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Wang J, Kharrat FGZ, Gariépy G, Gagné C, Pelletier JF, Massamba VK, Lévesque P, Mohammed M, Lesage A. Predicting the Population Risk of Suicide Using Routinely Collected Health Administrative Data in Quebec, Canada: Model-Based Synthetic Estimation Study. JMIR Public Health Surveill 2024; 10:e52773. [PMID: 38941610 DOI: 10.2196/52773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/24/2024] [Accepted: 05/07/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Suicide is a significant public health issue. Many risk prediction tools have been developed to estimate an individual's risk of suicide. Risk prediction models can go beyond individual risk assessment; one important application of risk prediction models is population health planning. Suicide is a result of the interaction among the risk and protective factors at the individual, health care system, and community levels. Thus, policy and decision makers can play an important role in suicide prevention. However, few prediction models for the population risk of suicide have been developed. OBJECTIVE This study aims to develop and validate prediction models for the population risk of suicide using health administrative data, considering individual-, health system-, and community-level predictors. METHODS We used a case-control study design to develop sex-specific risk prediction models for suicide, using the health administrative data in Quebec, Canada. The training data included all suicide cases (n=8899) that occurred from January 1, 2002, to December 31, 2010. The control group was a 1% random sample of living individuals in each year between January 1, 2002, and December 31, 2010 (n=645,590). Logistic regression was used to develop the prediction models based on individual-, health care system-, and community-level predictors. The developed model was converted into synthetic estimation models, which concerted the individual-level predictors into community-level predictors. The synthetic estimation models were directly applied to the validation data from January 1, 2011, to December 31, 2019. We assessed the performance of the synthetic estimation models with four indicators: the agreement between predicted and observed proportions of suicide, mean average error, root mean square error, and the proportion of correctly identified high-risk regions. RESULTS The sex-specific models based on individual data had good discrimination (male model: C=0.79; female model: C=0.85) and calibration (Brier score for male model 0.01; Brier score for female model 0.005). With the regression-based synthetic models applied in the validation data, the absolute differences between the synthetic risk estimates and observed suicide risk ranged from 0% to 0.001%. The root mean square errors were under 0.2. The synthetic estimation model for males correctly predicted 4 of 5 high-risk regions in 8 years, and the model for females correctly predicted 4 of 5 high-risk regions in 5 years. CONCLUSIONS Using linked health administrative databases, this study demonstrated the feasibility and the validity of developing prediction models for the population risk of suicide, incorporating individual-, health system-, and community-level variables. Synthetic estimation models built on routinely collected health administrative data can accurately predict the population risk of suicide. This effort can be enhanced by timely access to other critical information at the population level.
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Affiliation(s)
- JianLi Wang
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | | | - Geneviève Gariépy
- Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Christian Gagné
- Institut intelligence et données, Université Laval, Quebec City, QC, Canada
| | | | | | - Pascale Lévesque
- Institut national de santé publique du Québec, Quebec City, QC, Canada
| | - Mada Mohammed
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Alain Lesage
- Department of Psychiatry, University of Montreal, Montreal, QC, Canada
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Gholi Zadeh Kharrat F, Gagne C, Lesage A, Gariépy G, Pelletier JF, Brousseau-Paradis C, Rochette L, Pelletier E, Lévesque P, Mohammed M, Wang J. Explainable artificial intelligence models for predicting risk of suicide using health administrative data in Quebec. PLoS One 2024; 19:e0301117. [PMID: 38568987 PMCID: PMC10990247 DOI: 10.1371/journal.pone.0301117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/11/2024] [Indexed: 04/05/2024] Open
Abstract
Suicide is a complex, multidimensional event, and a significant challenge for prevention globally. Artificial intelligence (AI) and machine learning (ML) have emerged to harness large-scale datasets to enhance risk detection. In order to trust and act upon the predictions made with ML, more intuitive user interfaces must be validated. Thus, Interpretable AI is one of the crucial directions which could allow policy and decision makers to make reasonable and data-driven decisions that can ultimately lead to better mental health services planning and suicide prevention. This research aimed to develop sex-specific ML models for predicting the population risk of suicide and to interpret the models. Data were from the Quebec Integrated Chronic Disease Surveillance System (QICDSS), covering up to 98% of the population in the province of Quebec and containing data for over 20,000 suicides between 2002 and 2019. We employed a case-control study design. Individuals were considered cases if they were aged 15+ and had died from suicide between January 1st, 2002, and December 31st, 2019 (n = 18339). Controls were a random sample of 1% of the Quebec population aged 15+ of each year, who were alive on December 31st of each year, from 2002 to 2019 (n = 1,307,370). We included 103 features, including individual, programmatic, systemic, and community factors, measured up to five years prior to the suicide events. We trained and then validated the sex-specific predictive risk model using supervised ML algorithms, including Logistic Regression (LR), Random Forest (RF), Extreme Gradient Boosting (XGBoost) and Multilayer perceptron (MLP). We computed operating characteristics, including sensitivity, specificity, and Positive Predictive Value (PPV). We then generated receiver operating characteristic (ROC) curves to predict suicides and calibration measures. For interpretability, Shapley Additive Explanations (SHAP) was used with the global explanation to determine how much the input features contribute to the models' output and the largest absolute coefficients. The best sensitivity was 0.38 with logistic regression for males and 0.47 with MLP for females; the XGBoost Classifier with 0.25 for males and 0.19 for females had the best precision (PPV). This study demonstrated the useful potential of explainable AI models as tools for decision-making and population-level suicide prevention actions. The ML models included individual, programmatic, systemic, and community levels variables available routinely to decision makers and planners in a public managed care system. Caution shall be exercised in the interpretation of variables associated in a predictive model since they are not causal, and other designs are required to establish the value of individual treatments. The next steps are to produce an intuitive user interface for decision makers, planners and other stakeholders like clinicians or representatives of families and people with live experience of suicidal behaviors or death by suicide. For example, how variations in the quality of local area primary care programs for depression or substance use disorders or increased in regional mental health and addiction budgets would lower suicide rates.
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Affiliation(s)
- Fatemeh Gholi Zadeh Kharrat
- Institut Intelligence et Données (IID), Université Laval, Québec, Québec, Canada
- Institut National de Santé Publique du Québec (INSPQ), Québec, Québec, Canada
| | - Christian Gagne
- Institut Intelligence et Données (IID), Université Laval, Québec, Québec, Canada
| | - Alain Lesage
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Québec, Canada
| | - Geneviève Gariépy
- Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Canada
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada
- Montreal Mental Health University Institute Research Center, Montreal, Canada
| | - Jean-François Pelletier
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Québec, Canada
| | - Camille Brousseau-Paradis
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Québec, Canada
| | - Louis Rochette
- Institut National de Santé Publique du Québec (INSPQ), Québec, Québec, Canada
| | - Eric Pelletier
- Institut National de Santé Publique du Québec (INSPQ), Québec, Québec, Canada
| | - Pascale Lévesque
- Institut National de Santé Publique du Québec (INSPQ), Québec, Québec, Canada
| | - Mada Mohammed
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - JianLi Wang
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada
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[What is the contribution of smoking to the increased risk of suicide in young smokers? A systematic review]. L'ENCEPHALE 2023; 49:72-86. [PMID: 36253173 DOI: 10.1016/j.encep.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The correlation between smoking and suicide is well documented in the general population: there is an increased risk of suicide among tobacco smokers. However, the association between smoking and suicidal behaviors (ideations, plans, attempts) in youth is poorly elucidated. This is a systematic review of the literature examined data on the relationship between active and passive smoking and suicidal ideation (SI), suicide planning (SP), and suicide attempts (SA) among youth in the general population. METHOD Medline searches were performed for the period 1980-2020. Cross-sectional, case-control, prospective population-based studies of young people (age less than 18 years) were included in this review; studies of specific populations (patients with an identified pathology of any kind) were excluded. RESULTS This review included 43 studies: 23 studies on the association between active smoking and SI, SI and/or PS, TS; three studies on the association between passive smoking and suicidal behavior, three studies on the association between smoking and suicidal behavior in young people in psychiatric hospital settings, and five studies comparing the suicidal behavior of girls and boys. Analysis of the data collected lead to the conclusion that active or passive smoking is associated with suicidal behavior in young people. Smoking appears to contribute to psychopathological disorders, including depression, the use of other psychoactive substances, or psychosocial suffering which are often associated with an increased risk of suicide in young people. The correlations between smoking and the presence of mental disorders have been highlighted; tobacco use may contribute to the development of depression, anxiety and stress. Further studies are needed to verify the existence of a causal link between smoking and suicide. CONCLUSION Smoking is associated with the risk of suicidal behavior in young people; it should be included among the criteria for assessing suicidal risk in youth. Smoking cessation, which improves psychological well-being, should be further integrated into the prevention of suicidal behavior.
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Lesage A, Fortin G, Ligier F, Van Haaster I, Doyon C, Brouillard C, Daneau D, Rassy J. Implementing a Suicide Audit in Montreal: Taking Suicide Review Further to Make Concrete Recommendations for Suicide Prevention. Arch Suicide Res 2023; 27:29-42. [PMID: 34470592 DOI: 10.1080/13811118.2021.1965058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE A suicide audit was pilot implemented in order to generate recommendations on how to improve suicide prevention. METHODS Thirty-nine consecutive suicides that occurred in Montreal, Canada from January to October 2016 were audited. A retrospective analysis of their life trajectory and service utilization was conducted using the psychological autopsy method, which included interviewing suicide-bereaved survivors and examining health and social services records and the coroner's investigation file. A psychosocial and service utilization profile was drawn for each decedent. A multidisciplinary panel reviewed each case summary to identify gaps in terms of individual intervention, provincial public health and social services, and regional programs. RESULTS Five main suicide prevention recommendations were made to prevent similar suicides: (1) deploy mobile crisis intervention teams (short-term, high-intensity, home-based treatment) in hospital emergency departments; (2) train primary and specialized mental health care professionals to screen for and manage substance use disorders; and (3) implement public awareness campaigns to encourage help seeking for depression and substance use disorders; (4) access for all, regardless of age, to an effective psychosis treatment program; and (5) provide universal access to a general practitioner, especially for men. CONCLUSIONS The suicide audit procedure was implemented effectively and targeted recommendations were generated to prevent similar suicides. However, resistance from medical and hospital quality boards arose during the process, though these could be allayed if regional and provincial authorities actively endorsed the multidisciplinary and multi stakeholders suicide audit process. HighlightsA bottom-up approach to generate recommendations for suicide prevention.Implementation was challenging with resistance to our interdisciplinary approach.The audit needs the support of the regional health department to lift barriers.
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Rassy J, Lesage A, Labelle R, Saadi F, Goulet MH, Genest C, Maltais N, Larue C. Assessment and care of individuals at risk of suicide in Emergency Department: The SecUrgence protocol. Int Emerg Nurs 2022; 64:101199. [PMID: 36027701 DOI: 10.1016/j.ienj.2022.101199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 06/23/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022]
Abstract
Almost half (48,5%) of all individuals who die by suicide visited the Emergency Department (ED) in the year preceding their death by suicide and for almost a third (29,5%) of these individuals, the ED visit occurred within the month preceding their death by suicide. The ED is a key location for suicide prevention. The aim of this study was to develop and reach a consensus on the SecUrgence Protocol, a clinical protocol that intends to assess and provide care for individuals at risk of suicide that present themselves to the ED. This project was conducted in 3 stages: 1) Review of the literature, 2) Development of the list of the protocol statements by a first panel of experts, and 3) Validation, using the Delphi consensus method, on the final statements to include in the SecUrgence Protocol by a second panel of experts. Two rounds of the Delphi questionnaire were conducted until a final consensus of over 75% was reached. The SecUrgence Protocol is a first scientific step towards improving suicide prevention in the ED in Quebec as it was validated by a rigorous research process that included a consensus by all key stakeholders.
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Affiliation(s)
- Jessica Rassy
- Research Centre, Institut universitaire en santé mentale de Montréal, QC, Canada; School of Nursing, University of Sherbrooke, QC, Canada; Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, QC, Canada; Quebec Network on Nursing Intervention Research, QC, Canada; Quebec Network on Suicide, Mood Disorders and Associated Disorders, QC, Canada; Charles-Le Moyne Research Centre, QC, Canada.
| | - Alain Lesage
- Research Centre, Institut universitaire en santé mentale de Montréal, QC, Canada; Department of Psychiatry, University of Montreal, QC, Canada; Quebec Network on Suicide, Mood Disorders and Associated Disorders, QC, Canada
| | - Réal Labelle
- Research Centre, Institut universitaire en santé mentale de Montréal, QC, Canada; Department of Psychiatry, University of Montreal, QC, Canada; Department of Psychology, Université du Québec à Montréal, QC, Canada; Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, QC, Canada
| | - Farida Saadi
- Faculty of Nursing, University of Montreal, QC, Canada; CEMTL Maisonneuve Rosemont Hospital, CIUSSS de l'Est-de-l'île-de-Montréal, QC, Canada
| | - Marie-Hélène Goulet
- Research Centre, Institut universitaire en santé mentale de Montréal, QC, Canada; Faculty of Nursing, University of Montreal, QC, Canada
| | - Christine Genest
- Research Centre, Institut universitaire en santé mentale de Montréal, QC, Canada; Faculty of Nursing, University of Montreal, QC, Canada; Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, QC, Canada; Quebec Network on Nursing Intervention Research, QC, Canada
| | - Nathalie Maltais
- Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, QC, Canada; Department of Health Sciences, Université du Québec à Rimouski, QC, Canada
| | - Caroline Larue
- Research Centre, Institut universitaire en santé mentale de Montréal, QC, Canada; Faculty of Nursing, University of Montreal, QC, Canada; Quebec Network on Nursing Intervention Research, QC, Canada
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Searby A, Burr D, James R, Maude P. Service integration: The perspective of Australian alcohol and other drug (AOD) nurses. Int J Ment Health Nurs 2022; 31:908-919. [PMID: 35338569 PMCID: PMC9314025 DOI: 10.1111/inm.12998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 11/29/2022]
Abstract
The recently released Victorian Mental Health Royal Commission report has recommended a shift to integrated treatment, defined as treatment for alcohol and substance use disorders and mental ill health occurring in parallel, rather than distinct systems catering to each need. However, little work has sought to determine the perceptions of nurses working in alcohol and other drug (AOD) treatment towards integrating with mental health services. In this study, we explore the perspectives of specialist AOD nurses towards the integration of mental health and AOD treatment services. Secondary analysis of semi-structured interviews with Australian specialist AOD nurses (n = 46) conducted as part of a wider workforce study in 2019. Data were analysed using thematic analysis and reported using the COREQ guidelines. Of the interviews analysed, six were AOD nurses working in an Australian state that had recently undergone service integration; however, many participants expressed perceptions of service integration. Two key themes are reported in this paper: (i) perceptions of service integration, where AOD nurses participating in our study were concerned that integration would result in the model of care they worked under being replaced by a mental health-based model that was felt to be highly risk averse, and (ii) experiences of service integration. Concerns about the focus of care as well as the complexity of care differing between the two services demonstrated a contrast in both philosophical approaches to work with consumers and legislative difference in voluntary versus compulsory care provision.
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Affiliation(s)
- Adam Searby
- Institute for Health Transformation, School of Nursing & Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Dianna Burr
- Institute for Health Transformation, School of Nursing & Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Russell James
- School of Nursing, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Phil Maude
- La Trobe Rural Health School, Violet Vines Marshman Centre for Rural Health Research, Latrobe University, Melbourne, Victoria, Australia
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Rassy J, Daneau D, Larue C, Rahme E, Low N, Lamarre S, Turecki G, Bonin JP, Racine H, Morin S, Dasgupta K, Renaud J, Lesage A. Measuring Quality of Care Received by Suicide Attempters in the Emergency Department. Arch Suicide Res 2022; 26:81-90. [PMID: 32715983 DOI: 10.1080/13811118.2020.1793043] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
CONTEXT Audits conducted on medical records have been traditionally used in hospitals to assess and improve quality of medical care but have yet to be properly integrated and used for suicide prevention purposes. We aimed to (1) revise a quality of care grid and adapt it to an adult population of suicide attempters and (2) identify quality of care deficits in managing adult suicide attempters at the emergency department (ED) in two different Montreal university hospitals. METHODS An existing checklist for quality of medical and social care in the ED was adapted. A systematic search and data extraction of all suicide attempters in two different Montreal university hospitals were then conducted. All identified individuals who attempted suicide were fully reviewed and quality of care was assessed. RESULTS Eleven criteria were kept by the expert focus group in the revised grid that was then used to rate 369 individuals that attempted suicide. Suicide risk assessment was only present in 63% of attempters before discharge. Although family history was documented for 90% of attempters, in only 41% of the cases were interviews conducted with relatives. Most discharged patient lacked proper follow-up considering 11% of their relatives received written information on resources in case of need. DISCUSSION Paper records may be used to systematically assess the quality of care for suicide attempters seen in ED. Results reiterate the need for better suicide prevention strategies for these individuals. The checklist proved to be an excellent assessment of best practices or identification of possible improvements.
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Reccord C, Power N, Hatfield K, Karaivanov Y, Mulay S, Wilson M, Pollock N. Rural-Urban Differences in Suicide Mortality: An Observational Study in Newfoundland and Labrador, Canada: Différences de la Mortalité Par Suicide en Milieu Rural-Urbain: Une Étude Observationnelle à Terre-Neuve et Labrador, Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:918-928. [PMID: 33576277 PMCID: PMC8573702 DOI: 10.1177/0706743721990315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Suicide rates are higher in rural compared to urban areas. Although this pattern appears to be driven by higher rates among men, there is limited evidence about the characteristics of rural people who die by suicide in Canada. The objective of this study was to examine the demographics, manner of death, and social and clinical antecedents of people who died by suicide in rural areas compared to urban areas. METHODS We conducted an observational study of all suicide deaths that occurred among Newfoundland and Labrador residents between 1997 and 2016 using a linked data set derived from a comprehensive review of provincial medical examiner records. We used t tests and χ2 to assess associations between rural/urban status and variables related to demographics, circumstances, and manner of death, as well as social and medical history. Logistic regression was utilized to assess the independent contribution of any variable found to be significant in univariate analysis. RESULTS Rural people who died by suicide accounted for 54.8% of all deaths over a 20-year period. Overall, 81.6% of people who died were male. Compared to urban, rural people who died by suicide were younger, more likely to use firearms or hanging, and had a higher mean blood alcohol content at the time of death (27.69 vs. 22.95 mmol/L). Rural people were also less likely to have had a known history of a prior suicide attempt, psychiatric disorder, alcohol or substance abuse, or chronic pain. DISCUSSION The demographic and clinical differences between rural and urban people who died by suicide underscore the need for suicide prevention approaches that account for place-based differences. A key challenge for suicide prevention in rural communities is to ensure that interventions are developed and implemented in a manner that fits local contexts.
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Affiliation(s)
- Charlene Reccord
- Department of Research, Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Nicole Power
- Department of Research, Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Keeley Hatfield
- Department of Research, Eastern Health, St. John's, Newfoundland and Labrador, Canada.,McMaster University, Hamilton, Ontario, Canada
| | - Yordan Karaivanov
- Medical Services, Labrador Health Centre, Labrador-Grenfell Health, Labrador, Newfoundland and Labrador, Canada.,Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Shree Mulay
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Margo Wilson
- Discipline of Emergency Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.,Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Nathaniel Pollock
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.,School of Public Health, University of Alberta, Edmonton, Canada.,School of Arctic and Subarctic Studies, Labrador Institute, Memorial University, Happy Valley-Goose Bay, NL
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Fortin G, Ligier F, Van Haaster I, Doyon C, Daneau D, Lesage A. Systematic Suicide Audit: An Enhanced Method to Assess System Gaps and Mobilize Leaders for Prevention. Qual Manag Health Care 2021; 30:97-103. [PMID: 33633004 DOI: 10.1097/qmh.0000000000000302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES In Quebec, Canada, several independent processes are in place to investigate cases of death by suicide. An enhanced multidisciplinary audit process was developed to analyze these cases more thoroughly, with the aim of generating recommendations for suicide prevention. A study was undertaken to evaluate the feasibility and implementability of this process. METHODS The life trajectories of 14 people who died by suicide in Montreal, Canada, in 2016 were reconstructed on the basis of information retrieved by interviewing bereaved relatives and examining coroner investigation files and other records. A multidisciplinary panel that included a representative of families bereaved by suicide then reviewed case summaries to determine unmet needs and service gaps at 3 levels: individual intervention, regional programs, and the provincial health and social services system. RESULTS The feasibility of the audit process was demonstrated in the context of a public health care system. Thirty-one distinct recommendations were made variably across 13 of the 14 cases reviewed, whereas none had originally been made by the coroner. The recommendations that recurred most often were (1) improve training for professionals and educate the general public regarding depression and substance-related disorders; (2) deploy mobile crisis intervention teams from emergency departments; and (3) provide access to a family physician to all, especially men. CONCLUSION Although the audit produced novel recommendations and is implementable, there was resistance from physicians and their hospital mortality review committee against this multidisciplinary audit involving families. These concerns could be alleviated by having the process endorsed by provincial authorities.
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Affiliation(s)
- Gabrielle Fortin
- Institut universitaire en santé mentale de Montréal Research Centre, Montreal, Quebec, Canada (Mss Fortin and Daneau, Mr Doyon, and Dr Lesage); Centre Psychothérapique de Nancy, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Laxou, Lorraine, France (Dr Ligier); Université de Lorraine, EA 4360 APEMAC, Nancy, Lorraine, France (Dr Ligier); CIUSSS de l'Est-de-l'Île-de-Montréal, CLSC St-Michel, Montreal, Quebec, Canada (Dr Van Haaster); and Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada (Dr Lesage)
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Wyder M, Ray MK, Roennfeldt H, Daly M, Crompton D. How health care systems let our patients down: a systematic review into suicide deaths. Int J Qual Health Care 2021; 32:285-291. [PMID: 32484207 DOI: 10.1093/intqhc/mzaa011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/26/2019] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To synthesize the literature in relation to findings of system errors through reviews of suicide deaths in the public mental health system. DATA SOURCES A systematic narrative meta-synthesis using the PRISMA methodology was conducted. STUDY SELECTION All English language articles published between 2000 and 2017 that reported on system errors identified through reviews of suicide deaths were included. Articles that reported on patient factors, contact with General Practitioners or individual cases were excluded. DATA EXTRACTION Results were extracted and summarized. An overarching coding framework was developed inductively. This coding framework was reapplied to the full data set. RESULTS OF DATA SYNTHESIS Fourteen peer reviewed publications were identified. Nine focussed on suicide deaths that occurred in hospital or psychiatric inpatient units. Five studies focussed on suicide deaths while being treated in the community. Vulnerabilities were identified throughout the patient's journey (i.e. point of entry, transitioning between teams, and point of exit with the service) and centred on information gathering (i.e. inadequate and incomplete risk assessments or lack of family involvement) and information flow (i.e. transitions between different teams). Beyond enhancing policy, guidelines, documentation and regular training for frontline staff there were very limited suggestions as to how systems can make it easier for staff to support their patients. CONCLUSIONS There are currently limited studies that have investigated learnings and recommendations. Identifying critical vulnerabilities in systems and to be proactive about these could be one way to develop a highly reliable mental health care system.
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Affiliation(s)
- Marianne Wyder
- Metro South Health and Hospital Service.,Menzies Health Institute Queensland, Griffith University
| | | | - Helena Roennfeldt
- Menzies Health Institute Queensland, Griffith University.,Centre for Psychiatric Nursing, University of Melbourne, School of Health Sciences
| | - Michael Daly
- Metro South Health and Hospital Service.,Queensland university of Technology
| | - David Crompton
- Metro South Health and Hospital Service.,Menzies Health Institute Queensland, Griffith University
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Ligier F, Rassy J, Fortin G, van Haaster I, Doyon C, Brouillard C, Séguin M, Lesage A. Being pro-active in meeting the needs of suicide-bereaved survivors: results from a systematic audit in Montréal. BMC Public Health 2020; 20:1534. [PMID: 33036601 PMCID: PMC7547412 DOI: 10.1186/s12889-020-09636-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 09/30/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Suicide is a major public health concern. In 2017, the suicide rate in Canada was 11 per 100,000 inhabitants. According to literature, 1 in 5 people have experienced a death by suicide during their lifetime. The aim of this study was to describe the met and unmet needs of suicide-bereaved survivors and to provide postvention recommendations. METHODS Further to an exploratory mixed-method audit of 39 suicides that occurred in Montreal (Canada) in 2016, suicide-bereaved survivors (n = 29) participated in semi-structured interviews and completed instruments to discuss and assess potential pathological grief, depression (PHQ-9), and anxiety (GAD-7), as well as health and social services utilization. A panel then reviewed each case and provided recommendations. The mean age of participants was 57.7 years and 23 were women. RESULTS Although help was offered initially, in most cases by a health professional or service provider (16/29), 22 survivors would have liked to be contacted by telephone in the first 2 months post suicide. Four categories of individual unmet needs (medical/pharmacological, information, support, and outreach) and one collective unmet need (suicide pre/postvention training and delivery) emerged. CONCLUSIONS Although Quebec provincial services have been developed and offered to suicide-bereaved survivors in the past decade, many dwindled over time and none has been applied systematically. Recommendations for different stakeholders (Ministry of Health and Social Services, coroners, NGOs, and representatives of suicide-bereaved survivors) outlined in this study could be an interesting first step to help develop a suicide pre/postvention strategy.
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Affiliation(s)
- Fabienne Ligier
- Centre Psychothérapique de Nancy, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, 1 rue du Dr Archambault, F-54520, Laxou, France. .,EA 4360 APEMAC, Université de Lorraine, Vandoeuvre-lès-Nancy, France.
| | - Jessica Rassy
- School of Nursing, Université de Sherbrooke, Longueuil, Canada.,Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - Gabrielle Fortin
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - Ian van Haaster
- CIUSSS de l'Est de l'Ile de Montréal, CLSC St-Michel, Montreal, Canada
| | - Claude Doyon
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - Charlie Brouillard
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - Monique Séguin
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, Canada.,Centre intégré de santé et service social de l'Outaouais (CISSSO), Outaouais, Quebec, Canada
| | - Alain Lesage
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada.,Department of Psychiatry, Université de Montréal, Quebec, Canada
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12
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Rush B, Urbanoski K. Seven Core Principles of Substance Use Treatment System Design to Aid in Identifying Strengths, Gaps, and Required Enhancements. J Stud Alcohol Drugs Suppl 2020. [PMID: 30681944 PMCID: PMC6377009 DOI: 10.15288/jsads.2019.s18.9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective: System planners and funders encounter many challenges in taking action toward
evidence-informed enhancement of substance use treatment systems.
Researchers are increasingly asked to contribute expertise to these
processes through comprehensive system reviews. In this role, all parties
can benefit from guiding frameworks to help organize key questions and data
collection activities, and thereby set the stage for both high-level and
on-the-ground strategic directions and recommendations. This article
summarizes seven core principles of substance use treatment system design
that are supported by a large international evidence base and that together
have proven applicable as a framework for several systems review projects
conducted predominantly in Canada. Method: The methodology was based on a narrative review approach. Results: The principles address a wide range of issues. Specifically, a broad systems
approach is needed to address the full spectrum of issues; accessibility and
effectiveness are improved through collaboration across stakeholders; a
range of system supports are needed; need for services should be grounded in
self-determination, holistic cultural practices, choice, and partnership;
attention to diversity and social-structural disadvantages are crucial to
equitable system design; systematic screening and assessment is needed to
match people to appropriate treatment services in a stepped service
framework; and, last, individualized treatment planning must include the
right mix of evidence-informed interventions. Conclusions: By bringing researchers and stakeholders back to the high-level goals of
substance use treatment systems, these principles provide a comprehensive,
evidence-based, organizing framework that has the potential to improve the
quality of system design and review internationally. Objectifs : Les fonctionnaires et les bailleurs de fonds font face à plusieurs
défis lorsqu’ils tentent d’améliorer le système
de traitement en toxicomanie à partir des données probantes. Les
chercheurs sont de plus en plus sollicités pour mettre à
contribution leur expertise afin de revoir en profondeur les systèmes
de soin. À ce titre, tous peuvent bénéficier d’un
cadre-directeur qui les aide à organiser les questions-clés et les
activités de collectes de données afin de créer les
conditions requises pour faire émerger des recommandations et des
orientations stratégiques visant à la fois la haute direction et
le terrain. Cet article résume sept principes fondamentaux liés
à la conception de systèmes de traitement en toxicomanie,
appuyés par de nombreuses données probantes internationales et
qui, ensemble, se sont révélés être un cadre applicable
pour plusieurs projets, menés principalement au Canada. Méthode : La méthodologie était basée sur l’approche dites de
revue narrative. Résultats : Les principes abordent une large gamme d’enjeux. Plus
spécifiquement, une approche générale des systèmes est
nécessaire pour traiter l’ensemble des enjeux ;
l’accessibilité et l’efficacité sont
améliorées grâce à la collaboration entre les parties
prenantes; une variété de soutiens des systèmes est
nécessaire; l’estimation du besoin de services devrait
s’appuyer sur l’autodétermination, des pratiques
culturelles holistiques, la capacité de choix et le partenariat; une
attention à la diversité et aux désavantages
sociostructurels, éléments critiques à la conception
d’un système équitable; un dépistage systématique
et une évaluation sont nécessaires afin d’apparier les
personnes aux services de traitements appropriés, selon un modèle
de services par paliers ; finalement, la planification individualisée
du traitement doit inclure le bon dosage d’interventions basées
sur les données probantes. Conclusion : En ramenant les chercheurs et les décideurs aux finalités
supérieures des systèmes de traitement, ces principes fournissent
un cadre d’organisation qui est exhaustif et s’appuyant sur
des données probantes. Ils ont ainsi le potentiel
d’améliorer la qualité de la conception des systèmes
et de leur révision, et ce, internationalement. Objetivos: Los planificadores del sistema y los financiadores enfrentan muchos
desafíos al tomar medidas para mejorar los sistemas de tratamiento del
uso de sustancias con base en la evidencia. Se solicita cada vez más a
los investigadores que aporten su experiencia a estos procesos a través
de revisiones integrales del sistema. En esta función, todas las partes
pueden beneficiarse de los marcos de orientación para ayudar a
organizar las preguntas clave y las actividades de recopilación de
datos, y de ese modo preparar el escenario para las recomendaciones y
direcciones estratégicas de alto nivel y sobre el terreno. Este
documento resume siete principios básicos del diseño de sistemas
de tratamiento del uso de sustancias que cuentan con el respaldo de una gran
base de evidencia internacional y que, en conjunto, han demostrado ser
aplicables como marco para varios proyectos realizados principalmente en
Canadá. Métodos: La metodología se basó en un enfoque de revisión
narrativa. Resultados: Los principios abordan una amplia gama de problemas. Específicamente, se
necesita un enfoque de sistemas amplio para abordar todo el espectro de
problemas; la accesibilidad y la efectividad se mejoran mediante la
colaboración entre las partes interesadas; se necesita una gama de
soportes de sistemas; la necesidad de servicios debe basarse en la
autodeterminación, prácticas culturales holísticas,
elección y asociación; la atención a la diversidad y las
desventajas socio estructurales son fundamentales para el diseño
equitativo del sistema; se necesitan evaluaciones y exámenes
sistemáticos para unir a las personas con los servicios de tratamiento
adecuados en un marco de servicios escalonados; y, finalmente, la
planificación individualizada del tratamiento debe incluir la
combinación correcta de intervenciones basadas en la evidencia. Conclusiones: Al reunir a investigadores y partes interesadas con los objetivos de alto
nivel de los sistemas de tratamiento del uso de sustancias, estos principios
proporcionan un marco organizativo integral y basado en la evidencia que
tiene el potencial de mejorar la calidad del diseño y la revisión
de sistemas a nivel internacional.
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Affiliation(s)
- Brian Rush
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Karen Urbanoski
- Centre for Addictions Research of British Columbia, and School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
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13
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Đào GJ, Brunelle C, Speed D. Impact of Substance Use and Mental Health Comorbidity on Health Care Access in Canada. J Dual Diagn 2019; 15:260-269. [PMID: 31282295 DOI: 10.1080/15504263.2019.1634856] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Psychological disorders and substance use comorbidity is associated with greater symptomatology and a worse prognosis. Previous research has highlighted discrepancies in the level of use of health care services in individuals experiencing comorbidity compared to those with mental disorders or substance use disorders alone. The purpose of the current study was to compare mental health service use (i.e., access, number of professionals accessed, helpfulness of services received, and number of hours of services received) among individuals with mental disorders, substance use disorders, and comorbid disorders. Methods: Participants consisted of respondents to the 2012 Canadian Community Health Survey-Mental Health (N = 25,133). The researchers used a mixture of binary logistic regressions, Poisson regressions, linear regressions, and ordinal logistic regression to explore the impact of demographic variables, psychological distress, and clinical categories on health care access. Results: The mental disorders group, OR = 0.52, p = .008, 95% CI [0.32, 0.85], d = 0.36, and the substance use disorders group, OR = 0.31, p = .001, 95% CI [0.16, 0.60], d = 0.65, were significantly less likely than the comorbid group to report having accessed a professional in the past year. There were no significant differences in the perceived level of helpfulness for interventions received or in the time spent in professional consultation when comparing the substance use disorders and mental disorders groups to the comorbid group. Conclusions: Although the level of access to health care was low overall, those with concurrent disorders were more likely to access mental health services than those with substance use disorders or mental disorders only. The findings of this study reveal various treatment gaps, especially in those experiencing substance use disorders, and reaffirm the importance of improving treatment accessibility for these individuals.
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Affiliation(s)
- Grace J Đào
- Class of 2021, Dalhousie University, Saint John, New Brunswick, Canada
| | - Caroline Brunelle
- Department of Psychology, University of New Brunswick, Saint John, New Brunswick, Canada
| | - David Speed
- Department of Psychology, University of New Brunswick, Saint John, New Brunswick, Canada
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14
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Thibodeau L, Rahme E, Lachaud J, Pelletier É, Rochette L, John A, Reneflot A, Lloyd K, Lesage A. Individual, programmatic and systemic indicators of the quality of mental health care using a large health administrative database: an avenue for preventing suicide mortality. Health Promot Chronic Dis Prev Can 2018; 38:295-304. [PMID: 30129717 PMCID: PMC6126560 DOI: 10.24095/hpcdp.38.7/8.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Suicide is a major public health issue in Canada. The quality of health care services, in addition to other individual and population factors, has been shown to affect suicide rates. In publicly managed care systems, such as systems in Canada and the United Kingdom, the quality of health care is manifested at the individual, program and system levels. Suicide audits are used to assess health care services in relation to the deaths by suicide at individual level and when aggregated at the program and system levels. Large health administrative databases comprise another data source used to inform population-based decisions at the system, program and individual levels regarding mental health services that may affect the risk of suicide. This status report paper describes a project we are conducting at the Institut national de santé publique du Québec (INSPQ) with the Quebec Integrated Chronic Disease Surveillance System (QICDSS) in collaboration with colleagues from Wales (United Kingdom) and the Norwegian Institute of Public Health. This study describes the development of quality of care indicators at three levels and the corresponding statistical analysis strategies designed. We propose 13 quality of care indicators, including system-level and several population-level determinants, primary care treatment, specialist care, the balance between care sectors, emergency room utilization, and mental health and addiction budgets, that may be drawn from a chronic disease surveillance system.
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Affiliation(s)
- Lise Thibodeau
- Department of Medicine Division of Clinical Epidemiology, McGill University, Montréal, Quebec, Canada
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Québec, Quebec, Canada
| | - Elham Rahme
- Department of Medicine Division of Clinical Epidemiology, McGill University, Montréal, Quebec, Canada
- Research Institute of the McGill University Health Center (RI-MUHC), Montréal, Quebec, Canada
| | - James Lachaud
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Éric Pelletier
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Québec, Quebec, Canada
| | - Louis Rochette
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Québec, Quebec, Canada
| | - Ann John
- Farr Institute of Health Informatics Research, Swansea University Medical School, Institute of Life Sciences, Swansea, United Kingdom
| | - Anne Reneflot
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, Oslo, Norway
| | - Keith Lloyd
- Farr Institute of Health Informatics Research, Swansea University Medical School, Institute of Life Sciences, Swansea, United Kingdom
| | - Alain Lesage
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Québec, Quebec, Canada
- Department of Psychiatry, Université de Montréal, Montréal, Quebec, Canada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Quebec, Canada
- Quebec Network on Suicide, Mood Disorders and Related Disorders, Montréal, Quebec, Canada
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15
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Pollock NJ, Healey GK, Jong M, Valcour JE, Mulay S. Tracking progress in suicide prevention in Indigenous communities: a challenge for public health surveillance in Canada. BMC Public Health 2018; 18:1320. [PMID: 30482175 PMCID: PMC6260704 DOI: 10.1186/s12889-018-6224-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/15/2018] [Indexed: 01/07/2023] Open
Abstract
Indigenous peoples in Canada experience disproportionate rates of suicide compared to non-Indigenous populations. Indigenous communities and organizations have designed local and regional approaches to prevention, and the federal government has developed a national suicide prevention framework. However, public health systems continue to face challenges in monitoring the population burden of suicide and suicidal behaviour. National health data systems lack Indigenous identifiers, do not capture data from some regions, and do not routinely engage Indigenous communities in data governance. These challenges hamper efforts to detect changes in population-level outcomes and assess the impact of suicide prevention activities. Consequently, this limits the ability to achieve public health prevention goals and reduce suicide rates and rate inequities. This paper provides a critical analysis of the challenges related to suicide surveillance in Canada and assesses the strengths and limitations of existing data infrastructure for monitoring outcomes in Indigenous communities. To better understand these challenges, we discuss the policy context for suicide surveillance and examine the survey and administrative data sources that are commonly used in public health surveillance. We then review recent data on the epidemiology of suicide and suicidal behaviour among Indigenous populations, and identify challenges related to national surveillance. To enhance capacity for suicide surveillance, we propose strategies to better track progress in Indigenous suicide prevention. Specifically, we recommend establishing an independent community and scientific governing council, integrating Indigenous identifiers into population health datasets, increasing geographic coverage, improving suicide data quality, comprehensiveness, and timeliness, and developing a platform for making suicide data accessible to all stakeholders. Overall, the strategies we propose can build on the strengths of the existing national suicide surveillance system by adopting a collaborative and inclusive governance model that recognizes the stake Indigenous communities have in suicide prevention.
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Affiliation(s)
- Nathaniel J Pollock
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, Prince Philip Drive, St. John's, Newfoundland and Labrador, A1B 3V6, Canada. .,Labrador Institute of Memorial University, P.O. Box 490, Stn. B, 219 Hamilton River Road, Happy Valley-Goose Bay, Newfoundland and Labrador, A0P 1E0, Canada.
| | - Gwen K Healey
- Qaujigiartiit Health Research Centre, PO Box 11372, 764 Fred Coman Dr., Iqaluit, NT, X0A 0H0, Canada.,Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Michael Jong
- Labrador-Grenfell Regional Health Authority, Labrador Health Centre, Happy Valley-Goose Bay, Newfoundland and Labrador, Canada.,Northern Family Medicine Program (NorFam), Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, A1B 3V6, Canada
| | - James E Valcour
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, Prince Philip Drive, St. John's, Newfoundland and Labrador, A1B 3V6, Canada
| | - Shree Mulay
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, Prince Philip Drive, St. John's, Newfoundland and Labrador, A1B 3V6, Canada
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16
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Rhodes AE, Boyle MH, Bridge JA, Sinyor M, Katz LY, Bennett K, Newton AS, Links PS, Tonmyr L, Skinner R, Cheung A, Bethell J, Carlisle C. Les soins médicaux de jeunes hommes et de jeunes femmes qui décèdent par suicide. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:161-169. [PMID: 29121806 PMCID: PMC5846965 DOI: 10.1177/0706743717741060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Prior year medical care was compared among youth dying by suicide to their peers. Effect modification of these associations by age or place of residency (rural versus larger community sizes) was examined in a large, medically insured population. METHOD This population-based case control study used data from the Office of the Chief Coroner in Ontario, Canada, linked to health care administrative data to examine associations between medical care for mental health or other reasons (versus no medical care) and suicide. Decedents ( n = 1203 males and n = 454 females) were youth (aged 10 to 25 years) who died by suicide in Ontario between April 2003 and March 2014, inclusive. Peers of the same ages were frequency matched to decedents on sex and place of residency. Logistic regression was used to calculate odds ratios and 95% confidence intervals and to test effect modification. RESULTS Associations with mental health care were stronger in decedents than peers with a gradation of care (i.e., outpatient only, emergency department [ED], inpatient care) in both sexes. However, these associations were weaker among youth living in rural communities. Furthermore, older males (aged 18 to 25 years) were less likely than younger males (aged 10 to 17 years) to access the ED (ambulatory care only). This decrease was observed in rural and larger communities alongside no increase in medical care for other reasons. CONCLUSIONS Geographical and age-related barriers to mental health care exist for youth who die by suicide. Preventive efforts can address these barriers, intervening early and integrating services, including the ED.
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Affiliation(s)
- Anne E Rhodes
- 1 Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario.,2 The Institute for Clinical Evaluative Sciences, Toronto, Ontario.,3 The Offord Centre for Child Studies, Hamilton, Ontario.,4 Department of Psychiatry and Behavioural Neuroscience Sciences, McMaster University, Hamilton, Ontario
| | - Michael H Boyle
- 3 The Offord Centre for Child Studies, Hamilton, Ontario.,4 Department of Psychiatry and Behavioural Neuroscience Sciences, McMaster University, Hamilton, Ontario.,5 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario
| | - Jeffrey A Bridge
- 6 Center for Suicide Prevention and Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,7 The Ohio State University College of Medicine, Columbus, OH, USA
| | - Mark Sinyor
- 1 Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario.,8 Sunnybrook Health Sciences Centre, Toronto, Ontario.,9 Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Laurence Y Katz
- 10 Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba.,11 Child and Adolescent Mental Health, Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba
| | - Kathryn Bennett
- 3 The Offord Centre for Child Studies, Hamilton, Ontario.,4 Department of Psychiatry and Behavioural Neuroscience Sciences, McMaster University, Hamilton, Ontario.,5 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario
| | - Amanda S Newton
- 12 Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Paul S Links
- 4 Department of Psychiatry and Behavioural Neuroscience Sciences, McMaster University, Hamilton, Ontario
| | - Lil Tonmyr
- 13 Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa
| | - Robin Skinner
- 13 Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa
| | - Amy Cheung
- 1 Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario.,8 Sunnybrook Health Sciences Centre, Toronto, Ontario.,9 Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Jennifer Bethell
- 14 The Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Corine Carlisle
- 15 Department of Psychiatry, University of Toronto, Toronto, Ontario.,16 Department of Psychiatry, Hospital for Sick Children (SickKids), Toronto, Ontario
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17
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Vasiliadis HM, Lamoureux-Lamarche C, Rochette L, Levesque P, Pelletier É, Lesage A. Consultations médicales et types de services de santé utilisés dans les deux années
précédant le suicide auprès des Québécois diagnostiqués avec et sans troubles mentaux et
troubles avec utilisation de substances. SANTE MENTALE AU QUEBEC 2018. [DOI: 10.7202/1058614ar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Stene-Larsen K, Reneflot A. Contact with primary and mental health care prior to suicide: A systematic review of the literature from 2000 to 2017. Scand J Public Health 2017; 47:9-17. [DOI: 10.1177/1403494817746274] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: To examine rates of contact with primary and mental health care prior to suicide in men and women and across a range of age categories. Method: The authors performed a systematic review of 44 studies from 2000 to 2017 of which 36 reported rates on contact with primary health care and 14 reported on contact with mental health care prior to suicide. Results: Contact with primary health care was highest in the year prior to suicide with an average contact rate of 80%. At one month, the average rate was 44%. The lifetime contact rate for mental health care was 57%, and 31% in the final 12 months. In general, women and those over 50 years of age had the highest rates of contact with health care prior to suicide. Conclusions: Contact with primary health care prior to suicide is common even in the final month before death. The findings presented in this study highlight the importance of placing suicide prevention strategies and interventions within the primary health care setting.
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Affiliation(s)
- Kim Stene-Larsen
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, Norway
| | - Anne Reneflot
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, Norway
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19
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Populational and individual perspective on needs. Epidemiol Psychiatr Sci 2017; 26:609-611. [PMID: 29039301 PMCID: PMC6998985 DOI: 10.1017/s204579601700049x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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20
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Lesage A, Turecki G, Daniels S. PHAC and a national suicide prevention strategy. CMAJ 2017; 189:E169. [PMID: 28246317 DOI: 10.1503/cmaj.732474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Alain Lesage
- Quebec Network on Suicide, Mood Disorders and Related Disorders, Montréal, Que
| | - Gustavo Turecki
- Quebec Network on Suicide, Mood Disorders and Related Disorders, Montréal, Que
| | - Sylvanne Daniels
- Quebec Network on Suicide, Mood Disorders and Related Disorders, Montréal, Que
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21
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Beaulac É, Andronicos M, Lesage A, Robert M, Larochelle S, Séguin M. Quelle est l’influence du genre dans la recherche de soins chez les joueurs? JOURNAL OF GAMBLING ISSUES 2017. [DOI: 10.4309/jgi.2017.35.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cette étude vise à décrire l’influence du genre sur les différentes étapes amenant un joueur ayant des problèmes de jeu à prendre la décision de rechercher de l’aide. Le modèle de recherche d’aide de Goldsmith, Jackson et Hough (1988) a été utilisé pour conceptualiser les étapes de prise de décision menant à consulter des services d’aide pour un problème de jeu de hasard et d’argent. Au total, 83 participants, dont 45 femmes et 38 hommes adultes, y ont pris part. Les résultats indiquent que, comparativement aux hommes, les femmes sont plus nombreuses à habiter en couple, ont plus souvent de faibles revenus et subviennent moins fréquemment seules à leurs besoins, rapportent des conduites de jeu plus conséquentes, souffrent davantage de troubles anxieux au cours de leur vie et, enfin, consultent surtout des services non spécialisés. Au cours des 12 derniers mois, les femmes avaient consulté plus souvent les services médicaux de première ligne et avaient eu moins fréquemment recours aux services spécialisés que les hommes.The aim of this study was to describe the influence of gender on the various stages of the decision-making process that bring problem gamblers to seek help. The authors used the help-seeking model developed by Goldsmith, Jackson and Hough (1988) to conceptualize the different stages of the process that leads to consulting support services for a gambling problem. A total of 83 participants (45 females and 38 males) took part in the study. Results show that women are more likely to have a partner and to earn a lower income; they provide for their own needs less frequently than men; report more consistent gaming behaviours; are more prone to anxiety disorder during their lifetime; and consult primarily non-specialized services. In the previous 12 months, they had accessed front-line services more often and specialized services less frequently than men.
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Psychological and physical pain as predictors of suicide risk: evidence from clinical and neuroimaging findings. Curr Opin Psychiatry 2017; 30:159-167. [PMID: 28067727 DOI: 10.1097/yco.0000000000000314] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW Suicide is a multidimensional clinical phenomenon with complex biological, social and psychological risk factors. Therefore, it is imperative for studies to focus on developing a unified understanding of suicide risk that integrates current clinical and neurobiological findings. A recent line of research has implicated different classifications of pain in understanding suicide risk, including the concepts of psychache and pain tolerance. Although psychache is defined as the experience of unbearable psychological pain, pain tolerance refers to the greatest duration or intensity of painful stimuli that one is able to bear. This review will focus on integrating current clinical and neurobiological findings by which psychache and pain tolerance confer suicide risk. RECENT FINDINGS Results indicate that psychache has been identified as a significant risk factor for suicide and that psychache may be associated with the neurocircuitry involved in the modulation of physical pain. Converging evidence has also been found linking pain tolerance to self-injurious behaviours and suicide risk. The experience of psychache and physical pain in relation to other predictors of suicide, including reward processing, hopelessness and depression, are further discussed. SUMMARY Future research examining the pain-suicide connection is required to understand the mechanism behind clinically relevant risk factors for suicide, which can ultimately inform the construction of empirically supported suicide risk assessment and intervention techniques.
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Rahme E, Low NCP, Lamarre S, Daneau D, Habel Y, Turecki G, Bonin JP, Morin S, Szkrumelak N, Singh S, Lesage A. Correlates of Attempted Suicide from the Emergency Room of 2 General Hospitals in Montreal, Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:382-393. [PMCID: PMC4910406 DOI: 10.1177/0706743716639054] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Introduction: The epidemiology of attempted suicide has not been well characterized because of lack of national data or an International Classification of Diseases (ICD) code for suicide attempts. We conducted a retrospective chart review in 2 adult general hospitals (tertiary and community) in Montreal, Canada, in 2009-2010 to 1) describe the characteristics of men and women who presented to the emergency department (ED) and/or were hospitalized following a suicide attempt, 2) identify factors associated with attempts requiring hospitalizations, and 3) validate the use of International Classification of Diseases, 10th Revision (ICD-10) codes for “intentional self-harm” as a method to detect suicide attempts from hospital abstract summary records. Method: All potential suicide attempts were identified from hospital abstract summary records and ED nursing triage file using ICD-10 codes and keywords suggestive of suicide attempts. All identified charts were examined, and those with confirmed suicide attempts were fully reviewed. Results: Of the 5746 identified charts, 369 were fully reviewed. Of these, 176 were for suicide attempters treated in the ED and 193 for hospitalized attempters, of whom 46% had an ICD-10 code for intentional self-harm. Poisoning (46%) was the most frequent method of suicide used. Half of attempters were younger than 34 years, 53% were female, and 75% had a history of mental disorders. Conclusion: About half of individuals who seek medical care for attempted suicide are admitted to hospital. About half of attempters use poisoning as a method of suicide, and a quarter do not have a history of mental disorders. Intentional self-harm codes capture only about half of hospitalized attempters.
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Affiliation(s)
- Elham Rahme
- Research Institute of the McGill University Health Centre, Montreal, Quebec
- Department of Medicine, McGill University, Montreal, Quebec
| | - Nancy C. P. Low
- Department of Psychiatry, McGill University Health Centre, Montreal, Quebec
| | - Suzanne Lamarre
- Department of Psychiatry, McGill University, St-Mary’s Hospital Center, Montreal, Quebec
| | - Diane Daneau
- Douglas Mental Health University Institute, Montreal, Quebec
| | - Youssef Habel
- Department of Psychiatry, McGill University Health Centre, Montreal, Quebec
| | - Gustavo Turecki
- Department of Psychiatry, McGill University Health Centre, Montreal, Quebec
| | | | - Suzanne Morin
- Research Institute of the McGill University Health Centre, Montreal, Quebec
- Department of Medicine, McGill University, Montreal, Quebec
| | - Nadia Szkrumelak
- Department of Psychiatry, McGill University Health Centre, Montreal, Quebec
| | - Santokh Singh
- Department of Psychiatry, McGill University, St-Mary’s Hospital Center, Montreal, Quebec
| | - Alain Lesage
- Department of Psychiatry, Université de Montréal, Montreal, Quebec
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Vella VE, Deane FP, Kelly PJ. Comorbidity in Detoxification: Symptom Interaction and Treatment Intentions. J Subst Abuse Treat 2015; 49:35-42. [DOI: 10.1016/j.jsat.2014.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 07/26/2014] [Accepted: 07/29/2014] [Indexed: 11/30/2022]
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Zaheer J, Links PS, Law S, Shera W, Hodges B, Tsang AKT, Huang X, Liu P. Developing a Matrix Model of Rural Suicide Prevention. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2014. [DOI: 10.2753/imh0020-7411400403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Paul S. Links
- b University of Western Ontario, London, Ontario, Canada
| | - Samuel Law
- a University of Toronto, Toronto, Ontario, Canada
| | - Wes Shera
- a University of Toronto, Toronto, Ontario, Canada
| | - Brian Hodges
- a University of Toronto, Toronto, Ontario, Canada
| | | | | | - Pozi Liu
- d Department of Psychiatry, Yuquan Hospital, Tsinghua University, Beijing, China
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Renaud J, Séguin M, Lesage AD, Marquette C, Choo B, Turecki G. Service use and unmet needs in youth suicide: a study of trajectories. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:523-30. [PMID: 25565685 PMCID: PMC4197786 DOI: 10.1177/070674371405901005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 07/01/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE While 90% of suicide victims have suffered from mental health disorders, less than one-half are in contact with a mental health professional in the year preceding their death. Service use in the last year of life of young suicide victims and control subjects was studied in Quebec. We wanted to determine what kinds of health care services were needed and if they were actually received by suicide victims. METHOD We recruited 67 consecutive suicide victims and 56 matched living control subjects (aged 25 years and younger). We evaluated subjects' psychopathological profile and determined which services would have been indicated by conducting a needs assessment. We then compared this with what services were actually received. RESULTS Suicide victims were more likely than living control subjects to have a psychiatric diagnosis. They were most in need of services to address substance use disorder, depression, interpersonal distress, and suicide-related problems. There were significant deficits in the domains of coordination and continuity of care, mental health promotion and training, and governance. CONCLUSIONS Our results show that we need to urgently take action to address these identified deficits to prevent further loss of life in our young people.
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Affiliation(s)
- Johanne Renaud
- Child and Adolescent Psychiatrist and Associate Professor, Department of Psychiatry, McGill University, Montreal, Quebec; Medical Chief—Youth Section Outpatient Clinic of Depressive and Suicidal Disorders, Douglas Mental Health University Institute, Montreal, Quebec; Standard Life Senior Fellow, Standard Life Centre for Breakthroughs in Teen Depression and Suicide Prevention, Douglas Mental Health University Institute, McGill University, Montreal, Quebec; Researcher, McGill Group for Suicide Studies, McGill University, Montreal, Quebec
| | - Monique Séguin
- Psychologist, Université du Québec en Outaouais, Gatineau, Quebec; Professor, Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, Quebec; Researcher, McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, Quebec
| | - Alain D Lesage
- Psychiatrist and Professor, Department of Psychiatry, Institut universitaire en santé mentale de Montréal, Université de Montréal, Montreal, Quebec
| | - Claude Marquette
- Psychiatrist and Assistant Professor, Department of Psychiatry, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec
| | - Bettina Choo
- Resident in Psychiatry, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Quebec
| | - Gustavo Turecki
- Psychiatrist and Professor, Departments of Psychiatry, Human Genetics, and Neurology and Neurosurgery, McGill University, Montreal, Quebec; Vice-Chair, Research and Academic Affairs, Department of Psychiatry, McGill University, Montreal, Quebec; Director, McGill Group for Suicide Studies, McGill University, Montreal, Quebec; Co-Director, Douglas–Bell Canada Brain Bank (Suicide Studies), Montreal, Quebec; Head, Depressive Disorders Program, Douglas Mental Health University Institute, McGill University, Montreal, Quebec; Director, Réseau québécois de recherche sur le suicide, Montreal, Quebec
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Maussion G, Yang J, Suderman M, Diallo A, Nagy C, Arnovitz M, Mechawar N, Turecki G. Functional DNA methylation in a transcript specific 3'UTR region of TrkB associates with suicide. Epigenetics 2014; 9:1061-70. [PMID: 24802768 DOI: 10.4161/epi.29068] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Previous studies indicate that a subgroup of suicide completers has low cortical brain expression levels of TrkB-T1, a TrkB gene transcript that is highly expressed in astrocytes. Epigenetic modifications, including methylation changes in the TrkB promoter, partially explain TrkB-T1 low expression levels in brain tissue from suicide completers. The aim of this study was to investigate whether methylation changes in other regions of the TrkB gene could also contribute to the significant downregulation of the TrkB-T1 transcript observed in the brain of suicide completers. Methylation levels were assessed on BA8/9 from suicide completers expressing low TrkB-T1 transcript levels and controls, using custom-made Agilent arrays tiling the whole TrkB gene. After statistical correction for multiple testing, five probes located in the TrkB-T1 3'UTR region were found hypermethylated in the frontal cortex of suicide completers. These results were validated for four CpGs spanning a 150 bp sequence by cloning and Sanger sequencing bisulfite treated DNA. We found a significant correlation between the methylation level at these four CpGs and TrkB-T1 expression in BA8/9. Site-specific hypermethylation on this 3'UTR sequence induced decreased luciferase activity in reporter gene cell assays. Site-specific differential methylation in the TrkB-T1 3'UTR region associates with functional changes in TrkB-T1 expression and may play a significant role in the important decrease of cortical TrkB-T1 expression observed among suicide completers.
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Affiliation(s)
- Gilles Maussion
- McGill Group for Suicide Studies; Douglas Hospital Research Institute; McGill University; Montreal, QC Canada
| | - Jennie Yang
- McGill Group for Suicide Studies; Douglas Hospital Research Institute; McGill University; Montreal, QC Canada
| | - Matthew Suderman
- Departments of Pharmacology and Therapeutics; McGill University; Montreal, QC Canada
| | - Alpha Diallo
- McGill Group for Suicide Studies; Douglas Hospital Research Institute; McGill University; Montreal, QC Canada
| | - Corina Nagy
- McGill Group for Suicide Studies; Douglas Hospital Research Institute; McGill University; Montreal, QC Canada
| | - Mitchell Arnovitz
- McGill Group for Suicide Studies; Douglas Hospital Research Institute; McGill University; Montreal, QC Canada
| | - Naguib Mechawar
- McGill Group for Suicide Studies; Douglas Hospital Research Institute; McGill University; Montreal, QC Canada
| | - Gustavo Turecki
- McGill Group for Suicide Studies; Douglas Hospital Research Institute; McGill University; Montreal, QC Canada
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Sinyor M, Schaffer A, Streiner DL. Characterizing suicide in Toronto: an observational study and cluster analysis. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:26-33. [PMID: 24444321 PMCID: PMC4079226 DOI: 10.1177/070674371405900106] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine whether people who have died from suicide in a large epidemiologic sample form clusters based on demographic, clinical, and psychosocial factors. METHOD We conducted a coroner's chart review for 2886 people who died in Toronto, Ontario, from 1998 to 2010, and whose death was ruled as suicide by the Office of the Chief Coroner of Ontario. A cluster analysis using known suicide risk factors was performed to determine whether suicide deaths separate into distinct groups. Clusters were compared according to person- and suicide-specific factors. RESULTS Five clusters emerged. Cluster 1 had the highest proportion of females and nonviolent methods, and all had depression and a past suicide attempt. Cluster 2 had the highest proportion of people with a recent stressor and violent suicide methods, and all were married. Cluster 3 had mostly males between the ages of 20 and 64, and all had either experienced recent stressors, suffered from mental illness, or had a history of substance abuse. Cluster 4 had the youngest people and the highest proportion of deaths by jumping from height, few were married, and nearly one-half had bipolar disorder or schizophrenia. Cluster 5 had all unmarried people with no prior suicide attempts, and were the least likely to have an identified mental illness and most likely to leave a suicide note. CONCLUSIONS People who die from suicide assort into different patterns of demographic, clinical, and death-specific characteristics. Identifying and studying subgroups of suicides may advance our understanding of the heterogeneous nature of suicide and help to inform development of more targeted suicide prevention strategies.
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Affiliation(s)
- Mark Sinyor
- Psychiatrist, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario; Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Ayal Schaffer
- Head, Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario; Associate Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - David L Streiner
- Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario; Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
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Séguin M, Bordeleau V, Drouin MS, Castelli-Dransart DA, Giasson F. Professionals' reactions following a patient's suicide: review and future investigation. Arch Suicide Res 2014; 18:340-62. [PMID: 24846577 DOI: 10.1080/13811118.2013.833151] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The objective of this study was to review the literature and make suggestions for further investigation into the topic of professionals' reactions following a patient's suicide. An extensive search of the literature has been undertaken using computer database search. Even if findings are heterogenous, most studies suggest limited stress-related or affective-related reactions for the majority of respondents. Whereas, findings with regards to the impact on professional practice are consistent in identifying important consequences in the way professionals conduct their clinical assessment and reach treatment decisions after a patient's suicide. Future research should investigate how this event changes the clinician's personal growth and capacity to establish a therapeutic alliance with other suicidal patients.
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Affiliation(s)
- Monique Séguin
- a Université du Québec en Outaouais, Department of Psychology , Gatineau , Québec , Canada
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Séguin M, Di Mambro M, Desgranges A. [The contribution of research in psychology in the complex comprehension of the etiology of suicide]. SANTE MENTALE AU QUEBEC 2013; 37:95-105. [PMID: 23666283 DOI: 10.7202/1014946ar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
If certain risk factors are known to increase suicidal behaviors, the question is to determine the differential weight of these various risk factors, on which individuals, in which context and in what period of their lives? We have put to test a model that explains different life trajectories leading to suicide. This research allows to surpass a correlation model of identification of risk factors and to target four distinct sub-groups of individuals for whom the developmental history seems quite different. It is clear that suicide is a complex, multidimensional and multilevel issue. Being at the crossroads of many scientific disciplines, psychology may help integrate and connect knowledge with other disciplines in order to clarify the contexts that affect suicidal individuals differently. This knowledge may help in identifying specific prevention interventions that could modify this chain of events leading ultimately to suicide.
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Affiliation(s)
- Monique Séguin
- Groupe McGill d'étude sur le suicide, Département de psychoéducation et de psychologie, Université du Québec en Outaouais
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Séguin M, Robert M, DiMambro M, Lesage A, Reidi G, Roy M, Gagnon A, Larochelle S, Dutrisac S. Gambling over the life course and treatment-seeking. INTERNATIONAL GAMBLING STUDIES 2013. [DOI: 10.1080/14459795.2013.812675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bertrand K, Brunelle N, Richer I, Beaudoin I, Lemieux A, Ménard JM. Assessing covariates of drug use trajectories among adolescents admitted to a drug addiction center: mental health problems, therapeutic alliance, and treatment persistence. Subst Use Misuse 2013; 48:117-28. [PMID: 23127200 DOI: 10.3109/10826084.2012.733903] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study aimed to assess covariates of drug use trajectories among 102 adolescents admitted to a drug user treatment program between November 2005 and November 2006 in Québec, Canada. The influences of mental health, therapeutic alliance, and treatment persistence were examined. The Addiction Severity Index was used to measure drug use severity and mental health problems; the California Psychotherapy Alliance Scales was used for therapeutic alliance. latent growth curve analysis showed associations between (1) mental health and initial drug use severity; (2) therapeutic alliance and initial drug use severity; and (3) number of post-treatment sessions attended and drug use severity over time.
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Affiliation(s)
- Karine Bertrand
- Département des Sciences de la Santé Communautaire (Toxicomanie), Université de Sherbrooke, Longueuil, Quebec, Canada.
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Chartrand H, Robinson J, Bolton JM. A longitudinal population-based study exploring treatment utilization and suicidal ideation and behavior in major depressive disorder. J Affect Disord 2012; 141:237-45. [PMID: 22703701 DOI: 10.1016/j.jad.2012.03.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 03/12/2012] [Accepted: 03/19/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND This study aimed to longitudinally examine the relationship between treatment utilization and suicidal behavior among people with major depressive disorder in a nationally representative sample. METHODS Data came from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (Wave 1: N=43,093; Wave 2: N=34,653). Suicidal and non-suicidal individuals at Wave 1 were compared based on subsequent treatment utilization. Suicidal behavior at Wave 2 was compared between people with major depressive disorder who had sought treatment at Wave 1 versus those that had not. RESULTS Individuals with past year major depressive disorder at Wave 1 who attempted suicide were more likely to be hospitalized at follow up compared to non-suicidal people with major depressive disorder [adjusted odds ratio (AOR)=4.46; 95% confidence interval [95% CI]: 2.54-7.85]; however, they were not more likely to seek other forms of treatment. Among those with past year major depressive disorder who sought treatment at baseline, visiting an emergency room (AOR=3.08; 95% CI: 1.61-5.89) and being hospitalized (AOR=2.41; 95% CI: 1.13-5.14), was associated with an increased likelihood of attempting suicide within 3 years even after adjusting for mental disorder comorbidity, depression severity, and previous suicidal behavior. LIMITATIONS Unable to draw conclusions about completed suicide or adequacy of treatment. CONCLUSIONS Suicidal behavior does not lead individuals with major depressive disorder to seek treatment with professionals or use antidepressant medications; instead, they are more likely to use emergency services. These findings suggest that treatment efforts for people with major depressive disorder who are suicidal need improvement.
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Affiliation(s)
- Hayley Chartrand
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
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Riedi G, Mathur A, Séguin M, Bousquet B, Czapla P, Charpentier S, Genestal M, Cailhol L, Birmes P. Alcohol and Repeated Deliberate Self-Harm. CRISIS 2012; 33:358-63. [DOI: 10.1027/0227-5910/a000148] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Repeated episode(s) of deliberate self-harm (RDSH) is a major risk factor for suicide. Aims: To identify specific risk factors for RDSH among patients admitted following an episode of deliberate self-harm (DSH) through acute intoxication. Methods: A prospective 6-month study was conducted with 184 patients (71% female) admitted to the emergency room (ER) as a result of self-poisoning (SP). Results: Rate of RDSH stood at 18% after 6 months. The sociodemographic variables associated with repeated deliberate self-harm were to have no principal activity, consultation with a medical professional during the 6 months preceding the self-poisoning, and referral to psychiatric services upon release from the ER. The clinical variable associated with RDSH was alcohol addiction (OR = 2.7; IC 95% = 1.2–6.1, p < .05) as assessed at the time of the initial ER admission. Conclusions: When patients are initially admitted to the ER as a result of self-poisoning, it is important to evaluate specific factors, particularly alcohol use, that could subsequently lead to repeated deliberate self-harm. The goal is to improve the targeting and referral of patients toward structures that can best respond to their needs.
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Affiliation(s)
- G. Riedi
- Toulouse University, UPS, Laboratoire du Stress Traumatique, France
| | - A. Mathur
- Toulouse University, UPS, Laboratoire du Stress Traumatique, France
| | - M. Séguin
- McGill Group for Suicide Studies, Douglas Hospital Research Center, Montréal, Canada
| | - B. Bousquet
- Toulouse University, UPS, Laboratoire du Stress Traumatique, France
| | - P. Czapla
- Toulouse University, UPS, Laboratoire du Stress Traumatique, France
| | - S. Charpentier
- Adult ER, Purpan Hospital, Toulouse University Hospital, France
| | - M. Genestal
- Anesthesiology and Intensive Care, Purpan Hospital, Toulouse University Hospital, France
| | - L. Cailhol
- National Institute of Health and Medical Research (INSERM), Clinical Investigation Center 9302, Purpan Hospital, Toulouse University Hospital, France
| | - P. Birmes
- Toulouse University, UPS, Laboratoire du Stress Traumatique, France
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Maussion G, Yang J, Yerko V, Barker P, Mechawar N, Ernst C, Turecki G. Regulation of a truncated form of tropomyosin-related kinase B (TrkB) by Hsa-miR-185* in frontal cortex of suicide completers. PLoS One 2012; 7:e39301. [PMID: 22802923 PMCID: PMC3382618 DOI: 10.1371/journal.pone.0039301] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 05/18/2012] [Indexed: 01/03/2023] Open
Abstract
Background TrkB-T1 is a BDNF receptor lacking a tyrosine kinase domain that is highly expressed in astrocytes and regulates BDNF-evoked calcium transients. Previous studies indicate that downregulation of TrkB-T1 in frontal cortex may be involved in neurobiological processes underlying suicide. Methods In a microarray screening study (N = 8), we interrogated all known microRNA in the frontal cortex of suicide completers with low expression of TrkB-T1 and normal controls. These findings were validated and followed up in a larger sample of cases and controls (N = 55). Functional analyses included microRNA silencing, microRNA overexpression and luciferase assays to investigate specificity and to validate interactions between differentially expressed microRNA and TrkB-T1. Results MicroRNAs Hsa-miR-185* and Hsa-miR-491-3p were upregulated in suicide completers with low expression of TrkB.T1 (Pnominal: 9.10−5 and 1.8.10−4 respectively; FDR-corrected p = 0.031). Bioinformatic analyses revealed five putative binding sites for the DiGeorge syndrome linked microRNA Hsa-miR-185*in the 3′UTR of TrkB-T1, but none for Hsa-miR-491-3P. The increase of Hsa-miR-185* in frontal cortex of suicide completers was validated then confirmed in a larger, randomly selected group of suicide completers, where an inverse correlation between Hsa-miR-185* and TrkB-T1 expression was observed (R = −0.439; p = 0.001). Silencing and overexpression studies performed in human cell lines confirmed the inverse relationship between hsa-mir-185* and trkB-T1 expression. Luciferase assays demonstrated that Hsa-miR-185* binds to sequences in the 3′UTR of TrkB-T1. Conclusion These results suggest that an increase of Hsa-miR-185* expression levels regulates, at least in part, the TrkB-T1 decrease observed in the frontal cortex of suicide completers and further implicate the 22q11 region in psychopathology.
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Affiliation(s)
- Gilles Maussion
- McGill Group for Suicide Studies, Douglas Hospital Research Institute, McGill University, Montreal, Quebec, Canada
| | - Jennie Yang
- McGill Group for Suicide Studies, Douglas Hospital Research Institute, McGill University, Montreal, Quebec, Canada
| | - Volodymyr Yerko
- McGill Group for Suicide Studies, Douglas Hospital Research Institute, McGill University, Montreal, Quebec, Canada
| | - Philip Barker
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Naguib Mechawar
- McGill Group for Suicide Studies, Douglas Hospital Research Institute, McGill University, Montreal, Quebec, Canada
| | - Carl Ernst
- McGill Group for Suicide Studies, Douglas Hospital Research Institute, McGill University, Montreal, Quebec, Canada
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Douglas Hospital Research Institute, McGill University, Montreal, Quebec, Canada
- * E-mail:
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Routhier D, Leduc N, Lesage A, Benigeri M. [Portrait of the use of mental health services before and after a suicide attempt requiring hospitalization]. SANTE MENTALE AU QUEBEC 2012; 37:223-237. [PMID: 23666290 DOI: 10.7202/1014953ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Health care systems play an important role in suicide prevention. Medical and administrative data allow analysis of patterns of mental health service use before and after hospitalization following a suicide attempt among Montreal residents diagnosed with schizophrenia or depression. Some results tend to show improvement in suicide prevention, especially among men with comorbid substance abuse disorders known to be particularly vulnerable. However, other observations are somewhat worrisome. The emergency room as an introduction to mental health services did not ensure adequate aftercare. Interventions are needed to improve access and coordination between different health care services.
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Affiliation(s)
- Danielle Routhier
- Direction de la santé publique, Agence de la Santé et des Services sociaux de Montréal, Institut national de santé publique du Québec
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Kelly BJ, Perkins DA, Fuller JD, Parker SM. Shared care in mental illness: A rapid review to inform implementation. Int J Ment Health Syst 2011; 5:31. [PMID: 22104323 PMCID: PMC3235059 DOI: 10.1186/1752-4458-5-31] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 11/21/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While integrated primary healthcare for the management of depression has been well researched, appropriate models of primary care for people with severe and persistent psychotic disorders are poorly understood. In 2010 the NSW (Australia) Health Department commissioned a review of the evidence on "shared care" models of ambulatory mental health services. This focussed on critical factors in the implementation of these models in clinical practice, with a view to providing policy direction. The review excluded evidence about dementia, substance use and personality disorders. METHODS A rapid review involving a search for systematic reviews on The Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effects (DARE). This was followed by a search for papers published since these systematic reviews on Medline and supplemented by limited iterative searching from reference lists. RESULTS Shared care trials report improved mental and physical health outcomes in some clinical settings with improved social function, self management skills, service acceptability and reduced hospitalisation. Other benefits include improved access to specialist care, better engagement with and acceptability of mental health services. Limited economic evaluation shows significant set up costs, reduced patient costs and service savings often realised by other providers. Nevertheless these findings are not evident across all clinical groups. Gains require substantial cross-organisational commitment, carefully designed and consistently delivered interventions, with attention to staff selection, training and supervision. Effective models incorporated linkages across various service levels, clinical monitoring within agreed treatment protocols, improved continuity and comprehensiveness of services. CONCLUSIONS "Shared Care" models of mental health service delivery require attention to multiple levels (from organisational to individual clinicians), and complex service re-design. Re-evaluation of the roles of specialist mental health staff is a critical requirement. As expected, no one model of "shared" care fits diverse clinical groups. On the basis of the available evidence, we recommended a local trial that examined the process of implementation of core principles of shared care within primary care and specialist mental health clinical services.
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Affiliation(s)
- Brian J Kelly
- Centre for Brain and Mental Health Research, School of Medicine and Public Health, Faculty of Health University of Newcastle, University Drive, Callaghan 2308, Australia
| | - David A Perkins
- School of Nursing & Midwifery, Flinders University, Sturt Rd, Bedford Park 5024, Australia
| | - Jeffrey D Fuller
- Centre for Remote Health Research, Broken Hill University Department of Rural Health, University of Sydney, Corrindah Court, Broken Hill 2880, Australia
| | - Sharon M Parker
- Centre for Remote Health Research, Broken Hill University Department of Rural Health, University of Sydney, Corrindah Court, Broken Hill 2880, Australia
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Séguin M, Renaud J, Lesage A, Robert M, Turecki G. Youth and young adult suicide: a study of life trajectory. J Psychiatr Res 2011; 45:863-70. [PMID: 21636096 DOI: 10.1016/j.jpsychires.2011.05.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 05/02/2011] [Accepted: 05/06/2011] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Explore the unique developmental challenges and early adversity faced by youth and young adult who died of suicide. METHOD Sixty-seven suicide victims (SG) were compared with 56 living control with no suicidal ideations in the last year, matched for age, gender, and geographical region. Mixed methods were used: consensus DSM-IV diagnoses were formulated based on Structured Clinical Interview for DSM-IV (SCID)-I and -II interviews complemented by medical charts. Life calendar method was conducted with closest third party informant. Life-history calendar served to measure life events and adversity throughout the life course and were analyzed by attributing burden of adversity score per five-year segment, which was then cluster-analyzed to define suicide victim profiles. RESULTS During the last year, mood disorders, abuse and dependence disorders, and anxiety disorder were between 8 and 63 times more likely to be present in the suicide group. Between 0 and 4 years old, 50% of children in the SG were exposed to abuse, physical and/or sexual violence; 60% between 5 and 9 years old; and by the time they were 10-14 years old, 77% were exposed to these forms of violence. In the control group, the respective figures were 14%, 18% and 34%. In the suicide group, the trajectories leading to suicide are different as we observe two different subgroups, one with early-onset and one with later-onset of adversity. To a large extent, people in the suicide group were exposed to major adversity and they were more likely to present cumulative comorbid disorders.
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Affiliation(s)
- Monique Séguin
- Université du Québec en Outaouais, Department of Psychology, Canada.
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Bolton JM, Pagura J, Enns MW, Grant B, Sareen J. A population-based longitudinal study of risk factors for suicide attempts in major depressive disorder. J Psychiatr Res 2010; 44:817-26. [PMID: 20122697 PMCID: PMC2888712 DOI: 10.1016/j.jpsychires.2010.01.003] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 12/21/2009] [Accepted: 01/06/2010] [Indexed: 11/17/2022]
Abstract
No longitudinal study has examined risk factors for future suicide attempts in major depressive disorder in a nationally representative sample. The objective of this study was to investigate baseline sociodemographic characteristics, comorbid mental disorders, specific depressive symptoms, and previous suicidal behavior as potential risk factors for suicide attempts at 3 years follow-up. Data came from the national epidemiologic survey on alcohol and related conditions (NESARC), a large nationally representative longitudinal survey of mental illness in adults [Wave 1 (2001-2002); Wave 2 (2004-2005) n=34,653]. Logistic regression examined associations between risk factors present at Wave 1 and suicide attempts at Wave 2 (n=169) among individuals with major depressive disorder at baseline assessment (n=6004). Risk factors for incident suicide attempts at Wave 2 (n=63) were identified among those with major depressive disorder at Wave 1 and no lifetime history of suicide attempts (n=5170). Results revealed specific comorbid anxiety, personality, and substance use disorders to be associated with incident suicide attempts at Wave 2. Comorbid borderline personality disorder was strongly associated with suicide attempts in all models. Several comorbid disorders were strongly associated with suicide attempts at Wave 2 even after adjusting for previous suicidal behavior, notably posttraumatic stress disorder (adjusted odds ratio (AOR)=2.20; 95% confidence interval (95% CI) 1.27-3.83) and dependent personality disorder (AOR=4.43; 95% CI 1.93-10.18). These findings suggest that mental illness comorbidity confers an increased risk of future suicide attempts in major depressive disorder that is not solely accounted for by past suicidal behavior.
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Affiliation(s)
- James M Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada.
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Nepon J, Belik SL, Bolton J, Sareen J. The relationship between anxiety disorders and suicide attempts: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Depress Anxiety 2010; 27:791-8. [PMID: 20217852 PMCID: PMC2940247 DOI: 10.1002/da.20674] [Citation(s) in RCA: 196] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Previous work has suggested that anxiety disorders are associated with suicide attempts. However, many studies have been limited by lack of accounting for factors that could influence this relationship, notably personality disorders. This study aims to examine the relationship between anxiety disorders and suicide attempts, accounting for important comorbidities, in a large nationally representative sample. METHODS Data came from the National Epidemiologic Survey on Alcohol and Related Conditions Wave 2. Face-to-face interviews were conducted with 34,653 adults between 2004 and 2005 in the United States. The relationship between suicide attempts and anxiety disorders (panic disorder, agoraphobia, social phobia, specific phobia, generalized anxiety disorder, posttraumatic stress disorder (PTSD)) was explored using multivariate regression models controlling for sociodemographics, Axis I and Axis II disorders. RESULTS Among individuals reporting a lifetime history of suicide attempt, over 70% had an anxiety disorder. Even after adjusting for sociodemographic factors, Axis I and Axis II disorders, the presence of an anxiety disorder was significantly associated with having made a suicide attempt (AOR=1.70, 95% confidence interval (CI): 1.40-2.08). Panic disorder (AOR=1.31, 95% CI: 1.06-1.61) and PTSD (AOR=1.81, 95% CI: 1.45-2.26) were independently associated with suicide attempts in multivariate models. Comorbidity of personality disorders with panic disorder (AOR=5.76, 95% CI: 4.58-7.25) and with PTSD (AOR=6.90, 95% CI: 5.41-8.79) demonstrated much stronger associations with suicide attempts over either disorder alone. CONCLUSION Anxiety disorders, especially panic disorder and PTSD, are independently associated with suicide attempts. Clinicians need to assess suicidal behavior among patients presenting with anxiety problems.
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Affiliation(s)
- Josh Nepon
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shay-Lee Belik
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
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