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Hu FH, Zhao DY, Fu XL, Zhang WQ, Tang W, Hu SQ, Shen WQ, Chen HL. Effects of social support on suicide-related behaviors in patients with severe mental illness: A systematic review and meta-analysis. J Affect Disord 2023; 328:324-333. [PMID: 36813042 DOI: 10.1016/j.jad.2023.02.070] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE Patients with severe mental illness have a high risk of suicide and frequently living eliminated from mainstream society, but the effects of social support on suicide-related behaviors among this crowd is inconclusive. The present study aimed to explore such effects among patients with severe mental illness. METHODS We implemented a meta-analysis and a qualitative analysis of relevant studies published before February 6, 2023. Correlation coefficients (r) and 95 % CI were selected as the effect size index in meta-analysis. Studies that did not report correlation coefficients were employed for qualitative analysis. RESULTS Out of 4241 identified studies, 16 were identified in this review (6 for meta-analysis, 10 for qualitative analysis). The meta-analysis presented that the pooled correlation coefficients (r) were - 0.163 (95%CI = -0.243, -0.080, P < 0.001), suggesting a negative correlation between social support and suicidal ideation. The subgroup analysis showed that this effect works in all bipolar disorder, major depression, and schizophrenia. Concerning qualitative analysis, social support presented positive effects on reducing suicidal ideation, suicide attempts, and suicide death. The effects were consistently reported in female patients. However, there existed some unaffected results in males. LIMITATIONS The included studies were from middle- and high-income countries and used inconsistent measurement tools, our results may have some bias. CONCLUSIONS The effects of social support in reducing suicide-related behaviors were positive, but it showed better effects in both female patients and adults. Males and adolescents deserve more attention. Future research needs to pay more attention to the implementation methods and effects of personalized social support.
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Affiliation(s)
- Fei-Hong Hu
- School of Medicine, Nantong University, Nantong, Jiangsu, PR China
| | - Dan-Yan Zhao
- School of Medicine, Nantong University, Nantong, Jiangsu, PR China
| | - Xue-Lei Fu
- School of Medicine, Nantong University, Nantong, Jiangsu, PR China
| | - Wan-Qing Zhang
- School of Medicine, Nantong University, Nantong, Jiangsu, PR China
| | - Wen Tang
- School of Medicine, Nantong University, Nantong, Jiangsu, PR China
| | - Shi-Qi Hu
- School of Medicine, Nantong University, Nantong, Jiangsu, PR China
| | - Wang-Qin Shen
- School of Medicine, Nantong University, Nantong, Jiangsu, PR China
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, Jiangsu, PR China.
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Grassi L, Folesani F, Marella M, Tiberto E, Riba MB, Bortolotti L, Toffanin T, Palagini L, Belvederi Murri M, Biancosino B, Ferrara M, Caruso R. Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders. Curr Psychiatry Rep 2022; 24:325-335. [PMID: 35678920 PMCID: PMC9203391 DOI: 10.1007/s11920-022-01339-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Over the last 30 years, medical assistance in dying (MAiD) including euthanasia (EU) and physician-assisted death (or suicide, PAS) has become the center of a large debate, particularly when these practices have involved people with psychiatric illness, including resistant depression, schizophrenia, personality, or other severe psychiatric disorders. We performed a review utilizing several databases, and by including the most relevant studies in full journal articles investigating the problem of MAiD in patients with psychiatric disorders but not in physical terminal conditions (non-terminal, MAiD-NT). RECENT FINDINGS Literature has shown that a small percentage of people with psychiatric disorders died by MAiD-NT in comparison with patients with somatic diseases in terminal clinical conditions (e.g., cancer, AIDS). However, the problem in the field is complex and not solved yet as confirmed by the fact that only a few countries (e.g., the Netherlands, Belgium, Luxemburg) have legalized MAiD-NT for patients with psychiatric disorders, while most have maintained the practices accessible only to people with somatic disease in a terminal phase. Also, how to make objective the criterion of irremediability of a mental disorder; how to balance suicide prevention with assisted suicide; how to avoid the risk of progressively including in requests for MAiD-NT vulnerable segments of the population, such as minors, elderly, or people with dementia, in a productive-oriented society, are some of the critical points to be discussed. The application of MAiD-NT in people with psychiatric disorders should be further explored to prevent end-of-life rights from contradicting the principles of recovery-oriented care.
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Affiliation(s)
- Luigi Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121, Ferrara, Italy
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Pathological Addiction, S. Anna University Hospital and Local Health Trust, Ferrara, Italy
| | - Federica Folesani
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121, Ferrara, Italy.
| | - Marco Marella
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121, Ferrara, Italy
| | - Elisa Tiberto
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121, Ferrara, Italy
| | - Michelle B Riba
- Department of Psychiatry, University of Michigan, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Lisa Bortolotti
- Department of Philosophy in the School of Philosophy, Theology, and Religion and Institute for Mental Health in the School of Psychology, University of Birmingham, Birmingham, UK
| | - Tommaso Toffanin
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121, Ferrara, Italy
| | - Laura Palagini
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121, Ferrara, Italy
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Pathological Addiction, S. Anna University Hospital and Local Health Trust, Ferrara, Italy
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121, Ferrara, Italy
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Pathological Addiction, S. Anna University Hospital and Local Health Trust, Ferrara, Italy
| | - Bruno Biancosino
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Pathological Addiction, S. Anna University Hospital and Local Health Trust, Ferrara, Italy
| | - Maria Ferrara
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121, Ferrara, Italy
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Pathological Addiction, S. Anna University Hospital and Local Health Trust, Ferrara, Italy
| | - Rosangela Caruso
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121, Ferrara, Italy
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Pathological Addiction, S. Anna University Hospital and Local Health Trust, Ferrara, Italy
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