza R, Levin J, Ndyanabangi S, Abbo C. Adolescent suicidality as seen in rural northeastern Uganda: prevalence and risk factors. CRISIS 2011; 32:43-51. [PMID: 21371970 DOI: 10.1027/0227-5910/a000059] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Suicidal behavior in adolescence is a public health concern and has serious consequences for adolescents and their families. There is, however, a paucity of data on this subject from sub-Saharan Africa, hence the need for this study. AIMS A cross-sectional multistage survey to investigate adolescent suicidality among other things was undertaken in rural northeastern Uganda. METHODS A structured protocol administered by trained psychiatric nurses collected information on sociodemographics, mental disorders (DSM-IV criteria), and psychological and psychosocial risk factors for children aged 3-19 years (N = 1492). For the purposes of this paper, an analysis of a subsample of adolescents (aged 10-19 years; n = 897) was undertaken. RESULTS Lifetime suicidality in this study was 6.1% (95% CI, 4.6%-7.9%). CONCLUSIONS Factors significantly associated with suicidality included mental disorder, the ecological factor district of residence, factors suggestive of low socioeconomic status, and disadvantaged childhood experiences.
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Deliberate self-harm in rural and urban regions: A comparative study of prevalence and patient characteristics. Soc Sci Med 2011; 73:274-81. [DOI: 10.1016/j.socscimed.2011.05.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Revised: 04/19/2011] [Accepted: 05/09/2011] [Indexed: 11/18/2022]
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Congdon P. Spatial path models with multiple indicators and multiple causes: Mental health in US counties. Spat Spatiotemporal Epidemiol 2011; 2:103-16. [DOI: 10.1016/j.sste.2011.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 03/30/2011] [Accepted: 03/31/2011] [Indexed: 11/26/2022]
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When does neighbourhood matter? Multilevel relationships between neighbourhood social fragmentation and mental health. Soc Sci Med 2011; 72:1993-2002. [DOI: 10.1016/j.socscimed.2011.04.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 02/05/2011] [Accepted: 04/16/2011] [Indexed: 11/17/2022]
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Kaboré H, Levallois P, Michel P, Payment P, Déry P, Gingras S. Association between potential zoonotic enteric infections in children and environmental risk factors in Quebec, 1999-2006. Zoonoses Public Health 2011; 57:e195-205. [PMID: 20529210 DOI: 10.1111/j.1863-2378.2010.01328.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study was designed to evaluate the association of potential zoonotic gastroenteritis in children, and specifically giardiasis, salmonellosis and campylobacteriosis, with environmental risk factors in rural areas of Quebec. Notified cases of gastroenteritis in children of 0-4 years of age reported in the period of 1999 through 2006 from municipalities in southern Quebec with <100,000 inhabitants were investigated. Negative binomial regression models accounting for overdispersion and adjusted for clustering were used to estimate relative risks (RR) associated with livestock densities and drinking water quality. Analyses revealed that, during this period, 2500 cases of gastroenteritis were reported in children of 0-4 years, including 819 cases of giardiasis, 690 of salmonellosis and 852 of campylobacteriosis. The incidence rate associated with all potential zoonotic agents reported was 163 cases/100,000 children-years and this was statistically associated with cattle density: RR Quartile 4/Quartile 1 (Q4/Q1) = 1.92, 95% CI = 1.43-2.58. When estimated specifically for each pathogen, incidence rates of giardiasis (RR Q4/Q1 = 1.79, 95% CI = 1.11-2.87), salmonellosis (RR Q4/Q1 = 1.64, 95% CI = 1.15-2.33) and campylobacteriosis (RR Q4/Q1 = 2.43, 95% CI = 1.60-3.68) were also associated with cattle density, with a monotonic increase of RR with increasing animal density. Giardiasis incidence was also positively associated with a poor drinking water quality, although no statistically significant association was found. Our results suggest that, in rural Quebec, bacterial and parasitic enteric infections in young children may be zoonoses related to environmental risk factors and especially cattle production.
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Affiliation(s)
- H Kaboré
- Institut National de Santé Publique du Québec, Québec, QC, Canada
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Congdon P. The spatial pattern of suicide in the US in relation to deprivation, fragmentation and rurality. URBAN STUDIES (EDINBURGH, SCOTLAND) 2011; 48:2101-2122. [PMID: 22069804 DOI: 10.1177/0042098010380961] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Analysis of geographical patterns of suicide and psychiatric morbidity has demonstrated the impact of latent ecological variables (such as deprivation, rurality). Such latent variables may be derived by conventional multivariate techniques from sets of observed indices (for example, by principal components), by composite variable methods or by methods which explicitly consider the spatial framework of areas and, in particular, the spatial clustering of latent risks and outcomes. This article considers a latent random variable approach to explaining geographical contrasts in suicide in the US; and it develops a spatial structural equation model incorporating deprivation, social fragmentation and rurality. The approach allows for such latent spatial constructs to be correlated both within and between areas. Potential effects of area ethnic mix are also included. The model is applied to male and female suicide deaths over 2002–06 in 3142 US counties.
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Abstract
BACKGROUND Hospital-treated deliberate self harm and suicide among older adults have rarely been examined at a national level. METHODS The Irish Central Statistics Office provided suicide and undetermined death data for 1980-2006. The National Registry of Deliberate Self Harm collected data relating to deliberate self harm presentations made in 2006-2008 to all 40 Irish hospital emergency departments. RESULTS Rates of female suicide among older adults (over 55 years) were relatively stable in Ireland during 1980-2006 whereas male rates increased in the 1980s and decreased in more recent decades. Respectively, the annual male and female suicide and undetermined death rate was 22.1 and 7.6 per 100,000 in 1997-2006. Male and female deliberate self harm was 3.0 and 11.0 times higher at 67.4 and 83.4 per 100,000, respectively. Deliberate self harm and suicide decreased in incidence with increasing age. Deliberate self harm generally involved drug overdose (male: 72%; female 85%) or self-cutting (male: 15%; female 9%). The most common methods of suicide were hanging (41%) and drowning (29%) for men and drowning (39%) and drug overdose (24%) for women. City and urban district populations had the highest rates of hospital-treated self harm. The highest suicide rates were in urban districts. CONCLUSIONS Older Irish adults have high rates of hospital-treated deliberate self harm but below average rates of suicide. Drowning was relatively common as a method of suicide. Restricting availability of specific medications may reduce both forms of suicidal behavior.
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Burrows S, Laflamme L. Socioeconomic disparities and attempted suicide: state of knowledge and implications for research and prevention. Int J Inj Contr Saf Promot 2010; 17:23-40. [DOI: 10.1080/17457300903309231] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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