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Snowdon J. Recognising inaccuracies in Australian suicide and 'hidden suicide' data. Australas Psychiatry 2024; 32:323-329. [PMID: 38653498 DOI: 10.1177/10398562241245548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To examine the effects of revision of Australian mortality statistics every year since 2007 on numbers and rates of suicide and 'hidden suicide'. METHOD Nine months after the end of each year, the Australian Bureau of Statistics releases preliminary statistics concerning deaths registered in that year, together with revised and finalised data regarding previous years. Numbers and rates of suicide and of deaths coded to selected categories of accidental, undetermined and unknown cause deaths were tabled. RESULTS Upward revision of suicide and accidental drug poisoning death numbers, three years after first release, show that true rates are substantially higher than initially released data suggested. Concomitant downward revision of rates of undetermined and unknown cause deaths supports evidence that at first release some suicides are coded to these categories. CONCLUSIONS Australia's finalised suicide data are likely to be more accurate than equivalent data from nations that do not revise mortality data. More comprehensive investigation (including verbal or psychological autopsy) in doubtful cases in Australia and elsewhere would probably lead to reported suicide rates being higher.
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Affiliation(s)
- John Snowdon
- Department of Psychogeriatrics, Concord Repatriation General Hospital, Concord, NSW, Australia; and
- Speciality of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Cabral S, Rocha T, Caetano S, Mari J, Borschmann R, Asevedo E. Decrease in suicide rates in Brazil during the COVID-19 pandemic. Psychiatry Res 2023; 329:115443. [PMID: 37769372 DOI: 10.1016/j.psychres.2023.115443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/30/2023]
Abstract
Natural disasters such as public health epidemics may potentially affect suicide rates. The global COVID-19 pandemic poses an unprecedented challenge for healthcare systems and general populations worldwide. In this retrospective ecological study, we aimed to examine any changes in the suicide rates during the COVID-19 pandemic and to assess the relationship between COVID-19 death rates and deaths by suicide in Brazil. Data on suicide and COVID-19 case numbers were extracted from the Ministry of Health agencies and grouped weekly. We performed a time series analysis of suicide rates, a comparison of mean suicide rates between the pre-COVID-19 period and the COVID-19 period, and conducted a Poisson regression to examine the relationship between deaths due to COVID-19 and suicide rates. Our results showed decreased suicide rates during the COVID-19 pandemic. We also found that deaths owing to COVID-19 impact those owing to suicide after 10 weeks in the upward direction; however, we did not observe for enough time to see a change in the suicide rate curve. These findings are fundamental to understand suicidal behaviors in epidemic situations. However, the field needs more studies evaluating the impact of significant public health events on suicidality, incorporating extended follow-up periods.
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Affiliation(s)
- S Cabral
- Unidade de Psiquiatria, Hospital de Base, Instituto de Gestão Estratégica de Saúde do Distrito Federal (IGESDF), Distrito Federal, DF, Brazil; Departamento de Psiquiatria e Psicologia Médica, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - T Rocha
- Departamento de Psiquiatria e Psicologia Médica, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - S Caetano
- Unidade de Psiquiatria, Hospital de Base, Instituto de Gestão Estratégica de Saúde do Distrito Federal (IGESDF), Distrito Federal, DF, Brazil
| | - J Mari
- Unidade de Psiquiatria, Hospital de Base, Instituto de Gestão Estratégica de Saúde do Distrito Federal (IGESDF), Distrito Federal, DF, Brazil
| | - R Borschmann
- Justice Health Unit, Centre for Health Equity, The University of Melbourne, Carlton, Victoria, Australia; Department of Psychiatry, University of Oxford, Warneford Hospital, UK; Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia; Melbourne School of Psychological Sciences, The University of Melbourne, Victoria, Australia
| | - E Asevedo
- Departamento de Psiquiatria e Psicologia Médica, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
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Eide D, Skurtveit S, Clausen T, Hesse M, Mravčík V, Nechanská B, Rolová G, Thylstrup B, Tjagvad C, Seid AK, Odsbu I, Gabrhelík R. Cause-Specific Mortality among Patients in Treatment for Opioid Use Disorder in Multiple Settings: A Prospective Comparative Cohort Study. Eur Addict Res 2023; 29:272-284. [PMID: 37385232 PMCID: PMC10614278 DOI: 10.1159/000530822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 04/18/2023] [Indexed: 07/01/2023]
Abstract
INTRODUCTION Among people receiving current or previous opioid maintenance treatment (OMT), the leading cause of premature death is an opioid overdose. However, other causes of mortality remain high in this group. An understanding of causes of deaths across multiple settings can be useful in informing more comprehensive prevention responses. The aim of this study was to describe all non-overdose causes of death in three national cohorts (Czechia, Denmark, and Norway) among OMT patients and to explore associations of non-overdose mortality with age and gender. METHODS This prospective comparative cohort study used national mortality registry databases for OMT patients from Czechia (2000-2019), Denmark (2000-2018), and Norway (2010-2019). Crude mortality rates and age-standardized mortality rates (ASMRs) were calculated as deaths per 1,000 person years for cause-specific mortality. RESULTS In total, 29,486 patients were included, with 5,322 deaths recorded (18%). We found variations in causes of death among the cohorts and within gender and age groups. The leading non-overdose causes of death were accidents in Czechia and Denmark, and neoplasms in Norway. Cardiovascular deaths were highest in Czechia, particularly for women in OMT (ASMR 3.59 vs. 1.24 in Norway and 1.87 in Denmark). CONCLUSION This study found high rates of preventable death among both genders and all age groups. Different demographic structures, variations in risk exposure, as well as variations in coding practices can explain the differences. The findings support increased efforts towards screening and preventative health initiatives among OMT patients specific to the demographic characteristics in different settings.
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Affiliation(s)
- Desiree Eide
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Svetlana Skurtveit
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
- Norwegian Institute of Public Health, Oslo, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Morten Hesse
- Centre for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark
| | - Viktor Mravčík
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Addictology, General University Hospital in Prague, Prague, Czech Republic
| | - Blanka Nechanská
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Addictology, General University Hospital in Prague, Prague, Czech Republic
| | - Gabriela Rolová
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Addictology, General University Hospital in Prague, Prague, Czech Republic
| | - Birgitte Thylstrup
- Centre for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark
| | - Christian Tjagvad
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Abdu Kedir Seid
- Centre for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark
| | - Ingvild Odsbu
- Norwegian Institute of Public Health, Oslo, Norway
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Roman Gabrhelík
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Addictology, General University Hospital in Prague, Prague, Czech Republic
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Ramos-Martín J, Contreras-Peñalver MÁ, Moreno-Küstner B. Classification of suicidal behavior calls in emergency medical services: a systematic review. Int J Emerg Med 2023; 16:27. [PMID: 37069512 PMCID: PMC10108483 DOI: 10.1186/s12245-023-00504-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 04/02/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND The aim of this systematic review was to examine the classification of calls for suicidal behavior in emergency medical services (EMS). METHODS A search strategy was carried out in four electronic databases on calls for suicidal behavior in EMS published between 2010 and 2020 in Spanish and English. The outcome variables analyzed were the moment of call classification, the professional assigning the classification, the type of classification, and the suicide codes. RESULTS Twenty-five studies were included in the systematic review. The EMS classified the calls at two moments during the service process. In 28% of the studies, classification was performed during the emergency telephone call and in 36% when the professional attended the patient at the scene. The calls were classified by physicians in 40% of the studies and by the telephone operator answering the call in 32% of the studies. In 52% of the studies, classifications were used to categorize the calls, while in 48%, this information was not provided. Eighteen studies (72%) described codes used to classify suicidal behavior calls: a) codes for suicidal behavior and self-injury, and b) codes related to intoxication, poisoning or drug abuse, psychiatric problems, or other methods of harm. CONCLUSION Despite the existence of international disease classifications and standardized suicide identification systems and codes in EMS, there is no consensus on their use, making it difficult to correctly identify calls for suicidal behavior.
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Affiliation(s)
- Javier Ramos-Martín
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico. Universidad de Málaga, Doctor Ortiz Ramos, S/N 29010, Málaga, Spain.
| | - M Ángeles Contreras-Peñalver
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico. Universidad de Málaga, Doctor Ortiz Ramos, S/N 29010, Málaga, Spain
| | - Berta Moreno-Küstner
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico. Universidad de Málaga, Doctor Ortiz Ramos, S/N 29010, Málaga, Spain
- Grupo Andaluz de Investigación Psicosocial (GAP) (CTS-945), Málaga, Spain
- Instituto de Biomedicina de Málaga (IBIMA), Málaga, Spain
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Adviento BA, Regan EA, Make BJ, Han MK, Foreman MG, Iyer AS, Bhatt SP, Kim V, Bon J, Soler X, Kinney GL, Hanania NA, Lowe KE, Holm KE, Yohannes AM, Shinozaki G, Hoth KF, Fiedorowicz JG. Clinical Markers Associated With Risk of Suicide or Drug Overdose Among Individuals With Smoking Exposure: A Longitudinal Follow-up Study of the COPDGene Cohort. Chest 2023; 163:292-302. [PMID: 36167120 PMCID: PMC10083129 DOI: 10.1016/j.chest.2022.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/11/2022] [Accepted: 09/03/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Studies have shown that COPD and smoking are associated with increased suicide risk. To date, there are no prospective studies examining suicide risk among individuals with smoking exposure along a spectrum of pulmonary diseases ranging from normal spirometry to severe COPD. RESEARCH QUESTION Which clinical variables predict death by suicide or overdose of indeterminate intent in a large cohort of individuals with smoking exposure within the Genetic Epidemiology of COPD (COPDGene) study? STUDY DESIGN AND METHODS We studied data from 9,930 participants involved in COPDGene, a multisite, prospective cohort study of individuals with smoking exposure. Primary cause of adjudicated deaths was identified by using death certificates, family reports, and medical records. Time to death by suicide/overdose was examined as the primary outcome in Cox regression models including age, sex, race, BMI, pack-years, current smoking status, airflow limitation (FEV1 % predicted), dyspnea (modified Medical Research Council scale score ≥ 2), 6-min walk distance, supplemental oxygen use, and severe exacerbations in the prior year with time-varying covariates and other causes of death as a competing risk. RESULTS The cohort was 47% female and 33% Black (67% White); they had a mean ± SD age of 59.6 ± 9.0 years and a mean FEV1 % predicted of 76.1 ± 25.5. Sixty-three individuals died by suicide/overdose. Factors associated with risk of suicide/overdose were current smoking (hazard ratio [HR], 6.44; 95% CI, 2.64-15.67), use of sedative/hypnotics (HR, 2.33; 95% CI, 1.24-4.38), and dyspnea (HR, 2.23; 95% CI, 1.34-3.70). Lower risk was associated with older age (per-decade HR, 0.45; 95% CI, 0.31-0.67), higher BMI (HR, 0.95; 95% CI, 0.91-0.99), and African-American race (HR, 0.41; 95% CI, 0.23-0.74). Severity of airflow limitation (FEV % predicted) was not associated with suicide risk. INTERPRETATION In this well-characterized cohort of individuals with smoking exposure with and without COPD, risk factors for suicide/overdose were identified that emphasize the subjective experience of illness over objective assessments of lung function.
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Affiliation(s)
- Brigid A Adviento
- Department of Psychiatry, University of Iowa, Iowa City, IA; Department of Internal Medicine, University of Iowa, Iowa City, IA
| | - Elizabeth A Regan
- Division of Rheumatology, Department of Medicine, National Jewish Health, Denver, CO
| | - Barry J Make
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO; Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Marilyn G Foreman
- Pulmonary and Critical Care Medicine Division, Morehouse School of Medicine, Atlanta, GA
| | - Anand S Iyer
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Jessica Bon
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA; VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Xavier Soler
- Department of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, San Diego, CA
| | - Gregory L Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX
| | - Katherine E Lowe
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Kristen E Holm
- Division of Neurology and Behavioral Health, National Jewish Health, Denver, CO; Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado, Aurora, CO
| | | | - Gen Shinozaki
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA
| | - Karin F Hoth
- Department of Psychiatry, University of Iowa, Iowa City, IA; Iowa Neuroscience Institute, University of Iowa, Iowa City, IA.
| | - Jess G Fiedorowicz
- Ottawa Hospital, Ottawa Hospital Research Institute, and University of Ottawa, Ottawa, Ontario, Canada
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Rodrigues WTDS, Simões TC, Magnago C, Dantas ESO, Guimarães RM, Jesus JCD, de Andrade Fernandes SMB, Meira KC. The influence of the age-period-cohort effects on male suicide in Brazil from 1980 to 2019. PLoS One 2023; 18:e0284224. [PMID: 37053241 PMCID: PMC10101429 DOI: 10.1371/journal.pone.0284224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
Suicide is a complex and multi-determined phenomenon. Higher rates are observed in men and are related to multiple risk factors, including mental disorders, financial crises, unemployment, and easy access to highly lethal means of perpetration, such as firearms. We studied the effects of age, period, and cohort (APC) on total and firearm-related suicides in men in Brazil and its major regions from 1980 to 2019. Death records were extracted from the Brazilian Ministry of Health's Mortality Information System. Estimable functions were used to estimate APC models, through the Epi library of the R statistical program, version 4.2.1. During the study period, Brazil had an average rate of 10.22 deaths per 100,000 men. Among regions, rates ranged from 8.62 (Northeast) to 16.93 (South). The same profile was observed in suicides by firearms. After estimating the APC models, we observed a temporal trend of increasing total suicides for Brazil and regions, except for the South region, where the trend was stationary. The trend was downward for firearm suicides for all locations. A positive gradient was observed in the mortality rate with advancing age for total suicides; and peak incidence between 20-29 years, with subsequent stabilization, for suicides perpetrated by firearms. There was a reduction in the risk of death for suicides perpetrated by firearms in relation to the reference period (1995-1999) for all locations, except in the North region, where the effect was not significant. The younger generations from the 1960s onwards had a higher risk of death from total suicide and a lower risk for those perpetrated by firearms in relation to the reference cohort (1950-1954). We observed a reduction in the mortality trend for suicides perpetrated by firearms, a reduction in the risk of death in the 2000s and for men born after 1960. Our results suggest reducing the risk of death from suicide by firearms in Brazil and regions. However, there is an upward trend in mortality from total suicides in the study period (1980-2019) and for younger cohorts.
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Affiliation(s)
| | - Taynãna César Simões
- René Rachou Research Institute, Oswaldo Cruz Foundation of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Carinne Magnago
- School of Public Health, University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Karina Cardoso Meira
- School of Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Snowdon J, Choi N. Unanticipated Changes in Drug Overdose Death Rates in Canada During the Opioid Crisis. Int J Ment Health Addict 2022:1-19. [PMID: 36248265 PMCID: PMC9550153 DOI: 10.1007/s11469-022-00932-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 01/09/2023] Open
Abstract
Escalating drug overdose death rates in Canada are of ever-increasing concern. To better understand the extent of this health threat, we obtained mortality statistics and population figures for the years 2000 to 2020, and examined rates of overdose deaths, coded (using ICD-10) as accidental, suicide or "undetermined intent." The drug deemed as primarily responsible for the death was categorized as opioid, non-opioid, or unspecified. Age patterns of drug deaths were graphed. Joinpoint analysis was used to test the significance of changes in death rates. Accidental opioid and stimulant overdose death rates in Canada have climbed faster since 2011, though not as high as corresponding US rates. Unknown cause death rates have increased. However, opioid and non-opioid suicide rates have decreased significantly since 2011, and there have been fewer drug deaths of undetermined intent. Increased attention to the possibility that some suicides are being misclassified is warranted.
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Affiliation(s)
- John Snowdon
- Discipline of Psychiatry, Sydney Medical School, Sydney, NSW Australia
- Centre for Mental Health, Concord Hospital, Concord, NSW 2139 Australia
| | - Namkee Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX USA
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King TL, Disney G, Sutherland G, Kavanagh A, Spittal MJ, Simons K. Associations between workers’ compensation and self-harm: A retrospective case-series study of hospital admissions data. THE LANCET REGIONAL HEALTH - WESTERN PACIFIC 2022; 30:100614. [DOI: 10.1016/j.lanwpc.2022.100614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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9
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Kurisu K, Fujimori M, Harashima S, Akechi T, Matsuda T, Saika K, Yoshiuchi K, Miyashiro I, Uchitomi Y. Suicide, other externally caused injuries, and cardiovascular disease within 2 years after cancer diagnosis: A nationwide population-based study in Japan (J-SUPPORT 1902). Cancer Med 2022; 12:3442-3451. [PMID: 35941747 PMCID: PMC9939211 DOI: 10.1002/cam4.5122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/13/2022] [Accepted: 07/19/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND This study aimed to investigate the risk of death by suicide, other externally caused injuries (ECIs), or cardiovascular disease for patients with cancer. METHODS We used data from the National Cancer Registry, which include the entire population in Japan. Patients diagnosed with cancer from January 1 to December 31, 2016 were included, and their follow-up period was set to 2 years. The standardized mortality ratio (SMR) of death by suicide, other ECIs, and cardiovascular disease was calculated compared with the general population. Multivariate Poisson or negative binomial regression analysis was used to quantify the adjusted relative risks of factors of interest. RESULTS We evaluated 1,070,876 patients with cancer. The 2-year follow-up SMR was 1.84 (95% confidence interval [CI]: 1.71-1.99) for suicide, 1.30 (95% CI: 1.24-1.37) for other ECIs, and 1.19 (95% CI: 1.17-1.21) for cardiovascular disease. The SMR was higher with shorter follow-up periods but was significant 13-24 months after cancer diagnosis. The SMRs at 0-1 month and 13-24 months, respectively, were 4.40 (95% CI: 3.51-5.44) and 1.31 (95% CI: 1.14-1.50) for suicide; 2.27 (95% CI: 1.94-2.63) and 1.27 (95% CI: 1.18-1.37) for other ECIs; and 2.38 (95% CI: 2.27-2.50) and 1.07 (95% CI: 1.04-1.10) for cardiovascular disease. The multivariate analyses showed that patients with cancers other than localized tumors had significantly high relative risks of death for each cause. CONCLUSION Suicide prevention countermeasures for patients with cancer, especially those with advanced disease immediately after diagnosis, are warranted.
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Affiliation(s)
- Ken Kurisu
- Division of Supportive Care, Survivorship and Translational Research, Group for Supportive Care and Survivorship Research, Institute for Cancer ControlNational Cancer Center JapanTokyoJapan,Department of Stress Sciences and Psychosomatic Medicine, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Maiko Fujimori
- Division of Supportive Care, Survivorship and Translational Research, Group for Supportive Care and Survivorship Research, Institute for Cancer ControlNational Cancer Center JapanTokyoJapan
| | - Saki Harashima
- Division of Supportive Care, Survivorship and Translational Research, Group for Supportive Care and Survivorship Research, Institute for Cancer ControlNational Cancer Center JapanTokyoJapan,Department of Stress Sciences and Psychosomatic Medicine, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive‐Behavioral MedicineNagoya City University, Graduate School of Medical SciencesNagoyaJapan
| | - Tomohiro Matsuda
- Division of International Health Policy Research, Institute for Cancer ControlNational Cancer Center JapanTokyoJapan
| | - Kumiko Saika
- Division of International Health Policy Research, Institute for Cancer ControlNational Cancer Center JapanTokyoJapan
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Isao Miyashiro
- Cancer Control CenterOsaka International Cancer InstituteOsakaJapan
| | - Yosuke Uchitomi
- Division of Supportive Care, Survivorship and Translational Research, Group for Supportive Care and Survivorship Research, Institute for Cancer ControlNational Cancer Center JapanTokyoJapan,Innovation Center for Supportive, Palliative and Psychosocial CareNational Cancer CenterTokyoJapan
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10
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Chen Y, Yu K, Xiong J, Zhang J, Zhou S, Dai J, Wu M, Wang S. Suicide and Accidental Death Among Women With Primary Ovarian Cancer: A Population-Based Study. Front Med (Lausanne) 2022; 9:833965. [PMID: 35372450 PMCID: PMC8966220 DOI: 10.3389/fmed.2022.833965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/21/2022] [Indexed: 01/09/2023] Open
Abstract
Background Women with ovarian cancer had the highest suicidal rate among all patients with gynecological malignancies, but no large studies about suicide and accidental death for women with ovarian cancers in detail were conducted. We aimed to determine the relative risk of suicide and accidental death among patients with ovarian cancer to that of the general population, and to identify risk factors associated with suicide and accidental death. Methods Data are from the SEER (surveillance, epidemiology, and end results) cancer registry of women diagnosed with ovarian cancer data from 18 registries for the years 1973–2016. The study population comprised 149,204 patients after inclusion and exclusion criteria were applied. Standardized mortality ratios (SMRs) were calculated and Fine-Gray models were fitted to identify risk factors associated with suicidal and accidental death among cancer patients, with stratifications on demographic and tumor-related characteristics. Results Women with ovarian cancer had a higher risk of suicide and accidental death than the cancer-free group [SMR = 1.86; 95% CI (1.54–2.25) and SMR = 1.54; 95% CI (1.39–1.71)]. Subgroup analysis indicated that only patients with type II epithelial ovarian cancer [SMR = 2.31; 95% CI (1.83–2.91)] had an increased risk of suicide, and those with type I and type II epithelial ovarian cancer [SMR = 1.65; 95% CI (1.39–1.97) and SMR = 1.49; 95% CI (1.30–1.70)] were at a higher risk of accidental death. Patients with ovarian cancer who were younger, white, diagnosed with high-grade, non-metastatic cancer and pelvic exenteration were at a higher risk of suicide. The advanced age, earlier year of diagnosis, and non-metastatic cancer were associated with a higher risk of accidental death. Additionally, pelvic exenteration increased the risk of suicide but not the risk of accidental death among women with primary ovarian cancer. Conclusions Women with ovarian cancer had a higher risk of suicide and accidental death compared with the general population. The findings suggested that clinicians should identify high-risk subgroups of ovarian cancer patients for suicide and accidental death as early as possible, with appropriate prevention strategies.
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Affiliation(s)
- Ying Chen
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaixu Yu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaqiang Xiong
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jinjin Zhang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Su Zhou
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Dai
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Meng Wu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shixuan Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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11
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Hein TC, Cooper SA, McCarthy JF. Mortality following non-fatal suicide attempts by Veterans in Veterans Health Administration care. Suicide Life Threat Behav 2022; 52:222-230. [PMID: 34816474 DOI: 10.1111/sltb.12811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/28/2021] [Accepted: 09/30/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Little is known regarding long-term mortality outcomes after non-fatal suicide attempts among Veterans Health Administration (VHA) patients, which may inform services delivery and program evaluation. METHODS For 4,601,081 Veterans with 2005 VHA encounters, we assessed unadjusted and age-adjusted all-cause and cause-specific mortality through 2017, overall and for Veterans with (N = 8243) versus without (N = 4,592,838) 2005 VHA suicide attempt documentation. Standardized mortality ratios compared mortality rates by suicide attempt status. Multivariable proportional hazards regression models assessed age- and gender-adjusted mortality risk. RESULTS Among Veteran VHA users with non-fatal suicide attempt diagnoses, 1.6% died of suicide, 4.6% of non-suicide external causes, and 30.7% of any cause. In age- and gender-adjusted analyses, Veterans who attempted suicide had increased suicide (hazard ratio [HR] = 4.52, 95% confidence interval [CI] = 3.82-5.36), non-suicide external cause (HR = 3.75, 95% CI = 3.38-4.17), and all-cause (separate due to non-proportional hazards: 2006, HR = 2.05, 95% CI = 1.81-2.31; 2007-2017, HR = 1.72, 95% CI = 1.65-1.80) mortality through 2017. CONCLUSION Over 12 years, Veteran VHA patients with non-fatal suicide attempt diagnoses had increased risk of suicide, non-suicide external cause, and all-cause mortality. Over 98% of Veteran VHA users who had a diagnosed non-fatal attempt did not die by suicide, highlighting additional program evaluation outcomes and opportunities to support physical and mental health.
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Affiliation(s)
- Tyler C Hein
- Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, Ann Arbor, Michigan, USA
| | - Samantha A Cooper
- Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, Ann Arbor, Michigan, USA
| | - John F McCarthy
- Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, Ann Arbor, Michigan, USA
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12
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Swoboda MMM, Bartova L, Dremel M, Rabl U, Laggner A, Frey R. The Toxicity Potential of Antidepressants and Antipsychotics in Relation to Other Medication and Alcohol: A Naturalistic and Retrospective Study. Front Psychiatry 2022; 13:825546. [PMID: 35669269 PMCID: PMC9165614 DOI: 10.3389/fpsyt.2022.825546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/11/2022] [Indexed: 01/09/2023] Open
Abstract
QT interval prolongation and ventricular tachyarrhythmia are potential adverse effects of antidepressant (AD) and antipsychotic- (AP) agents, especially when overdosed. Since AD and AP agents are often prescribed to patients suffering from suicidal intentions, it is essential to estimate these risks in the context of intoxications. This retrospective and naturalistic one-year registry study included 105 patients treated for oral intoxication at the University Department of Emergency Medicine in Vienna, Austria. AD/AP intoxications were present in 26 patients, while in the control group (n = 79) non-AD/AP drugs (n = 54) and exclusively alcohol (n = 25) were the toxic agents. QT intervals, the necessity of intubation, the extent of conscious state, and the subsequent discharge management were compared. The mean age was 34.94 ± 14.6 years, 62 patients (59%) were female. There were no significant between-group differences regarding QT prolongation >470 ms using Bazett's correction (p = 0.178), or >440 ms using Fridericia's correction (p = 0.760). No significant group differences concerning the need for intubation were observed (p = 0.747). The AD/AP and the control group did not significantly differ regarding Glasgow Coma Scale scores (p = 0.439). Patients with AD/AP intoxication were significantly more often transferred to the psychiatric department, while discharge to home was more likely in the control group (p = 0.002). These results suggest that the risk of a potentially life-threatening outcome in cases of intoxication with AD/AP is not substantially higher than in other easily available toxic agents, in line with the advantageous risk/benefit ratio of newer ADs and APs.
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Affiliation(s)
- Marleen M M Swoboda
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Marlene Dremel
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Ulrich Rabl
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Anton Laggner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Richard Frey
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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13
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Matsubayashi T, Ueda M. Is suicide underreported? Evidence from Japan. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1571-1578. [PMID: 34767033 PMCID: PMC9288949 DOI: 10.1007/s00127-021-02188-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/31/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE The underreporting of suicides has been a serious global concern among scholars and policymakers. Several studies have sought to detect the prevalence of underreporting by examining whether suicide mortality rates are negatively correlated with those due to unknown intent or causes. This study adds to the literature by examining the potential underreporting of suicides in Japan, where suicide rates have greatly declined in the recent years. METHODS We compiled subnational data from 47 prefectures between 1995 and 2016, obtained from Vital Statistics of Japan. We examined whether (1) mortality rates due to unknown intent or causes increased as suicide rates decreased; and (2) major socioeconomic causes of suicide (unemployment and divorce rates) had any relationship with the deaths due to unknown intent or causes. RESULTS Our analysis indicates that mortality rates due to unknown intent or causes were uncorrelated with suicide rates and the above socioeconomic indicators. CONCLUSIONS In Japan, the frequency of suicides has no systematic relationship with deaths due to unknown intent or causes, suggesting the accuracy of suicide statistics.
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Affiliation(s)
| | - Michiko Ueda
- grid.5290.e0000 0004 1936 9975Waseda University, Tokyo, Japan
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14
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Barreto AAM, Souza LEPFD. Unemployment and suicide among the Brazilian population in the crisis of capitalism. CIENCIA & SAUDE COLETIVA 2021; 26:5869-5882. [PMID: 34909980 DOI: 10.1590/1413-812320212612.14672021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/21/2021] [Indexed: 01/09/2023] Open
Abstract
The current crisis of capitalism has multiple economic, financial, social, environmental, cultural and political facets. In Brazil, the severity of the crisis is no different, resulting from the exhaustion of the neo-developmentalist model and its inability to resist global crisis. This study compares suicide mortality rates (MR) among employed and unemployed persons in Brazil prior to and during the economic crisis using death records from the period 2011 to 2016. The findings show that in the period 2011 to 2016 the suicide MR fell from 2.66/100,000 to 2.46 among unemployed persons and increased from 5.52/100,000 to 6.89/100,000 in employed persons. Suicide is a complex, multi-causal phenomenon determined by a diverse range of social factors, including strategies that increase worker exploitation. Indeed, being employed can have a greater negative impact on the mental health of workers than being unemployed.
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Affiliation(s)
- Antonio Angelo Menezes Barreto
- Instituto de Saúde Coletiva, Universidade Federal da Bahia. R. Basílio da Gama s/n, Canela. 40110-040 Salvador BA Brasil.
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15
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Sujan AC, O'Reilly LM, Rickert ME, Larsson H, Lichtenstein P, Oberg AS, D'Onofrio BM. A Nation-Wide Swedish Cohort Study on Early Maternal Age at First Childbirth and Risk for Offspring Deaths, Accidents, and Suicide Attempts. Behav Genet 2021; 52:38-47. [PMID: 34762227 DOI: 10.1007/s10519-021-10091-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 10/31/2021] [Indexed: 01/09/2023]
Abstract
In a sample of over one million Swedish first-born offspring, we examined associations between early maternal age at first childbirth (MAFC; i.e., < 20 and 20-24 vs 25-29 years) and offspring non-accidental deaths, accidental deaths, deaths by suicide, non-fatal accidents, and suicide attempts. We included year of birth and several maternal and paternal characteristics as covariates and conducted maternal cousin comparisons to adjust for unmeasured confounding. Early MAFC (e.g., teenage childbearing) was associated with all outcomes, with the most pronounced risk elevation for accidental deaths [Hazard Ratio (HR) < 20 2.50, 95% confidence interval (CI) 2.23, 2.80], suicides (HR < 20 2.08, 95% CI 1.79, 2.41), and suicide attempts (HR < 20 2.85, 95% CI 2.71, 3.00). Adjusting for covariates and comparing cousins greatly attenuated associations (e.g., accidental deaths HR < 20 1.61, 95% CI 1.22, 2.11; suicides HR < 20 1.01, 95% CI 0.69, 1.47; and suicide attempts HR < 20 1.35, 95% CI 1.19, 1.52). A similar pattern emerged for non-accidental deaths and non-fatal accidents. Therefore, results indicated maternal background factors may be largely responsible for observed associations.
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Affiliation(s)
- Ayesha C Sujan
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
| | - Lauren M O'Reilly
- Department of Psychological & Brain Sciences, Indiana University-Bloomington, Bloomington, IN, USA
| | - Martin E Rickert
- Department of Psychological & Brain Sciences, Indiana University-Bloomington, Bloomington, IN, USA
| | - Henrik Larsson
- School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - A Sara Oberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, T.H. Chan School of Public Health, Harvard, Boston, USA
| | - Brian M D'Onofrio
- Department of Psychological & Brain Sciences, Indiana University-Bloomington, Bloomington, IN, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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16
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Dantas ESO, Farias YMF, Rezende EB, Silva GWDS, Silva PGD, Meira KC. Estimates of suicide mortality in women residents in northeast brazilian states from 1996 to 2018. CIENCIA & SAUDE COLETIVA 2021; 26:4795-4804. [PMID: 34730664 DOI: 10.1590/1413-812320212610.29552020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 08/24/2020] [Indexed: 01/09/2023] Open
Abstract
The objective of this study was to analyze the temporal trend of suicide mortality in women in the states of Northeastern Brazil. This is an ecological study of a time series stratified by states in Northeast Brazil from 1996 to 2018, with data extracted from the Mortality Information System (SIM). The temporal trend was evaluated by negative binomial regression (p values≤0.05). There was a higher proportion of deaths in black and brown women (73.9%), single (57.3%), with the place of death occurring in the home (53.4%). Hanging and strangulation stood out as the perpetration means (47.6%). Most states showed an upward temporal trend, except for Pernambuco, Rio Grande do Norte, Sergipe and Maranhão, which showed a steady trend (p>0.05). An upward temporal trend was identified in the analysis of deaths by suicide in women in five states in northeastern Brazil between 1996 and 2018. The information presented can support planning and decision-making for the prevention of suicide among women in northeastern Brazil.
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Affiliation(s)
- Eder Samuel Oliveira Dantas
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte (UFRN). Av. Nilo Peçanha 620, Petrópolis. 59012-300 Natal RN Brasil.
| | | | | | | | - Pedro Gilson da Silva
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte (UFRN). Av. Nilo Peçanha 620, Petrópolis. 59012-300 Natal RN Brasil.
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17
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Eiffert S, Li CX, Anthony K, Poole C. RE: "TRENDS IN 'DEATHS OF DESPAIR' AMONG WORKING-AGED WHITE AND BLACK AMERICANS, 1990-2017". Am J Epidemiol 2021; 191:363-365. [PMID: 34664613 PMCID: PMC8897988 DOI: 10.1093/aje/kwab256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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18
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Adams RS, Jiang T, Rosellini AJ, Horváth-Puhó E, Street AE, Keyes KM, Cerdá M, Lash TL, Sørensen HT, Gradus JL. Sex-Specific Risk Profiles for Suicide Among Persons with Substance Use Disorders in Denmark. Addiction 2021; 116:2882-2892. [PMID: 33620758 PMCID: PMC8459184 DOI: 10.1111/add.15455] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/14/2020] [Accepted: 02/10/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND AIMS Persons with substance use disorders (SUDs) are at elevated risk of suicide death. We identified novel risk factors and interactions that predict suicide among men and women with SUD using machine learning. DESIGN Case-cohort study. SETTING Denmark. PARTICIPANTS The sample was restricted to persons with their first SUD diagnosis during 1995 to 2015. Cases were persons who died by suicide in Denmark during 1995 to 2015 (n = 2774) and the comparison subcohort was a 5% random sample of individuals in Denmark on 1 January 1995 (n = 13 179). MEASUREMENTS Suicide death was recorded in the Danish Cause of Death Registry. Predictors included social and demographic information, mental and physical health diagnoses, surgeries, medications, and poisonings. FINDINGS Persons among the highest risk for suicide, as identified by the classification trees, were men prescribed antidepressants in the 4 years before suicide and had a poisoning diagnosis in the 4 years before suicide; and women who were 30+ years old and had a poisoning diagnosis 4 years before and 12 months before suicide. Among men with SUD, the random forest identified five variables that were most important in predicting suicide; reaction to severe stress and adjustment disorders, drugs used to treat addictive disorders, age 30+ years, antidepressant use, and poisoning in the 4 prior years. Among women with SUD, the random forest found that the most important predictors of suicide were prior poisonings and reaction to severe stress and adjustment disorders. Individuals in the top 5% of predicted risk accounted for 15% of all suicide deaths among men and 24% of all suicides among women. CONCLUSIONS In Denmark, prior poisoning and comorbid psychiatric disorders may be among the most important indicators of suicide risk among persons with substance use disorders, particularly among women.
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Affiliation(s)
- Rachel Sayko Adams
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
- Rocky Mountain Mental Illness Research Education and Clinical Center, Veterans Health Administration, Aurora, CO, USA
| | - Tammy Jiang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Anthony J Rosellini
- Center for Anxiety and Related Disorders, Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | | | - Amy E Street
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Katherine M Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Henrik Toft Sørensen
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Jaimie L Gradus
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
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Karnecki K, Steiner J, Guest PC, Krzyżanowska M, Mańkowski D, Gos T, Kaliszan M. Epidemiology of suicide in the Tricity metropolitan area in northern Poland 1980–2009: Evidence of influence by political and socioeconomic changes. FORENSIC SCIENCE INTERNATIONAL: REPORTS 2021. [DOI: 10.1016/j.fsir.2021.100219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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20
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Doucette ML, Borrup KT, Lapidus G, Whitehill JM, McCourt AD, Crifasi CK. Effect of Washington State and Colorado's cannabis legalization on death by suicides. Prev Med 2021; 148:106548. [PMID: 33838156 DOI: 10.1016/j.ypmed.2021.106548] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 04/02/2021] [Accepted: 04/03/2021] [Indexed: 01/09/2023]
Abstract
In the U.S., death by suicide is a leading cause of death and was the 2nd leading cause of death for ages 15-to-34 in 2018. Though incomplete, much of the scientific literature has found associations between cannabis use and death by suicide. Several states and the District of Columbia have legalized cannabis for general adult use. We sought to evaluate whether cannabis legalization has impacted suicide rates in Washington State and Colorado, two early adopters. We used a quasi-experimental research design with annual, state-level deaths by suicide to evaluate the legalization of cannabis in Washington State and Colorado. We used synthetic control models to construct policy counterfactuals as our primary method of estimating the effect of legalization, stratified by age, gender, and race/ethnicity. Overall death by suicide rates were not impacted in either state. However, when stratified by age categories, deaths by suicide increased 17.9% among 15-24-year-olds in Washington State, or an additional 2.13 deaths per 100,000 population (p-value ≤0.001). Other age groups did not show similar associations. An ad hoc analysis revealed, when divided into legal and illegal consumption age, 15-20-year olds had an increase in death by suicides of 21.2% (p-value = 0.026) and 21-24-year olds had an increase in death by suicides of 18.6% (p-value ≤0.001) in Washington State. The effect of legalized cannabis on deaths by suicide appears to be heterogeneous. Deaths by suicide among 15-24-year-olds saw significant increases post-implementation in Washington State but not in Colorado.
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Affiliation(s)
- Mitchell L Doucette
- Johns Hopkins Center for Injury Research and Policy, Baltimore, MD United States of America; Injury Prevention Center, Connecticut Children's Medical Center, Hartford, CT, United States of America.
| | - Kevin T Borrup
- University of Connecticut School of Medicine, Farmington, CT, United States of America
| | - Garry Lapidus
- University of Connecticut School of Medicine, Farmington, CT, United States of America
| | | | - Alexander D McCourt
- Johns Hopkins Center for Injury Research and Policy, Baltimore, MD United States of America; Johns Hopkins Center for Gun Violence Prevention and Policy, Baltimore, MD, United States of America
| | - Cassandra K Crifasi
- Johns Hopkins Center for Injury Research and Policy, Baltimore, MD United States of America; Johns Hopkins Center for Gun Violence Prevention and Policy, Baltimore, MD, United States of America
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21
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Mercado MC, Stone DM, Kokubun CW, Trudeau ART, Gaylor E, Holland KM, Bartholow BN. Inconsistencies in Overdose Suicide Death Investigation Practice and Potential Remedies Using Technology: A Centers for Disease Control and Prevention Consultation Meeting Summary. Acad Forensic Pathol 2021; 11:83-93. [PMID: 34567327 PMCID: PMC8408809 DOI: 10.1177/19253621211022464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 05/02/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION It is widely accepted that suicides-which account for more than 47 500 deaths per year in the United States-are undercounted by 10% to 30%, partially due to incomplete death scene investigations (DSI) and varying burden-of-proof standards across jurisdictions. This may result in the misclassification of overdose-related suicides as accidents or undetermined intent. METHODS Virtual and in-person meetings were held with suicidologists and DSI experts from five states (Spring-Summer 2017) to explore how features of a hypothetical electronic DSI tool may help address these challenges. RESULTS Participants envisioned a mobile DSI application for cell phones, tablets, or laptop computers. Features for systematic information collection, scene description, and guiding key informant interviews were perceived as useful for less-experienced investigators. DISCUSSION Wide adoption may be challenging due to differences in DSI standards, practices, costs, data privacy and security, and system integration needs. However, technological tools that support consistent and complete DSIs could strengthen the information needed to accurately identify overdose suicides.
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Affiliation(s)
- Melissa C. Mercado
- Melissa C. Mercado, PhD, 4770 Buford Hwy NE, MS-64, Atlanta, GA 30341-3717,
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22
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Harashima S, Fujimori M, Akechi T, Matsuda T, Saika K, Hasegawa T, Inoue K, Yoshiuchi K, Miyashiro I, Uchitomi Y, J Matsuoka Y. Death by suicide, other externally caused injuries and cardiovascular diseases within 6 months of cancer diagnosis (J-SUPPORT 1902). Jpn J Clin Oncol 2021; 51:744-752. [PMID: 33529336 DOI: 10.1093/jjco/hyab001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To conduct the first national population-based study in Japan to characterize risks of death by suicide, other externally caused injuries and cardiovascular diseases within 6 months of cancer diagnosis. METHODS Cancer patients diagnosed between 1 January and 30 June 2016 and registered in the National Cancer Registry in Japan were followed up until death or 6 months after diagnosis. We calculated standardized mortality ratios and excess absolute risks per 10 000 person-years for death by suicide, other externally caused injuries and cardiovascular diseases compared with the Japanese general population. RESULTS Of 546 148 patients with cancer (249 116 person-years at risk), we observed 145 suicides, 298 deaths due to other externally caused injuries and 2366 cardiovascular deaths during the follow-up period. Standardized mortality ratios within 6 months were 2.68 for suicide (95% confidence interval, 2.26-3.16; excess absolute risk, 3.65), 1.49 for other externally caused injuries (95% confidence interval, 1.32-1.67; excess absolute risk, 3.92) and 1.38 for cardiovascular diseases (95% confidence interval, 1.33-1.44; excess absolute risk, 26.85). Risks were highest during the first month after cancer diagnosis (standardized mortality ratios: suicide, 4.06 [95% confidence interval, 2.90-5.53]; other externally caused injuries, 2.66 [95% confidence interval, 2.17-3.12] and cardiovascular diseases, 2.34 [95% confidence interval, 2.18-2.51]). CONCLUSIONS The first 6 months, and especially the first month, after cancer diagnosis were found to be a critical period for risks of death by suicide, other externally caused injuries and cardiovascular diseases. Our findings suggest that oncologists need to evaluate suicidal and cardiovascular risks of patients immediately after cancer diagnosis and provide preventive interventions.
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Affiliation(s)
- Saki Harashima
- Division of Behavioral Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan.,Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Maiko Fujimori
- Division of Behavioral Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tomohiro Matsuda
- Center for Cancer Registries, Center for Cancer Control and Information Services, National Cancer Center Japan, Tokyo, Japan
| | - Kumiko Saika
- Center for Cancer Registries, Center for Cancer Control and Information Services, National Cancer Center Japan, Tokyo, Japan
| | - Takaaki Hasegawa
- Center for Psycho-Oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
| | - Keisuke Inoue
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan.,Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Yosuke Uchitomi
- Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka J Matsuoka
- Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
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Snowdon J. Spain's suicide statistics: do we believe them? Soc Psychiatry Psychiatr Epidemiol 2021; 56:721-729. [PMID: 32918553 DOI: 10.1007/s00127-020-01948-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 09/01/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE There is a widespread belief that suicides around the world are under-counted. A substantial proportion of suicides may have been inappropriately registered as accidental or of undetermined cause or intent. There is reason to explore to what extent low suicide rates in some nations could be partly attributable to under-counting. METHODS Mortality statistics of most countries are available on-line. Numbers of suicide deaths in Spain, and in England and Wales (E & W), in male and female 5-year age groups, in each year between 2014 and 2018, were documented, along with deaths coded to ICD-10 accident or 'undetermined death' categories. Crude mortality rates were calculated using official population figures. Single year suicide, undetermined death, and non-transport accidental death rates of 12 other nations were calculated. RESULTS Spain's crude suicide rate per 100,000 remains low (7.89) compared to other nations; its event of undetermined intent (EUI) death rate was 0.09 (contrasting with E & W's 1.74). Its accidental poisoning rate is much lower than that of E & W. The study showed much higher rates of ill-defined/unknown cause deaths in late life in Spain (both genders) than in E & W, and age-associated increases in accidental drowning rates parallel with increased suicide by drowning. CONCLUSIONS Reportedly low suicide rates in Spain could be partly attributable to increased rates of 'hidden suicide' (accidental drowning, male accidental poisoning, and possibly ill-defined/unknown cause deaths, but not EUIs). It would be appropriate (and not just in Spain) to increase numbers of verbal and/or forensic autopsies in questionable 'undetermined' cases.
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Affiliation(s)
- John Snowdon
- Discipline of Psychiatry, Sydney Medical School, Sydney, Australia. .,Centre for Mental Health, Concord Hospital, Sydney, Australia.
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24
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Warfield S, Karras E, Lilly C, Brumage M, Bossarte RM. Causes of death among U.S. Veterans with a prior nonfatal opioid overdose. Drug Alcohol Depend 2021; 219:108484. [PMID: 33395597 PMCID: PMC8406624 DOI: 10.1016/j.drugalcdep.2020.108484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND For over a decade, there has been a surge in opioid-related morbidity and mortality among Veterans. To better understand the impact of the growing epidemic, it is important to identify the cause-specific mortality rates among Veterans with a prior nonfatal opioid overdose. METHODS We followed 8370 Veterans who received medical care for a nonfatal opioid overdose between 2011 through 2015.Mortality records were linked to clinical records from the Veterans Health Administration (VHA). We compared the mortality rates among those with a nonfatal opioid overdose to a 5 % stratified random sample of patients accessing services during the same time period. SMRs were calculated using age-adjusted cause-specific mortality rates for the l U.S. population obtained from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER). RESULTS The crude mortality for Veterans with a history of a nonfatal overdose was 370.6 per 10,000 person years. Those with a prior nonfatal overdose had a higher risk of substance-related mortality (aHR [adjusted Hazard Ratio] 5.0), including a higher risk of death from drugs (aHR 6.9) and alcohol (aHR 2.7). Similarly, cause-specific mortalities assessed between Veterans and the U.S. population, SMRs were also highest for deaths associated with substances (114.0). CONCLUSION Veterans with a prior nonfatal overdose experienced substantially higher mortality rates compared to other Veterans or the general U.S. POPULATION Causes of death related to substance use and mental health were significantly higher than other causes of death, highlighting the importance of integrated treatment and substance use services.
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Affiliation(s)
- Sara Warfield
- Center of Excellence for Suicide Prevention, Department of Veterans Affairs, 400 Fort Hill Avenue, Canandaigua, NY, 14424, USA; Department of Epidemiology, School of Public Health, West Virginia University, 64 Medical Center Drive, P.O. Box 9190, Morgantown, WV, 26506, USA; Injury Control Research Center, West Virginia University, 3606 Collins Ferry Rd, Suites 201 & 202, Morgantown, WV 26505, USA.
| | - Elizabeth Karras
- Center of Excellence for Suicide Prevention, Department of Veterans Affairs, 400 Fort Hill Avenue, Canandaigua, NY, 14424, USA; Injury Control Research Center, West Virginia University, 3606 Collins Ferry Rd, Suites 201 & 202, Morgantown, WV 26505, USA; Department of Psychiatry, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA
| | - Christa Lilly
- Department of Biostatistics, West Virginia University, 64 Medical Center Drive, P.O. Box 9190, Morgantown, WV, 26506, USA
| | - Michael Brumage
- Injury Control Research Center, West Virginia University, 3606 Collins Ferry Rd, Suites 201 & 202, Morgantown, WV 26505, USA; Department of Occupational Medicine, West Virginia University, 64 Medical Center Drive, P.O. Box 9190, Morgantown, WV, 26506, USA
| | - Robert M Bossarte
- Center of Excellence for Suicide Prevention, Department of Veterans Affairs, 400 Fort Hill Avenue, Canandaigua, NY, 14424, USA; Department of Epidemiology, School of Public Health, West Virginia University, 64 Medical Center Drive, P.O. Box 9190, Morgantown, WV, 26506, USA; Injury Control Research Center, West Virginia University, 3606 Collins Ferry Rd, Suites 201 & 202, Morgantown, WV 26505, USA; Department of Behavioral Medicine and Psychiatry, West Virginia University, 64 Medical Center Drive, P.O. Box 9190, Morgantown, WV, 26506, USA
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Goldman-Mellor S, Hall C, Cerdá M, Bhat H. Firearm suicide mortality among emergency department patients with physical health problems. Ann Epidemiol 2020; 54:38-44.e3. [PMID: 32950655 DOI: 10.1016/j.annepidem.2020.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/30/2020] [Accepted: 09/10/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE Individuals with poor physical and mental health may face elevated risk for suicide, particularly suicide by firearm. METHODS This retrospective cohort study used statewide, longitudinally linked emergency department (ED) patient record and mortality data to examine 12-month incidence of firearm suicide among ED patients presenting with a range of physical health problems. Participants included all residents presenting to a California ED in 2009-2013 with nonfatal visits for somatic diagnoses hypothesized to increase suicide risk, including myocardial infarction, congestive heart failure, cerebrovascular disease, chronic obstructive pulmonary disease, diabetes, cancer, back pain, headache, joint disorder, and injuries. For each patient diagnostic group, we calculated rates of firearm suicide per 100,000 person-years and standardized mortality ratios (SMRs) relative to the demographically matched California population. RESULTS Firearm suicide rates per 100,000 person-years ranged from 9.6 (among patients presenting with unintentional injury) to 55.1 (patients with cancer diagnoses), with SMRs from 1.48 to 7.45 (all p < 0.05). SMRs for patients with cardiovascular conditions ranged from 2.45 to 5.10. Men and older individuals had higher firearm suicide rates, and there was substantial between-group variability in the proportion of suicide decedents who used a firearm. CONCLUSIONS ED patients presenting with deliberate self-harm injuries, substance use, and cancer were especially at risk for firearm suicide. To avoid missed suicide prevention opportunities, EDs should implement evidence-based suicide interventions as a best practice for their patients.
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Affiliation(s)
- Sidra Goldman-Mellor
- Department of Public Health; School of Social Sciences, Humanities, and Arts; University of California, Merced CA.
| | - Carlisha Hall
- Department of Public Health; School of Social Sciences, Humanities, and Arts; University of California, Merced CA
| | - Magdalena Cerdá
- Department of Population Health at NYU Grossman School of Medicine, New York, NY
| | - Harish Bhat
- Department of Applied Mathematics, School of Natural Sciences; University of California, Merced CA
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Wang J, Sumner SA, Simon TR, Crosby AE, Annor FB, Gaylor E, Xu L, Holland KM. Trends in the Incidence and Lethality of Suicidal Acts in the United States, 2006 to 2015. JAMA Psychiatry 2020; 77:684-693. [PMID: 32320023 PMCID: PMC7177650 DOI: 10.1001/jamapsychiatry.2020.0596] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/17/2020] [Indexed: 01/09/2023]
Abstract
Importance Understanding changes in the incidence rates and lethality of suicidal acts may explain increasing suicide rates. Objective To examine trends in the incidence rates and lethality of suicidal acts from 2006 to 2015 among persons aged 10 to 74 years. Design, Setting, and Participants This cross-sectional study was conducted from May 2, 2018, to January 30, 2019. Medically treated nonfatal suicide attempts were identified from the 2006 to 2015 Nationwide Inpatient Sample and Nationwide Emergency Department Sample databases. Suicides were identified from the 2006 to 2015 mortality files of the National Vital Statistics System. Main Outcomes and Measures The incidence rate of suicidal acts was calculated by dividing the number of total suicidal acts by the US population. Lethality was measured through the case fatality rates (CFRs) of suicidal acts by dividing the number of suicides by the total number of suicidal acts. Results A total of 1 222 419 (unweighted) suicidal acts, which included both suicides and nonfatal suicide attempts, were identified from 2006 to 2015. Overall, the incidence rates of total suicidal acts increased 10% from 2006 to 2015 (annual percentage change [APC], 0.8%; 95% CI, 0.3%-1.3%), and the CFRs of suicidal acts increased 13% during the 2006 to 2015 period (APC, 2.3%; 95% CI, 1.3%-3.3%). In subgroup analyses, incidence rates increased by 1.1% (95% CI, 0.6%-1.6%) per year for female individuals during the 2006 to 2015 period but remained stable for male individuals. The CFRs increased for both sexes (APC, 5.0% [95% CI, 3.1%-6.9%] since 2010 for female individuals; 1.6% [95% CI, 0.6%-2.5%] since 2009 for male individuals). Incidence rates increased among adolescents from 2011 to 2015 and among older adults aged 65 to 74 years throughout the 2006 to 2015 period. Conversely, the CFRs increased since 2009 among persons aged 20 to 44 years (APC, 3.7%; 95% CI, 2.5%-5.0%) and since 2012 for those aged 45 to 64 years (APC, 2.7%; 95% CI, 0.0%-5.4%). Persons aged 20 to 44 years and 45 to 64 years experienced increases in suicidal acts by more lethal means, whereas adolescents and older adults aged 65 to 74 years showed increased incidence by all means. Conclusions and Relevance This study found increased suicidal acts among female persons, adolescents, and older adults aged 65 to 74 years, implying the need to address emerging or exacerbating suicide risk factors for these populations. The findings on the increased lethality particularly among persons aged 20 to 64 years highlighted the need to reduce access to materials that could be used as lethal means among persons at risk of suicide. These findings on population-level epidemiologic patterns can be used to guide the development of comprehensive suicide prevention strategies.
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Affiliation(s)
- Jing Wang
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Steven A. Sumner
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Thomas R. Simon
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alex E. Crosby
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Francis B. Annor
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elizabeth Gaylor
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Likang Xu
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kristin M. Holland
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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Gunnarsdottir OS, Rafnsson V. Accidental poisoning, intentional self-harm and event of undetermined intent mortality over 20 years in Iceland: a population-based cohort study. BMJ Open 2020; 10:e034590. [PMID: 32439692 PMCID: PMC7247372 DOI: 10.1136/bmjopen-2019-034590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES The aim was to study mortality due to suicide, accidental poisoning, event of undetermined intent and drug-related deaths through 20 years in Iceland. DESIGN A population-based register study. PARTICIPANTS Individuals who died due to road traffic injury, suicide, accidental poisoning, event of undetermined intent and drug-related deaths in the population of Iceland during the years 1996-2015. Annual age-standardised rates were calculated, and the trend analysed by Pearson correlation and joinpoint regression. SETTING The population of Iceland framed the study material, and the data were obtained from nationwide registries for information on number of deaths and age-specific mean population in each year by gender. RESULTS The crude overall suicide rate during the last 10 years was 12.2 per 100 000 persons per year (95% CI 7.4 to 18.1), while the crude overall rate due to road traffic injuries was 4.6 per 100 000 persons per year (95% CI 2.0 to 8.3). Among men, suicide rates decreased, however not significantly (r(19)=-0.22, p=0.36), and for overdose by narcotics the rates increased significantly (r(19)=0.72, p<0.001) during the study period. Among women, the suicide rates increased, however not significantly (r(19)=0.35, p=0.13), for accidental poisoning, suicide and event of undetermined intent combined the rates increased significantly (r(19)=0.60, p=0.006); and the rates for overdose by sedative and overdose by narcotics both increased significantly r(19)=0.49, p=0.03, and r(19)=0.67, p=0.001, respectively. CONCLUSION The suicide rates have not changed during 1996 to 2015; however, the rates for the combined accidental poisoning, suicide and event of undetermined intent increased significantly for women. The rise of the overdose rates for sedative among women and for narcotics among both genders are consistent with reports elsewhere.
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Affiliation(s)
- Oddny Sigurborg Gunnarsdottir
- Office of Education, Research and Development, Landspitali-the National University Hospital of Iceland, Reykjavík, Iceland
| | - Vilhjálmur Rafnsson
- Department of Preventive Medicine, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
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Choi NG, Marti CN, DiNitto DM, Choi BY. Suicides and Deaths of Undetermined Intent by Poisoning: Reexamination of Classification Differences by Race/Ethnicity and State. Arch Suicide Res 2020; 24:S264-S281. [PMID: 30955464 DOI: 10.1080/13811118.2019.1592042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This study examined differences by race/ethnicity and state in poisoning deaths of undetermined intent (UnD) versus suicide classification and the potential impact of state variations on UnD rates for Blacks and Hispanics. We used data from the 2005-2015 U.S. National Violent Death Reporting System (N = 29,567 aged 15+) and weighted coarsened exact matching. The odds of UnD classification were 7-10 times higher in the 5 highest UnD states (Kentucky, Maryland, Michigan, Utah, and Rhode Island) than in other states. Blacks in these 5 states had twice the odds of Whites of being classified as UnDs than suicides, but had lower odds in other states. Other significant UnD classification factors were opioid and cocaine positive toxicologies.
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Goldman-Mellor S, Margerison CE. Maternal drug-related death and suicide are leading causes of postpartum death in California. Am J Obstet Gynecol 2019; 221:489.e1-489.e9. [PMID: 31173749 PMCID: PMC6829056 DOI: 10.1016/j.ajog.2019.05.045] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/17/2019] [Accepted: 05/29/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Reducing maternal mortality is a priority in the United States and worldwide. Drug-related deaths and suicide may account for a substantial and growing portion of maternal deaths, yet information on the incidence of and sociodemographic variation in these deaths is scarce. OBJECTIVE We sought to examine incidence of drug-related and suicide deaths in the 12 months after delivery, including heterogeneity by sociodemographic factors. We also explored maternal decedents' health care utilization prior to death. STUDY DESIGN This retrospective, population-based cohort study followed up 1,059,713 women who delivered a live-born infant in California hospitals during 2010-2012 to ascertain maternal death. Analyses were conducted using statewide, all-payer, longitudinally-linked hospital and death data. RESULTS A total of 300 women died during follow-up, a rate of 28.33 deaths per 100,000 person-years. The leading cause of death was obstetric-related problems (6.52 per 100,000 person-years). Drug-related deaths were the second leading cause of death (3.68 per 100,000 person-years), and suicide was the seventh leading cause (1.42 per 100,000 person-years); together these deaths comprised 18% of all maternal deaths. Non-Hispanic white women, Medicaid-insured women, and women residing in micropolitan areas were especially likely to die from drugs/suicide. Two thirds of women who died, including 74% of those who died by drugs/suicide, made ≥1 emergency department or hospital visit between their delivery and death. CONCLUSION Deaths caused by drugs and suicide are a major contributor to mortality in the postpartum period and warrant increased clinical attention, including recognition by physicians and Maternal Mortality Review Committees as a medical cause of death. Importantly, emergency department and inpatient hospital visits may serve as a point of identification of, and eventually prevention for, women at risk for these deaths.
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Affiliation(s)
- Sidra Goldman-Mellor
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, CA.
| | - Claire E Margerison
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI
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Rockett IRH, Caine ED, Connery HS, Nolte KB, Nestadt PS, Nelson LS, Jia H. Unrecognised self-injury mortality (SIM) trends among racial/ethnic minorities and women in the USA. Inj Prev 2019; 26:439-447. [PMID: 31551367 PMCID: PMC7513258 DOI: 10.1136/injuryprev-2019-043371] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/22/2019] [Accepted: 08/24/2019] [Indexed: 01/09/2023]
Abstract
AIM To assess whether an enhanced category combining suicides with nonsuicide drug self-intoxication fatalities more effectively captures the burden of self-injury mortality (SIM) in the USA among US non-Hispanic black and Hispanic populations and women irrespective of race/ethnicity. METHODS This observational study used deidentified national mortality data for 2008-2017 from the CDC's Web-based Injury Statistics Query and Reporting System. SIM comprised suicides by any method and age at death plus estimated nonsuicide drug self-intoxication deaths at age ≥15 years. Measures were crude SIM and suicide rates; SIM-to-suicide rate ratios; and indices of premature mortality. RESULTS While the suicide rate increased by 29% for blacks, 36% for Hispanics and 25% for non-Hispanic whites between 2008 and 2017, corresponding SIM rate increases were larger at 109%, 69% and 55% (p<0.0001). SIM:suicide rate ratio gaps were widest among blacks but similar for the other two groups. Gaps were wider for females than males, especially black females whose ratios measured ≥3.71 across the observation period versus <3.00 for white and Hispanic counterparts. Total lost years of life for Hispanic, white and black SIM decedents in 2017 were projected to be 42.6, 37.1 and 32.4, respectively. CONCLUSION Application of SIM exposed substantial excess burdens from substance poisoning relative to suicide for minorities, particularly non-Hispanic blacks and for women generally. Results underscored the need to define, develop, implement and evaluate comprehensive strategies to address common antecedents of self-injurious behaviours.
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Affiliation(s)
- Ian R H Rockett
- Department of Epidemiology, West Virginia University, Morgantown, West Virginia, USA .,Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA.,Injury Control Research Center for Suicide Prevention, University of Rochester Medical Center, Rochester, New York, USA
| | - Eric D Caine
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Hilary S Connery
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Kurt B Nolte
- Office of the Medical Investigator, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Paul S Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, USA
| | - Lewis S Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Haomiao Jia
- Department of Biostatistics, Columbia University, New York, New York, USA.,School of Nursing, Columbia University, New York, New York, USA
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Applebaum KM, Asfaw A, O’Leary PK, Busey A, Tripodis Y, Boden LI. Suicide and drug-related mortality following occupational injury. Am J Ind Med 2019; 62:733-741. [PMID: 31298756 PMCID: PMC7485601 DOI: 10.1002/ajim.23021] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/15/2019] [Accepted: 06/18/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Drug overdoses and suicides have been rising since 2000 and are major contributors to a 3-year decline in US life expectancy. Studies suggest that injured workers have elevated rates of depression and opioid use, but no studies have measured excess mortality related to these risks. MATERIALS AND METHODS We linked New Mexico workers' compensation data for 100 806 workers injured in 1994 through 2000 with Social Security Administration earnings and mortality data through 2013 and National Death Index cause of death data. We then estimated the association between receiving lost-time workers' compensation benefits and mortality hazard ratios (HRs) and 95% confidence intervals (CIs) based on Fine and Gray cause-specific subdistribution hazards for common causes of death and for drug-related, suicide, and alcohol-related mortality. RESULTS There was almost a 3-fold increase in combined drug-related and suicide mortality hazard among women (HR = 2.63, 95% CI = 1.91-3.64) and a substantial increase among men (HR = 1.42, 95% CI = 1.13-1.79). Circulatory disease mortality hazard was elevated for men (HR = 1.25, 95% CI = 1.05-1.50). CONCLUSION Workplace injuries severe enough to require more than a week off work may impair workers' long-term health and well-being. Drug-related deaths and suicides may be important contributors to the long-term excess mortality of injured workers. Improved workplace conditions, improved pain treatment, better treatment of substance use disorders, and treatment of postinjury depression may substantially reduce mortality consequent to workplace injuries.
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Affiliation(s)
- Katie M. Applebaum
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Abay Asfaw
- Economic Research and Support Office, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, District of Columbia
| | - Paul K. O’Leary
- Office of Retirement and Disability Policy, US Social Security Administration, Washington, District of Columbia
| | - Andrew Busey
- Department of Economics, Boston University, Boston, Massachusetts
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Leslie I. Boden
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
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The Burden of Unintentional Injury Mortality Among American Indians/Alaska Natives in Michigan, Minnesota, and Wisconsin. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2019; 25 Suppl 5, Tribal Epidemiology Centers: Advancing Public Health in Indian Country for Over 20 Years:S20-S28. [PMID: 31348187 DOI: 10.1097/phh.0000000000001018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To characterize the burden of unintentional injury mortality among American Indians/Alaska Natives (AI/ANs) in Michigan, Minnesota, and Wisconsin and identify segments of the population that may especially benefit from policy and practice actions to reduce unintentional injury mortality risk factors. DESIGN Surveillance of mortality data from CDC WONDER and WISQARS online databases. SETTING The 3 states in the Indian Health Service (IHS) Bemidji Area: Michigan, Minnesota, and Wisconsin. PARTICIPANTS AI/ANs and whites who died from unintentional injuries in 2011-2015 in Michigan, Minnesota, and Wisconsin. MAIN OUTCOME MEASURE Unintentional injury mortality rates and AI/AN versus white unintentional injury mortality disparity ratios. RESULTS For all types of unintentional injury mortality, from 2011 to 2015, AI/ANs in the Bemidji Area died at an age-adjusted rate that was 77% higher than that for whites, a statistically significant difference. For AI/ANs in the 3-state area, the top cause of unintentional death was poisoning. The poisoning rate was a statistically significant 2.64 times as high for AI/ANs as that for whites, the highest disparity seen by type. When analyzed by age, gender, and rural/urban residence, unintentional injury mortality rates were almost always higher for AI/ANs. AI/ANs also had a much higher burden of years of potential life lost. CONCLUSIONS Unintentional injury mortality significantly affects AI/ANs in the 3-state area and to a larger degree than for whites. However, some of the risk factors for unintentional injury are modifiable and, if addressed effectively, can reduce injury deaths. Governments, local leaders, organizations, and individuals can reduce AI/ANs' risk of unintentional injury by providing effective programming; encouraging or modeling behavior change; advocating for, creating, and enforcing laws and policies; and making infrastructure improvements. Increased attention to this topic and equitable efforts to reduce risk factors have great potential to reduce the burden of unintentional injury deaths for AI/ANs and all peoples.
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Harashima S, Fujimori M, Akechi T, Matsuda T, Saika K, Hasegawa T, Inoue K, Yoshiuchi K, Miyashiro I, Uchitomi Y, Matsuoka YJ. Suicide, other externally caused injuries and cardiovascular death following a cancer diagnosis: study protocol for a nationwide population-based study in Japan (J-SUPPORT 1902). BMJ Open 2019; 9:e030681. [PMID: 31278108 PMCID: PMC6615787 DOI: 10.1136/bmjopen-2019-030681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION A growing body of literature has demonstrated that cancer patients have a higher risk of suicide and cardiovascular mortality compared with the general population, especially immediately after a cancer diagnosis. Using data from the National Cancer Registry in Japan launched in January 2016, we will conduct the first nationwide population-based study in Japan to compare incidence of death by suicide, other externally caused injuries (ECIs) and cardiovascular disease following a cancer diagnosis with that of the general population in Japan. We will also aim to identify the patient subgroups and time periods associated with particularly high risk. METHODS AND ANALYSIS Our study subjects will consist of cancer cases diagnosed between 1 January 2016 and 31 December 2016 in Japan and they will be observed until 31 December 2018. We will calculate standardised mortality ratios (SMRs) and excess absolute risks (EARs) for suicide, other ECIs and cardiovascular death compared with the general population in Japan, after adjustment for sex, age and prefecture. SMRs and EARs will be calculated separately in relation to a number of factors: sex; age at diagnosis; time since cancer diagnosis; prefecture of residence at diagnosis; primary tumour site; behaviour code of tumour; extension of tumour; whether definitive surgery of the primary site was performed; and presence/absence of multiple primary tumours. ETHICS AND DISSEMINATION The study protocol was approved by the institutional review board and ethics committee of the National Cancer Center Japan and Nagoya City University Graduate School of Medical Sciences. The findings will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER UMIN000035118; Pre-results.
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Affiliation(s)
- Saki Harashima
- Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
- Department of Stress Sciences and Psychosomatic Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Maiko Fujimori
- Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tomohiro Matsuda
- Center for Cancer Registries, Center for Cancer Control and Information Services, National Cancer Center Japan, Tokyo, Japan
| | - Kumiko Saika
- Center for Cancer Registries, Center for Cancer Control and Information Services, National Cancer Center Japan, Tokyo, Japan
| | - Takaaki Hasegawa
- Division of Psycho-Oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
| | - Keisuke Inoue
- Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Yosuke Uchitomi
- Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
- Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka J Matsuoka
- Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
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Hempstead K, Phillips J. Divergence In Recent Trends In Deaths From Intentional And Unintentional Poisoning. Health Aff (Millwood) 2019; 38:29-35. [DOI: 10.1377/hlthaff.2018.05186] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Katherine Hempstead
- Katherine Hempstead is a senior policy adviser at the Robert Wood Johnson Foundation, in Princeton, New Jersey
| | - Julie Phillips
- Julie Phillips is a professor of sociology at Rutgers, the State University of New Jersey, in New Brunswick
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Abstract
PURPOSE OF REVIEW This was a retrospective ecological study to examine the relationship between suicide rates and economic indicators in large Brazilian urban centers. Data on macroeconomic indicators (GDP and unemployment rates) and suicide rates of the largest Brazilian cities were collected from January 2006 to December 2015. RECENT FINDINGS Six cities were included in the study: Porto Alegre in the South, Recife and Salvador in the Northeast, and Belo Horizonte, São Paulo and Rio de Janeiro in the Southeast region. We observed a 4% increase in the age-adjusted suicide rate in these large Brazilian urban centers from 2006 to 2015, which is less pronounced than the 9% increase in the national rates of suicide observed in the same period. SUMMARY The effect of economic indicators was heterogeneous among the centers, but, overall, the variation in suicide rates was inversely related to unemployment and did not show a significant relationship with GDP. These findings indicate a more complex link between economics and suicide whenever looking at local regional indicators. Further research should focus on possible intervening factors, what may inform better preventive interventions.
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Mitchell RJ, Cameron CM. Self-harm hospitalised morbidity and mortality risk using a matched population-based cohort design. Aust N Z J Psychiatry 2018; 52:262-270. [PMID: 28675938 DOI: 10.1177/0004867417717797] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Prior and repeated self-harm hospitalisations are common risk factors for suicide. However, few studies have accounted for pre-existing comorbidities and prior hospital use when quantifying the burden of self-harm. The aim is to quantify hospitalisation in the 12 months preceding and re-hospitalisation and mortality risk in the 12 months post a self-harm hospitalisation. METHOD A population-based matched cohort using linked hospital and mortality data for individuals ⩾18 years from four Australian jurisdictions. A non-injured comparison cohort was matched on age, gender and residential postcode. Twelve-month pre- and post-index self-harm hospitalisations and mortality were examined. RESULTS The 11,597 individuals who were hospitalised following self-harm in 2009 experienced 21% higher health service use in the 12 months pre and post the index admission and a higher mortality rate (2.9% vs 0.3%) than their matched counterparts. There were 133 (39.0%) deaths within 2 weeks of hospital discharge and 342 deaths within 12 months of the index hospitalisation in the self-harm cohort. Adjusted rate ratios for hospital readmission were highest for females (2.86; 95% confidence interval: [2.33, 2.52]) and individuals aged 55-64 years (3.96; 95% confidence interval: [2.79, 5.64]). CONCLUSION Improved quantification of the burden of self-harm-related hospital use can inform resource allocation for intervention and after-care services for individuals at risk of repeated self-harm. Better assessment of at-risk self-harm behaviour, appropriate referrals and improved post-discharge care, focusing on care continuity, are needed.
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Affiliation(s)
- Rebecca J Mitchell
- 1 Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Cate M Cameron
- 2 Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
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Soares AM, Cortez-Escalante JJ, França E. Review of deaths correction methods and quality dimensions of the underlying cause for accidents and violence in Brazil. CIENCIA & SAUDE COLETIVA 2018; 21:3803-3818. [PMID: 27925121 DOI: 10.1590/1413-812320152112.13682015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 11/21/2015] [Indexed: 01/09/2023] Open
Abstract
This review article aims to perform analysis and critical discussion about the literature on methods correcting mortality from accidents and violence reported to the Brazilian Mortality Information System. We consulted Medline and SciELO databases, as well as the Global Burden of Disease site, using time filter for the 1996-2015 interval. Of the 77 studies identified, we selected 29, and 14 met the corrections production criteria for cases of underreporting: underreporting of deaths in the Mortality Information System, deaths declared as ill-defined causes or deaths from external causes declared with nonspecific codes. We found that the underreporting of external causes was not significantly different from what occurs in total deaths and sometimes was higher in small and medium-sized municipalities. The reclassification of ill-defined causes of death corrected external causes to non-negligible values. The selected studies differ on proposals for correction of unspecified external causes. Evidence supports interventions to improve the quality of data, and the availability of correction procedure of external causes that bring together application conditions.
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Affiliation(s)
- Adauto Martins Soares
- Departamento de Vigilância de Doenças e Agravos não Transmissíveis e Promoção à Saúde, Secretaria de Vigilância em Saúde, Ministério da Saúde. SAF, trecho 2, Lote 05/06, Bloco F, Torre 1, Edifício Premium, Setor de embaixadas. 70070-600 Brasília DF Brasil.adauto
| | | | - Elisabeth França
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina. Belo Horizonte MG Brasil
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Discerning suicide in drug intoxication deaths: Paucity and primacy of suicide notes and psychiatric history. PLoS One 2018; 13:e0190200. [PMID: 29320540 PMCID: PMC5761891 DOI: 10.1371/journal.pone.0190200] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/14/2017] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE A paucity of corroborative psychological and psychiatric evidence may be inhibiting detection of drug intoxication suicides in the United States. We evaluated the relative importance of suicide notes and psychiatric history in the classification of suicide by drug intoxication versus firearm (gunshot wound) plus hanging/suffocation-the other two major, but overtly violent methods. METHODS This observational multilevel (individual/county), multivariable study employed a generalized linear mixed model (GLMM) to analyze pooled suicides and undetermined intent deaths, as possible suicides, among the population aged 15 years and older in the 17 states participating in the National Violent Death Reporting System throughout 2011-2013. The outcome measure was relative odds of suicide versus undetermined classification, adjusted for demographics, precipitating circumstances, and investigation characteristics. RESULTS A suicide note, prior suicide attempt, or affective disorder was documented in less than one-third of suicides and one-quarter of undetermined deaths. The prevalence gaps were larger among drug intoxication cases than gunshot/hanging cases. The latter were more likely than intoxication cases to be classified as suicide versus undetermined manner of death (adjusted odds ratio [OR], 41.14; 95% CI, 34.43-49.15), as were cases documenting a suicide note (OR, 33.90; 95% CI, 26.11-44.05), prior suicide attempt (OR, 2.42; 95% CI, 2.11-2.77), or depression (OR, 1.61; 95% CI, 1.38 to 1.88), or bipolar disorder (OR, 1.41; 95% CI, 1.10-1.81). Stratification by mechanism/cause intensified the association between a note and suicide classification for intoxication cases (OR, 45.43; 95% CI, 31.06-66.58). Prior suicide attempt (OR, 2.64; 95% CI, 2.19-3.18) and depression (OR, 1.48; 95% CI, 1.17-1.87) were associated with suicide classification in intoxication but not gunshot/hanging cases. CONCLUSIONS Without psychological/psychiatric evidence contributing to manner of death classification, suicide by drug intoxication in the US is likely profoundly under-reported. Findings harbor adverse implications for surveillance, etiologic understanding, and prevention of suicides and drug deaths.
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Austin AE, Proescholdbell SK, Creppage KE, Asbun A. Characteristics of self-inflicted drug overdose deaths in North Carolina. Drug Alcohol Depend 2017; 181:44-49. [PMID: 29032024 DOI: 10.1016/j.drugalcdep.2017.09.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/08/2017] [Accepted: 09/08/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Drug overdose mortality is a major public health concern in the United States, with prescription opioids contributing substantially to recent increases in drug overdose deaths. Compared to unintentional drug overdose deaths, relatively little data describes intentional self-inflicted drug overdose deaths (i.e., suicide by drug overdose). The aim of this study was to examine the characteristics of self-inflicted drug overdose deaths, overall and in comparison to unintentional drug overdose deaths. METHODS We linked vital statistics, prescription drug monitoring program, and toxicology data for self-inflicted and unintentional drug overdose deaths among North Carolina residents in 2012. RESULTS Most self-inflicted (79.2%) and unintentional (75.6%) drug overdose decedents had a prescription for a controlled substance within one year of death. Toxicology results revealed that antidepressants contributed to a significantly higher percent of self-inflicted compared to unintentional drug overdose deaths (45.0% vs. 8.1%). Among deaths in which commonly prescribed opioids (oxycodone, hydrocodone) or benzodiazepines (alprazolam, clonazepam) contributed to death, a significantly higher percent of self-inflicted drug overdose decedents had a prescription for the substance within 30days of death compared to unintentional drug overdose decedents. CONCLUSIONS The results highlight the use of prescription opioids, benzodiazepines, and antidepressants among self-inflicted drug overdose decedents. Importantly, the results indicate that self-inflicted drug overdose decedents were more likely than unintentional drug overdose decedents to have potential contact with the health care system in the weeks preceding death, offering an opportunity for professionals to identify and intervene on risk factors or signs of distress and potential for self-harm.
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Affiliation(s)
- Anna E Austin
- Department of Maternal and Child Health and Injury Prevention Research Center, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States.
| | - Scott K Proescholdbell
- Injury and Violence Prevention Branch, Chronic Disease and Injury Section, Division of Public Health, North Carolina Department of Health and Human Services, United States
| | - Kathleen E Creppage
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, United States
| | - Alex Asbun
- Drug Control Unit, Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, North Carolina Department of Health and Human Services, United States
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Hsieh N. A Global Perspective on Religious Participation and Suicide. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2017; 58:322-339. [PMID: 29164943 DOI: 10.1177/0022146517715896] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Although sociological research in the Durkheimian tradition has generally accepted that religious involvement protects against suicide, few studies have examined this theoretical proposition outside Western industrialized settings. Using multilevel models to analyze data from the World Health Organization Mortality Database and the World Values Survey (1981-2007) across 42 countries in seven geographical-cultural regions, this study explores whether religious participation is more protective against suicide in some regions than others and, if so, why. Results indicate that while religious participation is protective in Latin America, eastern Europe, northern Europe, and English-speaking countries, it may aggravate the risk of suicide in East Asia, western Europe, and southern Europe. This regional variation is the result of differences in both the degree of integration/regulation of religious communities and suicide underreporting. Overall, the findings support the network perspective of Durkheim's classical theory and suggest that researchers should be more cautious about suicide underreporting in less industrialized settings.
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Affiliation(s)
- Ning Hsieh
- 1 Michigan State University, East Lansing, MI, USA
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Stone DM, Holland KM, Bartholow B, E Logan J, LiKamWa McIntosh W, Trudeau A, Rockett IRH. Deciphering Suicide and Other Manners of Death Associated with Drug Intoxication: A Centers for Disease Control and Prevention Consultation Meeting Summary. Am J Public Health 2017; 107:1233-1239. [PMID: 28640689 PMCID: PMC5508151 DOI: 10.2105/ajph.2017.303863] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2017] [Indexed: 01/09/2023]
Abstract
Manner of death (MOD) classification (i.e., natural, accident, suicide, homicide, or undetermined cause) affects mortality surveillance and public health research, policy, and practice. Determination of MOD in deaths caused by drug intoxication is challenging, with marked variability across states. The Centers for Disease Control and Prevention hosted a multidisciplinary meeting to discuss drug intoxication deaths as they relate to suicide and other MOD. The meeting objectives were to identify individual-level, system-level, and place-based factors affecting MOD classification and identify potential solutions to classification barriers. Suggested strategies included improved standardization in death scene investigation, toxicology, and autopsy practice; greater accountability; and creation of job aids for investigators. Continued collaboration and coordination of activities are needed among stakeholders to affect prevention efforts.
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Affiliation(s)
- Deborah M Stone
- Deborah M. Stone, Kristin M. Holland, Brad Bartholow, Joseph E. Logan, Wendy LiKamWa McIntosh, and Aimee Trudeau are with the Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA. Ian R. H. Rockett is with the Department of Epidemiology, School of Public Health, and the Injury Control Research Center, West Virginia University, Morgantown
| | - Kristin M Holland
- Deborah M. Stone, Kristin M. Holland, Brad Bartholow, Joseph E. Logan, Wendy LiKamWa McIntosh, and Aimee Trudeau are with the Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA. Ian R. H. Rockett is with the Department of Epidemiology, School of Public Health, and the Injury Control Research Center, West Virginia University, Morgantown
| | - Brad Bartholow
- Deborah M. Stone, Kristin M. Holland, Brad Bartholow, Joseph E. Logan, Wendy LiKamWa McIntosh, and Aimee Trudeau are with the Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA. Ian R. H. Rockett is with the Department of Epidemiology, School of Public Health, and the Injury Control Research Center, West Virginia University, Morgantown
| | - Joseph E Logan
- Deborah M. Stone, Kristin M. Holland, Brad Bartholow, Joseph E. Logan, Wendy LiKamWa McIntosh, and Aimee Trudeau are with the Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA. Ian R. H. Rockett is with the Department of Epidemiology, School of Public Health, and the Injury Control Research Center, West Virginia University, Morgantown
| | - Wendy LiKamWa McIntosh
- Deborah M. Stone, Kristin M. Holland, Brad Bartholow, Joseph E. Logan, Wendy LiKamWa McIntosh, and Aimee Trudeau are with the Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA. Ian R. H. Rockett is with the Department of Epidemiology, School of Public Health, and the Injury Control Research Center, West Virginia University, Morgantown
| | - Aimee Trudeau
- Deborah M. Stone, Kristin M. Holland, Brad Bartholow, Joseph E. Logan, Wendy LiKamWa McIntosh, and Aimee Trudeau are with the Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA. Ian R. H. Rockett is with the Department of Epidemiology, School of Public Health, and the Injury Control Research Center, West Virginia University, Morgantown
| | - Ian R H Rockett
- Deborah M. Stone, Kristin M. Holland, Brad Bartholow, Joseph E. Logan, Wendy LiKamWa McIntosh, and Aimee Trudeau are with the Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA. Ian R. H. Rockett is with the Department of Epidemiology, School of Public Health, and the Injury Control Research Center, West Virginia University, Morgantown
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Churruca K, Mitchell R. Exploring coronial determination of intent for poisoning-related deaths in Australia, 2001-2013. BMC Public Health 2017; 18:83. [PMID: 28764673 PMCID: PMC5540196 DOI: 10.1186/s12889-017-4633-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 07/26/2017] [Indexed: 01/09/2023] Open
Abstract
Background In countries like the United States and the United Kingdom, systematic variation in the classification of intent in pharmaceutical poisoning deaths have been identified between jurisdictions. This study aimed to explore whether the coronial determination of intent (unintentional, intentional, undetermined) for pharmaceutical-related poisoning deaths may have affected death rates over time and by jurisdiction in Australia. Methods A retrospective examination of mortality records in the National Coronial Information System (NCIS) during 1 January 2001 to 31 December 2013 was conducted. The NCIS is a national internet-based data storage and retrieval system for deaths that were notified to a coroner. Pharmaceutical deaths due to unintentional, intentional or undetermined intent were identified using the NCIS classification. Proportions of the different intent classifications and the mortality rates by intent over time were compared between jurisdictions. Results There were 17,895 pharmaceutical-related poisoning deaths in Australia between 2001 and 2013 that had closed cases in the NCIS. Proportions of deaths classified as unintentional (48.3–66.3%), intentional (24.7–35.9%) and undetermined (6.7–24.7%) varied significantly among Australian jurisdictions. There were significant increases in the rate of classification of unintentional poisoning for some states, and significant increases in intentional poisoning classification in Western Australia, and decreases in New South Wales and Victoria. There was no significant change in classification of undetermined intent. Conclusions Significant variation in classifications of intent, both between state jurisdictions and over time, may be the result of regional differences in demographics and increases in prescription drug misuse. However, the inconsistent use of ‘undetermined’ intent between state jurisdictions suggests coroners may experience varying difficulty in retrospectively ruling on intent in the equivocal circumstances of pharmaceutical poisoning. The widespread use of psychological autopsy may assist coroners to classify intent, while the implementation of new classifications for pharmaceutical poisoning death may overcome some of the inherent difficulty in intent classification and improve the potential for injury surveillance irrespective of intent.
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Affiliation(s)
- Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, Sydney, NSW, 2109, Australia.
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, Sydney, NSW, 2109, Australia
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Snowdon J, Phillips J, Zhong B, Yamauchi T, Chiu HFK, Conwell Y. Changes in age patterns of suicide in Australia, the United States, Japan and Hong Kong. J Affect Disord 2017; 211:12-19. [PMID: 28081432 DOI: 10.1016/j.jad.2017.01.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/29/2016] [Accepted: 01/03/2017] [Indexed: 01/09/2023]
Abstract
The patterns of association between age and suicide rate vary by country, subpopulation and gender, and over time. To shed light on factors associated with these differences, we analysed suicide data from four populations, two 'Western' (Australia, the United States [US]) and two Asian (Japan and Hong Kong). We computed suicide rates in five-year age-groups (between 10 and 14 years and 85+ years) for men and women separately, and present graphical representations of the age patterns during selected five-year periods. Rates and age patterns differed markedly, as did gender patterns except in Hong Kong. In 1964-8, male suicide rates in Australia and US were represented by upward-sloping graphs, whereas in Japan the pattern was bimodal. By 1979-83, male patterns in Australia and US were bimodal, but Japan's was trimodal, including a middle-age peak reached in 1994-98. In contrast, female age patterns in the Western countries were shallowly convex or uniform, while in Hong Kong and Japan the upward-sloping graphs became, over time, less steep; by 2009-13, the pattern in Japan was uniform (flat). In recent decades, suicide rates of older men in Australia, US and Japan, and older women in Japan and Hong Kong, have fallen considerably. Suicide rates of men aged 45-64 in Australia and US also fell, though by 2009-13 the US rate had risen again. The suicide rate of Australian men in their twenties halved between 1994-98 and 2009-13, while rates for younger men and women in Japan have risen since 1994-98. In Hong Kong, suicide rates of young men have increased. Age patterns of suicide likely reflect period and cohort effects shaped by socioeconomic stressors, availability of health and welfare services, access to lethal methods of suicide, and other factors. Greater understanding of their impact on age patterns of suicide can result in potential preventive solutions.
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Affiliation(s)
- John Snowdon
- Discipline of Psychiatry, Sydney Medical School, Sydney, Australia.
| | - Julie Phillips
- Department of Sociology, Institute for Health, Health Care Research and Aging Research, Rutgers University, USA
| | - Baoliang Zhong
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong
| | - Takashi Yamauchi
- Research Center for Overwork-related Disorders, National Institute of Occupational Safety and Health, Kawasaki, Japan
| | - Helen F K Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
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Sharma S, Dewan A, Singh G. Toxico-vigilance - An inevitable prerequisite to keep a watch on toxins around you. J Forensic Leg Med 2016; 45:32-35. [PMID: 27939952 DOI: 10.1016/j.jflm.2016.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 08/10/2016] [Accepted: 11/25/2016] [Indexed: 01/09/2023]
Abstract
India has got a handful of poison centers to compensate about 1.25 billion population of India. Hence, a lot of under-reporting of poisoning cases occurs due to limited resources. Gujarat being an upcoming industrial centre of India has got many key industries like textiles, automobiles, chemicals, diamonds, pharmaceuticals etc. This magnificent industrial growth has resulted upon increased exposure of various hazardous chemicals among the general and working population. This study reflects trends of poisoning observed in a poison center named Center For Education Awareness and Research On Chemicals and Health (CEARCH) at Ahmedabad. A retrospective study of around 659 cases were analytically analyzed which have been reported at CEARCH. Variables considered for analysis are age, gender, route of exposure, intention, agent group, agent subgroup and agent name. Out of which 274 cases of females, 384 cases were of males and one case of a transgender was reported. Maximum poisoning cases reported were of pesticides (57.35%) followed by pharmaceuticals (21.24%), industrial chemicals (6.22%), metals (5%), substance of abuse (3.94%), plant poisons (1.82%), household chemicals (1.36%), mixture of more than one agent (1.36%), herbicides (0.75%), animal poisons (0.45%), bacterial poisons (0.30%) and other poisons (0.15%). The data analysis reports that among all the routes of exposure, Oral route (94%) is the major route of exposure followed by inhalation (4%), dermal and injections respectively clearly emphasizing the need for appropriate steps towards the protection of the most vulnerable populations from the consequences of the pervasive poisons exposure.
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Affiliation(s)
- Shweta Sharma
- Raksha Shakti University, Meghaninagar, Ahmedabad, India.
| | | | - Gyanendra Singh
- National Institute of Occupational Health, Meghaninagar, Ahmedabad, India.
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Abstract
Drug overdose is now the leading cause of injury-related mortality in the USA, but the prognostic utility of cardiac biomarkers is unknown. We investigated whether serum cardiac troponin I (cTnI) was associated with overdose mortality. This prospective observational cohort studied adults with suspected acute drug overdose at two university hospital emergency departments (ED) over 3 years. The endpoint was in-hospital mortality, which was used to determine test characteristics of initial/peak cTnI. There were 437 overdoses analyzed, of whom there were 20 (4.6 %) deaths. Mean initial cTnI was significantly associated with mortality (1.2 vs. 0.06 ng/mL, p < 0.001), and the ROC curve revealed excellent cTnI prediction of mortality (AUC 0.87, CI 0.76-0.98). Test characteristics for initial cTnI (90 % specificity, 99 % negative predictive value) were better than peak cTnI (88.2 % specificity, 99.2 % negative predictive value), and initial cTnI was normal in only one death out of the entire cohort (1/437, CI 0.1-1.4 %). Initial cTnI results were highly associated with drug overdose mortality. Future research should focus on high-risk overdose features to optimize strategies for utilization of cTnI as part of the routine ED evaluation for acute drug overdose.
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Affiliation(s)
- Alex F Manini
- Division of Medical Toxicology, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, Box 1620, One Gustave Levy Place, New York, NY, 10029, USA.
- Elmhurst Hospital Center, New York, NY, 11373, USA.
| | - Barry Stimmel
- Cardiology Division, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Robert S Hoffman
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, NY, 10016, USA
- New York City Poison Control Center, Department of Health and Mental Hygiene, New York City, NY, 10016, USA
| | - David Vlahov
- School of Nursing, University of California, San Francisco, CA, 94143, USA
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Aly Z, Rosen N, Evans RW. Migraine and the Risk of Suicide. Headache 2016; 56:753-61. [PMID: 27028299 DOI: 10.1111/head.12815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 02/26/2016] [Indexed: 01/09/2023]
Abstract
Rarely and tragically, migraineurs commit suicide or overdose on medications we prescribe.
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Affiliation(s)
- Zarmeneh Aly
- Department of Neuro Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Noah Rosen
- Cushing Neuroscience Institute, Hofstra Northwell Health, Great Neck, NY, USA
| | - Randolph W Evans
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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Jia T, Tynelius P, Rasmussen F. U-shaped association of body mass index in early adulthood with unintentional mortality from injuries: a cohort study of Swedish men with 35 years of follow-up. Int J Obes (Lond) 2015; 40:809-14. [PMID: 26607037 DOI: 10.1038/ijo.2015.239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 11/04/2015] [Accepted: 11/06/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To investigate the dose-response association between body mass index (BMI) in young adulthood and the risk of mortality caused by unintentional injuries. METHODS We performed a cohort study including 7 43 398 men identified by linkage of the Multigeneration Register and the Military Service Conscription Register. Cox regression models were used to examine crude and adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) of the relationships between BMI at age 18-20 years and the risk of death from all unintentional injuries as well as from specific unintentional injuries. We then estimated the population attributable fractions (PAFs)-the proportion of unintentional deaths that was attributable to underweight, overweight and obesity in this population-based cohort. RESULTS During 35.9 years of follow-up, 6461 deaths occurred from unintentional injuries, including 3064 deaths from road injury, 978 from poisoning, 503 from falls, 243 from fire and 348 from drowning. Underweight subjects had a higher risk of mortality in all unintentional injuries (HR, 1.05; 95% CI, 1.03-1.10) and mortality in burns (HR, 1.65; 95% CI, 1.13-2.40) compared with BMI between 18.5 and 22.5 kg m(-2) (reference group). BMI >25 kg m(-2) was associated with increased risk of death from all unintentional injuries (HR, 1.36; 95% CI, 1.12-1.65) and road accidents (HR, 1.50; 95% CI, 1.14-1.97). Estimates of PAF suggested that 4.4% of the mortality in Swedish men caused by unintentional injuries could have been avoided if BMI values were kept between 18.5 and 22.5 kg m(-2). CONCLUSIONS A U-shaped association was observed between BMI and risk of unintentional death. Both underweight and overweight were associated with increased mortality risk for all unintentional injuries and for subtype causes. Our study suggests that BMI might be a significant target for preventive interventions on deaths caused by unintentional injuries.
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Affiliation(s)
- T Jia
- Child and Adolescent Public Health Epidemiology Unit, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - P Tynelius
- Child and Adolescent Public Health Epidemiology Unit, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - F Rasmussen
- Child and Adolescent Public Health Epidemiology Unit, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Health Care Services, Stockholm, Sweden
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Cha ES, Chang SS, Lee WJ. Potential underestimation of pesticide suicide and its impact on secular trends in South Korea, 1991–2012. Inj Prev 2015; 22:189-94. [DOI: 10.1136/injuryprev-2015-041781] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/20/2015] [Indexed: 01/09/2023]
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Dalela D, Krishna N, Okwara J, Preston MA, Abdollah F, Choueiri TK, Reznor G, Sammon JD, Schmid M, Kibel AS, Nguyen PL, Menon M, Trinh QD. Suicide and accidental deaths among patients with non-metastatic prostate cancer. BJU Int 2015; 118:286-97. [DOI: 10.1111/bju.13257] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Deepansh Dalela
- Division of Urologic Surgery and Center for Surgery and Public Health; Harvard Medical School; Brigham and Women's Hospital/Dana-Farber Cancer Institute; Boston MA USA
- VUI Center for Outcomes Research, Analytics and Evaluation; Vattikuti Urology Institute; Henry Ford Health System; Detroit MI USA
| | - Nandita Krishna
- Division of Urologic Surgery and Center for Surgery and Public Health; Harvard Medical School; Brigham and Women's Hospital/Dana-Farber Cancer Institute; Boston MA USA
| | - James Okwara
- Division of Urologic Surgery and Center for Surgery and Public Health; Harvard Medical School; Brigham and Women's Hospital/Dana-Farber Cancer Institute; Boston MA USA
| | - Mark A. Preston
- Division of Urologic Surgery and Center for Surgery and Public Health; Harvard Medical School; Brigham and Women's Hospital/Dana-Farber Cancer Institute; Boston MA USA
| | - Firas Abdollah
- VUI Center for Outcomes Research, Analytics and Evaluation; Vattikuti Urology Institute; Henry Ford Health System; Detroit MI USA
| | - Toni K. Choueiri
- Department of Medical Oncology; Harvard Medical School; Brigham and Women's Hospital/Dana-Farber Cancer Institute; Boston MA USA
| | - Gally Reznor
- Division of Urologic Surgery and Center for Surgery and Public Health; Harvard Medical School; Brigham and Women's Hospital/Dana-Farber Cancer Institute; Boston MA USA
| | - Jesse D. Sammon
- VUI Center for Outcomes Research, Analytics and Evaluation; Vattikuti Urology Institute; Henry Ford Health System; Detroit MI USA
| | - Marianne Schmid
- Division of Urologic Surgery and Center for Surgery and Public Health; Harvard Medical School; Brigham and Women's Hospital/Dana-Farber Cancer Institute; Boston MA USA
| | - Adam S. Kibel
- Division of Urologic Surgery and Center for Surgery and Public Health; Harvard Medical School; Brigham and Women's Hospital/Dana-Farber Cancer Institute; Boston MA USA
| | - Paul L. Nguyen
- Department of Radiation Oncology; Harvard Medical School; Brigham and Women's Hospital/Dana-Farber Cancer Institute; Boston MA USA
| | - Mani Menon
- VUI Center for Outcomes Research, Analytics and Evaluation; Vattikuti Urology Institute; Henry Ford Health System; Detroit MI USA
| | - Quoc-Dien Trinh
- Division of Urologic Surgery and Center for Surgery and Public Health; Harvard Medical School; Brigham and Women's Hospital/Dana-Farber Cancer Institute; Boston MA USA
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Rockett IRH, Hobbs GR, Wu D, Jia H, Nolte KB, Smith GS, Putnam SL, Caine ED. Variable Classification of Drug-Intoxication Suicides across US States: A Partial Artifact of Forensics? PLoS One 2015; 10:e0135296. [PMID: 26295155 PMCID: PMC4546666 DOI: 10.1371/journal.pone.0135296] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 07/20/2015] [Indexed: 01/09/2023] Open
Abstract
Background The 21st-century epidemic of pharmaceutical and other drug-intoxication deaths in the United States (US) has likely precipitated an increase in misclassified, undercounted suicides. Drug-intoxication suicides are highly prone to be misclassified as accident or undetermined. Misclassification adversely impacts suicide and other injury mortality surveillance, etiologic understanding, prevention, and hence clinical and public health policy formation and practice. Objective To evaluate whether observed variation in the relative magnitude of drug-intoxication suicides across US states is a partial artifact of the scope and quality of toxicological testing and type of medicolegal death investigation system. Methods This was a national, state-based, ecological study of 111,583 drug-intoxication fatalities, whose manner of death was suicide, accident, or undetermined. The proportion of (nonhomicide) drug-intoxication deaths classified by medical examiners and coroners as suicide was analyzed relative to the proportion of death certificates citing one or more specific drugs and two types of state death investigation systems. Our model incorporated five sociodemographic covariates. Data covered the period 2008–2010, and derived from NCHS’s Multiple Cause-of-Death public use files. Results Across states, the proportion of drug-intoxication suicides ranged from 0.058 in Louisiana to 0.286 in South Dakota and the rate from 1 per 100,000 population in North Dakota to 4 in New Mexico. There was a low correlation between combined accident and undetermined drug-intoxication death rates and corresponding suicide rates (Spearman’s rho = 0.38; p<0.01). Citation of 1 or more specific drugs on the death certificate was positively associated with the relative odds of a state classifying a nonhomicide drug-intoxication death as suicide rather than accident or undetermined, adjusting for region and type of state death investigation system (odds ratio, 1.062; 95% CI,1.016–1.110). Region, too, was a significant predictor. Relative to the South, a 10% increase in drug citation was associated with 43% (95% CI,11%-83%), 41% (95% CI,7%-85%), and 33% (95% CI,1%-76%) higher odds of a suicide classification in the West, Midwest, and Northeast, respectively. Conclusion Large interstate variation in the relative magnitude of nonhomicide drug-intoxication deaths classified as suicide by medical examiners and coroners in the US appears partially an artifact of geographic region and degree of toxicological assessment in the case ascertainment process. Etiologic understanding and prevention of drug-induced suicides and other drug-intoxication deaths first require rigorous standardization involving accurate concepts, definitions, and case ascertainment.
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Affiliation(s)
- Ian R. H. Rockett
- Injury Control Research Center and Department of Epidemiology, West Virginia University School of Public Health, Morgantown, West Virginia, United States of America
- * E-mail:
| | - Gerald R. Hobbs
- Department of Statistics, West Virginia University, Morgantown, West Virginia, United States of America
| | - Dan Wu
- Department of Psychology, Guangdong Medical College, Dongguan, Guandong, China and Department of Social Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Haomiao Jia
- Department of Biostatistics, Mailman School of Public Health, and School of Nursing, Columbia University, New York, New York, United States of America
| | - Kurt B. Nolte
- Office of the Medical Investigator – Department of Pathology, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States of America
| | - Gordon S. Smith
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland, United States of America
| | - Sandra L. Putnam
- Social Solutions International Inc., Silver Spring, Maryland, United States of America
| | - Eric D. Caine
- Injury Control Research Center for Suicide Prevention and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, United States of America
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