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Pacchioni F, Bosia M, Moretti G, Barbieri C, Bellumore S, Travaini G. Mind the past: A systematic review on psychological autopsy. BEHAVIORAL SCIENCES & THE LAW 2023; 41:343-372. [PMID: 36941531 DOI: 10.1002/bsl.2619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/28/2023] [Accepted: 03/05/2023] [Indexed: 06/18/2023]
Abstract
Psychological Autopsy (PA) has become widespread to the point of being applied in many diverse fields. However, it is difficult to identify a standard model. In this systematic review, we focused on PA studies assessing mental illness as a major risk factor for suicide. The research, performed on Scopus, Embase, and Pubmed to cover the last 20 years led to 321 reports of which 15 met the inclusion criteria. Results confirmed mental illness as the main risk factor for suicide, followed by specific socio-demographic factors and life events. The analysis of methodologies depicted a still highly heterogeneous scenario, especially regarding data collection and variables included. However, concerning psychiatric evaluations, an initial standardization process of PA models emerged. In conclusion, the approach is in evolution, and novel guidelines are needed to promote the application of PA as a fundamental tool to inform suicide prevention efforts and to assist forensic examiners in court.
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Affiliation(s)
- Federico Pacchioni
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marta Bosia
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Moretti
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cristiano Barbieri
- IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Legal Medicine and Forensic Sciences, University of Pavia, Pavia, Italy
| | - Silvia Bellumore
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Guido Travaini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
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Rodway C, Tham SG, Richards N, Ibrahim S, Turnbull P, Kapur N, Appleby L. Online harms? Suicide-related online experience: a UK-wide case series study of young people who die by suicide. Psychol Med 2023; 53:4434-4445. [PMID: 35587034 PMCID: PMC10388316 DOI: 10.1017/s0033291722001258] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/22/2022] [Accepted: 04/14/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Few studies have examined online experience by young people who die by suicide. METHODS A 3-year UK-wide consecutive case series of all young people aged 10-19 who died by suicide, based on national mortality data. We extracted information on the antecedents of suicide of 544 of these 595 deaths (91%) from official investigations, mainly inquests. RESULTS Suicide-related online experience was reported in 24% (n = 128/544) of suicide deaths in young people between 2014 and 2016, equivalent to 43 deaths per year, and was more common in girls than boys (OR 1.87, 95% CI 1.23-2.85, p = 0.003) and those identifying as LGBT (OR 2.35, 95% CI 1.10-5.05, p = 0.028). Searching for information about method was most common (n = 68, 13%), followed by posting suicidal ideas online (n = 57, 10%). Self-harm, bereavement (especially by suicide), social isolation, and mental and physical ill-health were more likely in those known to have suicide-related online experience compared to those who did not. 29 (5%) were bullied online, more often girls (OR 2.84, 1.34-6.04, p = 0.007). Online bullying often accompanied face-to-face bullying (n = 16/29, 67%). CONCLUSIONS Suicide-related online experience is a common, but likely underestimated, antecedent to suicide in young people. Although its causal role is unclear, it may influence suicidality in this population. Mental health professionals should be aware that suicide-related online experience - not limited to social media - is a potential risk for young patients, and may be linked to experiences offline. For public health, wider action is required on internet regulation and support for children and their families.
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Affiliation(s)
- C. Rodway
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, 2nd Floor Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - S. G. Tham
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, 2nd Floor Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - N. Richards
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, 2nd Floor Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - S. Ibrahim
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, 2nd Floor Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - P. Turnbull
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, 2nd Floor Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - N. Kapur
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, 2nd Floor Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - L. Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, 2nd Floor Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
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Niraula SR, Manandhar N, Pandey S, Jha N. Stressors of Suicide Among the Residents of Ilam, Eastern Nepal: an Investigation Into a Neglected Burden. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-020-00480-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Hogan WB, Daniels AH. Orthopaedic Surgeon Burnout and Suicide: Social Isolation as a Driver of Self-Harm. J Bone Joint Surg Am 2022; 104:e22. [PMID: 34648475 DOI: 10.2106/jbjs.21.00657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- William B Hogan
- Department of Orthopedics, Warren Alpert Medical School, Brown University, East Providence, Rhode Island
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Lombardo F, Daly M. Analyzing suicide life stories on Wikipedia with Highway_star and other textual visualization tools. SN SOCIAL SCIENCES 2021; 1:268. [PMID: 34729497 PMCID: PMC8553402 DOI: 10.1007/s43545-021-00272-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 10/05/2021] [Indexed: 11/29/2022]
Abstract
Being responsible for a death every 40s, suicide is a major public health concern (Brunier et al. 2019). Even if many of its risk factors are social (Van Orden et al. 2010), there are surprisingly few qualitative sociological studies about the phenomenon. This study aim is to provide a life-story sociological analysis of suicidal trajectories. Two challenges are identified: gathering suicidal narrative and maintaining a quantitative foreground in order to deepen and rationalize the interpretation of data. They are both faced using a self-made, free to use, open access, algorithm: Highway_star (https://github.com/matheo-daly/highway_star). Two corpora of Wikipedia biographies of people who died by suicide in the 1920s (N = 82) and 2020s (N = 49) are gathered. Following an application of Fritze Schütze's methodology (Schütze, 2014), classical textual visualizations are produced. A Hierarchical Descending Classification, a Factorial Correspondence Analysis and a Similarity Analysis reveal five narration categories centered around different topics: cinema, death, family, poetry and politics. As none of those visualizations focuses on the developmental aspect of the biography, they offer limited interest for a life-story investigation. The second functionality of the Highway_star tool, which represents a narrative's unfolding with a Sankey Diagram, allows completing the analysis. It shows interesting differences between decades or gender. An example of the last being that men narratives tend to be more complex and achievement focused, while the women ones are more linear and family centered. The study's range has limitations. A major one is related to the corpus and the inability to identify clearly which parts of the narratives are associated to fame and which to suicide. Another one is linked to the Highway_star tool that sometimes lack of flexibility.
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Conner KR, Chapman BP, Beautrais AL, Brent DA, Bridge JA, Conwell Y, Falter T, Holbrook A, Schneider B. Introducing the Psychological Autopsy Methodology Checklist. Suicide Life Threat Behav 2021; 51:673-683. [PMID: 33559215 PMCID: PMC8378509 DOI: 10.1111/sltb.12738] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Case-control psychological autopsy studies are the research standard for the postmortem, quantitative study of ongoing or recent risk factors for suicide. We aimed to develop a reliable checklist of methodological quality of these studies. METHOD We adapted items from a validated checklist to address general methodological elements and created novel items to address the unique aspects of psychological autopsy research to generate a 16-item checklist assessing reporting, external validity, internal validity, and power. We used percent agreement and kappa to evaluate inter-rater reliability of the items and overall checklist based on independent ratings of 26 case-control psychological autopsy studies conducted internationally. We also summed the items to generate overall quality ratings, assessing internal consistency with coefficient alpha (α). RESULTS Inter-rater reliability for the overall checklist was high (percent agreement, 86.5%) and that based conservatively on kappa was substantial (κ .71) whereas internal consistency was low (α = 0.56). The inter-rater reliability of the individual items showed acceptable to high agreement. CONCLUSION A novel checklist provides a reliable means to assess the methodological quality of specific elements of quantitative case-control psychological autopsy studies, providing detailed guidance in planning such studies. Lower internal consistency may limit its utility as a summary measure of study quality.
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Affiliation(s)
- Kenneth R. Conner
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA,Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Benjamin P. Chapman
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA,Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | | | - David A. Brent
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeffrey A. Bridge
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Tyler Falter
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Amanda Holbrook
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Barbara Schneider
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Centre of Psychiatry, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany
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Titus L, Stephany A, Porada K, McFadden V. Intent, Substance, and Care: Characteristics of Adolescent Ingestion Hospitalizations. Hosp Pediatr 2021; 11:160-166. [PMID: 33468552 DOI: 10.1542/hpeds.2020-0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To characterize the patient population of adolescents hospitalized at a tertiary center for ingestions and identify opportunities to improve health care delivered and resources offered to these adolescents. METHODS Retrospective study of a consecutive sample of adolescent patients (12-18 years old) discharged from the hospitalist service at a large academic pediatric tertiary care center from May 2017 through April 2018. Data were collected regarding patient and hospital encounter characteristics including length of stay, admission service, reason for ingestion, substance(s) ingested, previous suicidal ideation (SI) screening, sexual history documentation, pregnancy testing, disposition at discharge and follow-up with primary care physicians (PCPs). RESULTS Most hospitalizations for ingestions were reported as intentional suicide attempts (79%). Most commonly, adolescents ingested exclusively prescription medications (45%) or over-the-counter medications (32%). Of adolescents with a reported suicide attempt for whom PCP records were available, 56% did not have SI screening documented in the medical record. One-quarter of adolescents hospitalized for an ingestion did not have a sexual history documented, and 11% of female patients were not tested for pregnancy before discharge. A majority (66%) of the adolescents with PCP records available did not follow-up with their PCP within 2 months after their hospitalization. CONCLUSIONS On the basis of our study results, opportunities to improve adolescent health include increased screening for SI and mental health symptoms throughout medical environments, comprehensive risk assessment of all adolescents hospitalized for an ingestion and increased guidance for caregivers of adolescents regarding prescription and over-the-counter medication storage in the home.
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Affiliation(s)
- Lauren Titus
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin; and.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Alyssa Stephany
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin; and.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kelsey Porada
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Vanessa McFadden
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin; and .,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
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Park A, Kim D, Shin HG. Perceptions of Therapeutic Intervention in Suicide Crisis Counseling in Experienced Korean Counselors: A Concept Mapping Study. Front Psychiatry 2021; 12:784710. [PMID: 35095599 PMCID: PMC8791305 DOI: 10.3389/fpsyt.2021.784710] [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: 09/28/2021] [Accepted: 12/01/2021] [Indexed: 11/21/2022] Open
Abstract
Within Organization for Economic Cooperation and Development (OECD) nations, South Korea has the highest suicide rate for which immediate prevention measures are sought including effective therapeutic counseling interventions. As such, the present study explored and examined experienced South Korean counselors' perception of therapeutic interventions for the prevention or delaying of completed suicide, using concept mapping methodology. The semi-structured interviews were provided to 15 study participants of experienced counselors having a minimum of 5 years of professional counseling career and at least 10 suicide crisis counseling sessions. A total of 77 statements were extracted with 8 major clusters: "Securing Safety," "Active Advocacy for Client," "Coping Skills Training," "Conceptualization of Suicide Crisis," "Emotional Identification and Validation," "Empowerment," "Counselor Self-Disclosure," "Counselor Self-Awareness and Regulation." From the results, the present study described unique findings in Korean counselors' perceptions of suicide crisis therapeutic intervention. Study limitations and future implications are further discussed.
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Affiliation(s)
- AeShil Park
- College of Medicine, Ulsan of University, Seoul, South Korea
| | - Dongil Kim
- Department of Education, Seoul National University, Seoul, South Korea
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Gray NS, O'Connor C, Knowles J, Pink J, Simkiss NJ, Williams SD, Snowden RJ. The Influence of the COVID-19 Pandemic on Mental Well-Being and Psychological Distress: Impact Upon a Single Country. Front Psychiatry 2020; 11:594115. [PMID: 33262714 PMCID: PMC7686842 DOI: 10.3389/fpsyt.2020.594115] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/14/2020] [Indexed: 01/01/2023] Open
Abstract
The COVID-19 pandemic is likely to have affected the psychological well-being and mental health of many people. Data on prevalence rates of mental health problems are needed for mental health service planning. Psychological well-being and prevalence of clinically significant mental distress were measured in a large sample from Wales 11-16 weeks into lockdown and compared to population-based data collected in 2019 before the COVID-19 pandemic. Data were collected using an online survey disseminated across Wales and open to adults (age 16+) from 9th June to 13th July 2020. Psychological well-being was indexed via the Warwick-Edinburgh Mental Well-being Scale, and psychological distress was indexed via the K10. Data from 12,989 people who took part in this study were compared to that from April 2018 - March 2019, gathered by the National Survey for Wales (N = 11,922). Well-being showed a large decrease from 2019 levels. Clinically significant psychological distress was found in around 50% of the population (men = 47.4%, women = 58.6%), with around 20% showing "severe" effects (men = 17.0%, women = 20.9%): a 3-4-fold increase in prevalence. Most affected were young people, women, and those in deprived areas. By June-July 2020 the COVID-19 pandemic had dramatic effects on the mental health of people living in Wales (and by implication those in the UK and beyond). The effects are larger than previous reports. This probably reflects that the current data were taken deeper into the lockdown period than previous evaluations. Mental health services need to prepare for this wave of mental health problems with an emphasis on younger adults, women, and in areas of greater deprivation.
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Affiliation(s)
- Nicola S. Gray
- Department of Psychology, Swansea University, Swansea, & Swansea Bay University Health Board, Swansea, United Kingdom
| | - Chris O'Connor
- Aneurin Bevan University Health Board, Newport, United Kingdom
| | - James Knowles
- Department of Psychology, Swansea University, Swansea, United Kingdom
| | - Jennifer Pink
- Department of Psychology, Swansea University, Swansea, United Kingdom
| | - Nicola J. Simkiss
- Department of Psychology, Swansea University, Swansea, United Kingdom
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Epstein S, Roberts E, Sedgwick R, Polling C, Finning K, Ford T, Dutta R, Downs J. School absenteeism as a risk factor for self-harm and suicidal ideation in children and adolescents: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2020; 29:1175-1194. [PMID: 30989389 PMCID: PMC7116080 DOI: 10.1007/s00787-019-01327-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/30/2019] [Indexed: 11/29/2022]
Abstract
Self-harm and suicidal ideation in children and adolescents are common and are risk factors for completed suicide. Social exclusion, which can take many forms, increases the risk of self-harm and suicidal ideation. One important marker of social exclusion in young people is school absenteeism. Whether school absenteeism is associated with these adverse outcomes, and if so to what extent, remains unclear. To determine the association between school absenteeism and both self-harm (including completed suicide) and suicidal ideation in children and adolescents, we conducted a systematic review of observational studies. We conducted meta-analysis and report a narrative synthesis where this was not possible. Meta-analysis of cross-sectional studies showed that school absenteeism was associated with an increased risk of self-harm [pooled adjusted odds ratio (aOR) 1.37, 95% confidence interval 1.20-1.57, P = 0.01] and of suicidal ideation (pooled aOR 1.20, 95% CI 1.02-1.42, P = 0.03). A small number of studies showed that school absenteeism had a longitudinal association with both adverse outcomes. Heterogeneity in the exposure and outcome variables, study design and reporting was prominent and limited the extent to which it was appropriate to pool results. School absenteeism was associated with both self-harm and suicidal ideation in young people, but this evidence was derived from a small number of cross-sectional studies. Further research into the mechanisms of this association could help to inform self-harm and suicide prevention strategies at clinical, school and population levels.
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Affiliation(s)
- Sophie Epstein
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
- Department of Child and Adolescent Psychiatry, King's College London, London, UK.
| | - Emmert Roberts
- South London and Maudsley NHS Foundation Trust, London, UK
- National Addiction Centre, King's College London, London, UK
- Department of Psychological Medicine, King's College London, London, UK
| | - Rosemary Sedgwick
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - Catherine Polling
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, King's College London, London, UK
| | | | - Tamsin Ford
- University of Exeter Medical School, Exeter, UK
| | - Rina Dutta
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, King's College London, London, UK
| | - Johnny Downs
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
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Verma DK, Khanra S, Goyal N, Das B, Khess CRJ, Munda SK, Ram D. Absconding During Inpatient Care from a Tertiary Psychiatric Hospital: A Comparative Study. Indian J Psychol Med 2020; 42:456-463. [PMID: 33414593 PMCID: PMC7750842 DOI: 10.1177/0253717620929182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 03/05/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Absconding from psychiatric hospitals is of great concern for patients and caregivers. Absconding affects not only the treatment and safety of these patients but also patient's caregivers and the community. Further investigation is needed to examine the pattern of this event and the characteristics of patients who abscond. Hence, our study was aimed to examine the sociodemographic and clinical profiles of inpatients who absconded from a psychiatric hospital in five years and to compare them with matched controls. METHODS A retrospective chart review of inpatients who absconded and matched control inpatients during the specified period of five years from January 2014 to December 2018 was done at a psychiatric hospital. Each control was matched with a corresponding absconding case on the following order: (a) admission ward, (b) admission period, (c) diagnosis, and (d) age. Results: Among 20,052 adult admissions during the specified period, 38 patients absconded, with a rate of 1.8 per 1,000 admissions. Most of them were male, from a younger age group, diagnosed with schizophrenia or mood disorder, and having comorbid substance use disorder, irritable affect, impaired judgment, and absent insight. Most of the events occurred within the first two weeks of admission. About 11% of them had a history of prior absconding from the hospital. CONCLUSION Knowledge about the associated sociodemographic and clinical profile would help clinicians and mental health care professionals to prevent absconding. Further risk assessment using a patient's profile would help to reduce absconding events from psychiatric hospitals in the future.
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Affiliation(s)
| | - Sourav Khanra
- Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Nishant Goyal
- Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Basudeb Das
- Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | | | | | - Daya Ram
- Central Institute of Psychiatry, Ranchi, Jharkhand, India
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Swain RS, Taylor LG, Braver ER, Liu W, Pinheiro SP, Mosholder AD. A systematic review of validated suicide outcome classification in observational studies. Int J Epidemiol 2020; 48:1636-1649. [PMID: 30907424 DOI: 10.1093/ije/dyz038] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Suicidal outcomes, including ideation, attempt, and completed suicide, are an important drug safety issue, though few epidemiological studies address the accuracy of suicidal outcome ascertainment. Our primary objective was to evaluate validated methods for suicidal outcome classification in electronic health care database studies. METHODS We performed a systematic review of PubMed and EMBASE to identify studies that validated methods for suicidal outcome classification published 1 January 1990 to 15 March 2016. Abstracts and full texts were screened by two reviewers using prespecified criteria. Sensitivity, specificity, and predictive value for suicidal outcomes were extracted by two reviewers. Methods followed PRISMA-P guidelines, PROSPERO Protocol: 2016: CRD42016042794. RESULTS We identified 2202 citations, of which 34 validated the accuracy of measuring suicidal outcomes using International Classification of Diseases (ICD) codes or algorithms, chart review or vital records. ICD E-codes (E950-9) for suicide attempt had 2-19% sensitivity, and 83-100% positive predictive value (PPV). ICD algorithms that included events with 'uncertain' intent had 4-70% PPV. The three best-performing algorithms had 74-92% PPV, with improved sensitivity compared with E-codes. Read code algorithms had 14-68% sensitivity and 0-56% PPV. Studies estimated 19-80% sensitivity for chart review, and 41-97% sensitivity and 100% PPV for vital records. CONCLUSIONS Pharmacoepidemiological studies measuring suicidal outcomes often use methodologies with poor sensitivity or predictive value or both, which may result in underestimation of associations between drugs and suicidal behaviour. Studies should validate outcomes or use a previously validated algorithm with high PPV and acceptable sensitivity in an appropriate population and data source.
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Affiliation(s)
- Richard S Swain
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology, Divisions of Epidemiology I and II, Silver Spring, MD, USA
| | - Lockwood G Taylor
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology, Divisions of Epidemiology I and II, Silver Spring, MD, USA
| | - Elisa R Braver
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology, Divisions of Epidemiology I and II, Silver Spring, MD, USA
| | - Wei Liu
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology, Divisions of Epidemiology I and II, Silver Spring, MD, USA
| | - Simone P Pinheiro
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology, Divisions of Epidemiology I and II, Silver Spring, MD, USA
| | - Andrew D Mosholder
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology, Divisions of Epidemiology I and II, Silver Spring, MD, USA
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13
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Rodway C, Tham SG, Ibrahim S, Turnbull P, Kapur N, Appleby L. Children and young people who die by suicide: childhood-related antecedents, gender differences and service contact. BJPsych Open 2020; 6:e49. [PMID: 32390589 PMCID: PMC7331086 DOI: 10.1192/bjo.2020.33] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Worldwide suicide is commonest in young people and in many countries, including the UK, suicide rates in young people are rising. AIMS To investigate the stresses young people face before they take their lives, their contact with services that could be preventative and whether these differ in girls and boys. METHOD We identified a 3-year UK national consecutive case series of deaths by suicide in people aged 10-19, based on national mortality data. We extracted information on the antecedents of suicide from official investigations, primarily inquests. RESULTS Between 2014 and 2016, there were 595 suicides by young people, almost 200 per year; 71% were male (n = 425). Suicide rates increased from the mid-teens, most deaths occurred in those aged 17-19 (443, 74%). We obtained data about the antecedents of suicide for 544 (91%). A number of previous and recent stresses were reported including witnessing domestic violence, bullying, self-harm, bereavement (including by suicide) and academic pressures. These experiences were generally more common in girls than boys, whereas drug misuse (odds ratio (OR) = 0.54, 95% CI 0.35-0.83, P = 0.006) and workplace problems (OR 0.52, 95% CI 0.28-0.96, P = 0.04) were less common in girls. A total of 329 (60%) had been in contact with specialist children's services, and this was more common in girls (OR 1.86, 95% CI 1.19-2.94, P = 0.007). CONCLUSIONS There are several antecedents to suicide in young people, particularly girls, which are important in a multiagency approach to prevention incorporating education, social care, health services and the third sector. Some of these may also have contributed to the recent rise.
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Affiliation(s)
- Cathryn Rodway
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, UK
| | - Su-Gwan Tham
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, UK
| | - Saied Ibrahim
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, UK
| | - Pauline Turnbull
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, UK
| | - Nav Kapur
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester; and Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, UK
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Schneider B, Schnabel A, Weber B, Frölich L, Maurer K, Wetterling T. Nicotine use in suicides: a case–control study. Eur Psychiatry 2020; 20:129-36. [PMID: 15797697 DOI: 10.1016/j.eurpsy.2004.04.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AbstractPurposeDespite of higher rates of substance-related disorders in psychiatric patients and suicides than in the general population, there is no clear specificity to the relationship between nicotine use and other psychiatric disorders for suicide risk.MethodsOne hundred and sixty-three suicides (mean age 49.8 ± 19.3 years; 64.4% males; using psychological autopsy method) and 396 control persons (mean age 51.6 ± 17.0 years; 55.8% males) were assessed with a standardised semi-structured interview including SCID-I and SCID-II (for DSM-IV). Suicides and controls were compared in terms of nicotine consumption and psychiatric disorders. Logistic regression was used to evaluate the interactions of tobacco consumption with psychiatric disorders.ResultsSuicides were significantly more often current smokers and heavy users of cigarettes (>20 cigarettes per day; P < 0.001, each). Alcohol dependence, other axis I disorders than substance-related disorders, and cluster B personality disorder(s) remained independent predictors for suicide in both genders, current nicotine consumption only in men (OR = 2.6, 95% CI 1.3–5.2).ConclusionsIn males, but not in females, nicotine consumption contributed to risk of completed suicide after control for psychiatric disorders and has to be considered as independent risk factor for suicide.
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Affiliation(s)
- Barbara Schneider
- Centre of Psychiatry, Department of Psychiatry and Psychotherapy I, Johann Wolfgang Goethe-University, Frankfurt/Main, Heinrich-Hoffmann Street 10, 60528 Frankfurt/Main, Germany.
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15
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Maung HH. Pluralism and incommensurability in suicide research. STUDIES IN HISTORY AND PHILOSOPHY OF BIOLOGICAL AND BIOMEDICAL SCIENCES 2020; 80:101247. [PMID: 31902654 DOI: 10.1016/j.shpsc.2019.101247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 11/29/2019] [Accepted: 12/27/2019] [Indexed: 06/10/2023]
Abstract
This paper examines the complex research landscape of contemporary suicidology from a philosophy of science perspective. I begin by unpacking the methods, concepts, and assumptions of some of the prominent approaches to studying suicide causation, including psychological autopsy studies, epidemiological studies, biological studies, and qualitative studies. I then analyze the different ways these approaches partition the causes of suicide, with particular emphasis on the ways they conceptualize the domain of mental disorder. I argue that these different ways of partitioning the causal space and conceptualizing mental disorder result in incommensurabilities between the approaches. These incommensurabilities restrict the degrees to which the different approaches can be integrated, thus lending support to explanatory pluralism in the study of suicide causation. They also shed light on some of the philosophical underpinnings of the disagreement between mainstream suicidology and the emerging area of critical suicidology.
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Affiliation(s)
- Hane Htut Maung
- Department of Philosophy, School of Social Sciences, Humanities Bridgeford Street, University of Manchester, Manchester, M13 9PL, UK.
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16
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Abstract
Much of our knowledge about the risk factors for suicide comes from case-control studies that either use a psychological autopsy approach or are nested within large register-based cohort studies. We would argue that case-control studies are appropriate in the context of a rare outcome like suicide, but there are issues with using this design. Some of these issues are common in psychological autopsy studies and relate to the selection of controls (e.g. selection bias caused by the use of controls who have died by other causes, rather than live controls) and the reliance on interviewing informants (e.g. recall bias caused by the loved ones of cases having thought about the events leading up to the suicide in considerable detail). Register-based studies can overcome some of these problems because they draw upon contain information that is routinely collected for administrative purposes and gathered in the same way for cases and controls. However, they face issues that mean that psychological autopsy studies will still sometimes be the study design of choice for investigating risk factors for suicide. Some countries, particularly low and middle income countries, don't have sophisticated population-based registers. Even where they do exist, there will be variable of interest that are not captured by them (e.g. acute stressful life events that may immediately precede a suicide death), or not captured in a comprehensive way (e.g. suicide attempts and mental illness that do not result in hospital admissions). Future studies of risk factors should be designed to progress knowledge in the field and overcome the problems with the existing studies, particularly those using a case-control design. The priority should be pinning down the risk factors that are amenable to modification or mitigation through interventions that can successfully be rolled out at scale.
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17
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Lee S, Dwyer J, Paul E, Clarke D, Treleaven S, Roseby R. Differences by age and sex in adolescent suicide. Aust N Z J Public Health 2019; 43:248-253. [PMID: 30786107 DOI: 10.1111/1753-6405.12877] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 11/01/2018] [Accepted: 01/01/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To compare demographic and psychosocial characteristics of completed suicide between younger and older adolescents, and by sex. METHODS Data was collected from the Victorian Suicide Register, which contains information on suicides reported to the Coroners Court of Victoria. RESULTS Between 2006 and 2015, there were 273 completed suicides aged 10-19 years, with none aged 10-12 years. There were 171 (63%) suicides in the older adolescent group (17-19 years), and 102 (37%) in the younger group (13-16 years). Males comprised 184 cases (67%) and females 89 (33%). A higher proportion of both younger and female adolescents had experienced abuse, peer conflict and bullying. There was also a higher incidence of previous self-harm in younger and female adolescents. Older adolescents were more likely to not be in formal education, employment or training. CONCLUSION Suicide in younger adolescents and females appear to share characteristics, and differ from older and male adolescents. Negative interpersonal relationships and previous self-harm with possible co-existenting mental illness appear to be key differentiating features. Implications for public health: Understanding completed suicide is an important step towards prevention, and our results suggest a need for developmentally and sex-specific suicide prevention strategies.
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Affiliation(s)
- Stephanie Lee
- Monash Children's Hospital, Victoria.,Coroners Prevention Unit, Coroners Court of Victoria
| | - Jeremy Dwyer
- Coroners Prevention Unit, Coroners Court of Victoria.,Melbourne School of Population and Global Health, The University of Melbourne
| | - Eldho Paul
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Victoria
| | - David Clarke
- Department of Psychiatry, School of Clinical Sciences, Monash University, Victoria.,Monash Health, Victoria
| | - Sophie Treleaven
- Monash Children's Hospital, Victoria.,Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM), Victoria
| | - Robert Roseby
- Monash Children's Hospital, Victoria.,Department of Paediatrics, School of Clinical Sciences, Monash University, Victoria
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18
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Conner KR, Bridge JA, Davidson DJ, Pilcher C, Brent DA. Metaanalysis of Mood and Substance Use Disorders in Proximal Risk for Suicide Deaths. Suicide Life Threat Behav 2019; 49:278-292. [PMID: 29193261 PMCID: PMC8378507 DOI: 10.1111/sltb.12422] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 09/07/2017] [Indexed: 11/30/2022]
Abstract
Evidence for proximal risk factors for suicide is based on case-control psychological autopsy studies, with these reports showing that mood and substance use disorders are the most prevalent mental disorders among suicide decedents worldwide and are associated with marked risk. However, moderators of risk and the degree of risk associated with (nonalcohol) drug use disorder are unknown. A comprehensive search was used to identify 35 case-control psychological autopsy studies published worldwide over a 30-year period that were metaanalyzed using random effects models. Major depression, odds ratio (95% confidence interval) = 9.14 (5.53, 15.09), and drug use disorder, OR (95% CI) = 7.18 (3.22, 16.01), had large effect sizes, among other results. Risk estimates associated with major depression were greater in studies with a larger proportion of women and those conducted in Asia compared with other regions. There was no evidence of publication bias or that any one study had a disproportionate impact on findings. Risk for suicide associated with major depression appears to be moderated by sex and/or world region. Drug use disorder is a potent risk factor, illustrating the importance of assessing drug use in clinical risk assessment.
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Affiliation(s)
| | - Jeffrey A. Bridge
- Nationwide Children's Hospital; Columbus OH USA
- Ohio State University; Columbus OH USA
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19
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Rogers ML, Chu C, Joiner T. The necessity, validity, and clinical utility of a new diagnostic entity: Acute suicidal affective disturbance. J Clin Psychol 2019; 75:999-1010. [PMID: 30632615 DOI: 10.1002/jclp.22743] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/31/2018] [Accepted: 12/04/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Here we argue for the necessity, validity, and clinical utility of a new diagnostic entity, acute suicidal affective disturbance (ASAD). METHOD We expand on the conceptual, clinical, and practical rationale for ASAD, propose its defining features, describe research results to date, and suggest avenues for future research. RESULTS There is accruing evidence for the existence of a previously unclassified, rapid-onset mood disturbance that geometrically escalates and regularly results in life-threatening behavior. CONCLUSIONS ASAD research may not only improve the field's understanding of suicidal behavior but also enhance clinical effectiveness and save lives.
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Affiliation(s)
- Megan L Rogers
- Department of Psychology, Florida State University, Tallahassee, Florida
| | - Carol Chu
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Thomas Joiner
- Department of Psychology, Florida State University, Tallahassee, Florida
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20
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Chalker SA, Comtois KA. Personal Technology Use and Thwarted Belongingness Among Suicidal Active-Duty Military Personnel. Suicide Life Threat Behav 2018; 48:732-744. [PMID: 28926675 DOI: 10.1111/sltb.12393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 06/20/2017] [Indexed: 11/29/2022]
Abstract
This study (a) provides descriptive information about the personal technology use of a suicide sample of active-duty military personnel and (b) uses a traditional and a technology-based measure of social connectedness to examine their relation to suicide ideation and behaviors. Higher thwarted belongingness, and therefore lower perceived social connectedness, was associated with higher current and worst suicide ideation and a greater lifetime self-directed violence regardless of intent to die. Higher social connectedness based on personal technology usage was associated with higher current suicide ideation and a higher number of lifetime self-directed violence and suicide attempts.
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Affiliation(s)
- Samantha A Chalker
- Department of Psychology, The Catholic University of America, Washington, DC, USA
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21
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Hagaman AK, Khadka S, Wutich A, Lohani S, Kohrt BA. Suicide in Nepal: Qualitative Findings from a Modified Case-Series Psychological Autopsy Investigation of Suicide Deaths. Cult Med Psychiatry 2018; 42:704-734. [PMID: 29881930 PMCID: PMC6286252 DOI: 10.1007/s11013-018-9585-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
South Asia accounts for the majority of the world's suicide deaths, but typical psychiatric or surveillance-based research approaches are limited due to incomplete vital surveillance. Despite rich anthropological scholarship in the region, such work has not been used to address public health gaps in surveillance and nor inform prevention programs designed based on surveillance data. Our goal was to leverage useful strategies from both public health and anthropological approaches to provide rich narrative reconstructions of suicide events, told by family members or loved ones of the deceased, to further contextualize the circumstances of suicide. Specifically, we sought to untangle socio-cultural and structural patterns in suicide cases to better inform systems-level surveillance strategies and salient community-level suicide prevention opportunities. Using a mixed-methods psychological autopsy approach for cross-cultural research (MPAC) in both urban and rural Nepal, 39 suicide deaths were examined. MPAC was used to document antecedent events, characteristics of persons completing suicide, and perceived drivers of each suicide. Patterns across suicide cases include (1) lack of education (72% of cases); (2) life stressors such as poverty (54%), violence (61.1%), migrant labor (33% of men), and family disputes often resulting in isolation or shame (56.4%); (3) family histories of suicidal behavior (62%), with the majority involving an immediate family member; (4) gender differences: female suicides were attributed to hopeless situations, such as spousal abuse, with high degrees of social stigma. In contrast, male suicides were most commonly associated with drinking and resulted from internalized stigma, such as financial failure or an inability to provide for their family; (5) justifications for suicide were attributions to 'fate' and personality characteristics such as 'stubbornness' and 'egoism'; (5) power dynamics and available agency precluded some families from disputing the death as a suicide and also had implications for the condemnation or justification of particular suicides. Importantly, only 1 out of 3 men and 1 out of 6 women had any communication to family members about suicidal ideation prior to completion. Findings illustrate the importance of MPAC methods for capturing cultural narratives evoked after completed suicides, recognizing culturally salient warning signs, and identifying potential barriers to disclosure and justice seeking by families. These findings elucidate how suicide narratives are structured by family members and reveal public health opportunities for creating or supplementing mortality surveillance, intervening in higher risk populations such as survivors of suicide, and encouraging disclosure.
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Affiliation(s)
- Ashley K Hagaman
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 W Franklin St, Chapel Hill, NC, 27516, USA.
| | - Seema Khadka
- Transcultural Psychosocial Organization Nepal, Research Department, Kathmandu, Nepal
| | - Amber Wutich
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, USA
| | - Shyam Lohani
- Nobel College, Pokhara University, Kathmandu, Nepal
| | - Brandon A Kohrt
- Department of Psychiatry, George Washington University, Washington, DC, USA
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22
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23
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Olfson M, Wall M, Wang S, Crystal S, Bridge JA, Liu SM, Blanco C. Suicide After Deliberate Self-Harm in Adolescents and Young Adults. Pediatrics 2018; 141:peds.2017-3517. [PMID: 29555689 DOI: 10.1542/peds.2017-3517] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Among adolescents and young adults with nonfatal self-harm, our objective is to identify risk factors for repeated nonfatal self-harm and suicide death over the following year. METHODS A national cohort of patients in the Medicaid program, aged 12 to 24 years (n = 32 395), was followed for up to 1 year after self-harm. Cause of death information was obtained from the National Death Index. Repeat self-harm per 1000 person-years and suicide deaths per 100 000 person-years were determined. Hazard ratios (HRs) of repeat self-harm and suicide were estimated by Cox proportional hazard models. Suicide standardized mortality rate ratios were derived by comparison with demographically matched general population controls. RESULTS The 12-month suicide standardized mortality rate ratio after self-harm was significantly higher for adolescents (46.0, 95% confidence interval [CI]: 29.9-67.9) than young adults (19.2, 95% CI: 12.7-28.0). Hazards of suicide after self-harm were significantly higher for American Indians and Alaskan natives than non-Hispanic white patients (HR: 4.69, 95% CI: 2.41-9.13) and for self-harm patients who initially used violent methods (HR: 18.04, 95% CI: 9.92-32.80), especially firearms (HR: 35.73, 95% CI: 15.42-82.79), compared with nonviolent self-harm methods (1.00, reference). The hazards of repeat self-harm were higher for female subjects than male subjects (HR: 1.25, 95% CI: 1.18-1.33); patients with personality disorders (HR: 1.55, 95% CI: 1.42-1.69); and patients whose initial self-harm was treated in an inpatient setting (HR: 1.65, 95% CI: 1.49-1.83) compared with an emergency department (HR: 0.62, 95% CI: 0.55-0.69) or outpatient (1.00, reference) setting. CONCLUSIONS After nonfatal self-harm, adolescents and young adults were at markedly elevated risk of suicide. Among these high-risk patients, those who used violent self-harm methods, particularly firearms, were at especially high risk underscoring the importance of follow-up care to help ensure their safety.
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Affiliation(s)
- Mark Olfson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, New York, New York;
| | - Melanie Wall
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, New York, New York
| | - Shuai Wang
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, New York, New York
| | - Stephen Crystal
- Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Jeffrey A Bridge
- Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital and Department of Pediatrics, Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio; and
| | - Shang-Min Liu
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, New York, New York
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Rockville, Maryland
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24
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Hubers AAM, Moaddine S, Peersmann SHM, Stijnen T, van Duijn E, van der Mast RC, Dekkers OM, Giltay EJ. Suicidal ideation and subsequent completed suicide in both psychiatric and non-psychiatric populations: a meta-analysis. Epidemiol Psychiatr Sci 2018; 27:186-198. [PMID: 27989254 PMCID: PMC6998965 DOI: 10.1017/s2045796016001049] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 11/21/2016] [Indexed: 11/06/2022] Open
Abstract
AIMS Several authors claimed that expression of suicidal ideation is one of the most important predictors of completed suicide. However, the strength of the association between suicidal ideation and subsequent completed suicide has not been firmly established in different populations. Furthermore, the absolute suicide risk after expression of suicidal ideation is unknown. In this meta-analysis, we examined whether the expression of suicidal ideation predicted subsequent completed suicide in various populations, including both psychiatric and non-psychiatric populations. METHODS A meta-analysis of cohort and case-control studies that assessed suicidal ideation as determinant for completed suicide in adults. Two independent reviewers screened 5726 articles for eligibility and extracted data of the 81 included studies. Pooled risk ratios were estimated in a random effects model stratified for different populations. Meta-regression analysis was used to determine suicide risk during the first year of follow-up. RESULTS The risk for completed suicide was clearly higher in people who had expressed suicidal ideation compared with people who had not, with substantial variation between the different populations: risk ratio ranging from 2.35 (95% confidence interval (CI) 1.43-3.87) in affective disorder populations to 8.00 (95% CI 5.46-11.7) in non-psychiatric populations. In contrast, the suicide risk after expression of suicidal ideation in the first year of follow-up was higher in psychiatric patients (risk 1.40%, 95% CI 0.74-2.64) than in non-psychiatric participants (risk 0.23%, 95% CI 0.10-0.54). Past suicide attempt-adjusted risk ratios were not pooled due to large underreporting. CONCLUSIONS Assessment of suicidal ideation is of priority in psychiatric patients. Expression of suicidal ideation in psychiatric patients should prompt secondary prevention strategies to reduce their substantial increased risk of suicide.
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Affiliation(s)
- A. A. M. Hubers
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - S. Moaddine
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - S. H. M. Peersmann
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - T. Stijnen
- Department of Medical Statistics & Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - E. van Duijn
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Center for Mental Health Care Delfland, Delft, The Netherlands
| | - R. C. van der Mast
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Faculty of Medicine, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - O. M. Dekkers
- Department of Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - E. J. Giltay
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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25
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Rhodes AE, Boyle MH, Bridge JA, Sinyor M, Katz LY, Bennett K, Newton AS, Links PS, Tonmyr L, Skinner R, Cheung A, Bethell J, Carlisle C. Les soins médicaux de jeunes hommes et de jeunes femmes qui décèdent par suicide. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:161-169. [PMID: 29121806 PMCID: PMC5846965 DOI: 10.1177/0706743717741060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Prior year medical care was compared among youth dying by suicide to their peers. Effect modification of these associations by age or place of residency (rural versus larger community sizes) was examined in a large, medically insured population. METHOD This population-based case control study used data from the Office of the Chief Coroner in Ontario, Canada, linked to health care administrative data to examine associations between medical care for mental health or other reasons (versus no medical care) and suicide. Decedents ( n = 1203 males and n = 454 females) were youth (aged 10 to 25 years) who died by suicide in Ontario between April 2003 and March 2014, inclusive. Peers of the same ages were frequency matched to decedents on sex and place of residency. Logistic regression was used to calculate odds ratios and 95% confidence intervals and to test effect modification. RESULTS Associations with mental health care were stronger in decedents than peers with a gradation of care (i.e., outpatient only, emergency department [ED], inpatient care) in both sexes. However, these associations were weaker among youth living in rural communities. Furthermore, older males (aged 18 to 25 years) were less likely than younger males (aged 10 to 17 years) to access the ED (ambulatory care only). This decrease was observed in rural and larger communities alongside no increase in medical care for other reasons. CONCLUSIONS Geographical and age-related barriers to mental health care exist for youth who die by suicide. Preventive efforts can address these barriers, intervening early and integrating services, including the ED.
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Affiliation(s)
- Anne E Rhodes
- 1 Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario.,2 The Institute for Clinical Evaluative Sciences, Toronto, Ontario.,3 The Offord Centre for Child Studies, Hamilton, Ontario.,4 Department of Psychiatry and Behavioural Neuroscience Sciences, McMaster University, Hamilton, Ontario
| | - Michael H Boyle
- 3 The Offord Centre for Child Studies, Hamilton, Ontario.,4 Department of Psychiatry and Behavioural Neuroscience Sciences, McMaster University, Hamilton, Ontario.,5 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario
| | - Jeffrey A Bridge
- 6 Center for Suicide Prevention and Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,7 The Ohio State University College of Medicine, Columbus, OH, USA
| | - Mark Sinyor
- 1 Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario.,8 Sunnybrook Health Sciences Centre, Toronto, Ontario.,9 Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Laurence Y Katz
- 10 Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba.,11 Child and Adolescent Mental Health, Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba
| | - Kathryn Bennett
- 3 The Offord Centre for Child Studies, Hamilton, Ontario.,4 Department of Psychiatry and Behavioural Neuroscience Sciences, McMaster University, Hamilton, Ontario.,5 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario
| | - Amanda S Newton
- 12 Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Paul S Links
- 4 Department of Psychiatry and Behavioural Neuroscience Sciences, McMaster University, Hamilton, Ontario
| | - Lil Tonmyr
- 13 Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa
| | - Robin Skinner
- 13 Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa
| | - Amy Cheung
- 1 Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario.,8 Sunnybrook Health Sciences Centre, Toronto, Ontario.,9 Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Jennifer Bethell
- 14 The Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Corine Carlisle
- 15 Department of Psychiatry, University of Toronto, Toronto, Ontario.,16 Department of Psychiatry, Hospital for Sick Children (SickKids), Toronto, Ontario
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26
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Appleby L. Safer services: conclusions from the report of the National Confidential Inquiry. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.6.1.5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In May 1999, the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness published its first major report since it was reestablished at the University of Manchester (Appleby et al, 1999a). Entitled Safer Services, it presented findings from a two-year sample of suicides and an 18-month sample of homicides occurring in England and Wales, and on the basis of these put forward 31 recommendations for mental health services (Appleby, 1999b; Shaw et al, 1999). This article, modified from a chapter in Safer Services, discusses how services might deal with the risk of suicide and homicide or serious violence.
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Morriss RK, Morriss EE. Contextual evaluation of social adversity in the management of depressive disorder. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.6.6.423] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Contextual rating of social adversity has its origins in the work of George Brown and colleagues (Brown & Harris, 1978). This review evaluates its strengths and weaknesses in rating the effects of social adversity on depressive disorder. We write from the perspective of its usefulness for clinical and training purposes both to the consultant psychiatrist and to the community mental health team working in general adult psychiatry.
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Raymont V. Suicide in schizophrenia – how can research influence training and clinical practice? PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.25.2.46] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Suicide has consistently been the most common cause of premature death in schizophrenia. A large 5-year World Health Organization study consisting of the follow-up of 1056 patients exhibiting psychotic symptoms found the most common cause of death in those with schizophrenia was suicide (Sartorius et al, 1986). In their review of the subject Caldwell and Gottesman (1990) found that 9–13% of patients with schizophrenia eventually commit suicide. At least 20–40% make suicide attempts (Meltzer & Fatemi, 1995) and 1–2% go on to complete in their attempt within the next 12 months (Meltzer & Okayli 1995). Therefore, suicide in schizophrenia has long been a major area of concern and research efforts.
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An Investigation into Suicides Among Bhutanese Refugees Resettled in the United States Between 2008 and 2011. J Immigr Minor Health 2017; 18:819-827. [PMID: 26758579 DOI: 10.1007/s10903-015-0326-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
An increase of Bhutanese refugee suicides were reported in the US between 2009 and 2012. This investigation examined these reported suicides in depth to gain a better understanding of factors associated with suicide within this population. The study employed 14 psychological autopsies to elicit underlying motivations and circumstances for self-inflicted death and to identify potential future avenues for prevention and intervention among refugee communities. Disappointment with current (un)employment, lack of resettlement services and social support, and frustrations with separation from family were believed to contribute to suicidal acts. Suicide within refugee populations may be connected with experiences of family withdrawal, integration difficulties, and perceived lack of care. It is important to assess the effectiveness of improving refugee services on the mental health of migrants. More research is needed in order to better understand, and respond to, suicide in resettled populations.
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Hagaman AK, Khadka S, Lohani S, Kohrt B. Suicide in Nepal: a modified psychological autopsy investigation from randomly selected police cases between 2013 and 2015. Soc Psychiatry Psychiatr Epidemiol 2017; 52:1483-1494. [PMID: 28856382 PMCID: PMC5705471 DOI: 10.1007/s00127-017-1433-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/16/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Yearly, 600,000 people complete suicide in low- and middle-income countries, accounting for 75% of the world's burden of suicide mortality. The highest regional rates are in South and East Asia. Nepal has one of the highest suicide rates in the world; however, few investigations exploring patterns surrounding both male and female suicides exist. This study used psychological autopsies to identify common factors, precipitating events, and warning signs in a diverse sample. METHODS Randomly sampled from 302 police case reports over 24 months, psychological autopsies were conducted for 39 completed suicide cases in one urban and one rural region of Nepal. RESULTS In the total police sample (n = 302), 57.0% of deaths were male. Over 40% of deaths were 25 years or younger, including 65% of rural and 50.8% of female suicide deaths. We estimate the crude urban and rural suicide rates to be 16.1 and 22.8 per 100,000, respectively. Within our psychological autopsy sample, 38.5% met criteria for depression and only 23.1% informants believed that the deceased had thoughts of self-harm or suicide before death. Important warning signs include recent geographic migration, alcohol abuse, and family history of suicide. CONCLUSIONS Suicide prevention strategies in Nepal should account for the lack of awareness about suicide risk among family members and early age of suicide completion, especially in rural and female populations. Given the low rates of ideation disclosure to friends and family, educating the general public about other signs of suicide may help prevention efforts in Nepal.
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Affiliation(s)
- Ashley K Hagaman
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - S Khadka
- Research Department, Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - S Lohani
- Nobel College, Pokhara University, Kathmandu, Nepal
| | - B Kohrt
- Department of Psychiatry, George Washington University, Washington, DC, USA
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Khanra S, Mahintamani T, Bose S, Khess CRJ, Umesh S, Ram D. Inpatient Suicide in a Psychiatric Hospital: A Nested Case-control Study. Indian J Psychol Med 2016; 38:571-576. [PMID: 28031595 PMCID: PMC5178043 DOI: 10.4103/0253-7176.194914] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Risk factors for inpatient suicide are different from those in the general population. We examined sociodemographic and clinical variables of patients who committed suicide as an inpatient in a psychiatric hospital in India. METHODS Matched retrospective nested case-control design was adopted. Ten patients who died by suicide as inpatients between 2000 and 2013 were included, along with fifty controls, matched with respect to age, sex, diagnosis, and period of admission. RESULTS Suicide completers were mostly unskilled in occupation (P = 0.03), had a history of past suicide attempts (P < 0.001), shorter duration of hospital stay (P = 0.001), poorer improvement on psychopathology (P = 0.02), and were having more suicidal ideation (P = 0.02). Significantly more completers were receiving antidepressants (P = 0.04). CONCLUSION This study adds to the existing sparse literature on inpatient suicides from Asia. Strength of the study was close matching between case and controls and blindedness. Limitations were retrospective design, and variations in prescription behavior and treatment decisions.
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Affiliation(s)
- Sourav Khanra
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | | | - Swarnali Bose
- Department of Clinical Psychology, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | | | - Shreekantiah Umesh
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Daya Ram
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
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Tong Y, Phillips MR, Conner KR. DSM-IV Axis II personality disorders and suicide and attempted suicide in China. Br J Psychiatry 2016; 209:319-326. [PMID: 26585099 PMCID: PMC6173803 DOI: 10.1192/bjp.bp.114.151076] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 03/01/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND There are meagre data on Axis II personality disorders and suicidal behaviour in China. AIMS To describe the prevalence of Axis II personality disorders in suicides and suicide attempts in China and to estimate risk for these outcomes associated with personality disorders. METHOD People who died by suicide (n = 151), people who attempted suicide (n = 118) and living community controls (n = 140) were randomly sampled from four Chinese counties and studied using the Structured Clinical Interviews for DSM-IV-TR Axis I Disorders (SCID-I) and Axis II Personality Disorders (SCID-II). We also determined the prevalence of subthreshold versions of ten DSM-IV personality disorders. RESULTS Axis II personality disorders were present in 7% of the suicide group, 6% of the suicide attempt group and 1% of the control group. Threshold and subthreshold personality disorders had adjusted odds ratios (point estimates) in the range of 2.7-8.0 for suicide and for suicide attempts. CONCLUSIONS Axis II personality disorders may confer increased risk for suicidal behaviour in China, but their low prevalence in the community and among people with suicidal behaviour suggests that other personality constructs such as select dimensional traits may be a more fruitful avenue for understanding and preventing suicide in China.
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Affiliation(s)
- Yongsheng Tong
- Yongsheng Tong, MD, PhD, Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing, WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA; Michael R. Phillips, MD, MA, MPH, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China, Departments of Psychiatry and Public Health, Emory University, Atlanta Georgia, USA, and Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing, China; Kenneth R. Conner, PsyD, MPH, Department of Psychiatry, University of Rochester Medical Center, Rochester, New York and US Department of Veterans Affairs VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, New York, USA
| | - Michael R. Phillips
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China, Departments of Psychiatry and Public Health, Emory University, Atlanta Georgia, USA, and Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing, China
| | - Kenneth R. Conner
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NewYork and US Department of Veterans Affairs VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, New York, USA
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Kar N. Factors associated with suicides in Wolverhampton: Relevance of local audits exploring preventability. MEDICINE, SCIENCE, AND THE LAW 2016; 56:245-251. [PMID: 27385769 DOI: 10.1177/0025802416657761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Suicide rates and associated risk factors are known to change over time. The periodic evaluation of suicides in a particular locality may identify specific issues that may help in prevention efforts. The profile of 146 consecutive cases with suicide, open and narrative verdicts between January 2004 and July 2011 in Wolverhampton was studied in order to explore associated factors. Specific information about methods, mental health issues and stressors was collected. There was considerable variation in suicides in different wards of the city, with higher occurrences in inner-city areas. Male suicides were three times more common, and they were significantly younger than in female suicides. Common methods were hanging (52.7%) and poisoning (21.9%) involving a wide range of drugs. Life events were reported in 52.1% suicides, most frequently relational problems (28.1%), followed by physical illness and bereavement. Mental-health factors were associated with 63.0% of suicides, predominantly depression (45.9%) and alcohol and drug abuse (6.8%). The majority of the suicide victims (63.0%) were not in contact with mental-health services, including: most men (68.8%), young suicides up to age 34 (78.6%), the elderly (69.2%) and Asians (70.0%). A considerable proportion of these suicides had mental-health issues, mainly depression (42.4%) and alcohol or drug abuse (6.5%). Significantly more of them (69.6% vs. 22.2%) had stressors compared with suicides known to mental-health services. The findings of the study highlighted risk factors that may help prioritising intervention initiatives. It appears that local suicide audits may complement national information on suicide in designing appropriate local suicide-prevention strategies.
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Benson O, Gibson S, Boden ZV, Owen G. Exhausted without trust and inherent worth: A model of the suicide process based on experiential accounts. Soc Sci Med 2016; 163:126-34. [DOI: 10.1016/j.socscimed.2016.06.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 06/21/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
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Rodway C, Tham SG, Ibrahim S, Turnbull P, Windfuhr K, Shaw J, Kapur N, Appleby L. Suicide in children and young people in England: a consecutive case series. Lancet Psychiatry 2016; 3:751-759. [PMID: 27236279 DOI: 10.1016/s2215-0366(16)30094-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 05/09/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is concern about the mental health of children and young people and a possible rise in suicidal behaviour in this group. We have done a comprehensive national multi-agency study of suicide in under 20s in England. We aimed to establish how frequently suicide is preceded by child-specific and young person-specific suicide risk factors, as well as all-age factors, and to identify contact with health-care and social-care services and justice agencies. METHODS This study is a descriptive examination of suicide in a national consecutive sample of children and young people younger than 20 years who died by suicide in England between Jan 1, 2014, and April 30, 2015. We obtained general population mortality data from the Office for National Statistics (ONS). We collected information about antecedents considered to be relevant to suicide (eg, abuse, bullying, bereavement, academic pressures, self-harm, and physical health) from a range of investigations and inquiries, including coroner inquest hearings, child death investigations, criminal justice system reports, and the National Health Service, including data on people in contact with mental health services in the 12 months before their death. FINDINGS 145 suicides in people younger than 20 years were notified to us during the study period, of which we were able to obtain report data about antecedents for 130 (90%). The number of suicides rose sharply during the late teens with 79 deaths by suicide in people aged 18-19 years compared with 66 in people younger than 18 years. 102 (70%) deaths were in males. 92 (63%) deaths were by hanging. Various antecedents were reported among the individuals for whom we had report data, including academic (especially exam) pressures (35 [27%] individuals), bullying (28 [22%]), bereavement (36 [28%]), suicide in family or friends (17 [13%]), physical health conditions (47 [36%]), family problems (44 [34%]), social isolation or withdrawal (33 [25%]), child abuse or neglect (20 [15%]), excessive drinking (34 [26%]), and illicit drug use (38 [29%]). Suicide-related internet use was recorded in 30 (23%) cases. In the week before death 13 (10%) individuals had self-harmed and 35 (27%) had expressed suicidal ideas. 56 (43%) individuals had no known contact with health-care and social-care services or justice agencies. INTERPRETATION Improved services for self-harm and mental health are crucial to suicide prevention, but the wide range of antecedents emphasises the roles of schools, primary care, social services, and the youth justice system. FUNDING The Healthcare Quality Improvement Partnership.
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Affiliation(s)
- Cathryn Rodway
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Jean McFarlane Building, University of Manchester, Manchester, UK.
| | - Su-Gwan Tham
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Jean McFarlane Building, University of Manchester, Manchester, UK
| | - Saied Ibrahim
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Jean McFarlane Building, University of Manchester, Manchester, UK
| | - Pauline Turnbull
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Jean McFarlane Building, University of Manchester, Manchester, UK
| | - Kirsten Windfuhr
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Jean McFarlane Building, University of Manchester, Manchester, UK
| | - Jenny Shaw
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Jean McFarlane Building, University of Manchester, Manchester, UK
| | - Nav Kapur
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Jean McFarlane Building, University of Manchester, Manchester, UK
| | - Louis Appleby
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Jean McFarlane Building, University of Manchester, Manchester, UK
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Linsley KR, Schapira MA, Schapira K, Lister C. Changes in risk factors for young male suicide in Newcastle upon Tyne, 1961-2009. BJPsych Bull 2016; 40:136-41. [PMID: 27280034 PMCID: PMC4887731 DOI: 10.1192/pb.bp.114.048884] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims and method To ascertain differences in patterns of suicide in young men over three decades (1960s, 1990s and 2000s) and discuss implications for suicide prevention. Data on suicides and open verdicts in men aged 15-34 were obtained from coroner's records in Newcastle upon Tyne and analysed using SPSS software. Results An increase in suicide rates from the first to the second decade was followed by a fall in the third decade. This was associated with an increasing proportion of single men, those living alone, unemployment, consumption of alcohol, use of hanging, previous suicide attempt and history of treatment for mental illness. Clinical implications This study highlights the need for more interventions and focus to be given to young males in the suicide prevention area and is of high importance in the field of public health. Areas that could be tackled include reducing access to means of suicide, reducing alcohol use, support for relationship difficulties, engagement with mental health services and management of chronic illness.
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Bakst SS, Braun T, Shohat T. The postmortem proxy-based interview--future directions. J Psychiatr Res 2016; 75:46-56. [PMID: 26802810 DOI: 10.1016/j.jpsychires.2016.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/01/2015] [Accepted: 01/07/2016] [Indexed: 12/13/2022]
Abstract
The present study aims to provide an overview of the procedural and methodological challenges that need to be addressed when determining the content and application of postmortem proxy-based interviews and recommendations for meeting these challenges in future death investigations are outlined. Preliminary interview considerations are discussed and a step-by-step procedural algorithm for applying proxy-based interview protocol is supplied. A vulnerability-stress model is used for organizing the conceptualization of risk and protective factors into domains of theoretically similar factors. Techniques to improve data collected about mental disorders and stressful life events-variables addressed in nearly all psychological autopsy studies-are suggested, and the importance of examining certain understudied constructs (e.g., psychological factors, family history, select situational factors, childhood adversity, and protective factors) is emphasized. Given the convergence of findings across postmortem proxy-based interviews, whereby extracting postmortem psychiatric diagnoses is the rule, the next generation of studies must offer a point of departure from univariate models, by studying how and why well known exposures interact to produce suicide. In practical terms, targeting specific sub-populations and high-risk individuals can serve as the basis for constructing and testing different clinical hypothesis, which in turn may yield insights into the underlying etiological heterogeneity of suicide.
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Affiliation(s)
- Shelly S Bakst
- Israel Center for Disease Control (ICDC), Israel Ministry of Health, Ramat Gan, Israel.
| | - Tali Braun
- Israel Center for Disease Control (ICDC), Israel Ministry of Health, Ramat Gan, Israel
| | - Tamy Shohat
- Israel Center for Disease Control (ICDC), Israel Ministry of Health, Ramat Gan, Israel; Department of Epidemiology and Preventive Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Fegg M, Kraus S, Graw M, Bausewein C. Physical compared to mental diseases as reasons for committing suicide: a retrospective study. BMC Palliat Care 2016; 15:14. [PMID: 26860949 PMCID: PMC4746811 DOI: 10.1186/s12904-016-0088-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 02/03/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several studies investigated the relationship between mental disorders and suicidal ideation. However, little is known about physical illnesses being the major trigger for committed suicides. It is necessary to understand these risk factors to be able to meet the needs of patients in a palliative care setting. METHODS Suicide, medical and police notes were retrospectively analysed from all autopsies conducted in 2009-11 at the University of Munich, Germany. Documented reasons for suicide were classified into a "physical disease" (PD) or "mental disease" (MD) group and compared with respect to their sociodemographic characteristics and autopsy outcomes. RESULTS Of all 1069 cases, 18.9% gave a PD as reason for committing suicide (MD, 32.7%). Those indicating PD were older than MD (68.8 vs. 48.7 years; p < 0.001) with more men being in this group (72.8% vs. 59.1%; p=0.002). In PD, 30.7% suffered from cancer, 28.7% from chronic pain and 12.4% from lung disease. 38.8% of MD and 12.4% of PD had previous suicide attempts. CONCLUSIONS In palliative care, it is necessary to screen patients on a regular basis for suicidal ideation, especially those with previous suicide attempts.
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Affiliation(s)
- Martin Fegg
- Department of Palliative Medicine, University of Munich, Munich, Germany.
| | - Sybille Kraus
- Department of Forensic Medicine, University of Munich, Munich, Germany.
| | - Matthias Graw
- Department of Forensic Medicine, University of Munich, Munich, Germany.
| | - Claudia Bausewein
- Department of Palliative Medicine, University of Munich, Munich, Germany.
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Cho SE, Na KS, Cho SJ, Im JS, Kang SG. Geographical and temporal variations in the prevalence of mental disorders in suicide: Systematic review and meta-analysis. J Affect Disord 2016; 190:704-713. [PMID: 26600412 DOI: 10.1016/j.jad.2015.11.008] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 11/01/2015] [Accepted: 11/09/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND In contrast to the previous studies reporting that most suicides occur among people with mental disorders, recent studies have reported various rates of mental disorders in suicide in different geographical regions. We aimed to comprehensively investigate the factors influencing the variation in the prevalence of mental disorders reported among suicide victims. METHOD The authors searched Embase, Medline, Web of Science, and the Cochrane Library to identify psychological autopsy studies reporting the prevalence of any mental disorders among suicide victims. A meta-regression analysis was conducted to identify the potential effects of geographical regions, the year of publication, measurements of personality disorder, measurements of comorbidity, and the ratio of females on the prevalence of mental disorders in addition to examining the heterogeneity across studies. RESULTS From 4475 potentially relevant studies, 48 studies met eligibility criteria, with 6626 suicide victims. The studies from East Asia had a significantly lower mean prevalence (69.6% [95% CI=56.8 to 80.0]) than those in North America (88.2% [95% CI=79.7-93.5]) and South Asia (90.4% [95% CI=71.8-97.2]). The prevalence of any mental disorder decreased according to the year of publication (coefficients=-0.0715, p<0.001). LIMITATIONS Substantial heterogeneities were identified within all subgroup analyses. CONCLUSIONS The prevalence of mental disorders among suicide cases seemed relatively low in the East Asia region, and recently published studies tended to report a lower prevalence of mental disorders. The link between the risk factors and suicide in the absence of a mental disorder should be examined in different geographical and sociocultural contexts.
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Affiliation(s)
- Seo-Eun Cho
- Department of Psychiatry, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Kyoung-Sae Na
- Department of Psychiatry, Gachon University Gil Medical Center, Incheon, Republic of Korea.
| | - Seong-Jin Cho
- Department of Psychiatry, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jeong-Soo Im
- Department of Preventive Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Seung-Gul Kang
- Department of Psychiatry, Gachon University Gil Medical Center, Incheon, Republic of Korea
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Tucker RP, Michaels MS, Rogers ML, Wingate LR, Joiner TE. Construct validity of a proposed new diagnostic entity: Acute Suicidal Affective Disturbance (ASAD). J Affect Disord 2016; 189:365-78. [PMID: 26476421 DOI: 10.1016/j.jad.2015.07.049] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/30/2015] [Accepted: 07/29/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND The current study presents initial support for the construct validity of Acute Suicidal Affective Disturbance (ASAD), a clinical entity consisting of acute suicide risk and several related features. METHODS Participants (N=195) were university students who were recruited for a history of suicide attempt(s), history of suicidal ideation, or no history of suicide attempts or suicidal ideation. Participants completed study measures online. RESULTS Factor analytic results indicated a one factor solution for a lifetime measure of ASAD symptoms. The measure demonstrated strong convergent and divergent validity with common correlates of suicide-related outcomes and incremental predictive validity, as lifetime occurrence of ASAD symptoms predicted number of past suicide attempts above and beyond a host of suicide risk factors. Lifetime ASAD symptoms differed between those with multiple suicide attempts, those with a single attempt, and participants without a history of attempts, as well as between participants with a history of both suicidal ideation and attempts and those with a history of suicidal ideation but not suicide attempts. LIMITATIONS The cross-sectional research design limits the ability to infer causation between ASAD symptoms and suicidal behavior. Only past ASAD symptoms (not current symptoms) were measured. CONCLUSIONS ASAD appears to be a unified clinical entity that characterizes acute suicide risk which may assist clinicians in determining a client's potential for death by suicide.
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Affiliation(s)
- Raymond P Tucker
- Oklahoma State University, 116 North Murray, Stillwater, OK 74078, USA.
| | - Matt S Michaels
- Florida State University, Department of Psychology, 1107 West Call Street, Tallahassee, FL 32306-4301, USA
| | - Megan L Rogers
- Florida State University, Department of Psychology, 1107 West Call Street, Tallahassee, FL 32306-4301, USA
| | - LaRicka R Wingate
- Oklahoma State University, 116 North Murray, Stillwater, OK 74078, USA
| | - Thomas E Joiner
- Florida State University, Department of Psychology, 1107 West Call Street, Tallahassee, FL 32306-4301, USA
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Joiner TE, Hom MA, Hagan CR, Silva C. Suicide as a derangement of the self-sacrificial aspect of eusociality. Psychol Rev 2015; 123:235-54. [PMID: 26524155 DOI: 10.1037/rev0000020] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Building upon the idea that humans may be a eusocial species (i.e., rely on multigenerational and cooperative care of young, utilize division of labor for successful survival), we conjecture that suicide among humans represents a derangement of the self-sacrificial aspect of eusociality. In this article, we outline the characteristics of eusociality, particularly the self-sacrificial behavior seen among other eusocial species (e.g., insects, shrimp, mole rats). We then discuss parallels between eusocial self-sacrificial behavior in nonhumans and suicide in humans, particularly with regard to overarousal states, withdrawal phenomena, and perceptions of burdensomeness. In so doing, we make the argument that death by suicide among humans is an exemplar of psychopathology and is due to a derangement of the self-sacrificial behavioral suite found among eusocial species. Implications and future directions for research are also presented.
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Jia CX, Zhang J. Confucian Values, Negative Life Events, and Rural Young Suicide with Major Depression in China. OMEGA-JOURNAL OF DEATH AND DYING 2015; 76:3-14. [PMID: 28969515 DOI: 10.1177/0030222815575014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this research was to understand the characteristics of rural young suicides with major depression in China and the relationship of these events with Confucian values and negative life events. Our cases were 90 rural suicides with major depression with victims aged 15 to 34 years and living matched controls of the same gender, age (within 3 years), and county of residence. Confucian values appear to be a protective factor for men but a risk factor for women with regard to suicide with major depression. More attention should be paid to Confucian values in suicide prevention efforts.
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Affiliation(s)
- Cun-Xian Jia
- 1 Department of Epidemiology and Health Statistics, Shandong University School of Public Health, Jinan, China.,2 Shandong University School of Public Health, Center for Suicide Prevention Research, Jinan, China
| | - Jie Zhang
- 2 Shandong University School of Public Health, Center for Suicide Prevention Research, Jinan, China.,3 Department of Sociology, State University of New York College at Buffalo, NY, USA
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Sweeney L, Owens C, Malone K. Communication and interpretation of emotional distress within the friendships of young Irish men prior to suicide: a qualitative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2015; 23:150-158. [PMID: 25323463 DOI: 10.1111/hsc.12124] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/29/2014] [Indexed: 06/04/2023]
Abstract
The potential for young men in crisis to be supported by their lay networks is an important issue for suicide prevention, due to the under-utilisation of healthcare services by this population. Central to the provision of lay support is the capability of social networks to recognise and respond effectively to young men's psychological distress and suicide risk. The aim of this qualitative study was to explore young men's narratives of peer suicide, in order to identify how they interpreted and responded to behavioural changes and indications of distress from their friend before suicide. In-depth qualitative interviews were conducted during 2009/10 with 15 Irish males (aged 19-30 years) who had experienced the death by suicide of a male friend in the preceding 5 years. The data were analysed using a thematic approach. Through the analysis of the participants' stories and experiences, we identified several features of young male friendships and social interactions that could be addressed to strengthen the support available to young men in crisis. These included the reluctance of young men to discuss emotional or personal issues within male friendships; the tendency to reveal worries and emotion only within the context of alcohol consumption; the tendency of friends to respond in a dismissive or disapproving way to communication of suicidal thoughts; the difficulty of knowing how to interpret a friend's inconsistent or ambiguous behaviour prior to suicide; and beliefs about the sort of person who takes their own life. Community-based suicide prevention initiatives must enhance the potential of young male social networks to support young men in crisis, through specific provisions for developing openness in communication and responsiveness, and improved education about suicide risk.
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Affiliation(s)
- Lorna Sweeney
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Karasouli E, Owens D, Latchford G, Kelley R. Suicide After Nonfatal Self-Harm. CRISIS 2015; 36:65-70. [DOI: 10.1027/0227-5910/a000285] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Nonfatal self-harm is the strongest predictor of suicide, with some of the risk factors for subsequent suicide after nonfatal self-harm being similar to those for suicide in general. However, we do not have sufficient information regarding the medical care provided to nonfatal self-harm episodes preceding suicide. Aims: Our study sought to explore hospital care and predictive characteristics of the risk of suicide after nonfatal self-harm. Method: Individuals with history of nonfatal self-harm who died by suicide were compared with those who had a nonfatal self-harm episode but did not later die by suicide. Cases were identified by cross-linking data collected through a self-harm monitoring project, 2000–2007, and comprehensive local data on suicides for the same period. Results: Dying by suicide after nonfatal self-harm was more common for male subjects than for female subjects (OR = 3.3, 95% CI = 1.7–6.6). Self-injury as the method of nonfatal self-harm was associated with higher risk of subsequent suicide than was self-poisoning (OR = 2.0, 95% CI = 1.04–3.9). More urgent care at the emergency department (OR = 2.7, 95% CI = 1.1–6.3) and admission to hospital (OR = 2.0, 95% CI = 1.0–4.0) at the index episode were related to a heightened risk of suicide. Conclusion: The findings of our study could help services to form assessment and aftercare policies.
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Affiliation(s)
| | - David Owens
- Leeds Institute of Health Sciences, University of Leeds, UK
| | - Gary Latchford
- Leeds Institute of Health Sciences, University of Leeds, UK
| | - Rachael Kelley
- Leeds Institute of Health Sciences, University of Leeds, UK
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Cramer RJ, Stroud CH, Fraser T, Graham J. A trait-interpersonal analysis of suicide proneness among lesbian, gay, and bisexual community members. Suicide Life Threat Behav 2014; 44:601-15. [PMID: 24702204 DOI: 10.1111/sltb.12092] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 01/06/2014] [Indexed: 11/30/2022]
Abstract
Suicide remains a concerning issue for lesbian, gay, and bisexual (LGB) persons. The integrated effects of five-factor model personality traits and interpersonal-psychological theory of suicide (IPTS) constructs on suicide proneness in a community sample of 336 LGB adults were examined. Results supported a model inclusive of all five-factor model domains predicting IPTS constructs leading to suicide proneness. Effects of neuroticism and extraversion were both mediated by perceived burdensomeness and thwarted belongingness. Thwarted belongingness mediated the effect of agreeableness on suicide proneness. Identified mediation pathways build on existing trait-interpersonal theory and may inform clinical services for sexual minority persons.
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Ross AM, Kelly CM, Jorm AF. Re-development of mental health first aid guidelines for non-suicidal self-injury: a Delphi study. BMC Psychiatry 2014; 14:236. [PMID: 25134432 PMCID: PMC4197339 DOI: 10.1186/s12888-014-0236-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 08/08/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Up to 12% of Australian adults and almost one in five adolescents are estimated to have engaged in non-suicidal self-injury (NSSI) at some time in their life. Friends and family are most likely to notice signs of NSSI, but may be unsure how to intervene. Mental health first aid guidelines were developed in 2008 on how to do this through providing initial support and encouraging appropriate professional help-seeking. This study aims to re-develop the 2008 NSSI first aid guidelines to ensure they contain current recommended helping actions and remain consistent with the NSSI intervention literature. METHODS The Delphi consensus method was used to determine the importance of the inclusion of helping statements in the guidelines. These statements describe helping actions a member of the public can take, and information they should have, to help someone who is engaging in NSSI. Systematic searches of the available NSSI intervention literature were conducted to find helping statements. Two expert panels, comprising 28 NSSI professionals and 33 consumer advocates, rated the importance of each statement. RESULTS 98 out of 220 statements were endorsed as appropriate helping actions in providing assistance to someone engaging in NSSI. These statements were used to form the updated mental health first aid guidelines for NSSI. CONCLUSION The re-development of the guidelines has resulted in more comprehensive guidance than the original version (98 versus 30 statements containing helping actions). This substantial increase in endorsed statements adds detail and depth to the guidelines, as well as covers additional ways of providing guidance and support.
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Affiliation(s)
- Anna M Ross
- Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie St, 3010 Parkville, Victoria Australia
| | - Claire M Kelly
- Mental Health First Aid Australia, Level 6, 369 Royal Parade, 3052 Parkville, Victoria Australia ,School of Psychology, Deakin University, Burwood, Victoria 3125 Australia
| | - Anthony F Jorm
- Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie St, 3010 Parkville, Victoria Australia
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Abstract
AbstractObjectives: To determine whether assessments of patients admitted to a general hospital following deliberate self-harm (DSH) were in line with the Royal College of Psychiatrists guidelines. To examine the profile of cases and presentations and to make recommendations for improvements to the service.Method: Clinical and demographic data recorded on 70 admissions after DSH during 1997-98 were analysed retrospectively. A checklist was also developed, using factors shown by previous research to be associated with future risk of suicide, to determine the quality of assessments.Results: The majority (70%) of assessments took place within 24 hours of admission thereby meeting College recommendations. Medical personnel performed all adult assessments. Circumstances of the overdose, recent stresses, psychiatric diagnosis, immediate risk and follow-up arrangements were documented in the majority of cases. Family psychiatric history, past suicidal behaviour, alcohol and drug abuse history, and previous violence, were frequently not documented. A copy of a discharge summary to the GP was found in 41% of charts. Overdoses accounted for 93% of cases of DSH. The most frequently recorded problem (37.5%) was adjustment disorder.Conclusions: Despite evidence showing that non-psychiatric medical staff are competent in assessing DSH and guidelines encouraging multidisciplinary involvement, DSH assessments remain the preserve of the medical psychiatric team. Closer attention should be paid to all the risk factors associated with suicide by assessors; a checklist could prove helpful. There is room for improved communication between psychiatric services and GPs following DSH. The setting up of a self-harm service planning group could improve the co-ordination and efficiency of delivery of general hospital services to this patient group.
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Ali NH, Zainun KA, Bahar N, Haniff J, Hamid AM, Bujang MAH, Mahmood MS. Pattern of suicides in 2009: data from the National Suicide Registry Malaysia. Asia Pac Psychiatry 2014; 6:217-25. [PMID: 23857761 DOI: 10.1111/j.1758-5872.2012.00227.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 06/13/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The National Suicide Registry Malaysia (NSRM) is a nationwide system that captures data on completed suicides in Malaysia from all forensic departments under the purview of the Ministry of Health Malaysia. METHODS This paper examines all suicidal deaths reported to the NSRM from 1 January 2009 to 31 December 2009. The relevant variables were recorded in the paper-based Case Report Form (CRF) and then entered into the online reporting system for analysis. RESULTS The overall suicide rate for 2009 was 1.18 per 100,000 population (n = 328). The age range was 14-94 years, with a median of 37 (IQR 24) years. There were more men than women, the gender ratio being 2.9:1 (males : females), and the majority (89% or 293/328) were Malaysian citizens. Ethnicity-wise, Indians had the highest suicide rate of 3.67 per 100,000. The Malays and Bumiputera of Sabah and Sarawak had lower rates of 0.32 to 0.37 per 100,000. Mental illness was reported in 22% (72/328) of the cases and physical illnesses in 20.4% (67/328). Previous suicide attempts were reported in 15.5% (51/328) of cases. History of substance abuse was present in 28.7% (83/328). Life events were positive in 41.2% (135/328) of cases. DISCUSSION Malaysia is able to generate statistics on suicide by enhancing the collaboration between forensic, psychiatry and clinical research agencies. These trends should be monitored to gain a better understanding of suicide trends.
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Affiliation(s)
- Nor Hayati Ali
- Department of Psychiatry and Mental Health, Hospital Selayang, Batu Caves, Selangor, Malaysia
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Abstract
The causes of suicidal behaviour are not fully understood; however, this behaviour clearly results from the complex interaction of many factors. Although many risk factors have been identified, they mostly do not account for why people try to end their lives. In this Review, we describe key recent developments in theoretical, clinical, and empirical psychological science about the emergence of suicidal thoughts and behaviours, and emphasise the central importance of psychological factors. Personality and individual differences, cognitive factors, social aspects, and negative life events are key contributors to suicidal behaviour. Most people struggling with suicidal thoughts and behaviours do not receive treatment. Some evidence suggests that different forms of cognitive and behavioural therapies can reduce the risk of suicide reattempt, but hardly any evidence about factors that protect against suicide is available. The development of innovative psychological and psychosocial treatments needs urgent attention.
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Liu RT, Miller I. Life events and suicidal ideation and behavior: A systematic review. Clin Psychol Rev 2014; 34:181-92. [DOI: 10.1016/j.cpr.2014.01.006] [Citation(s) in RCA: 170] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 12/18/2013] [Accepted: 01/23/2014] [Indexed: 11/29/2022]
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