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Schwinn T, Paul RH, Hirschmiller J, Brähler E, Wiltink J, Zwerenz R, O'Connor RC, Wild PS, Münzel T, König J, Geschke K, Moehler M, Konstantinides S, Justenhoven C, Lackner KJ, Pfeiffer N, Beutel ME, Ernst M. Prevalence of current suicidal thoughts and lifetime suicide attempts in individuals with cancer and other chronic diseases in Germany: Evidence for differential associations from a representative community cohort. J Affect Disord 2024; 367:193-201. [PMID: 39178957 DOI: 10.1016/j.jad.2024.08.093] [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: 03/12/2024] [Revised: 08/16/2024] [Accepted: 08/17/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND Research indicates an elevated risk for suicidal thoughts and behaviors (STBs) among individuals with cancer, but community-based studies on the prevalence of STBs in comparison to the general population and other chronic diseases are lacking. METHODS Data was drawn from the representative population-based, prospective Gutenberg Health Study (GHS). Participants (N = 12,382; age: M = 59.5, SD = 10.8; 48.9 % women) completed highly standardized medical assessments and validated questionnaires such as the PHQ-9. In addition to prevalence estimates (stratified by STBs and gender), logistic regression models were calculated (controlling for confounders). RESULTS The sample included 1910 individuals with cancer, 8.2 % of whom reported current suicidal thoughts and 2.0 % reported lifetime suicide attempts. There was neither a significant association between a cancer diagnosis and suicidal thoughts (p = .077) nor suicide attempts (p = .17) in models adjusting for age, gender, and income. Other chronic diseases were linked to suicidal thoughts and attempts only in men. LIMITATIONS Although the investigation of the two kinds of STB are a strength of the study, the items' different time frames complicate comparisons. In addition, the cross-sectional design limits the ability to understand observed relationships and to identify periods of risk. CONCLUSION This study expands the evidence base regarding the vulnerability to STBs in individuals with cancer, including long-term survivors. It highlights their heterogeneity, differential risk factors underlying suicidal thoughts and attempts, and the relevance of other (contextual) factors shaping an individual's susceptibility to suicidal crises.
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Affiliation(s)
- Tamara Schwinn
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
| | - Roman H Paul
- Institute for Medical Biometry, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Judith Hirschmiller
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of Medical Psychology and Medical Sociology, University Medical Center of Leipzig, Leipzig, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Rory C O'Connor
- Suicidal Behaviour Research Laboratory, School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Philipp S Wild
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany; Preventive Cardiology and Preventive Medicine - Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Münzel
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany; Department of Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jochem König
- Institute for Medical Biometry, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Katharina Geschke
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Markus Moehler
- I. Dept. Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Christina Justenhoven
- Cancer Registry of Rhineland-Palatinate in the Institute of Digital Health Data gGmbH, Mainz, Germany
| | - Karl J Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Mareike Ernst
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of Clinical Psychology, Psychotherapy and Psychoanalysis, Institute of Psychology, University of Klagenfurt, Klagenfurt, Austria
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Ramm M, Jedamzik J, Lenz P, Jürgens L, Heuft G, Conrad R. Older adults coping with critical life events - results of the revised demoralization scale in a representative sample of older adulthood. Front Psychiatry 2024; 15:1389021. [PMID: 38800056 PMCID: PMC11116776 DOI: 10.3389/fpsyt.2024.1389021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Background High suicide rates in older adults are a relevant public health concern. Social isolation or widowhood as well as physical decline play a crucial role for suicidality in older adulthood. Previous evidence suggested that demoralization is an important risk factor for suicide. Whether demoralization is a relevant phenomenon in older adulthood which possibly could account for high suicide rates remains unclear. Methods Demoralization Scale II (DS-II) scores assessed in a survey of the German general population were investigated with respect to older adults (aged ≥ 65 years). DS-II scores were compared between older (≥ 65 years) and younger (< 65 years) adulthood and between young-old (65-74y), middle-old (75-84y), and old-old (85+y) individuals. We tested the impact of sociodemographic factors on DS-II scores within older adults. Results The sample comprised N = 545 adults ≥ 65 years and N = 1922 adults < 65 years. DS-II scores increased in older compared to younger adults (F(1,2465) = 6.1; p = 0.013; d = 0.09) and further from young-old to old-old (Mdiff = 2.7; 95% CI 0.45, 5.46; p = 0.034). One-fourth of individuals ≥ 65 years and almost half of old-old individuals reported DS-II scores above the cut-off > 5. Living with a partner protected from demoralization in old-old individuals. Discussion This study provides first evidence for an increased rate of demoralization in very old adults, in particular women, which is partly related to partnership status. We suggest that demoralization is considered as a crucial entity in older adulthood which can be missed by standard psychological screenings.
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Affiliation(s)
- Markus Ramm
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Johanna Jedamzik
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Philipp Lenz
- West German Cancer Center, University Hospital Münster, Münster, Germany
- Institute of Palliative Care, University Hospital Münster, Münster, Germany
| | - Lara Jürgens
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Gereon Heuft
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany
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Śledzik K, Płoska R, Chmielewski M, Barembruch A, Szmelter-Jarosz A, Kędzierska-Szczepaniak A, Antonowicz P. Multivariate Pharma Technology Transfer Analysis: Civilization Diseases and COVID-19 Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1954. [PMID: 36767318 PMCID: PMC9915368 DOI: 10.3390/ijerph20031954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
The importance of studying civilization diseases manifests itself in the impact of changing lifestyles, on the number of deaths and causes of death. Technology transfer plays an important role in the prevention and treatment of these diseases. Through this, it is possible to transfer new treatments and diagnostics to clinics and hospitals more quickly and effectively, which leads to better healthcare for patients. Technology transfer can also aid in the development of new drugs and therapies that can be effective in the treatment of civilization diseases. The paper aims to evaluate the technology transfer process in the field of civilization diseases, using COVID-19 as an example of a pandemic that requires quick development and transfer of technology. To achieve the assumed goal, we propose a multivariate synthetic ratio in the field of civilization diseases (SMTT-Synthetic Measure of Technology Transfer) to analyze data from the Global Data database. We used sub-measures like SMTT_value (Synthetic Measure of Technology Transfer_value) and SMTT_quantity (Synthetic Measure of Technology Transfer_quantity) to measure technology transfer and put the data into a graph. Our analysis focuses on 14 diseases over a period of 10 years (2012-2021) and includes nine forms of technology transfer, allowing us to create a tool for analysing the process in multiple dimensions. Our results show that COVID-19 is similar in terms of technology transfer to diseases such as diabetes, cardiovascular diseases, neurodegenerative diseases, and breast cancer, even though data for COVID-19 is available for only 2 years.
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Affiliation(s)
- Karol Śledzik
- Department of Banking and Finance, Faculty of Management, University of Gdańsk, ul. Armii Krajowej 101, 81-824 Sopot, Poland
| | - Renata Płoska
- Department of Business Economics, Faculty of Management, University of Gdańsk, ul. Armii Krajowej 101, 81-824 Sopot, Poland
| | - Mariusz Chmielewski
- Department of Business Economics, Faculty of Management, University of Gdańsk, ul. Armii Krajowej 101, 81-824 Sopot, Poland
| | - Adam Barembruch
- Department of Banking and Finance, Faculty of Management, University of Gdańsk, ul. Armii Krajowej 101, 81-824 Sopot, Poland
| | - Agnieszka Szmelter-Jarosz
- Department of Logistics, Faculty of Economics, University of Gdańsk, ul. Armii Krajowej 109/111, 81-824 Sopot, Poland
| | - Angelika Kędzierska-Szczepaniak
- Department of Banking and Finance, Faculty of Management, University of Gdańsk, ul. Armii Krajowej 101, 81-824 Sopot, Poland
| | - Paweł Antonowicz
- Department of Business Economics, Faculty of Management, University of Gdańsk, ul. Armii Krajowej 101, 81-824 Sopot, Poland
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Molebatsi K, Ho-Foster A, Ntsayagae E, Bikimane B, Bauer AM, Suleiman K, Acosta E, Beidas R, Schnoll R. Implementation Planning for Integrating Depression Screening in Diabetes Mellitus and HIV Clinics in Botswana. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2022; 2:384-393. [PMID: 36340843 PMCID: PMC9628413 DOI: 10.1007/s43477-022-00062-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
Depression is highly prevalent and, when comorbid with other medical conditions, can worsen health outcomes. Implementing routine depression screening within medical clinics can ensure that patients receive suitable treatment and improve overall health outcomes. Unfortunately, depression screening within medical settings is rare, particularly in low- and middle-income countries. This qualitative study evaluated patient and clinician perspectives on implementing depression screening within HIV and diabetes clinics in Botswana. Seven clinicians and 23 patients within these clinics were purposively selected and interviewed using a guide informed by the Consolidated Framework for Implementation Research (CFIR) to understand barriers and facilitators to depression screening in medical clinics in Botswana. Interviews were recorded, transcribed, and analyzed using NVivo. Three general themes emerged: (1) Appropriateness and Acceptability: attitudes and beliefs from clinicians and patients about whether depression screening should occur in this setting; (2) Stigma as an important barrier: the need to address the negative associations with depression to facilitate screening; and (3) Recommendations to facilitate screening including improving knowledge and awareness about depression, offering incentives to complete the screening, providing staff training, ensuring resources for treatment, the need to preserve confidentiality, and utilizing leadership endorsement. These results offer insights into how to implement depression screening within medical clinics in Botswana. These results can help design implementation strategies to increase depression screening in these clinics, which can be tested in future studies. Supplementary Information The online version contains supplementary material available at 10.1007/s43477-022-00062-3.
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Affiliation(s)
- Keneilwe Molebatsi
- Department of Psychiatry, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Ari Ho-Foster
- Research and Graduate Studies Office, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Esther Ntsayagae
- School of Nursing, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Boikanyo Bikimane
- Ministry of Health and Wellness, Gaborone Health District, Government of Botswana, Gaborone, Botswana
| | - Anna-Marika Bauer
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 4th Floor, Philadelphia, PA 19143 USA
| | | | - Erika Acosta
- University of Pennsylvania, Philadelphia, PA USA
| | - Rinad Beidas
- Departments of Psychiatry, Medical Ethics and Health Policy, and Medicine, Penn Implementation Science Center (PISCE@LDI), Penn Medicine Nudge Unit, Center for Health Incentives and Behavioral Economics (CHIBE), Leonard Davis Institute of Health Economics, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Robert Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA USA
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Otsuka T, Sugawara Y, Matsuyama S, Tsuji I. How does social support modify the association between psychological distress and risk of suicide death? Depress Anxiety 2022; 39:614-623. [PMID: 35543590 DOI: 10.1002/da.23265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/29/2022] [Accepted: 04/16/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Social support (SS) has been reported as a factor preventing suicide death, but whether this association is independent of mental status is unclear. The present study examined the effect modification of SS on the association between psychological distress status and risk of suicide death. METHODS Follow-up data for 43,015 subjects participating in a prospective cohort study were analyzed. At baseline, the subjects were asked about SS and mental status with the Kessler six-item Distress (K6) Scale. A Cox model was used to estimate the multivariate-adjusted hazard ratios (HRs) of suicide death according to two levels of psychological distress (K6 ≤ 4, K6 ≥ 5). The HRs in each SS subtype (emotional and instrumental) were also calculated. RESULTS There was a significant association between SS and a lower risk of suicide death in the stratum of K6 ≥ 5, with an HR of 0.58 (95% confidence interval, 0.35-0.96). On the other hand, the association with the K6 ≤ 4 strata was not significant. CONCLUSION SS appears to be associated with a lower risk of suicide death only among participants with moderate or severe psychological distress. These results imply that early detection of psychological distress and provision of SS is important for preventing suicide death.
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Affiliation(s)
- Tatsui Otsuka
- Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine, Sendai, Japan.,Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
| | - Yumi Sugawara
- Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine, Sendai, Japan
| | - Sanae Matsuyama
- Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine, Sendai, Japan
| | - Ichiro Tsuji
- Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine, Sendai, Japan
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Fernando DT, Clapperton A, Berecki-Gisolf J. Suicide following hospital admission for mental health conditions, physical illness, injury and intentional self-harm in Victoria, Australia. PLoS One 2022; 17:e0271341. [PMID: 35816509 PMCID: PMC9273064 DOI: 10.1371/journal.pone.0271341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 06/28/2022] [Indexed: 11/18/2022] Open
Abstract
Objective The majority of suicide decedents have had contact with health services close to their death. Some of these contacts include admissions to hospitals for physical and mental health conditions, injury and intentional self-harm. This study aims to establish and quantify the risks of suicide following hospital admission for a range of mental and physical illnesses. Methods A retrospective analysis was carried out on existing morbidity and mortality data in Victoria. Data was extracted from the Victorian Admitted Episodes Dataset and the Victorian Suicide Register. Unplanned hospital admissions among adult patients (> = 15 years of age), discharged between 01 January 2011 and 31 December 2016 (2,430,154 admissions), were selected. Standardised Mortality Ratios were calculated for conditions with at least five linked suicides within one year of discharge from hospital. Results Forty-three conditions defined at the three-digit level of the International Statistical Classification of Diseases and Related Health Problems 10th Revision, were associated with at least five subsequent suicides (within one year of hospital discharge); 14 physical illnesses, 5 symptoms, signs and abnormal clinical and laboratory findings, 12 mental health conditions, and 12 types of injury and poisonings. The highest Standardised Mortality Ratios were for poisonings (range; 27.8 to 140.0) and intentional self-harm (78.8), followed by mental health conditions (range; 15.5 to 72.9), symptoms, signs and abnormal clinical and laboratory findings (range; 1.4 to 43.2) and physical illnesses (range; 0.7 to 4.9). Conclusions Hospital admissions related to mental health conditions and injury and poisonings including self-harm were associated with a greater risk of suicide than physical conditions. Mental health conditions such as depressive episodes, personality disorders and psychotic episodes, injuries caused by intentional-self-harm and poisonings by certain types of drugs, carbon monoxide and hormones such as insulin can be prioritised for targeting suicide prevention initiatives for persons discharged from hospitals.
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Affiliation(s)
- Dasamal Tharanga Fernando
- Victorian Injury Surveillance Unit, Monash University Accident Research Centre, Monash University, Clayton, Victoria, Australia
- * E-mail:
| | - Angela Clapperton
- Victorian Injury Surveillance Unit, Monash University Accident Research Centre, Monash University, Clayton, Victoria, Australia
| | - Janneke Berecki-Gisolf
- Victorian Injury Surveillance Unit, Monash University Accident Research Centre, Monash University, Clayton, Victoria, Australia
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Kim SW, Park WY, Kim H, Jhon M, Kim JW, Kang HJ, Kim SY, Ryu S, Lee JY, Shin IS, Kim JM. Development of a Checklist for Predicting Suicidality Based on Risk and Protective Factors: The Gwangju Checklist for Evaluation of Suicidality. Psychiatry Investig 2022; 19:470-479. [PMID: 35753686 PMCID: PMC9233948 DOI: 10.30773/pi.2022.0063] [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: 02/26/2022] [Accepted: 04/26/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The aim of the study was to develop a checklist for mental health clinicians to predict and manage suicidality. METHODS A literature review of the risk and protective factors for suicide was conducted to develop a checklist for evaluating suicidality. RESULTS The fixed risk factors included sex (male), age (older individuals), history of childhood adversity, and a family history of suicide. Changeable risk factors included marital status (single), economic status (poverty), physical illness, history of psychiatric hospitalization, and history of suicide attempts. Recent discharge from a mental hospital and a recent history of suicide attempts were also included. Manageable risk factors included depression (history and current), alcohol problems (frequent drinking and alcohol abuse), hopelessness, agitation, impulsivity, impaired reality testing, and command hallucinations. Protective factors included responsibility to family, social support, moral objections to suicide, religiosity, motivation to get treatment, ability to cope with stress, and a healthy lifestyle. A final score was assigned based on the sum of the risk and protective factor scores. CONCLUSION We believe that the development of this checklist will help mental health clinicians to better assess those at risk for suicidal behavior. Further studies are necessary to validate the checklist.
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Affiliation(s)
- Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.,Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
| | - Woo-Young Park
- Department of Psychiatry, Gwangju Veterans Hospital, Gwangju, Republic of Korea
| | - Honey Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.,Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
| | - Min Jhon
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.,Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seon-Young Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seunghyoung Ryu
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.,Gwangju Metropolitan Mental Health Welfare Center, Gwangju, Republic of Korea
| | - Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.,Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
| | - Il-Seon Shin
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
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Roncero C, Pérez J, Molina J, Quintano JA, Campuzano AI, Pérez J, Miravitlles M. Frequency and Associated Factors of Suicidal Ideation in Patients with Chronic Obstructive Pulmonary Disease. J Clin Med 2022; 11:2558. [PMID: 35566685 PMCID: PMC9101437 DOI: 10.3390/jcm11092558] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 02/04/2023] Open
Abstract
We aimed to examine the prevalence of suicidal ideation in patients with chronic obstructive pulmonary disease (COPD) and the association between demographic and clinical variables and the occurrence of suicidal thoughts. This was a cross-sectional study. Sociodemographic and clinical data were recorded, and questionnaires were used to assess depressive symptoms (Beck Depression Inventory), comorbidities (Charlson Index), cognitive performance (Mini Mental State Examination), and quality of life (EuroQoL-5 dimensions and CAT). Specific questions about suicide-related behavior were included. Multivariate logistic regression analysis identified the significant factors associated with previous suicidal ideation and suicide attempts. The analysis included 1190 subjects. The prevalence of suicidal ideation and suicide attempts were 12.1% and 2.5%, respectively. Severely depressed patients had the highest prevalence of suicide-related behavior. The adjusted logistic model identified factors significantly associated with suicidal ideation: sex (odds ratio (OR) for women vs. men = 2.722 (95% confidence interval (CI) = 1.771-4.183)), depression score (OR = 1.163 (95% IC = 1.127-1.200)), and Charlson Index (OR 1.228 (95% IC 1.082-1.394)). Suicidal ideation is common in COPD patients, especially in women. While addressing suicidal ideation and suicide prevention, clinicians should first consider the management of depressive symptomatology and the improvement of coping strategies.
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Affiliation(s)
- Carlos Roncero
- Psychiatric Service, University of Salamanca Health Care Complex, 37007 Salamanca, Spain;
- Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, 37007 Salamanca, Spain
| | - Joselín Pérez
- Medical Department, Grupo Ferrer, 08029 Barcelona, Spain; (J.P.); (A.I.C.)
| | - Jesús Molina
- Centro de Salud Francia, Dirección Asistencial Oeste, 28993 Madrid, Spain;
| | | | | | - Javier Pérez
- Psychiatric Service, University of Salamanca Health Care Complex, 37007 Salamanca, Spain;
- Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, 37007 Salamanca, Spain
| | - Marc Miravitlles
- Department of Pneumology, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
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Rasheduzzaman M, al-Mamun F, Hosen I, Akter T, Hossain M, Griffiths MD, Mamun MA. Suicidal behaviors among Bangladeshi university students: Prevalence and risk factors. PLoS One 2022; 17:e0262006. [PMID: 35025905 PMCID: PMC8758040 DOI: 10.1371/journal.pone.0262006] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022] Open
Abstract
Background Bangladeshi university students are considered to be highly suicide-prone compared to other populations and cohorts. However, no prior epidemiological studies have assessed the suicidality (i.e., past-year suicidal ideation [SI], lifetime suicide plan [SP], and lifetime suicide attempt [SA]) among Bangladeshi students, including the variables such as past-year stressful life events and family mental health history. This is arguably a major knowledge gap in the country. Therefore, the present study investigated the prevalence and associated risk factors for suicidal behaviors among Bangladeshi university students. Methods A cross-sectional study was conducted utilizing a convenience sampling method among a total of 1844 university students between October and November 2019. Data were collected based on the information related to socio-demographics, perceived health-related questions, past-year stressful life events, family mental health history, and suicidal behaviors (i.e., SI, SP, and SA). Chi-square tests and binary logistic regressions were used to analyze the data utilizing SPSS statistical software. Results The prevalence of past-year suicidal ideation, lifetime suicide plans, and suicide attempts were 13.4%, 6.0%, and 4.4%, respectively. Females reported significantly higher suicidal behavior than males (i.e., 20.6% vs.10.2% SI; 9% vs. 4.6% SP; and 6.4% vs.3.6% SA). Risk factors for SI were being female, year of academic study, residing in an urban area, using psychoactive substances, experiencing both past year physical and mental illness, experiencing any type of stressful past-year life events, experiencing campus ragging (i.e., senior students abusing, humiliating and/or harassing freshers or more junior students), experiencing family mental illness history, and having family suicide attempt history. SP was associated with several factors including being female, year of academic study, using psychoactive substance, experiencing both past-year physical and mental illness, and experiencing any type of stressful past-year life events. Risk factors for SA were being female, year of academic study, using psychoactive substances, experiencing past-year mental illness, experiencing any type of stressful past-year life events, and having family suicide attempt history. Conclusions University students appear to be a vulnerable group for experiencing suicidal behaviors. The present findings warrant rigorous action and early intervention programs such as counseling and other mental health professional services by university authorities. Longitudinal studies are highly recommended involving countrywide representative samples.
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Affiliation(s)
- M. Rasheduzzaman
- CHINTA Research Bangladesh, Savar, Dhaka, Bangladesh
- Institute of Social Welfare and Research, University of Dhaka, Dhaka, Bangladesh
| | - Firoj al-Mamun
- CHINTA Research Bangladesh, Savar, Dhaka, Bangladesh
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Ismail Hosen
- CHINTA Research Bangladesh, Savar, Dhaka, Bangladesh
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Tahmina Akter
- CHINTA Research Bangladesh, Savar, Dhaka, Bangladesh
- Department of Epidemiology, Bangladesh University of Health Sciences, Dhaka, Bangladesh
| | - Moazzem Hossain
- Institute of Allergy and Clinical Immunology of Bangladesh, Savar, Dhaka, Bangladesh
| | - Mark D. Griffiths
- Psychology Department, Nottingham Trent University, Nottingham, United Kingdom
- * E-mail: (MAM); (MDG)
| | - Mohammed A. Mamun
- CHINTA Research Bangladesh, Savar, Dhaka, Bangladesh
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
- * E-mail: (MAM); (MDG)
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10
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Gentile G, Tambuzzi S, Calati R, Zoja R. A Descriptive Cohort of Suicidal Cancer Patients: Analysis of the Autopsy Case Series from 1993 to 2019 in Milan (Italy). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020829. [PMID: 35055655 PMCID: PMC8776118 DOI: 10.3390/ijerph19020829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/29/2021] [Accepted: 01/04/2022] [Indexed: 12/10/2022]
Abstract
Suicide in cancer patients has always been a subject of clinical studies, but the contribution of forensic pathology to this phenomenon is poorly reported. With the aim of at least partially filling this gap in information, at the Institute of Forensic Medicine of Milan, Italy, we assessed all suicides that occurred in cancer patients. A descriptive and retrospective analysis was carried out by examining the database of the Institute and autopsy reports. We included 288 suicide cases with proven cancer diseases. For each suicide, sex, age, country of origin, body area affected by cancer, further pathological history, medications, previous suicide attempts and suicidal communications, as well as the place where the suicide occurred, were assessed. Furthermore, from a forensic point of view, we considered the chosen suicide method and any involved means. The majority of cases were male older adults affected by lung, colon and prostate cancer. Violent suicide methods were prevalent, and the most represented suicide method was falling from height regardless of the body area affected by cancer. Such data may be of clinical use for clinicians engaged in the front lines in order to address suicide risk prevention strategies among cancer patients.
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Affiliation(s)
- Guendalina Gentile
- Department of Biomedical Sciences for Health, Section of Legal Medicine and Insurance, University of Milan, 20133 Milan, Italy; (G.G.); (S.T.); (R.Z.)
| | - Stefano Tambuzzi
- Department of Biomedical Sciences for Health, Section of Legal Medicine and Insurance, University of Milan, 20133 Milan, Italy; (G.G.); (S.T.); (R.Z.)
| | - Raffaella Calati
- Department of Psychology, University of Milan-Bicocca, 20126 Milan, Italy
- Department of Adult Psychiatry, Nimes University Hospital, 30029 Nimes, France
- Correspondence:
| | - Riccardo Zoja
- Department of Biomedical Sciences for Health, Section of Legal Medicine and Insurance, University of Milan, 20133 Milan, Italy; (G.G.); (S.T.); (R.Z.)
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11
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Hugunin J, Yuan Y, Rothschild AJ, Lapane KL, Ulbricht CM. Risk factors associated with suicidal ideation in newly admitted working-age nursing home residents. J Affect Disord 2021; 295:243-249. [PMID: 34482055 PMCID: PMC8551025 DOI: 10.1016/j.jad.2021.08.042] [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: 04/28/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Suicide is a leading cause of mortality in the United States and recent initiatives have sought to increase monitoring of suicide risk within healthcare systems. Working-age adults (22-64 years) admitted to nursing homes may be at risk for suicidal ideation, yet little is known about this population. METHODS The national nursing home database, Minimum Dataset 3.0, was used to identify 323,436 working-age adults newly admitted to a nursing home in 2015. This cross-sectional study sought to describe sociodemographic and clinical characteristics, examine behavioral health treatment received, and determine resident characteristics associated with suicidal ideation at nursing home admission using logistic regression and reports adjusted odds ratios (aOR). RESULTS Suicidal ideation was present among 1.27% of newly admitted working-age residents. Almost 25% of those with suicidal ideation had no psychiatric diagnosis. Factors associated with increased odds of suicidal ideation included younger age (aOR 1.90), admission from the community (aOR 1.92) or a psychiatric hospital (aOR 2.38), cognitive impairments (aOR 1.46), pain (aOR 1.40), rejection of care (aOR 1.91), and psychiatric comorbidity (aOR depression: 1.91, anxiety disorder: 1.11, bipolar disorder: 1.62, schizophrenia: 1.32, post-traumatic stress disorder: 1.17). LIMITATIONS Due to the cross-sectional nature of this study, no causal inferences about suicidal ideation and the explored covariates can be made. The Minimum Dataset 3.0 has only one measure of suicidal ideation the Patient Health Questionnaire. CONCLUSION Factors other than psychiatric diagnosis may be important in identifying newly admitted working-age nursing home residents who require on-going suicide screening and specialized psychiatric care.
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Affiliation(s)
- Julie Hugunin
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, United States.
| | - Yiyang Yuan
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Anthony J Rothschild
- Department of Psychiatry, University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, MA, United States
| | - Kate L Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Christine M Ulbricht
- National Institute of Mental Health, National Institutes of Health, the Department of Health and Human Services, Bethesda, MD, United States (formerly: Departments of Population and Quantitative Health Sciences & Psychiatry, University of Massachusetts Medical School, Worcester, MA, United States)
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12
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Tang W, Zhang WQ, Hu SQ, Shen WQ, Chen HL. Incidence and risk factors of suicide in patients with lung cancer: a scoping review. Support Care Cancer 2021; 30:2945-2957. [PMID: 34628516 DOI: 10.1007/s00520-021-06604-z] [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: 07/22/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To explore the high-risk period of the occupation of suicide after diagnosis; and clarify the risk factors of suicidal behaviors (suicidal ideation, suicide attempt, and suicidal death) behind the lung cancer patients during the cancer cure process. METHODS This scoping review was conducted through the whole month of April 2021. We extracted data of the suicide mortality after diagnosis and latent risk factors of suicidal behaviors among lung cancer patients where we used to study from the two online databases which are PubMed and Web of Science. Two online databases were searched and written in English without age restriction. To note that the standardized mortality ratio (SMR), person-years, and odds ratio (OR) associated with lung cancer were documented. RESULTS Out of 570 records, 23 studies mentioned suicidal behaviors and lung cancer met the included criteria. Eleven (n = 47.8%) of the selected publications reported changes in suicide mortality. None of them reported suicidal ideation or suicide attempt after diagnosis. The individuals with lung cancer have significantly higher rates of suicidal death (SMR, 2.04-13.4) during the first years after diagnosis and decrease over subsequent years (SMR, 0.66-3.17). The median time from cancer diagnosis to suicide death was around 7 months. Across all studies with the 22 studies that examined factors, we extracted the data of the suicidal ideation (n = 3), suicide attempt (n = 1), and suicidal death (n = 18) in individuals. For patients with suicidal ideation, there was a significantly higher incidence in males than in females. Among patients who attempted suicide, the incidence of mental illness is greater than the incidence of physical illness. Factors for suicidal death, including gender (male, 56.3-100%), prognosis tumors (poor, 25.8-66.3%), marital status (widowhood or unmarried, 19-75.7%), and age of patients (> 70 years, 24.5-47%) with lung cancer, play a vital role. Treatment of lung cancer is expected to affect a patient in his/her mental state. CONCLUSION Overall, our finding indicates that lung cancer patients have been presented with a higher incidence of suicide death in a specific period, especially the early years after diagnosis. Discovering risk factors for suicide helps prevent potential suicide. It is essential to screen lung cancer patients for suicidal ideation, especially those with high-risk factors. Future prospective studies are necessary to confirm these findings to support care.
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Affiliation(s)
- Wen Tang
- School of Medicine, Nantong University, Nantong, China
| | | | - Shi-Qi Hu
- School of Medicine, Nantong University, Nantong, China
| | - Wang-Qin Shen
- School of Medicine, Nantong University, Nantong, China.
| | - Hong-Lin Chen
- School of Public Health, Nantong University, 9# Seyuan Road, Nantong, 226000, Jiangsu, China.
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13
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Renemane L, Kivite-Urtane A, Rancans E. Suicidality and Its Relation with Physical and Mental Conditions: Results from a Cross-Sectional Study of the Nationwide Primary Care Population Sample in Latvia. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:970. [PMID: 34577893 PMCID: PMC8472357 DOI: 10.3390/medicina57090970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/02/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Physical and mental conditions are important risk factors for suicidality. However, there is no clear understanding of these relationships and the effect of co-occurrence on suicidality. We aimed to investigate the associations between current suicidality and mental disorders, physical conditions, and health-related factors in the nationwide primary care population in Latvia. Materials and Methods: A cross-sectional study was performed within the framework of the National Research Program BIOMEDICINE 2014-2017 at 24 primary care settings across Latvia in 2015. Adult patients were evaluated over one week at each facility. Socio-demographic variables, physical condition, and health-related factors were assessed on-site by trained psychiatrists. Mental disorders and suicidality were determined using the Mini International Neuropsychiatric Interview, and assessments were conducted over the telephone within two weeks after the visit to the general practitioner. Results: Of the 1485 cases, 18.6% reported suicidality. Only current depression, any anxiety disorder, any alcohol use disorder, and physical-mental multimorbidity were significantly associated with suicidality in the multivariate logistic regression analysis. Gastrointestinal diseases were associated with current depression alone (odds ratio (OR) 10.36; 95% confidence interval (CI) 2.34-45.76) and comorbid depression with any anxiety disorder (OR 7.55; 95% CI 2.15-26.49) among persons with current suicidality. Conclusions: Screening for depression, anxiety, and alcohol use disorders regularly among patients with physical illness may be important to help recognise suicidality in primary care that could improve the quality of life of patients and prevent suicides.
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Affiliation(s)
- Lubova Renemane
- Department of Psychiatry and Narcology, Riga Stradins University, Tvaika Street 2, LV-1005 Riga, Latvia;
| | - Anda Kivite-Urtane
- Department of Public Health and Epidemiology, Institute of Public Health, Riga Stradins University, Dzirciema Street 16, LV-1007 Riga, Latvia;
| | - Elmars Rancans
- Department of Psychiatry and Narcology, Riga Stradins University, Tvaika Street 2, LV-1005 Riga, Latvia;
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14
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Macchi ZA, Kletenik I, Olvera C, Holden SK. Psychiatric Comorbidities in Functional Movement Disorders: A Retrospective Cohort Study. Mov Disord Clin Pract 2021; 8:725-732. [PMID: 34307745 DOI: 10.1002/mdc3.13226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 04/05/2021] [Accepted: 04/11/2021] [Indexed: 01/20/2023] Open
Abstract
Background Functional movement disorders (FMD) are characterized by abnormal movements and motor symptoms incongruent with a known structural neurologic cause. While psychological stressors have long been considered an important risk factor for developing FMD, little is known about the impact of psychiatric comorbidities on disease manifestations or complexity. Objectives To compare characteristics of FMD patients with co-occurring mood and trauma-related psychiatric conditions to FMD patients without psychiatric conditions. Methods We performed a retrospective cohort study of patients seen in the University of Colorado Health system between January 1, 2015 and December 31, 2019. Patients were included if they had a diagnosis of FMD, determined by ICD-10 coding and ≥1 phenomenology-related diagnostic code (tremor, gait disturbances, ataxia, spasms, and weakness), and at least one encounter with a neurology specialist. Fisher's exact and unpaired t-tests were used to compare demographics, healthcare utilization, and phenomenologies of patients with psychiatric conditions to those with none. Results Our review identified 551 patients with a diagnosis of FMD who met inclusion criteria. Patients with psychiatric conditions (N = 417, 75.7%) had increased five-year healthcare utilization (mean emergency room encounters 9.9 vs. 3.5, P = 0.0001) and more prevalent non-epileptic seizures (18.2% vs. 7.5%, P = 0.001). Suicidal ideation (8.4%) and self-harm (4.1%) were only observed amongst patients with comorbid psychiatric conditions. Conclusions Patients with FMD and comorbid psychiatric conditions require more healthcare resources and have greater disease complexity than patients without psychiatric illness. This may have implications for treatment of patients without comorbid psychiatric conditions who may benefit from targeted physiotherapy alone.
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Affiliation(s)
- Zachary A Macchi
- Department of Neurology, Section of Behavioral Neurology University of Colorado Anschutz Aurora Colorado USA.,Department of Internal Medicine, Division of General Internal Medicine University of Colorado Anschutz Aurora Colorado USA
| | - Isaiah Kletenik
- Brigham and Women's Hospital, Department of Neurology, Division of Cognitive and Behavioral Neurology Harvard Medical School Boston Massachusetts USA
| | - Caroline Olvera
- Department of Neurological Sciences, Section of Movement Disorders Rush University Medical Center Chicago Illinois USA
| | - Samantha K Holden
- Department of Neurology, Section of Behavioral Neurology University of Colorado Anschutz Aurora Colorado USA
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15
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Abstract
Mutations in the genes coding for tryptophan-hydrolase-2 and the scaffold protein FKBP5 are associated with an increased risk of suicide. The mutation in both cases enhances the enzymatic activity of glycogen synthase kinase-3 (GSK3). Conversely, anti-suicidal medications, such as lithium, clozapine, and ketamine, indirectly inhibit the activity of GSK3. When GSK3 is active, it promotes the metabolic removal of the transcription factor NRF2 (nuclear factor erythroid 2-related factor-2), which suppresses the transcription of multiple genes that encode anti-oxidative and anti-inflammatory proteins. Notably, several suicide-biomarkers bear witness to an ongoing inflammatory process. Moreover, alterations in serum lipid levels measured in suicidal individuals are mirrored by data obtained in mice with genetic deletion of the NRF2 gene. Inflammation is presumably causally related to both dysphoria and anger, two factors relevant for suicide ideation and attempt. Preventing the catabolism of NRF2 could be a strategy to obtain novel suicide-prophylactic medications. Possible candidates are minocycline and nicotinic-α7 agonists. The antibiotic minocycline indirectly activates NRF2-transcriptional activity, whereas the activation of nicotinic-α7 receptors indirectly inhibits GSK3.
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16
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Associations between the type and number of chronic diseases and suicidal thoughts among Korean adults. Psychiatry Res 2021; 296:113694. [PMID: 33418459 DOI: 10.1016/j.psychres.2020.113694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/26/2020] [Indexed: 11/20/2022]
Abstract
Suicide and chronic diseases are global public issues. However, the relationship between chronic diseases, multimorbidity, and suicidal thoughts is unclear. Thus, we aimed to examine the association between the type and number of chronic diseases and suicidal thoughts among Korean adults. We analyzed data from the Korea National Health and Nutrition Examination Survey. A total of 16,059 individuals participated. We performed a multivariable logistic regression analysis adjusted for age, sex, educational level, personal income, smoking status, alcohol consumption, body mass index, comorbidity, and depressive mood, and calculated odds ratios (ORs) and 95% confidence intervals (CIs) of having suicidal thoughts. Suicidal thoughts were reported by 5.2% of participants. After adjusting for confounding variables, renal failure (OR: 4.43, 95% CI: 1.97-9.96), asthma (2.10, 1.42-3.11), atopic dermatitis (1.77, 1.15-2.70), stroke (1.59, 1.01-2.53), and arthritis (1.31, 1.02-1.69) were associated with higher risks of suicidal thoughts compared to no diagnosis. Participants with five or more chronic diseases had 2.78 times (95% CI: 1.40-5.50) higher odds of suicidal thoughts than those without chronic diseases. Having more chronic diseases was associated with a greater risk of suicidal thoughts. Early detection of and interventions for chronic diseases may be essential in developing suicide prevention strategies for adults.
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17
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Khan AR, Ratele K, Helman R, Dlamini S, Makama R. Masculinity and Suicide in Bangladesh. OMEGA-JOURNAL OF DEATH AND DYING 2020; 86:218-240. [PMID: 33076754 DOI: 10.1177/0030222820966239] [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] [Indexed: 11/16/2022]
Abstract
Suicide is a serious but under-researched public health problem in Bangladesh. In light of this, we sought to explore the association between masculinities and suicide. We interviewed 20 family members/friends of men who died by suicide across 12 rural areas of the Jhenaidah district, Bangladesh. We found that male suicide was attributed to men's inability to fulfil hegemonic masculine demands such as financial provision and meeting the sexual needs of their spouses. Suicide was also linked to men's loss of self-respect and respect from others. Some participants mentioned that men committed suicide as an act of self-sacrifice, while others cited mental and physical illness. As a result of these findings, we propose that addressing socio-cultural and religious issues associated with men's troubles may help to prevent suicide. At the same time, changing the restrictive gender roles and masculinity-related ideals is also needed to counter the problem.
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Affiliation(s)
| | - Kopano Ratele
- Masculinity and Health Research Unit, South African Medical Research Council-University of South Africa/Institute for Social and Health Sciences, University of South Africa, Cape Town, South Africa
| | - Rebecca Helman
- Masculinity and Health Research Unit, South African Medical Research Council-University of South Africa/Institute for Social and Health Sciences, University of South Africa, Cape Town, South Africa
| | - Sipho Dlamini
- Masculinity and Health Research Unit, South African Medical Research Council-University of South Africa/Institute for Social and Health Sciences, University of South Africa, Cape Town, South Africa
| | - Refiloe Makama
- Masculinity and Health Research Unit, South African Medical Research Council-University of South Africa/Institute for Social and Health Sciences, University of South Africa, Cape Town, South Africa
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18
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Costanza A, Amerio A, Radomska M, Ambrosetti J, Di Marco S, Prelati M, Aguglia A, Serafini G, Amore M, Bondolfi G, Michaud L, Pompili M. Suicidality Assessment of the Elderly With Physical Illness in the Emergency Department. Front Psychiatry 2020; 11:558974. [PMID: 33024437 PMCID: PMC7516267 DOI: 10.3389/fpsyt.2020.558974] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/21/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland.,Department of Psychiatry, ASO Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Andrea Amerio
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Department of Psychiatry, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Mood Disorders Program, Tufts Medical Center, Boston, MA, United States
| | - Michalina Radomska
- Faculty of Psychology, University of Geneva (UNIGE), Geneva, Switzerland
| | - Julia Ambrosetti
- Emergency Psychiatric Unit, Department of Psychiatry and Emergency Department, Geneva University Hospitals, Geneva, Switzerland
| | - Sarah Di Marco
- Department of Psychiatry, ASO Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Massimo Prelati
- Department of Psychiatry, ASO Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Andrea Aguglia
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Department of Psychiatry, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianluca Serafini
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Department of Psychiatry, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Department of Psychiatry, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Guido Bondolfi
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland.,Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention, Geneva University Hospitals, Geneva, Switzerland
| | - Laurent Michaud
- Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland.,McGill Group for Suicide Studies, McGill University, Montreal, QC, Canada
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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19
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Zhu RT, Ma Z, Jia C, Zhou L. Suicide Means Used by the Older Adults in Rural China: A Comparison Between Those Using Pesticides and Other Means. J Geriatr Psychiatry Neurol 2019; 32:319-326. [PMID: 31480983 DOI: 10.1177/0891988719862625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The most frequently used means of committing suicide was pesticide poisoning in rural China, yet little is known about the characteristics and risk factors for suicides committed with pesticides compared to those committed via other means in older adults. METHODS The participants were 242 older adults (aged 60 or older) who had committed suicide in the rural areas of 3 provinces (Shandong, Hunan, and Guangxi) in China. This study was conducted using the psychological autopsy (PA) method. RESULTS In univariate analyses, no statistically significant differences were found between those who committed suicide with pesticide or with other means in terms of demographic and clinical variables except age, prevalence of mental disorders, suicidal intent, number of recent life events, social support, hopelessness, impulsivity, and depressive symptoms (P > .05); age, history of suicide attempts, having pesticides available at home, the total number of life events, and the number of long-term life events were significantly different (P < .05) between the 2 groups. In multivariate logistic regression model, the factors associated with committing suicide with pesticides were the availability of pesticides at home (odds ratio [OR] = 3.48, 95% confidence interval [CI]: 1.99-6.08) and the number of long-term life events (OR = 0.87, 95% CI: 0.78-0.97). CONCLUSION The older adults who committed suicide by pesticides and those using other means are probably the same population. The main determinant of choosing pesticides as suicide means was likely the availability of pesticides at home. Suicide risk among older adults might be reduced by placing appropriate restrictions on access to pesticides.
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Affiliation(s)
- Rong-Ting Zhu
- 1 Department of Social Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,2 Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Zhenyu Ma
- 3 School of Public Health, Guangxi Medical University, Nanning, China
| | - Cunxian Jia
- 4 School of Public Health, Shandong University, Jinan, China
| | - Liang Zhou
- 1 Department of Social Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,2 Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
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20
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Chock MM, Lin JC, Athyal VP, Bostwick JM. Differences in Health Care Utilization in the Year Before Suicide Death: A Population-Based Case-Control Study. Mayo Clin Proc 2019; 94:1983-1993. [PMID: 31427140 DOI: 10.1016/j.mayocp.2019.04.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/05/2019] [Accepted: 04/03/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To compare health care usage between suicide decedents and living controls in the year before suicide in a large representative US population. PATIENTS AND METHODS Cases (n=1221) and controls (n=3663) belonged to an integrated health care system from January 1, 2009, through December 31, 2014. Cases and controls were matched for age and sex in a 1:3 ratio, with diagnostic and/or billing codes used to enumerate and classify health care visits in the year before the index suicide. Matched analysis via conditional logistic regression related odds of suicide to visit type. A generalized estimating equation model was used to compare timing and frequency of visits between cases and controls. RESULTS In the year before death, cases had an increased odds of both inpatient hospitalizations and emergency department nonmental health visits (odds ratio [OR], 1.55; 95% CI, 1.27-1.88; P<.001 and OR, 1.42; 95% CI, 1.26-1.60; P<.001) but not outpatient nonmental health visits (OR, 1.00; 95% CI, 0.99-1.01; P=.63). Decedents increased health care utilization closer to suicide death and had significantly more health care visits than did controls 3 months before suicide (6 vs 2; P=.01) but not 9 to 12 months before suicide (4 vs 2; P=.07). At all time points, cases used more mental health care services than did controls. CONCLUSION Compared with controls, suicide decedents had emergency department visits and more inpatient hospitalizations, both mental health and nonmental health related. As death approached, cases' frequency of health care usage increased. The only category in which cases and controls did not differ was in the frequency of outpatient nonmental health visits.
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Affiliation(s)
- Megan M Chock
- Family Medicine Residency Program, Kaiser Permanente, San Diego, CA.
| | - Jane C Lin
- Division of Biostatistics, Department of Research & Evaluation, Kaiser Permanente, Pasadena, CA
| | - Vidush P Athyal
- Southern California Permanente Medical Group, Kaiser Permanente, San Diego, CA
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21
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Choi NG, DiNitto DM, Marti CN, Conwell Y. Physical Health Problems as a Late-Life Suicide Precipitant: Examination of Coroner/Medical Examiner and Law Enforcement Reports. THE GERONTOLOGIST 2019; 59:356-367. [PMID: 28958040 DOI: 10.1093/geront/gnx143] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In light of high late-life suicide rates, we compared older suicide decedents with and without physical health problems as a suicide precipitant with respect to their clinical characteristics and suicide means. We also examined health-related concerns noted in summary coroner/medical examiner or law enforcement (CME/LE) reports. RESEARCH DESIGN AND METHODS The National Violent Death Reporting System, 2005-2014, provided data (N = 16,924 aged 65 or older). Quantitative data were analyzed using logistic regression models with physical health problems as a suicide precipitant as the dependent variable and depressive symptoms, other precipitating/risk factors, and suicide means as the independent variables. CME/LE reports were analyzed using content analysis and descriptive statistics. RESULTS Physical health problems were recorded as a suicide precipitant for 50% of the older decedents. Compared to those without, those with physical health problems as a precipitant were older and more likely to have had depressed mood (adjusted odds ratios [AOR] = 2.39, 95% confidence interval [CI] = 2.21-2.59 for men and AOR = 1.79, 95% CI = 1.50-2.14 for women), disclosed suicide intent, left a suicide note, and used a firearm as suicide means. In CME/LE reports, pain and cancer were mentioned most frequently (29% and 28%, respectively). Dementia-related functional decline, fear of becoming a burden to loved ones, refusal of nursing homes, and loss of independence were also mentioned. DISCUSSION AND IMPLICATIONS Study findings call for more targeted, intensive suicide prevention strategies for older adults suffering from debilitating and painful health conditions. Training health care providers and informal support systems to assess suicide risk and in evidence-based intervention plans/guidelines is needed.
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Affiliation(s)
| | | | | | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, New York
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Clapperton A, Newstead S, Frew C, Bugeja L, Pirkis J. Pathways to Suicide Among People With a Diagnosed Mental Illness in Victoria, Australia. CRISIS 2019; 41:105-113. [PMID: 31310164 DOI: 10.1027/0227-5910/a000611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: People who have mental illness are at increased risk of suicide. Therefore, identifying "typical" trajectories to suicide in this population has the potential to improve the effectiveness of suicide prevention strategies. Aim: The aim of this study was to explore the pathways to suicide among a sample of Victorians with a diagnosed mental illness. Method: Victorian Suicide Register (VSR) data were used to generate life charts and identify typical life trajectories to suicide among 50 Victorians. Results: Two distinct pathways to suicide were identified: (1) where diagnosis of mental illness appeared to follow life events/stressors; and (2) where diagnosis appeared to precede exposure to life events/stressors. Some events acted as distal factors related to suicide, other events were more common as proximal factors, and still others appeared to act as both distal and proximal factors. Limitations: The data source might be biased because of the potential for incomplete information, or alternatively, the importance of some factors in a person's life may have been overstated. Conclusion: Strategies to reduce suicide need to consider the chronology of exposure to stressors in people's lives and clearly need to be different depending on whether proximal or distal risk factors are the target of a given strategy or intervention.
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Affiliation(s)
- Angela Clapperton
- Monash University Accident Research Centre, Monash University, Melbourne, VIC, Australia
| | - Stuart Newstead
- Monash University Accident Research Centre, Monash University, Melbourne, VIC, Australia
| | - Charlotte Frew
- Monash University Accident Research Centre, Monash University, Melbourne, VIC, Australia
| | - Lyndal Bugeja
- Department of Forensic Medicine, Monash University, Melbourne, VIC, Australia
| | - Jane Pirkis
- Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
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Min JY, Min KB. Outdoor light at night and the prevalence of depressive symptoms and suicidal behaviors: A cross-sectional study in a nationally representative sample of Korean adults. J Affect Disord 2018; 227:199-205. [PMID: 29100153 DOI: 10.1016/j.jad.2017.10.039] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 10/22/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Outdoor light at night (LAN) is an increasingly prevalent type of environmental pollution. Studies have demonstrated that outdoor LAN can disrupt circadian rhythms, potentially contributing to insomnia, cancer, cardiovascular disease, and metabolic changes in humans. We investigated the association of outdoor LAN with depressive symptoms and suicidal behaviors in South Korean adults. METHODS This study used data from the 2009 Korean Community Health Survey, a representative sample dataset. Study population consisted of 113,119 participants for the assessment of depressive symptoms and 152,159 participants for the assessment of suicidal behavior. Depressive symptoms were measured using the Korean version of the Center for Epidemiologic Studies Depression Scale (depressive symptoms, score of > 16). Suicidal behaviors were defined as the experience of suicidal ideation or attempt. Outdoor LAN was estimated by satellite data from the National Centers for Environmental Information. RESULTS Participants with depressive symptoms or history of suicidal behaviors were more likely to have exposure to outdoor LAN than those without depressive symptoms or suicidal behaviors. Compared with adults living in areas exposed to the lowest outdoor LAN, those living in areas exposed to the highest levels had higher likelihood depressive symptoms (OR = 1.29; 95% CI: 1.15-1.46) or suicidal behaviors (OR = 1.27; 95% CI: 1.16-1.39). Significant dose-response relationships were observed between outdoor LAN and the odds of depressive symptoms and suicidal behaviors. CONCLUSION Outdoor LAN was found to be significantly associated with depressive symptoms and suicidal behaviors, suggesting that it may be an environmental contributor to mental health problems.
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Affiliation(s)
- Jin-Young Min
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| | - Kyoung-Bok Min
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea.
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Choi NG, DiNitto DM, Marti CN, Kaplan MS. Older Suicide Decedents: Intent Disclosure, Mental and Physical Health, and Suicide Means. Am J Prev Med 2017; 53:772-780. [PMID: 28985982 DOI: 10.1016/j.amepre.2017.07.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 06/05/2017] [Accepted: 07/24/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION This study examined: (1) associations of suicide intent disclosure with depressed mood and health problems; (2) age-group differences in those associations; and (3) relationship between disclosure and suicide means among suicide decedents aged ≥50 years (N=46,857). METHODS Data came from the National Violent Death Reporting Systems, 2005-2014. Data analysis was conducted in 2017. Chi-square tests were used to compare disclosers and nondisclosers on sociodemographic and precipitating factors and suicide means. Logistic regression analyses were used to examine the research questions. RESULTS The overall disclosure rate was 23.4%. Logistic regression results showed that both depressed mood (AOR=1.57, 95% CI=1.50, 1.65, p<0.001) and health problems (AOR=1.56, 95% CI=1.48, 1.64, p<0.001) were associated with increased odds of disclosure. Compared with decedents aged 50-59 years, those aged 70-79 years and ≥80 years had greater disclosure odds. When interaction terms of age group X health problems were entered in the model, disclosure odds increased among those with health problems in the groups aged 60-69 years (ratio of AOR=1.19, 95% CI=1.06, 1.34, p=0.003), 70-79 years (ratio of AOR=1.29, 95% CI=1.13, 1.48, p<0.001), and ≥80 years (ratio of AOR=1.41, 95% CI=1.20, 1.66, p<0.001). Compared with other suicide means, both firearm use and hanging/suffocation were associated with lower disclosure odds. CONCLUSIONS The older the decedents were, the more likely they were to have disclosed suicidal intent, and health problems largely explained their higher odds of disclosure. Healthcare providers need better preparation to screen and aid those in need to prevent suicide. Social support system members should also be assisted in identifying warning signs and linking older adults to services.
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Affiliation(s)
- Namkee G Choi
- University of Texas at Austin School of Social Work, Austin, Texas.
| | - Diana M DiNitto
- University of Texas at Austin School of Social Work, Austin, Texas
| | - C Nathan Marti
- University of Texas at Austin School of Social Work, Austin, Texas
| | - Mark S Kaplan
- University of California at Los Angeles Luskin School of Public Affairs, Los Angeles, California
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Dantas AP, Azevedo UND, Nunes AD, Amador AE, Marques MV, Barbosa IR. Analysis of suicide mortality in Brazil: spatial distribution and socioeconomic context. BRAZILIAN JOURNAL OF PSYCHIATRY 2017; 40:12-18. [PMID: 28832751 PMCID: PMC6899420 DOI: 10.1590/1516-4446-2017-2241] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/16/2017] [Indexed: 11/22/2022]
Abstract
Objective: To perform a spatial analysis of suicide mortality and its correlation with socioeconomic indicators in Brazilian municipalities. Methods: This is an ecological study with Brazilian municipalities as a unit of analysis. Data on deaths from suicide and contextual variables were analyzed. The spatial distribution, intensity and significance of the clusters were analyzed with the global Moran index, MoranMap and local indicators of spatial association (LISA), seeking to identify patterns through geostatistical analysis. Results: A total of 50,664 deaths from suicide were registered in Brazil between 2010 and 2014. The average suicide mortality rate in Brazil was 5.23/100,000 population. The Brazilian municipalities presenting the highest rates were Taipas do Tocantins, state of Tocantins (79.68 deaths per 100,000 population), Itaporã, state of Mato Grosso do Sul (75.15 deaths per 100,000 population), Mampituba, state of Rio Grande do Sul (52.98 deaths per 100,000 population), Paranhos, state of Mato Grosso do Sul (52.41 deaths per 100,000 population), and Monjolos, state of Minas Gerais (52.08 deaths per 100,000 population). Although weak spatial autocorrelation was observed for suicide mortality (I = 0.2608), there was a formation of clusters in the South. In the bivariate spatial and classical analysis, no correlation was observed between suicide mortality and contextual variables. Conclusion: Suicide mortality in Brazil presents a weak spatial correlation and low or no spatial relationship with socioeconomic factors.
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Affiliation(s)
- Ana P Dantas
- Departamento de Medicina Clínica, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | | | - Aryelly D Nunes
- Programa de Pós-graduação em Saúde Coletiva, UFRN, Natal, RN, Brazil
| | - Ana E Amador
- Programa de Pós-graduação em Saúde Coletiva, UFRN, Natal, RN, Brazil
| | | | - Isabelle R Barbosa
- Faculdade de Ciências da Saúde do Trairi (FACISA), UFRN, Natal, RN, Brazil
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Abstract
BACKGROUND In the limited research into suicides in older adults, they have been treated as a homogenous group without distinguishing between different age groups. This study aimed to compare differences in sociodemographic variables, recent life events, and mental and physical illnesses between three age groups within older adults who died by suicide: young-old (65-74 years), middle-old (75-84 years), and oldest old (85 years and over) in Queensland, Australia, during the years 2000-2012 (N = 978). METHODS The Queensland Suicide Register was utilized for the analysis. Annual suicide rates were calculated. Odds ratios with 95% confidence intervals and χ 2 tests for trend were calculated to examine differences between the three groups. RESULTS Suicide rates were increasing with age for males, but not for females. Hanging and firearms were the predominant methods of suicides. However, suffocation by plastic bag and drowning as suicide methods increased with age, in contrast firearms and explosives decreased with age. Overall, psychiatric problems, suicidal behavior, legal and financial stressors, and relationship problems decreased significantly with age, meanwhile physical conditions and bereavement increased with age. CONCLUSION Suicide across older adulthood is not a homogenous phenomenon. Our findings showed significant differences in the prevalence of potential risk factors within the three different age groups considered. To prevent suicide in older adults would require targeting specific factors for each subgroup while using holistic and comprehensive approaches.
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Lester J, Stout R, Crosthwaite K, Andersen B. Self-Reported Distress: Adult Acute Leukemia Survivors During and After Induction Therapy. Clin J Oncol Nurs 2017; 21:211-218. [DOI: 10.1188/17.cjon.211-218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Gender and age group differences in suicide risk associated with co-morbid physical and psychiatric disorders in older adults. Int Psychogeriatr 2017; 29:249-257. [PMID: 27605541 DOI: 10.1017/s1041610216001290] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND It is unclear whether health service use influences the association between psychiatric and physical co-morbidity and suicide risk in older adults. METHODS Controls were older adults (n = 2,494) participating in a longitudinal study on the health of the elderly carried out between 2004 and 2007, in Quebec. The cases were all suicide decedents (n = 493) between 2004 and 2007, confirmed by the Quebec Coroner's office. Multivariate analyses were carried out to test the association between suicide and the presence of psychiatric and physical illnesses controlling for health service use and socio-demographic factors by gender and age group. Interaction terms were also tested between suicide and co-morbidity on outpatient service use. RESULTS The presence of physical illnesses only, was associated with a reduced risk of suicide across all sex and age groups. The presence of a mental disorder only was associated with an increased risk of suicide overall and specifically in females and those aged 70 to 84 years of age. Suicide risk was lower in those with a psychiatric and physical co-morbidity and consulting mental health services. CONCLUSIONS Increased mental health follow-up in older adults with psychiatric illnesses is needed for the detection of suicidal behavior and reducing suicide risk in males. Further research should focus on the mitigating effect of the presence of physical illnesses on stigma and health service use and the presence of social support in the elderly.
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