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Shoib S, Shaheen N, Anwar A, Saad AM, Mohamed Akr L, I Saud A, Kundu M, Nahidi M, Chandradasa M, Swed S, Saeed F. The effectiveness of telehealth interventions in suicide prevention: A systematic review and meta-analysis. Int J Soc Psychiatry 2024; 70:415-423. [PMID: 37994403 DOI: 10.1177/00207640231206059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND Suicidal attempt is a significant risk factor for future attempts, with the highest risk during the first-year post-suicide. Telepsychiatry has shown promise by providing easy access to evidence-based interventions during mental health crises. AIMS investigation the effectiveness of telehealth interventions in suicide prevention. METHODS Four electronic databases (PubMed, Scopus, Web of Science, and Ovid) were systematically searched for studies on patients undergoing telepsychiatry intervention (TPI) up to June 2022. Following PRISMA guidelines, a systematic review and meta-analysis were conducted to investigate the effectiveness of telehealth interventions in suicide prevention. Continuous data were pooled as standardised mean difference (SMD), and dichotomous data were pooled as risk ratio using the random effects model with the corresponding 95% confidence intervals (CI). RESULTS Sixteen studies were included in the review. Most studies were case-control and randomised controlled trials conducted in Europe and North America. The findings of the studies generally showed that TPIs are effective in reducing suicide rates (odds ratio = 0.68; 95% CI [-0.47, 0.98], p = .04) and suicidal reattempts. The interventions were also found to be well-accepted, with high retention rates. CONCLUSION Our results suggest that TPIs are well-accepted and effective in reducing suicide rates and reattempts. It is recommended to maintain telephone follow-ups for at least 12 months. Further research is needed to understand the potential of telepsychiatry in suicide prevention fully.
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Affiliation(s)
- Sheikh Shoib
- Department of Health Services, Srinagar, India
- Sharda University, Greater Noida, India (SSh)
- Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Healing Mind and Wellness Initiative Nawab Bazar Srinagar
| | | | | | | | | | - Alaa I Saud
- Faculty of Medicine, Kasr Alainy University, Cairo, Egypt
| | - Mrinmoy Kundu
- Institute of Medical Sciences and SUM Hospital, Bhubaneswar, India
| | - Mahsa Nahidi
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Sarya Swed
- Faculty of Medicine, Aleppo University, Syria
| | - Fahimeh Saeed
- Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Suekane A, Takayama W, Hashimoto R, Morishita K, Otomo Y. Risk factors for recurrence of suicide attempt via overdose: A prospective observational study. Am J Emerg Med 2024; 75:1-6. [PMID: 37890336 DOI: 10.1016/j.ajem.2023.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 09/19/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Although the prevalence of drug overdose has gradually increased worldwide, the risk factors associated with the recurrence of suicide attempts via drug overdose have not been well elucidated. In this study, we investigated the clinical course of patients with drug overdose and whether or not patients reattempted suicide via overdose, using telephone interviews, to evaluate the risk factors associated with overdose recurrence. METHODS This prospective observational study enrolled patients who attempted suicide by drug overdose and were transferred to a tertiary emergency hospital in Japan between January 1, 2015 and July 30, 2021. Recurrence of overdose within 1 year of admission for overdose was designated as the primary outcome. Multivariable logistic regression analysis was performed to assess the independent risk factors for the recurrence of overdose. Furthermore, we compared the difference in the recurrence interval between patients with and without cohabitants using the log-rank test. RESULTS A total of 94 patients were identified, and recurrence of overdose was observed in 28 patients (29.8%). The median recurrence interval was 6.0 months [IQR (interquartile range), 4.0-7.0 months]. The recurrence rate was significantly higher in patients with a history of schizophrenia than that in patients without a history of schizophrenia (58.3% vs 25.6%, p = 0.048), and significantly lower in patients with cohabitants than that in patients without cohabitants (22.6% vs 43.8%, p = 0.015). The presence of a cohabitant was significantly associated with a longer recurrence interval (p = 0.049). The effect of psychiatric intervention during hospitalization and psychiatric visits after discharge could not be found in this study. CONCLUSIONS A history of schizophrenia was an independent risk factor for the recurrence of overdose, and the presence of a cohabitant was significantly associated with a lower risk of recurrence. Large-scale, long-term studies are required to confirm the results of this study.
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Affiliation(s)
- Akira Suekane
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Wataru Takayama
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan; Department of Acute Critical Care and Disaster Medicine, Graduate School of Tokyo Medical and Dental University, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan.
| | - Rio Hashimoto
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Koji Morishita
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan; Department of Acute Critical Care and Disaster Medicine, Graduate School of Tokyo Medical and Dental University, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
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Comendador L, Jiménez-Villamizar MP, Losilla JM, Sanabria-Mazo JP, Mateo-Canedo C, Cebrià AI, Sanz A, Palao DJ. Effect of synchronous remote-based interventions on suicidal behaviours: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e075116. [PMID: 38056944 PMCID: PMC10711844 DOI: 10.1136/bmjopen-2023-075116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/31/2023] [Indexed: 12/08/2023] Open
Abstract
INTRODUCTION Suicide is among the leading causes of preventable death worldwide. The impact of suicide affects the personal, social and economic levels. Therefore, its prevention is a priority for public health systems. Previous studies seem to support the efficacy of providing active contact to people who have made a suicide attempt. The current systematic review and meta-analysis aims to investigate the efficacy of distance suicide prevention strategies implemented through synchronous technology-based interventions. METHODS AND ANALYSIS This protocol is designed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. The bibliographical searches were conducted in the databases PubMed, PsycINFO, Scopus and Web of Science in April 2022, with no restrictions on the time of publication and limited to publications in English or Spanish. The search strategy was performed using free-text terms and Medical Subject Headings terms: suicide, follow-up, synchronous, remote, telehealth, telephone, hotline, video-conference and text message. Two reviewers will independently conduct study screening, selection process, data extraction and risk of bias assessment. The analysis and synthesis of the results will be both qualitative and quantitative. A narrative synthesis, presented in a comprehensive table, will be performed and meta-analysis will be conducted, as appropriate, if sufficient data are provided. ETHICS AND DISSEMINATION The present review and meta-analysis will not require ethical approval, as it will use data collected from previously published primary studies. The findings of this review will be published in peer-reviewed journals and widely disseminated. PROSPERO REGISTRATION NUMBER CRD42021275044.
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Affiliation(s)
- Laura Comendador
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
- Parc Taulí Research and Innovation Institute, Sabadell, Spain
| | - María Paola Jiménez-Villamizar
- Department of Basic, Developmental, and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Josep-Maria Losilla
- Department of Psychobiology and Methodology of Health Sciences, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Juan P Sanabria-Mazo
- Department of Basic, Developmental, and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Corel Mateo-Canedo
- Department of Basic, Developmental, and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Ana Isabel Cebrià
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
- Parc Taulí Research and Innovation Institute, Sabadell, Spain
| | - Antoni Sanz
- Department of Basic, Developmental, and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Diego J Palao
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
- Parc Taulí Research and Innovation Institute, Sabadell, Spain
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Cations M, Lang C, Draper B, Caughey GE, Evans K, Wesselingh S, Crotty M, Whitehead C, Inacio MC. Death by suicide among aged care recipients in Australia 2008-2017. Int Psychogeriatr 2023; 35:724-735. [PMID: 36803904 DOI: 10.1017/s104161022300008x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVE To characterize the features of aged care users who died by suicide and examine the use of mental health services and psychopharmacotherapy in the year before death. DESIGN Population-based, retrospective exploratory study. SETTING AND PARTICIPANTS Individuals who died while accessing or waiting for permanent residential aged care (PRAC) or home care packages in Australia between 2008 and 2017. MEASUREMENTS Linked datasets describing aged care use, date and cause of death, health care use, medication use, and state-based hospital data collections. RESULTS Of 532,507 people who died, 354 (0.07%) died by suicide, including 81 receiving a home care package (0.17% of all home care package deaths), 129 in PRAC (0.03% of all deaths in PRAC), and 144 approved for but awaiting care (0.23% of all deaths while awaiting care). Factors associated with death by suicide compared to death by another cause were male sex, having a mental health condition, not having dementia, less frailty, and a hospitalization for self-injury in the year before death. Among those who were awaiting care, being born outside Australia, living alone, and not having a carer were associated with death by suicide. Those who died by suicide more often accessed Government-subsidized mental health services in the year before their death than those who died by another cause. CONCLUSIONS Older men, those with diagnosed mental health conditions, those living alone and without an informal carer, and those hospitalized for self-injury are key targets for suicide prevention efforts.
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Affiliation(s)
- Monica Cations
- Registry of Senior Australians, South Australian Health and Medical Research Institute, AdelaideSA, Australia
- College of Education, Psychology and Social Work, Flinders University, AdelaideSA, Australia
| | - Catherine Lang
- Registry of Senior Australians, South Australian Health and Medical Research Institute, AdelaideSA, Australia
| | - Brian Draper
- Discipline of Psychiatry and Mental Health, Faculty of Medicine, UNSW Sydney, SydneyAustralia
| | - Gillian E Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute, AdelaideSA, Australia
- UniSA Allied Health and Human Performance, University of South Australia, AdelaideSA, Australia
| | - Keith Evans
- Registry of Senior Australians, South Australian Health and Medical Research Institute, AdelaideSA, Australia
| | - Steve Wesselingh
- Registry of Senior Australians, South Australian Health and Medical Research Institute, AdelaideSA, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, AdelaideSA, Australia
| | - Craig Whitehead
- College of Medicine and Public Health, Flinders University, AdelaideSA, Australia
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, AdelaideSA, Australia
- UniSA Allied Health and Human Performance, University of South Australia, AdelaideSA, Australia
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5
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Wand AP, Browne R, Jessop T, Peisah C. A systematic review of evidence-based aftercare for older adults following self-harm. Aust N Z J Psychiatry 2022; 56:1398-1420. [PMID: 35021912 DOI: 10.1177/00048674211067165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Self-harm is closely associated with suicide in older adults and may provide opportunity to intervene to prevent suicide. This study aimed to systematically review recent evidence for three components of aftercare for older adults: (1) referral pathways, (2) assessment tools and safety planning approaches and (3) engagement and intervention strategies. METHODS Databases PubMed, Medline, PsychINFO, Embase and CINAHL were searched from January 2010 to 10 July 2021 by two reviewers. Empirical studies reporting aftercare interventions for older adults (aged 60+) following self-harm (including with suicidal intent) were included. Full text of articles with abstracts meeting inclusion criteria were obtained and independently reviewed by three authors to determine final studies for review. Two reviewers extracted data and assessed level of evidence (Oxford) and quality ratings (Alberta Heritage Foundation for Medical Research Standard Quality Assessment Criteria for quantitative and Attree and Milton checklist for qualitative studies), working independently. RESULTS Twenty studies were reviewed (15 quantitative; 5 qualitative). Levels of evidence were low (3, 4), and quality ratings of quantitative studies variable, although qualitative studies rated highly. Most studies of referral pathways were observational and demonstrated marked variation with no clear guidelines or imperatives for community psychiatric follow-up. Of four screening tools evaluated, three were suicide-specific and one screened for depression. An evidence-informed approach to safety planning was described using cases. Strategies for aftercare engagement and intervention included two multifaceted approaches, psychotherapy and qualitative insights from older people who self-harmed, carers and clinicians. The qualitative studies identified targets for improved aftercare engagement, focused on individual context, experiences and needs. CONCLUSION Dedicated older-adult aftercare interventions with a multifaceted, assertive follow-up approach accompanied by systemic change show promise but require further evaluation. Research is needed to explore the utility of needs assessment compared to screening and evaluate efficacy of safety planning and psychotherapeutic approaches.
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Affiliation(s)
- Anne Pf Wand
- Specialty of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,Older Peoples Mental Health Service, Jara Ward, Concord Centre for Mental Health, Sydney Local Health District, Concord, Australia
| | - Roisin Browne
- School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,ForeFront Motor Neuron Disease & Frontotemporal Dementia Clinic, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Capacity Australia, Sydney, NSW, Australia
| | - Tiffany Jessop
- School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,Capacity Australia, Sydney, NSW, Australia
| | - Carmelle Peisah
- School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,Capacity Australia, Sydney, NSW, Australia
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Educating Crisis Supporters About Self-Harm and Suicide in Older Adults. Am J Geriatr Psychiatry 2022; 30:1212-1220. [PMID: 34799248 DOI: 10.1016/j.jagp.2021.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/01/2021] [Accepted: 10/12/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVES This study aimed to describe existing knowledge of crisis supporters (volunteers responding to crisis calls/texts/messages) regarding self-harm and suicide in older adults and investigate knowledge translation through use of a novel online adaptive learning tool. METHODS The online educational tool was tested in an Australian national sample of crisis supporters (trained volunteers) aged 18+. Knowledge Transfer was evaluated utilizing a pre/post intervention methodology for data collection. The collaboratively developed online educational tool comprised a pre-test (10 questions), middle learning module (individualised for participant's incorrect pre-test responses) and post-test (10 questions) on suicidal behaviours in older adults. Data analysed included the demographic characteristics of the participants, individual question scores, and summed pre- and post-tests scores. Group differences in change scores were assessed with either one-way between subjects ANOVA or independent samples t-test, depending on the number of groups within each variable. Pre-post education comparisons on individual change in scores were made using a paired samples t-test. Statistical significance was defined as p <0.05. RESULTS 104 crisis supporters completed the tool (pre-test, middle lesson and post-test). There was significant improvement in knowledge of crisis supporters after the intervention (pre-test scores Mean (M) = 4.56, SD = 1.62 and post-test scores M = 7.61, SD = 1.60; t (103) = 17.242, p <0.001.). CONCLUSION Dedicated training about suicidal behaviors in older adults is needed given their high rates of suicide and differing underlying reasons and needs compared to younger adults.
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7
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Mukhtar F, Candilis P. Pandemics and Suicide Risk: Lessons From COVID and Its Predecessors. J Nerv Ment Dis 2022; 210:799-807. [PMID: 36179374 PMCID: PMC9555599 DOI: 10.1097/nmd.0000000000001536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT In its mortality and global reach, COVID-19 is among the worst pandemics to hit the globe since the 1918 influenza. During a pandemic, it is not uncommon for deaths from suicide to be downplayed as communities respond to the immediate mortality of the disease. In this analysis, we review pandemic history to uncover its impact on suicide rates, a frequent proxy for community mental health, and whether public health responses were effective. We incorporate lessons from more than 100 years of epidemics to assess whether the current public health response can benefit from the lessons of history.
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Sakashita T, Oyama H. Suicide Prevention Interventions and Their Linkages in Multilayered Approaches for Older Adults: A Review and Comparison. Front Public Health 2022; 10:842193. [PMID: 35619820 PMCID: PMC9127334 DOI: 10.3389/fpubh.2022.842193] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
Multilayered approaches to suicide prevention combine universal, selective, and indicated prevention interventions. These approaches may be more successful in reducing suicide rates among older adults if they link these layers more systematically: that is, if the programs are designed so that interventions at a lower level facilitate involvement at a higher level when appropriate. This study aimed to examine the effect on suicide rates of the structure of multilayered approaches, and in particular the types of interventions and the connections or linkages between them. We also wished to consider any different effects by sex. A literature search used PubMed and PsycINFO to identify systematic reviews of interventions in this age group. From the reference lists of these articles, we identified controlled studies assessing the impact of a multilayered program on suicide incidence among older adults. We were particularly interested in initiatives linking different kinds of prevention interventions. We found three relevant systematic reviews, and from these, we identified nine eligible studies. These included seven non-randomized controlled studies from rural areas in Japan (average eligible population: 3,087, 59% women, average duration: 8 years). We also found two cohort studies. The first was from a semi-urban area in Padua, Italy (18,600 service users, 84% women, duration: 11 years). The second was from urban Hong Kong, with 351 participants (57% women) over a 2-year follow-up period. We used a narrative synthesis of these studies to identify five different multilayered programs with different forms of connections or linkages between layers. Two studies/programs (Italy and Hong Kong) involved selective and indicated prevention interventions. One study/program (Yuri, Japan) included universal and selective prevention interventions, and the final six studies (two programs in northern Japan) involved linkages between all three layers. We also found that these linkages could be either formal or informal. Formal linkages were professional referrals between levels. Informal linkages included advice from professionals and self-referrals. Several of the studies noted that during the program, the service users developed relationships with services or providers, which may have facilitated movements between levels. All five programs were associated with reduced suicide incidence among women in the target groups or communities. Two programs were also associated with a reduction among men. The study authors speculated that women were more likely to accept services than men, and that the care provided in some studies did less to address issues that are more likely to affect men, such as suicidal impulsivity. We therefore suggest that it is important to build relationships between levels, especially between selective and indicated prevention interventions, but that these can be both formal and informal. Additionally, to reach older men, it may be important to create systematic methods to involve mental health professionals in the indicated prevention intervention. Universal interventions, especially in conjunction with systematically linked indicated and selective interventions, can help to disseminate the benefits across the community.
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Affiliation(s)
- Tomoe Sakashita
- Department of Social Welfare, Faculty of Health Sciences, Aomori University of Health and Welfare, Aomori, Japan
| | - Hirofumi Oyama
- Department of Social Welfare, Faculty of Health Sciences, Aomori University of Health and Welfare, Aomori, Japan
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Seneviratne VL, Ranaweera S, Atkins M. Elder suicides: A reminder from the forgotten generation ……. Asian J Psychiatr 2022; 71:103028. [PMID: 35272255 DOI: 10.1016/j.ajp.2022.103028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/18/2022] [Accepted: 02/11/2022] [Indexed: 11/02/2022]
Abstract
Elder suicide is a significant public health issue in many countries. This reflects the complex underlying psychosocial, mental and physical health issues that older adults face. Increased life expectancy in developing countries has resulted in a gradual transition to an ageing population. Furthermore, in countries such as Sri Lanka, the transition occurs at a lower per capita income than in developed countries. This will negatively impact the availability of resources and service delivery to at-risk individuals. Thus, addressing elder suicide and concerns of elders are timely issues. This paper looks at the underlying risk factors associated with elder suicide and strategies that can be implemented in preventing elder suicide in the South Asian context, with reference to Sri Lanka.
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Affiliation(s)
- V Lakmi Seneviratne
- Victorian Institute of Forensic Mental Health, Yarra Bend Road, Fairfield, VIC 3078, Australia.
| | - Sajeeva Ranaweera
- Expert Committee on Suicide Prevention, Sri Lanka Medical Association, 6 Wijerama Mawatha, Colombo 7, Sri Lanka.
| | - Martin Atkins
- Gold Coast Mental Health Service, 1, Hospital Blvd, Southport, QLD 4215, Australia.
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10
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Wand APF, Peisah C. The Development of an Online Training Tool for Crisis Supporters on Late Life Suicide: Improving Knowledge While Promoting Empowerment. Arch Suicide Res 2022; 26:968-974. [PMID: 33076767 DOI: 10.1080/13811118.2020.1833798] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Telephone crisis services have an increasing role in suicide prevention yet existing interventions have not empowered crisis supporters with adequate education targeting the needs of older people in crisis. An existing educational intervention was adapted for crisis supporters through collaboration between a crisis support service, clinician researchers, and an eLearning technology company. Empowering crisis supporters, through improving knowledge and highlighting their strengths and expertise, was emphasized. The adaptive learning technology featured a pretest, middle learning module (educational content), and post-test individualized to the participant's incorrect pretest answers. The online training tool on suicidal behaviors in late-life combined clinician researcher expertise and evidence, insights from crisis supporters, and adaptive learning technology to create a purpose-built educational tool addressing an unmet need.
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11
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Heisel MJ, Flett GL. Screening for suicide risk among older adults: assessing preliminary psychometric properties of the Brief Geriatric Suicide Ideation Scale (BGSIS) and the GSIS-Screen. Aging Ment Health 2022; 26:392-406. [PMID: 33327729 DOI: 10.1080/13607863.2020.1857690] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To initially assess psychometric properties of two abbreviated versions of the Geriatric Suicide Ideation Scale (GSIS): a 10-item Brief Geriatric Suicide Ideation Scale (BGSIS), and a 5-item Geriatric Suicide Ideation Scale-Screen (GSIS-Screen). METHODS A series of psychometric analyses was conducted, assessing the internal consistency, test-retest reliability, construct and predictive validity of the abbreviated GSIS scales. This was done by selecting-out GSIS items from a combined dataset of studies on suicide ideation in older adults: 1) The GSIS scale development study (n = 107); 2) A clinical trial of Interpersonal Psychotherapy (IPT) modified for suicidal older adults(n = 25); 3) A longitudinal study of risk and resiliency to suicide ideation in community-residing older adults (n = 173). RESULTS Overall findings demonstrated strong internal consistency, test-retest reliability, concurrent and predictive validity for the BGSIS and GSIS-Screen with older adults across community, clinical, and residential settings. CONCLUSION Study findings support the use of the abbreviated GSIS scales when conducting research on suicide risk identification among older adults. Future research is recommended testing these scales prospectively in public health, residential, and clinical settings, in research and healthcare delivery contexts.
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Affiliation(s)
- Marnin J Heisel
- Departments of Psychiatry and of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,Department of Psychiatry, Center for the Study and Prevention of Suicide, University of Rochester Medical Center, Rochester, USA
| | - Gordon L Flett
- Department of Psychology, York University, Toronto, Ontario, Canada
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Brülhart M, Klotzbücher V, Lalive R, Reich SK. Mental health concerns during the COVID-19 pandemic as revealed by helpline calls. Nature 2021; 600:121-126. [PMID: 34789873 PMCID: PMC9973557 DOI: 10.1038/s41586-021-04099-6] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/06/2021] [Indexed: 01/22/2023]
Abstract
Mental health is an important component of public health, especially in times of crisis. However, monitoring public mental health is difficult because data are often patchy and low-frequency1-3. Here we complement established approaches by using data from helplines, which offer a real-time measure of 'revealed' distress and mental health concerns across a range of topics4-9. We collected data on 8 million calls from 19 countries, focusing on the COVID-19 crisis. Call volumes peaked six weeks after the initial outbreak, at 35% above pre-pandemic levels. The increase was driven mainly by fear (including fear of infection), loneliness and, later in the pandemic, concerns about physical health. Relationship issues, economic problems, violence and suicidal ideation, however, were less prevalent than before the pandemic. This pattern was apparent both during the first wave and during subsequent COVID-19 waves. Issues linked directly to the pandemic therefore seem to have replaced rather than exacerbated underlying anxieties. Conditional on infection rates, suicide-related calls increased when containment policies became more stringent and decreased when income support was extended. This implies that financial relief can allay the distress triggered by lockdown measures and illustrates the insights that can be gleaned from the statistical analysis of helpline data.
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Affiliation(s)
- Marius Brülhart
- University of Lausanne, Lausanne, Switzerland. .,Centre for Economic Policy Research, London, UK.
| | | | - Rafael Lalive
- University of Lausanne, Lausanne, Switzerland,CEPR, London, United Kingdom
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13
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De Leo D, Giannotti AV. Suicide in late life: A viewpoint. Prev Med 2021; 152:106735. [PMID: 34538377 PMCID: PMC8443431 DOI: 10.1016/j.ypmed.2021.106735] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/06/2021] [Accepted: 07/16/2021] [Indexed: 01/07/2023]
Abstract
Suicide in old age represents a sad public health concern. Despite the global decline in rates of suicide and the general amelioration of quality of life and access to health care for older adults, their rates of suicide remain the highest virtually in every part of the world. With the aging of the world population and the growing number of mononuclear families, the risk of an increase in isolation, loneliness and dependency does not appear ungrounded. The Covid-19 pandemic is claiming the life of many older persons and creating unprecedented conditions of distress, particularly for this segment of the population. This article briefly examines the main characteristics of suicidal behavior in late life, including observations deriving from the spread of the Sars-2 coronavirus and possible strategies for prevention.
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Hilgeman MM, Simons KV, Bower ES, Jacobs ML, Eichorst M, Luci K. Improving Suicide Risk Detection and Clinical Follow-up after Discharge from Nursing Homes. Clin Gerontol 2021; 44:536-543. [PMID: 34028341 PMCID: PMC10364454 DOI: 10.1080/07317115.2021.1927280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objectives: Suicide Awareness for Veterans Exiting Community Living Centers (SAVE-CLC) is a brief intervention to standardize suicide-risk screening and clinical follow-up after VA nursing home discharge. This paper examines the outcomes of SAVE-CLC compared to care as usual.Methods: A quasi-experimental evaluation was conducted (N = 124) with SAVE-CLC patients (n = 62) matched 1:1 to a pre-implementation comparison group. Data were obtained through VA Corporate Data Warehouse resources and chart reviews. Outcomes examined (within 30/90 days of discharge) included mortality rates, frequency of outpatient mental health visits, emergency department visits, rehospitalizations, depression screens (PHQ-2), and the latency period for outpatient mental health care.Results: A greater portion of SAVE-CLC patients received a depression screen after discharge, n = 42, 67.7% versus n = 8, 12.9%, OR = 14.2 (5.7, 35.3), p < .001. The number of days between discharge and first mental health visit was also substantially shorter for SAVE-CLC patients, M = 8.9, SD = 8.2 versus M = 17.6, SD = 9.1; t = 2.47 (122), p = .02. Significant differences were not observed in emergency department visits, hospitalizations, or mortality.Conclusions: SAVE-CLC is a time-limited intervention for detecting risk and speeding engagement in mental health care in the immediate high-risk post-discharge period.Clinical Implications: Care transitions present an important opportunity for addressing older adults' suicide risk; brief telephone-based interventions like SAVE-CLC may provide needed support to individuals returning home.
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Affiliation(s)
- Michelle M Hilgeman
- Research & Development Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama, USA.,Psychology Department, & Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa, Alabama, USA.,Department of Medicine, Division of Gerontology, Geriatrics, & Palliative Care, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kelsey V Simons
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York, USA.,Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Emily S Bower
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York, USA.,Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - M Lindsey Jacobs
- Research & Development Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama, USA.,Psychology Department, & Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Morgan Eichorst
- VA Northern Indiana Health Care System, St. Joseph County VA Healthcare Center, Mishawaka, Indiana, USA
| | - Katherine Luci
- Center for Aging and Neurocognitive Services, Salem VA Medical Center, Salem, Virginia, USA.,Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Blacksburg, Virginia, USA
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15
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KIM BJ, KIHL T. Suicidal ideation associated with depression and social support: a survey-based analysis of older adults in South Korea. BMC Psychiatry 2021; 21:409. [PMID: 34407801 PMCID: PMC8375215 DOI: 10.1186/s12888-021-03423-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/10/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND This study examined the effect of depression on suicidal ideation among older adults in South Korea. Furthermore, this study investigated how social support, as a factor that reduces depression among older adults, mediates the relationship between depression and suicidal ideation. METHODS Based on a survey of 260 older adults in Seoul and Gyeonggi Province, suicidal ideation, depression, and social support were evaluated using the Beck Scale for Suicidal Ideation, the Center of Epidemiological Studies Depression Scale, and the Measurement of Social Support in the Elderly, respectively. RESULTS A multiple regression analysis confirmed that depression and social support were significantly associated with suicidal ideation. Based on path analysis, we found that social support mediated the relationship between depression and suicidal ideation. CONCLUSIONS Therefore, this study provides concrete insights for policymakers and social workers about how suicidal ideation among older adults may be diminished. Particularly, the role of depression and social support in suicidal ideation is a matter of concern for older adults in South Korea.
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Affiliation(s)
- Bum Jung KIM
- grid.254224.70000 0001 0789 9563Department of Social Welfare, Chung-Ang University, Seoul, South Korea
| | - Taesuk KIHL
- grid.263136.30000 0004 0533 2389Graduate School, Sangmyung University, Seoul, South Korea
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16
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Van Orden KA, Areán PA, Conwell Y. A Pilot Randomized Trial of Engage Psychotherapy to Increase Social Connection and Reduce Suicide Risk in Later Life. Am J Geriatr Psychiatry 2021; 29:789-800. [PMID: 33952416 PMCID: PMC8286301 DOI: 10.1016/j.jagp.2021.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/09/2021] [Accepted: 03/29/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Targeting social connection to prevent suicide in later life shows promise but requires additional study to identify the most effective and acceptable interventions. This study examines acceptability, feasibility, and efficacy of Engage Psychotherapy to improve subjective disconnection (target mechanisms: low belonging and perceived burden), and improve clinical and functional outcomes (depression, suicide ideation, quality of life). METHODS Pilot randomized trial with adults age 60 and older who reported feeling lonely and/or like a burden. Participants were randomly assigned to 10 sessions of 'Social Engage' (S-ENG; n = 32) or care-as-usual (CAU; n = 30), with follow-up assessments at 3 weeks, 6 weeks, and 10 weeks. RESULTS S-ENG is feasible to deliver over 10 sessions and acceptable to older adults who report social disconnection-a population at risk for suicide. Participants were willing and able to focus each session on social engagement and demonstrated high levels of compliance. Social Engage did not show preliminary evidence of impact on belonging or perceived burden but was effective in reducing depressive symptoms and improving social-emotional quality of life. DISCUSSION S-ENG holds promise for improving social-emotional quality of life and depressive symptoms. Future research is needed to identify and measure target mechanisms that account for clinical and functional improvement.
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Affiliation(s)
- Kimberly A Van Orden
- Department of Psychiatry (KAO, YC), University of Rochester Medical Center, Rochester, NY.
| | - Patricia A Areán
- Department of Psychiatry & Behavioral Sciences (PAA), University of Washington, WA
| | - Yeates Conwell
- Department of Psychiatry (KAO, YC), University of Rochester Medical Center, Rochester, NY
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17
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Dragovic M, Pascu V, Hall T, Ingram J, Waters F. Emergency department mental health presentations before and during the COVID-19 outbreak in Western Australia. Australas Psychiatry 2020; 28:627-631. [PMID: 32961096 PMCID: PMC7509241 DOI: 10.1177/1039856220960673] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Coronavirus (COVID-19) has led to high levels of psychological distress in the community. This study aimed to examine whether emergency departments (EDs) also recorded a rise in mental health presentations. METHOD Changes in the number, and type, of mental health presentations to Western Australia EDs were examined between January and May 2020, and compared to 2019. RESULTS Data showed an unexpected decrease in the number of mental health presentations, compared to 2019, which was temporally coincident with the rise in local COVID-19 cases. Presentations for anxiety and panic symptoms, and social and behavioural issues, increased by 11.1% and 6.5%, respectively, but suicidal and self-harm behaviours decreased by 26%. CONCLUSION A rise in local COVID-19 cases was associated with a decrease in mental health presentations to EDs. This has important implications for the planning and provision of healthcare services in the current pandemic.
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Affiliation(s)
- Milan Dragovic
- North Metropolitan Health Service, Mental Health, Clinical Research Centre, Australia.,Division of Psychiatry, School of Medicine, the University of Western Australia, Australia
| | - Viki Pascu
- North Metropolitan Health Service, Mental Health, Clinical Research Centre, Australia
| | - Tammy Hall
- North Metropolitan Health Service, Mental Health, Clinical Research Centre, Australia
| | - Jesse Ingram
- North Metropolitan Health Service, Mental Health, Clinical Research Centre, Australia
| | - Flavie Waters
- North Metropolitan Health Service, Mental Health, Clinical Research Centre, Australia.,School of Psychology, the University of Western Australia, Australia
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18
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Leaune E, Samuel M, Oh H, Poulet E, Brunelin J. Suicidal behaviors and ideation during emerging viral disease outbreaks before the COVID-19 pandemic: A systematic rapid review. Prev Med 2020; 141:106264. [PMID: 33017599 PMCID: PMC7531915 DOI: 10.1016/j.ypmed.2020.106264] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 12/20/2022]
Abstract
The current COVID-19 pandemic is the most severe pandemic of the 21st century, on track to having a rising death toll. Beyond causing respiratory distress, COVID-19 may also cause mortality by way of suicide. The pathways by which emerging viral disease outbreaks (EVDOs) and suicide are related are complex and not entirely understood. We aimed to systematically review the evidence on the association between EVDOs and suicidal behaviors and/or ideation. An electronic search was conducted using five databases: Medline, Embase, Web of Science, PsycINFO and Scopus in April 2020. A rapid systematic review was carried out, which involved separately and independently extracting quantitative data of selected articles. The electronic search yielded 2480 articles, of which 9 met the inclusion criteria. Most of the data were collected in Hong Kong (n = 3) and the USA (n = 3). Four studies reported a slight but significant increase in deaths by suicide during EVDOs. The increase in deaths by suicide was mainly reported during the peak epidemic and in older adults. Psychosocial factors such as the fear of being infected by the virus or social isolation related to quarantine measures were the most prominent factors associated with deaths by suicide during EVDOs. Overall, we found scarce and weak evidence for an increased risk of deaths by suicide during EVDOs. Our results inform the need to orient public health policies toward suicide prevention strategies targeting the psychosocial effects of EVDOs. High-quality research on suicide risk and prevention are warranted during the current pandemic.
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Affiliation(s)
- Edouard Leaune
- Centre Hospitalier Le Vinatier, Bron, France; INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response - PSYR2 Team, Lyon F-69000, France; University Lyon 1, Villeurbanne F-69000, France.
| | - Maeva Samuel
- Centre Hospitalier Le Vinatier, Bron, France; University Lyon 1, Villeurbanne F-69000, France
| | - Hans Oh
- University of Southern California, Los Angeles, CA, USA
| | - Emmanuel Poulet
- Centre Hospitalier Le Vinatier, Bron, France; INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response - PSYR2 Team, Lyon F-69000, France; University Lyon 1, Villeurbanne F-69000, France; Department of Emergency Psychiatry, University Hospital Edouard Herriot, Hospices civils de Lyon, Lyon, France
| | - Jérôme Brunelin
- Centre Hospitalier Le Vinatier, Bron, France; INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response - PSYR2 Team, Lyon F-69000, France
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19
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Zortea TC, Brenna CTA, Joyce M, McClelland H, Tippett M, Tran MM, Arensman E, Corcoran P, Hatcher S, Heisel MJ, Links P, O'Connor RC, Edgar NE, Cha Y, Guaiana G, Williamson E, Sinyor M, Platt S. The Impact of Infectious Disease-Related Public Health Emergencies on Suicide, Suicidal Behavior, and Suicidal Thoughts. CRISIS 2020; 42:474-487. [PMID: 33063542 PMCID: PMC8689932 DOI: 10.1027/0227-5910/a000753] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Abstract. Background: Infectious disease-related public health emergencies (epidemics) may increase suicide risk, and high-quality evidence is needed to guide an international response. Aims: We investigated the potential impacts of epidemics on suicide-related outcomes. Method: We searched MEDLINE, EMBASE, PsycInfo, CINAHL, Scopus, Web of Science, PsyArXiv, medRxiv, and bioRxiv from inception to May 13–16, 2020. Inclusion criteria: primary studies, reviews, and meta-analyses; reporting the impact of epidemics; with a primary outcome of suicide, suicidal behavior, suicidal ideation, and/or self-harm. Exclusion criteria: not concerned with suicide-related outcomes; not suitable for data extraction. PROSPERO registration: #CRD42020187013. Results: Eight primary papers were included, examining the effects of five epidemics on suicide-related outcomes. There was evidence of increased suicide rates among older adults during SARS and in the year following the epidemic (possibly motivated by social disconnectedness, fears of virus infection, and concern about burdening others) and associations between SARS/Ebola exposure and increased suicide attempts. A preprint study reported associations between COVID-19 distress and past-month suicidal ideation. Limitations: Few studies have investigated the topic; these are of relatively low methodological quality. Conclusion: Findings support an association between previous epidemics and increased risk of suicide-related outcomes. Research is needed to investigate the impact of COVID-19 on suicide outcomes.
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Affiliation(s)
- Tiago C. Zortea
- Suicidal Behaviour Research Laboratory, University of Glasgow, UK
| | | | - Mary Joyce
- National Suicide Research Foundation, Cork, Ireland
| | | | - Marisa Tippett
- Western Libraries, University of Western Ontario, London, ON, Canada
| | | | - Ella Arensman
- National Suicide Research Foundation, Cork, Ireland
- School of Public Health, University College Cork, Ireland
| | - Paul Corcoran
- National Suicide Research Foundation, Cork, Ireland
- School of Public Health, University College Cork, Ireland
| | - Simon Hatcher
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Marnin J. Heisel
- Departments of Psychiatry and of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Paul Links
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Rory C. O'Connor
- Suicidal Behaviour Research Laboratory, University of Glasgow, UK
| | | | - Yevin Cha
- Departments of Psychiatry and of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Giuseppe Guaiana
- Departments of Psychiatry and of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | | | - Mark Sinyor
- Department of Psychiatry, University of Toronto, ON, Canada
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20
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21
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Wand APF, Zhong BL, Chiu HFK, Draper B, De Leo D. COVID-19: the implications for suicide in older adults. Int Psychogeriatr 2020; 32:1225-1230. [PMID: 32349837 PMCID: PMC7235297 DOI: 10.1017/s1041610220000770] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/22/2020] [Accepted: 04/26/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Anne Pamela Frances Wand
- Older Persons’ Mental Health Service, Concord Centre for Mental Health, Concord, Sydney, Australia
- Discipline of Psychiatry, School of Medicine, University of New South Wales, Sydney, Australia
| | - Bao-Liang Zhong
- Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Helen Fung Kum Chiu
- Chinese University of Hong Kong, Psychiatry Multicentre, G/F, TAi Po Hospital, Hong Kong, Hong Kong
| | - Brian Draper
- Discipline of Psychiatry, School of Medicine, University of New South Wales, Sydney, Australia
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Australia
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22
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Amadéo S, Nguyen NL, Teai T, Favro P, Mulet A, Colin-Fagotin N, Rereao M, Malogne A, Simone MD, Rioche G, Gassion V, Pere P, Prokop A, Bernis F, Dufour P, Tuheiava A, Vanquin G, Vilhem S, Gokalsing E, Spodenkiewicz M, Pradem M, Seguin M, Beauchamp G, Thomas P, Vaiva G, Jehel L. Supportive effect of body contact care with ylang ylang aromatherapy and mobile intervention team for suicide prevention: A pilot study. J Int Med Res 2020; 48:300060520946237. [PMID: 32883150 PMCID: PMC7479860 DOI: 10.1177/0300060520946237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 07/07/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To assess understudied, alternative suicide prevention modalities in a mental health care setting. METHODS This was a prospective study of patients (n = 140, 68 cases and 72 controls) who were admitted to hospital or who contacted an SOS suicide crisis line for suicidal ideation or attempts. Psychiatric diagnoses (Mini-International Neuropsychiatric Interview) and intensity of anxiety/depression/suicidality (Hamilton Anxiety Rating Scale, Montgomery-Åsberg Depression Rating Scale, and Beck Scale for Suicidal Ideation) were assessed. All intervention group subjects received a crisis card with a crisis line number, interviews with psychologists or volunteers and a telephone call on days 10 to 21, then 6 months later. These subjects also had a choice between two further 4-month interventions: body contact care or mobile intervention team visits. RESULTS The interventions significantly reduced the number of suicide attempts and suicide (3%) at 6 months compared with the control condition (12%). There were fewer losses to follow-up in the intervention group (7.35%) than in the control group (9.72%). CONCLUSIONS The results favour the implementation of integrated care and maintaining contact in suicide prevention.
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Affiliation(s)
- Stéphane Amadéo
- Centre hospitalier de Polynésie française (CHPF), & Maison
des Sciences de l'Homme du Pacifique (USR 2003, UPF / CNRS) Tahiti, Polynésie
française (SA), Tahiti, Polynésie française, France
- Centre de prévention du suicide (SPC), SOS Suicide NGO, Tahiti,
Polynésie française, France
- Inserm, Équipe Moods-IPSOM, CESP, 94807, Villejuif, France
| | - Ngoc Lam Nguyen
- Centre hospitalier de Polynésie française (CHPF), & Maison
des Sciences de l'Homme du Pacifique (USR 2003, UPF / CNRS) Tahiti, Polynésie
française (SA), Tahiti, Polynésie française, France
- Direction de la santé publique de la Polynésie française,
Tahiti, Polynésie française, France
| | - Taivini Teai
- Centre de prévention du suicide (SPC), SOS Suicide NGO, Tahiti,
Polynésie française, France
- Université de Polynésie française (UPF), Tahiti, Polynésie
française, France
| | - Patrick Favro
- Centre de prévention du suicide (SPC), SOS Suicide NGO, Tahiti,
Polynésie française, France
- Université de Polynésie française (UPF), Tahiti, Polynésie
française, France
| | - Aurélia Mulet
- Centre de prévention du suicide (SPC), SOS Suicide NGO, Tahiti,
Polynésie française, France
| | - Nathalie Colin-Fagotin
- Centre de prévention du suicide (SPC), SOS Suicide NGO, Tahiti,
Polynésie française, France
| | - Moerani Rereao
- Centre de prévention du suicide (SPC), SOS Suicide NGO, Tahiti,
Polynésie française, France
| | - Aurélia Malogne
- Centre de prévention du suicide (SPC), SOS Suicide NGO, Tahiti,
Polynésie française, France
| | - Michel De Simone
- Centre de prévention du suicide (SPC), SOS Suicide NGO, Tahiti,
Polynésie française, France
| | - Géraldine Rioche
- Centre de prévention du suicide (SPC), SOS Suicide NGO, Tahiti,
Polynésie française, France
| | - Virginie Gassion
- Centre de prévention du suicide (SPC), SOS Suicide NGO, Tahiti,
Polynésie française, France
| | - Paul Pere
- Centre de prévention du suicide (SPC), SOS Suicide NGO, Tahiti,
Polynésie française, France
| | - Alban Prokop
- Centre de prévention du suicide (SPC), SOS Suicide NGO, Tahiti,
Polynésie française, France
| | - Fabienne Bernis
- Centre de prévention du suicide (SPC), SOS Suicide NGO, Tahiti,
Polynésie française, France
| | - Pierre Dufour
- Centre de prévention du suicide (SPC), SOS Suicide NGO, Tahiti,
Polynésie française, France
| | - Annie Tuheiava
- Centre de prévention du suicide (SPC), SOS Suicide NGO, Tahiti,
Polynésie française, France
| | - Germaine Vanquin
- Centre de prévention du suicide (SPC), SOS Suicide NGO, Tahiti,
Polynésie française, France
| | - Steve Vilhem
- Service universitaire de psychiatrie de l’enfant et de
l’adolescent (SUPEA), centre hospitalier universitaire Vaudois (CHUV), Lausanne,
Switzerland
| | - Erick Gokalsing
- Inserm, Équipe Moods-IPSOM, CESP, 94807, Villejuif, France
- CUMP Océan Indien/VigilanS Océan Indien Etablissement Public de
Santé Mentale, La Réunion, France
| | - Michel Spodenkiewicz
- Inserm, Équipe Moods-IPSOM, CESP, 94807, Villejuif, France
- Pôle de Santé Mentale, CIC-EC 1410, CHU de la Réunion,
Saint-Pierre, France
| | | | - Monique Seguin
- Groupe McGill d'Étude sur le Suicide. Réseau québécois de
recherche sur le suicide, la dépression et les troubles associés (Rqsdta),
Université McGill -- Institut Universitaire en Santé Mentale de l’Hôpital
Douglas, Canada
| | - Guy Beauchamp
- Groupe McGill d'Étude sur le Suicide. Réseau québécois de
recherche sur le suicide, la dépression et les troubles associés (Rqsdta),
Université McGill -- Institut Universitaire en Santé Mentale de l’Hôpital
Douglas, Canada
| | - Pierre Thomas
- Université de Lille, Inserm, CHU Lille, U1172 -- Lille
Neuroscience & Cognition et Centre National de Ressource et Résilience pour
les psychotraumatismes (Cn2r Lille Paris), F-59000 Lille, France
| | - Guillaume Vaiva
- Université de Lille, Inserm, CHU Lille, U1172 -- Lille
Neuroscience & Cognition et Centre National de Ressource et Résilience pour
les psychotraumatismes (Cn2r Lille Paris), F-59000 Lille, France
| | - Louis Jehel
- Inserm, Équipe Moods-IPSOM, CESP, 94807, Villejuif, France
- Université des Antilles, Campus de Schoelcher, BP 7029, 97275
Schoelcher. Université Paris-Saclay, UVSQ & Université Paris-Sud. Centre
Hospitalier Universitaire de Martinique, BP632, 97261 Cedex Fort de France
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23
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de Leo D, Trabucchi M. COVID-19 and the Fears of Italian Senior Citizens. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103572. [PMID: 32443683 PMCID: PMC7277474 DOI: 10.3390/ijerph17103572] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/14/2020] [Accepted: 05/16/2020] [Indexed: 11/16/2022]
Abstract
Italy has been hit very hard by the severe acute respiratory syndrome—coronavirus-2 (SARS-CoV-2) pandemic. This brief report highlights some of the peculiarities manifested by its older adult population, with particular reference to those living in nursing institutions and at home. Mortality data (as of 26 April) are reported, together with reactions to forced isolation, loneliness, and fear of contracting the disease, which represent big challenges for all, especially for frail elderly people.
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Affiliation(s)
- Diego de Leo
- Italian Psychogeriatric Association, 25121 Brescia, Italy;
- De Leo Fund, 3139 Padua, Italy
- Australian Institute for Suicide Research and Prevention, Griffith University, Mt Gravatt campus, Brisbane 4122, Australia
- Correspondence:
| | - Marco Trabucchi
- Italian Psychogeriatric Association, 25121 Brescia, Italy;
- Department of Pharmacology, Tor Vergata University, 00133 Rome, Italy
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24
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De Leo D, Vichi M, Kolves K, Pompili M. Late life suicide in Italy, 1980-2015. Aging Clin Exp Res 2020; 32:465-474. [PMID: 31792764 DOI: 10.1007/s40520-019-01431-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/21/2019] [Indexed: 11/24/2022]
Abstract
AIM Suicide trends in older adults were examined in Italy from 1980 to 2015. Age groups considered were 65-74 years, 75-84 and 85 + years. METHODS Data on suicide deaths were obtained from the Italian Mortality Database (IMDB) collected by the Italian National Institute of Statistics (ISTAT) and processed by the Statistics Unit of the Italian National Institute of Health (Istituto Superiore di Sanità). Joinpoint regression analyses were carried out for age subgroups by sex. In addition, data related to four main macro-areas of Italy were considered: North-West, North-East, Centre, and South with Islands (Sicily and Sardinia). RESULTS Starting by 1985, declines were noted in all age groups with more noticeable decreases in older adults aged 75-84 and 85 + years. Female subjects demonstrated more ample falls in rates than male individuals. Declines were detected in all macro-areas of Italy. CONCLUSION Improved health assistance and quality of life of older individuals have probably contributed to the decline of suicide rates of senior citizens, who also showed improved poverty indices in the country, differently from all other age groups.
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Affiliation(s)
- Diego De Leo
- Australian Institute for Suicide Research and Prevention, Griffith University, Mt Gravatt Campus, Brisbane, 4122, Australia.
- Slovenian Centre for Suicide Research, Primorska University, Koper, Slovenia.
| | | | - Kairi Kolves
- Australian Institute for Suicide Research and Prevention, Griffith University, Mt Gravatt Campus, Brisbane, 4122, Australia
| | - Maurizio Pompili
- Psychiatric Clinic, University of Rome 'La Sapienza', Rome, Italy
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25
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Heisel MJ, Moore SL, Flett GL, Norman RMG, Links PS, Eynan R, O'Rourke N, Sarma S, Fairlie P, Wilson K, Farrell B, Grunau M, Olson R, Conn D. Meaning-Centered Men's Groups: Initial Findings of an Intervention to Enhance Resiliency and Reduce Suicide Risk in Men Facing Retirement. Clin Gerontol 2020; 43:76-94. [PMID: 31671031 DOI: 10.1080/07317115.2019.1666443] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objectives: To assess the preliminary effectiveness of Meaning-Centered Men's Groups (MCMG), a 12-session existentially-oriented, community-based, psychological group intervention designed to enhance psychological resiliency and prevent the onset or exacerbation of suicide ideation among men who are concerned about or struggling with the transition to retirement.Methods: We recruited 30 men (n= 10 per group), 55 years and older (M= 63.7, SD= 4.1) from community settings to participate in a course of MCMG to be delivered in a community center. Participants completed eligibility, pre-, mid-, and post-group assessments of suicide ideation and psychological risk and resiliency factors.Results: Participants experienced significant increases in attitudinal sources of meaning in life, psychological well-being, life satisfaction, retirement satisfaction, and general health, and decreases in depression, hopelessness, loneliness, and suicide ideation.Conclusions: Preliminary findings suggest that MCMG is a novel men's mental health intervention that may help to enhance psychological well-being and potentially reduce the severity or prevent the onset of symptoms of depression, hopelessness, and suicide ideation.Clinical Implications: Upstream psychological interventions may serve an important role in mental health promotion and suicide prevention with potentially vulnerable individuals facing challenging life transitions.
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Affiliation(s)
- Marnin J Heisel
- Department of Psychiatry, The University of Western Ontario (UWO).,Lawson Health Research Institute, London, ON, Canada.,Center for the Study and Prevention of Suicide, University of Rochester Medical Center, Rochester, NY, USA.,Department of Epidemiology & Biostatistics, The University of Western Ontario, London, Canada
| | | | | | - Ross M G Norman
- Department of Epidemiology & Biostatistics, The University of Western Ontario, London, Canada
| | - Paul S Links
- Department of Psychiatry, The University of Western Ontario (UWO).,Lawson Health Research Institute, London, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University
| | - Rahel Eynan
- Department of Psychiatry, The University of Western Ontario (UWO).,Lawson Health Research Institute, London, ON, Canada
| | - Norm O'Rourke
- Department of Public Health and Multidisciplinary Research Center on Aging, Ben-Gurion University of the Negev
| | - Sisira Sarma
- Department of Epidemiology & Biostatistics, The University of Western Ontario, London, Canada
| | | | - Kimberley Wilson
- Department of Family Relations and Applied Nutrition, University of Guelph
| | | | | | | | - David Conn
- Canadian Coalition for Seniors' Mental Health, Baycrest Health Sciences, Department of Psychiatry, University of Toronto
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Sakashita T, Oyama H. Developing a Hypothetical Model for Suicide Progression in Older Adults With Universal, Selective, and Indicated Prevention Strategies. Front Psychiatry 2019; 10:161. [PMID: 30971963 PMCID: PMC6445050 DOI: 10.3389/fpsyt.2019.00161] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 03/05/2019] [Indexed: 12/11/2022] Open
Abstract
Suicide prevention is an increasingly important issue, especially among older people. Recent work on improving its effectiveness has focused on developing a framework aligning interventions with key risk factors and stages of the suicide process. We have developed this further, by integrating psycho-behavioral components associated with suicide, existing guidelines for identifying critical points of intervention, and the previous preventive strategies framework. Our schematic diagram shows the relationship between the suicide process and prevention strategies, combined with initiatives for linking different types of strategies, from universal strategies at population level, through selective strategies focusing on groups at risk, to indicated strategies, aimed at specific high-risk individuals. We tested our framework using previous studies assessing the impact of suicide prevention interventions on suicide rates in older adults. It was possible to place all identified interventions within the framework. Examining effectiveness within the framework suggests that some interventions may be more successful in reducing suicide rates because they developed systematic linkages between universal, selective, and indicated prevention interventions. Other studies, however, show that interventions can be successful without these linkages, so other factors may also be important. The main weakness of our framework is a lack of evidence about critical intervention points within the suicide process, which may limit its practical application. However, the framework may help to improve the linkages between types of interventions, and support practitioners in developing a wide range of strategies across different areas and stages of the suicide process.
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Affiliation(s)
- Tomoe Sakashita
- Department of Social Welfare, Faculty of Health Sciences, Aomori University of Health and Welfare, Aomori, Japan
| | - Hirofumi Oyama
- Department of Social Welfare, Faculty of Health Sciences, Aomori University of Health and Welfare, Aomori, Japan
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[Prevention of suicide of the elderly in France. To a multimodal strategy against depression and isolation: CQFDi]. Encephale 2018; 45 Suppl 1:S35-S37. [PMID: 30477900 DOI: 10.1016/j.encep.2018.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 09/17/2018] [Accepted: 09/26/2018] [Indexed: 10/27/2022]
Abstract
ISSUE Suicide is a major problem of public health around the world, and if suicidal mortality rates have declined in recent years, the elderly remain a category of the world's population at major risk of suicide. Seventeen percent of deaths by suicide across the world are individuals over the age of 65. The existence of suicidal ideas for an individual in this age group increases the risk of suicide attempt in the year by 34. In France, about a little less than a quarter of suicides belong to persons over 60-years-old. More risk factors found in the international literature are in the foreground of mental disorders and in particular the major depression episode, then secondarily addictions, neuro-degenerative disorders as well as pain and other diseases. Depression is found in 60% to 90% of suicides. We notice also that older people privileged the general practitioner as interlocutor to discuss their problems and worries much more than psychiatrists or psychologists. In fact, two-thirds of the elderly who committed suicide had consulted their general practioner in the month prior to suicide and half in the 10 last days. That raises the question of the identification of depression and the evaluation of suicidal risk. On the other side, there is an abundant literature about psychosocial risk factors especially on the influence of isolation and lack of social support as well as on conflicts and family losses. In France, more than 4 million of the elderly live alone. So, while the world population is increasing and life expectancy lengthens, it is important to already act for elderly suicide prevention. PERSPECTIVES Suicide prevention actions whose efficacity have been demonstrated around the world are designed as part of multimodal strategies combining several levers of action. The consensual recommendations for prevention of elderly suicide recommend the association of actions on the reduction of depression and combating social isolation in connection with the training of front-line actors such as general practitioners. As a result of these experiments and recommendations, the first francophone multimodal strategy was developed to act both on depression and social isolation: the Coopération Québec France sur la dépression et l'isolement (CQFDi) program which will be implemented in France and Quebec in 2019. CONCLUSION It has been proven that multimodal suicide prevention strategies allow a reduction in the number of suicides. The CQFDi program focuses on at risk of suicide population and aims to reduce the suicide rate of elderly people in France.
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Brooks SE, Burruss SK, Mukherjee K. Suicide in the Elderly: A Multidisciplinary Approach to Prevention. Clin Geriatr Med 2018; 35:133-145. [PMID: 30390980 DOI: 10.1016/j.cger.2018.08.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Suicide in the elderly is a growing problem. The elderly population is increasing, and elderly patients have multiple issues that place them at higher risk of suicidality. These issues include physical illnesses, mental illness, loss of functional status, isolation, and family, financial, and social factors. Access to firearms is another significant risk factor, because elderly patients are more likely to use firearms in suicide attempts; interventions to reduce firearms mortality may save lives. Tackling the difficult problem of suicide in the elderly may require a multidisciplinary, community-based series of interventions.
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Affiliation(s)
- Steven E Brooks
- Division of Trauma and Surgical Critical Care, Texas Tech University Health Sciences Center, 3601 4th Street MS 8312, Lubbock, TX 79430, USA
| | - Sigrid K Burruss
- Division of Acute Care Surgery, Loma Linda University Medical Center, 11175 Campus Street, CP 21109, Loma Linda, CA 92350, USA
| | - Kaushik Mukherjee
- Division of Acute Care Surgery, Loma Linda University Medical Center, 11175 Campus Street, CP 21109, Loma Linda, CA 92350, USA.
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Abstract
OBJECTIVES The South Korean government has recently implemented policies to prevent suicide. However, there were few studies examining the recent changing trends in suicide rates. This study aims to examine the changing trends in suicide rates by time and age group. DESIGN A descriptive study using nationwide mortality rates. SETTING Data on the nationwide cause of death from 1993 to 2016 were obtained from Statistics Korea. PARTICIPANTS People living in South Korea. INTERVENTIONS Implementation of national suicide prevention policies (first: year 2004, second: year 2009). PRIMARY OUTCOME MEASURES Suicide was defined as 'X60-X84' code according to the ICD-10 code. Age-standardised suicide rates were estimated, and a Joinpoint regression model was applied to describe the trends in suicide rate. RESULTS From 2010 to 2016, the suicide rates in South Korea have been decreasing by 5.5% (95% CI -10.3% to -0.5%) annually. In terms of sex, the suicide rate for men had increased by 5.0% (95% CI 3.6% to 6.4%) annually from 1993 to 2010. However, there has been no statistically significant change from 2010 to 2016. For women, the suicide rate had increased by 7.5% (95% CI 6.3% to 8.7%) annually from 1993 to 2009, but since 2009, the suicide rate has been significantly decreasing by 6.1% (95% CI -9.1% to -3.0%) annually until 2016. In terms of the age group, the suicide rates among women of almost all age groups have been decreasing since 2010; however, the suicide rates of men aged between 30 and 49 years showed continuously increasing trends. CONCLUSION Our results showed that there were differences in the changing trends in suicide rate by sex and age groups. Our finding suggests that there was a possible relationship between implementation of second national suicide prevention policies and a decline in suicide rate.
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Affiliation(s)
- Sang-Uk Lee
- Department of Mental Health Research, National Center for Mental Health, Seoul, Republic of Korea
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jong-Ik Park
- Department of Psychiatry, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Soojung Lee
- Department of Nursing, Kyungnam University, Changwon, Republic of Korea
| | - In-Hwan Oh
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Joong-Myung Choi
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Chang-Mo Oh
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
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Butcher HK, Ingram TN. Evidence-Based Practice Guideline: Secondary Prevention of Late-Life Suicide. J Gerontol Nurs 2018; 44:20-32. [PMID: 30208188 DOI: 10.3928/00989134-20180907-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Suicide is a tragic, traumatic loss, and one of the most emotionally devastating events families, friends, and communities experience. Suicide claims more than 800,000 lives every year, and some of the highest rates of suicide in the United States and globally are among older adults. The purpose of this evidence-based guideline is to help health care providers recognize those at risk for suicide and recommend appropriate and effective secondary suicide prevention interventions. The information in this guideline is intended for health care providers who work in a variety of settings, including hospitals, nursing homes, rehabilitation centers, out-patient clinics, mental health clinics, home health care, and other long-term care facilities. Assessment and preventive treatment strategies were derived by exhaustive literature review and synthesis of the current evidence on secondary prevention of late-life suicide across practice settings. [Journal of Gerontological Nursing, 44(11), 20-32.].
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Exploring the use of telephone helpline pertaining to older adult suicide prevention: A Hong Kong experience. J Affect Disord 2018; 236:75-79. [PMID: 29723765 DOI: 10.1016/j.jad.2018.04.093] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 03/15/2018] [Accepted: 04/08/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Older adults usually have a higher suicide rate than the general population. There are helpline services provided to older adults but limited studies have examined the suicidal risks among the users, and how those services could be used as a platform to engage older adults in suicide prevention. METHODS In regard to elderly suicide prevention, this study explored the potential usefulness and relevance of a telephone helpline service in Hong Kong, which had 106,583 users during 2012-2015. An estimation on the suicide rates of the users was made and compared with the general older adult population in Hong Kong. The users' suicide risks and their associated factors were assessed by survival analyses and an estimation system on the users' suicide mortality likelihood was also tested. RESULTS The suicide rates of both male and female users were more than two times higher than the general older adult population in Hong Kong. The users' risks of suicides were greater at the early period of using the service; men, living alone, and having a history of mental illnesses were also associated with increased risks. Based on the identified factors, an estimation system was developed with a sensitivity of 0.73 and specificity of 0.54. LIMITATIONS A secondary data analysis. CONCLUSIONS By identifying a suicide risk profile and distinct telephone calling pattern among the users, early detection and a warning system should be implemented to allow timely intervention to reduce the number of older adult suicides in the community.
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Abstract
UNLABELLED ABSTRACTBackground:Suicide rates increase with age in the population aged over 65 years. The aims of this study were to (i) report the characteristics of older people who died by suicide; and (ii) investigate whether these characteristics differ in three age bands: 65-74 years, 75-84 years, and 85+ years. METHODS Using information from national coroner records, relevant socio-demographic and clinical factors in all suicides (age ≥ 65 years; n = 225) from July 2007 to December 2012 in New Zealand were analyzed and compared in the three age bands. RESULTS We found the older the person, the more likely they are to be widowed but the less likely to have a past psychiatric admission or recent contact with psychiatric services in the month prior to suicide. However, most of the older people (61.7% of 65-74 years, 65.6% of 75-84 years, and 77.3% of 85+ years) had contact with their general practitioner within one month of suicide. Women were less likely to use violent methods than men in all three age bands but with increasing age, men were less likely to use violent methods. CONCLUSIONS Suicide characteristics in older people differ by age. The oldest people who die by suicide are not necessarily under psychiatric services and may benefit from a primary care-based approach in which there is screening for depression and suicide risk.
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Gould MS, Lake AM, Galfalvy H, Kleinman M, Munfakh JL, Wright J, McKeon R. Follow-up with Callers to the National Suicide Prevention Lifeline: Evaluation of Callers' Perceptions of Care. Suicide Life Threat Behav 2018; 48:75-86. [PMID: 28261860 DOI: 10.1111/sltb.12339] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/02/2016] [Indexed: 01/08/2023]
Abstract
Continuity of care for suicidal individuals engaged with a variety of health and mental health care systems has become a national priority, and crisis hotlines are increasingly playing a part in the risk management and continuum of care for these individuals. The current study evaluated a national initiative to have crisis centers in the National Suicide Prevention Lifeline network provide follow-up care to suicidal callers. Data were obtained from 550 callers followed by 41 crisis counselors from 6 centers. Two main data sources provided the information for the current study: a self-report counselor questionnaire on the follow-up activities completed on each clinical follow-up call and a telephone interview with follow-up clients, providing data on their perceptions of the follow-up intervention's effectiveness. The majority of interviewed follow-up clients reported that the intervention stopped them from killing themselves (79.6%) and kept them safe (90.6%). Counselor activities, such as discussing distractors, social contacts to call for help, and reasons for dying, and individual factors, such as baseline suicide risk, were associated with callers' perceptions of the impact of the intervention on their suicide risk. Our findings provide evidence that follow-up calls to suicidal individuals can reduce the perceived risk of future suicidal behavior.
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Affiliation(s)
- Madelyn S Gould
- Child and Adolescent Psychiatry, Columbia University, New York, NY, USA.,New York State Psychiatric Institute, New York, NY, USA
| | - Alison M Lake
- New York State Psychiatric Institute, New York, NY, USA
| | | | | | | | - James Wright
- Substance Abuse and Mental Health Services Administration, Rockville, MD, USA
| | - Richard McKeon
- Substance Abuse and Mental Health Services Administration, Rockville, MD, USA
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A systematic review of interventions to prevent suicidal behaviors and reduce suicidal ideation in older people. Int Psychogeriatr 2017; 29:1801-1824. [PMID: 28766474 DOI: 10.1017/s1041610217001430] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Older people have a high risk of suicide but research in this area has been largely neglected. Unlike for younger age groups, it remains unclear what strategies for prevention exist for older adults. This systematic review assesses the effectiveness of interventions to prevent suicidal behavior and reduce suicidal ideation in this age group. METHODS MEDLINE, EMBASE, PsycINFO, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for relevant publications from their dates of inception until 1 April 2016. Studies included in this review report effectiveness data about interventions delivered to older adults to prevent suicidal behavior (suicide, attempted suicide, and self-harm without suicidal intent) or reduce suicidal ideation. A narrative synthesis approach was used to analyze data and present findings. RESULTS Twenty one studies met the criteria for inclusion in the study. Most programs addressed risk predictors, specifically depression. Effective interventions were multifaceted primary care-based depression screening and management programs; treatment interventions (pharmacotherapy and psychotherapy); telephone counseling for vulnerable older adults; and community-based programs incorporating education, gatekeeper training, depression screening, group activities, and referral for treatment. Most of the studies were of low quality apart from the primary care-based randomized controlled trials. CONCLUSIONS Multifaceted interventions directed at primary care physicians and populations, and at-risk elderly individuals in the community may be effective at preventing suicidal behavior and reducing suicidal ideation in older adults. However, more high quality trials are needed to demonstrate successful interventions.
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Falcone G, Nardella A, Lamis DA, Erbuto D, Girardi P, Pompili M. Taking care of suicidal patients with new technologies and reaching-out means in the post-discharge period. World J Psychiatry 2017; 7:163-176. [PMID: 29043154 PMCID: PMC5632601 DOI: 10.5498/wjp.v7.i3.163] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/07/2017] [Accepted: 07/17/2017] [Indexed: 02/05/2023] Open
Abstract
Suicide is a global public health problem with over one million people dying by suicide each year worldwide. Research efforts have focused on developing and testing novel suicide prevention strategies employing recent technological advances. In order to provide a review regarding the role of new technologies (e.g., postcards/letters, text messages, crisis cards, telephone contacts, online interventions) in suicide prevention, we searched PubMed, ScienceDirect, ResearchGate, and Crisis to identify all papers in English from 1977 to 2016. Our results indicated that brief contact interventions show promise in reducing the number of episodes of repeated self-harm and/or suicide attempts following discharge from the Emergency Department or psychiatric units. Innovative methods of contact (e.g., text messages) are easily implemented by clinicians and received by patients in the period of post discharge and have been shown to be beneficial. However, more research employing randomized clinical trials investigating the potential benefits of these novel suicide prevention methods is warranted. Future researchers should continue improving and testing new technologies in the prevention of suicide.
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Affiliation(s)
- Giulia Falcone
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Adele Nardella
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Dorian A Lamis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30303, United States
| | - Denise Erbuto
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Paolo Girardi
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
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De Leo D, Kõlves K. Suicide at Very Advanced Age – The Extremes of the Gender Paradox. CRISIS 2017; 38:363-366. [DOI: 10.1027/0227-5910/a000514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Diego De Leo
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, QLD, Australia
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, QLD, Australia
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Parra-Uribe I, Blasco-Fontecilla H, Garcia-Parés G, Martínez-Naval L, Valero-Coppin O, Cebrià-Meca A, Oquendo MA, Palao-Vidal D. Risk of re-attempts and suicide death after a suicide attempt: A survival analysis. BMC Psychiatry 2017; 17:163. [PMID: 28472923 PMCID: PMC5415954 DOI: 10.1186/s12888-017-1317-z] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 04/20/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Suicide is the primary cause of unnatural death in Spain, and suicide re-attempts a major economic burden worldwide. The risk factors for re-attempt and suicide after an index suicide attempt are different. This study aims to investigate risk factors for re-attempt and suicide after an index suicide attempt. METHODS This observational study is part of a one-year telephone management program. We included all first-time suicide attempters evaluated in the emergency department at Parc Taulí-University Hospital (n = 1241) recruited over a five-year period (January 2008 to December 2012). Suicide attempters were evaluated at baseline using standardized instruments. Bivariate logistic regression models were used to identify risk factors. Kaplan-Meier curves were used to compare the time to re-attempt between categorical variables. Comparisons were performed using Log-Rank and Wilcoxon tests. Variables with a p-value lower than 0.2 were included in a multivariate Cox regression model. Bivariate logistic regression models were considered to identify risk factors for suicide. The significance level was set to 0.05. RESULTS Suicide re-attempters were more likely diagnosed with cluster B personality disorders (36.8% vs. 16.6%; p < 0.001), and alcohol use disorders (19.8 vs. 13.9; p = 0.02). Several [1.2% (15/1241)] of them died by suicide. Attempters who suicide were more likely alcohol users (33.3% vs. 17.2%; p = 0.047), and older (50.9 ± 11.9 vs. 40.7 ± 16.0; p = 0.004). CONCLUSIONS Alcohol use, personality disorders and younger age are risk factors for re-attempting. Older age is a risk factor for suicide among suicide attempters. Current prevention programs of suicidal behaviour should be tailored to the specific profile of each group.
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Affiliation(s)
- Isabel Parra-Uribe
- Department of Mental Health, Parc Tauli-University Hospital, Parc Taulí 1, 08208 Sabadell, Barcelone Spain ,grid.7080.fDepartment of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelone, Spain ,0000 0004 1762 4012grid.418264.dCIBERSAM, Madrid, Spain
| | - Hilario Blasco-Fontecilla
- Department of Psychiatry, IDIPHIM-Puerta de Hierro University Hospital, Autonoma University of Madrid, Avenida Manuel de Falla s/n, Madrid, Spain. .,CIBERSAM, Madrid, Spain.
| | - Gemma Garcia-Parés
- Department of Mental Health, Meritxell Hospital, Andorra la Vella, Andorra
| | | | - Oliver Valero-Coppin
- grid.7080.fStatistical Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Annabel Cebrià-Meca
- Department of Mental Health, Parc Tauli-University Hospital, Parc Taulí 1, 08208 Sabadell, Barcelone Spain ,0000 0004 1762 4012grid.418264.dCIBERSAM, Madrid, Spain
| | - Maria A. Oquendo
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, USA
| | - Diego Palao-Vidal
- Department of Mental Health, Parc Tauli-University Hospital, Parc Taulí 1, 08208, Sabadell, Barcelone, Spain. .,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelone, Spain. .,CIBERSAM, Madrid, Spain.
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Mousavi SG, Tehrani MN, Maracy M. The Effect of Active Treatment and Visit Compared to Conventional Treatment, on Preventing Recurrent Suicidal Attempts: A Randomized Controlled Clinical Trial. Adv Biomed Res 2017; 6:38. [PMID: 28503493 PMCID: PMC5414404 DOI: 10.4103/2277-9175.204586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Suicide is a major problem, and its prevention is a global priority. In many cases, suicide attempter attempts to do it again after the rescue. In current study we aimed to compare active visit and treatment of patients in a periodic manner with treatment as usual, in the prevention of recurrent suicidal attempts. MATERIALS AND METHODS This study was a randomized controlled clinical trial which was conducted in Isfahan Noor Hospital's Emergency Center on 60 patients in 2013-2014. The samples were selected using simple random sampling and they were assigned into two groups: The conventional treatment group (treatment as usual) (30 patients), and visit and active treatment (30 patients). In the intervention group, there were ten follow-ups by a face-to-face visit over 12 months, and six follow-ups by phone call in control group. Through the completion of the initial and follow-up questionnaire evaluation was performed. The data were analyzed using Cochran test, and repeated measure (ANOVA). RESULTS During the 12-month follow-up visit and active treatment, significant difference in reducing suicidal thoughts (P = 0.003) was observed and an increase in the life expectancy (P = 0.001), interest and motivation in life (P = 0.001) was found in the intervention group, and also nonsignificant reduction was found in the rate of suicidal attempts. CONCLUSION Visit and active treatment is useful in suicide attempters and it can helps in preventing recurrent suicide attempt as a preventive program by increasing hope and reducing suicidal thoughts.
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Affiliation(s)
- Seyed Ghafur Mousavi
- From the Department of Psychiatry, School of Medicine, Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marayam Nader Tehrani
- From the Department of Psychiatry, School of Medicine, Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammadreza Maracy
- Department of Epidemiology and Statistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Cebria AI, Pérez-Bonaventura I, Cuijpers P, Kerkhof A, Parra I, Escayola A, García-Parés G, Oliva JC, Puntí J, López D, Valles V, Pamias M, Hegerl U, Pérez-Sola V, Palao DJ. Telephone Management Program for Patients Discharged From an Emergency Department After a Suicide Attempt: A 5-Year Follow-Up Study in a Spanish Population. CRISIS 2016; 36:345-52. [PMID: 26502785 DOI: 10.1027/0227-5910/a000331] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIM In a previous controlled study, the authors reported on the significant beneficial effects of a telephone intervention program for prevention of suicide attempts by patients for up to 1 year. This study reports the 5-year follow-up data. Outcomes were number of recurrences and time to recurrence. METHOD The intervention was carried out on patients discharged from the emergency room (ER) following attempted suicide (Sabadell). It consisted of a systematic, 1-year telephone follow-up program: after 1 week, and thereafter at 1-, 3-, 6-, 9-, and 12-month intervals to assess the risk of suicide and encourage adherence to treatment. The population in the control group (Terrassa) received treatment as usual after discharge, without additional telephone contact. RESULTS The effect of reattempt prevention observed in the first year was not maintained over the long term. CONCLUSION A telephone management program for patients discharged from an ER after attempted suicide could be considered a useful strategy in delaying further suicide attempts and reducing the rate of reattempts in the first year. However, results showed that the beneficial effects were not maintained at the 5-year follow-up.
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Affiliation(s)
- Ana Isabel Cebria
- 1 Department of Mental Health, Corporació Sanitaria Parc Taulí de Sabadell (Barcelona), Institut Universitari Parc Taulí-Universitat Autònoma de Barcelona, Campus d'Excellència Internacional, Spain.,2 Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain.,3 Centro de Investigación Biomédica En Red de Salud Mental, CIBERSAM, Sabadell, Spain
| | - Iris Pérez-Bonaventura
- 1 Department of Mental Health, Corporació Sanitaria Parc Taulí de Sabadell (Barcelona), Institut Universitari Parc Taulí-Universitat Autònoma de Barcelona, Campus d'Excellència Internacional, Spain.,4 Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Spain
| | - Pim Cuijpers
- 5 Department of Clinical Psychology, VU University Amsterdam, The Netherlands
| | - Ad Kerkhof
- 5 Department of Clinical Psychology, VU University Amsterdam, The Netherlands
| | - Isabel Parra
- 1 Department of Mental Health, Corporació Sanitaria Parc Taulí de Sabadell (Barcelona), Institut Universitari Parc Taulí-Universitat Autònoma de Barcelona, Campus d'Excellència Internacional, Spain.,2 Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain
| | - Anna Escayola
- 1 Department of Mental Health, Corporació Sanitaria Parc Taulí de Sabadell (Barcelona), Institut Universitari Parc Taulí-Universitat Autònoma de Barcelona, Campus d'Excellència Internacional, Spain
| | - Gemma García-Parés
- 1 Department of Mental Health, Corporació Sanitaria Parc Taulí de Sabadell (Barcelona), Institut Universitari Parc Taulí-Universitat Autònoma de Barcelona, Campus d'Excellència Internacional, Spain.,2 Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain
| | - Joan Carles Oliva
- 6 Research Office, Corporació Sanitaria Parc Taulí de Sabadell, Barcelona, Spain
| | - Joaquim Puntí
- 1 Department of Mental Health, Corporació Sanitaria Parc Taulí de Sabadell (Barcelona), Institut Universitari Parc Taulí-Universitat Autònoma de Barcelona, Campus d'Excellència Internacional, Spain.,4 Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Spain
| | - David López
- 7 Department of Mental Health, Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Vicenç Valles
- 7 Department of Mental Health, Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Montserrat Pamias
- 1 Department of Mental Health, Corporació Sanitaria Parc Taulí de Sabadell (Barcelona), Institut Universitari Parc Taulí-Universitat Autònoma de Barcelona, Campus d'Excellència Internacional, Spain.,2 Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain
| | - Ulrich Hegerl
- 8 Department of Psychiatry, University of Leipzig, Germany
| | - Victor Pérez-Sola
- 2 Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain.,3 Centro de Investigación Biomédica En Red de Salud Mental, CIBERSAM, Sabadell, Spain.,9 Department of Psychiatry, Parc de Salut Mar de Barcelona, Spain
| | - Diego J Palao
- 1 Department of Mental Health, Corporació Sanitaria Parc Taulí de Sabadell (Barcelona), Institut Universitari Parc Taulí-Universitat Autònoma de Barcelona, Campus d'Excellència Internacional, Spain.,2 Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain
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Rational Suicide, Euthanasia, and the Very Old: Two Case Reports. Case Rep Psychiatry 2016; 2016:4242064. [PMID: 27833774 PMCID: PMC5090095 DOI: 10.1155/2016/4242064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 09/26/2016] [Indexed: 01/08/2023] Open
Abstract
Suicide amongst the very old is an important public health issue. Little is known about why older people may express a wish to die or request euthanasia and how such thoughts may intersect with suicide attempts. Palliative care models promote best care as holistic and relieving suffering without hastening death in severely ill patients; but what of those old people who are tired of living and may have chronic symptoms, disability, and reduced quality of life? Two cases of older people who attempted suicide but expressed a preference for euthanasia were it legal are presented in order to illustrate the complexity underlying such requests. The absence of a mood or anxiety disorder underpinning their wishes to die further emphasises the importance of understanding the individual's narrative and the role of a formulation in guiding broad biopsychosocial approaches to management.
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Carter G, Page A, Large M, Hetrick S, Milner AJ, Bendit N, Walton C, Draper B, Hazell P, Fortune S, Burns J, Patton G, Lawrence M, Dadd L, Dudley M, Robinson J, Christensen H. Royal Australian and New Zealand College of Psychiatrists clinical practice guideline for the management of deliberate self-harm. Aust N Z J Psychiatry 2016; 50:939-1000. [PMID: 27650687 DOI: 10.1177/0004867416661039] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To provide guidance for the organisation and delivery of clinical services and the clinical management of patients who deliberately self-harm, based on scientific evidence supplemented by expert clinical consensus and expressed as recommendations. METHOD Articles and information were sourced from search engines including PubMed, EMBASE, MEDLINE and PsycINFO for several systematic reviews, which were supplemented by literature known to the deliberate self-harm working group, and from published systematic reviews and guidelines for deliberate self-harm. Information was reviewed by members of the deliberate self-harm working group, and findings were then formulated into consensus-based recommendations and clinical guidance. The guidelines were subjected to successive consultation and external review involving expert and clinical advisors, the public, key stakeholders, professional bodies and specialist groups with interest and expertise in deliberate self-harm. RESULTS The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for deliberate self-harm provide up-to-date guidance and advice regarding the management of deliberate self-harm patients, which is informed by evidence and clinical experience. The clinical practice guidelines for deliberate self-harm is intended for clinical use and service development by psychiatrists, psychologists, physicians and others with an interest in mental health care. CONCLUSION The clinical practice guidelines for deliberate self-harm address self-harm within specific population sub-groups and provide up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus.
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Affiliation(s)
- Gregory Carter
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Centre for Translational Neuroscience and Mental Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia Department of Consultation Liaison Psychiatry, Calvary Mater Newcastle Hospital, Waratah, NSW, Australia
| | - Andrew Page
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Centre for Health Research, Western Sydney University, Richmond, NSW, Australia
| | - Matthew Large
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia
| | - Sarah Hetrick
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Allison Joy Milner
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Centre for Population Health Research, School of Health and Social Development, Deakin University, Burwood VIC, Australia Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Nick Bendit
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia
| | - Carla Walton
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Centre for Psychotherapy, Hunter New England Mental Health Service and Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Brian Draper
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Philip Hazell
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Sarah Fortune
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia The University of Auckland, Auckland, New Zealand University of Leeds, Leeds, UK Kidz First, Middlemore Hospital, Auckland, New Zealand
| | - Jane Burns
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Young and Well Cooperative Research Centre, The University of Melbourne, Melbourne, VIC, Australia Brain & Mind Research Institute, The University of Sydney, Sydney, NSW, Australia Orygen Youth Health Research Centre, Melbourne, VIC, Australia
| | - George Patton
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia National Health and Medical Research Council, Canberra, ACT, Australia Centre for Adolescent Health, The Royal Children's Hospital, Melbourne, VIC, Australia Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Mark Lawrence
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Tauranga Hospital, Bay of Plenty, New Zealand
| | - Lawrence Dadd
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Mental Health & Substance Use Service, Hunter New England, NSW Health, Waratah, NSW, Australia Awabakal Aboriginal Medical Service, Hamilton, NSW, Australia Pital Tarkin, Aboriginal Medical Student Mentoring Program, The Wollotuka Institute, The University of Newcastle, Callaghan, NSW, Australia Specialist Outreach NT, Darwin, Northern Territory, Australia
| | | | - Jo Robinson
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Helen Christensen
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Black Dog Institute, The University of New South Wales, Sydney, NSW, Australia
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Ahmed N, John A, Islam S, Jones R, Anderson P, Davies C, Khanom A, Harris S, Huxley P. Investigating the feasibility of an enhanced contact intervention in self-harm and suicidal behaviour: a protocol for a randomised controlled trial delivering a Social support and Wellbeing Intervention following Self Harm (SWISH). BMJ Open 2016; 6:e012043. [PMID: 27630071 PMCID: PMC5030583 DOI: 10.1136/bmjopen-2016-012043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 08/17/2016] [Accepted: 08/26/2016] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Self-harm is a strong predictor for suicide. Risks for repeat behaviour are heightened in the aftermath of an index episode. There is no consensus on the most effective type of intervention to reduce repetition. Treatment options for patients who do not require secondary mental health services include no support, discharge to general practitioner or referral to primary care mental health support services. The aim of this study is to assess whether it is feasible to deliver a brief intervention after an episode and whether this can reduce depressive symptoms and increase the sense of well-being for patients who self-harm. METHODS This is a non-blinded parallel group randomised clinical trial. 120 patients presenting with self-harm and/or suicidal ideation to mental health services over a 12-month period who are not referred to secondary services will be randomised to either intervention plus treatment as usual (TAU), or control (TAU only). Patients are assessed at baseline, 4 and 12 weeks with standardised measures to collect data on depression, well-being and service use. Primary outcome is depression scores and secondary outcomes are well-being scores and use of services. The findings will indicate whether a rapid response brief intervention is feasible and can reduce depression and increase well-being among patients who self-harm and do not require secondary services. ETHICS AND DISSEMINATION Ethical approval was granted by the UK National Health Service (NHS) Ethics Committee process (REC 6: 14/WA/0074). The findings of the trial will be disseminated through presentations to the participating Health Board and partners, peer-reviewed journals and national and international conferences. TRIAL REGISTRATION NUMBER ISRCTN76914248; Pre-results.
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Affiliation(s)
| | | | | | - Richard Jones
- Hywel Dda University Health Board, Haverfordwest, UK
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Sakashita T, Oyama H. Overview of community-based studies of depression screening interventions among the elderly population in Japan. Aging Ment Health 2016; 20:231-9. [PMID: 26226514 DOI: 10.1080/13607863.2015.1068740] [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] [Indexed: 10/23/2022]
Abstract
OBJECTIVES In most Western and Asian countries, a higher risk of suicide is found among elderly people than those in other age groups. However, the treatment needs of elderly people who are at risk of committing suicide are not well understood. We conducted an overview of studies that assessed the impact of suicide prevention interventions on suicide rates in elderly people in Japan. We interpreted the results of these studies, as well as prominent findings associated with other successful interventions, within a framework of the suicidal process and preventive strategies. METHOD We assessed six quasi-experimental studies of community-based interventions providing universal depression screening, subsequent care, and education to elderly people in Japan, and performed a combined analysis of outcome data. RESULTS Screening interventions were associated with lower suicide rates. We also found a gender difference in the response to subsequent psychiatric or primary care. Two types of interventions decreased the rate of suicide among elderly people: crisis helplines and screening interventions. These interventions featured a close link between universal, selective, and indicated prevention strategies, which reflect different approaches tailored to the size and risk profile of the target individuals. CONCLUSION Successful interventions appear to hinge on systematic links between multi-level prevention interventions. Multi-level interventions for depression screening may result in lower suicide rates among elderly individuals in communities, although primary care interventions alone appear to be insufficient in men. The benefit of linked multi-level prevention interventions may highlight the importance of the multiple steps and components of the suicidal process.
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Affiliation(s)
- Tomoe Sakashita
- a Faculty of Health Sciences , Aomori University of Health and Welfare , Aomori , Japan
| | - Hirofumi Oyama
- a Faculty of Health Sciences , Aomori University of Health and Welfare , Aomori , Japan
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Van Orden KA, Smith PN, Chen T, Conwell Y. A Case Controlled Examination of the Interpersonal Theory of Suicide in the Second Half of Life. Arch Suicide Res 2016. [PMID: 26219512 PMCID: PMC4899307 DOI: 10.1080/13811118.2015.1025121] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The interpersonal theory of suicide proposes that the most proximal cause of suicide is the combination of thwarted belongingness and perceived burdensomeness coupled with a pre-existing vulnerability of reduced fear of death and increased pain tolerance. This pre-existing vulnerability develops in response to painful and provocative life events. According to the theory, empirically demonstrated risk factors for suicide operate by increasing the likelihood of one or more of the theory's constructs. The current study examined the relations of the major constructs of the interpersonal theory with suicide case status compared to living controls in the second half of life. The current study used a pre-existing psychological autopsy database to compare suicide decedents to living controls 50 years and older. Theory constructs were measured by composite scores of thwarted belongingness, perceived burdensomeness, and painful and provocative experiences using an a priori selection of items comprising each construct. Suicide decedents experienced greater levels of all three of the theory's constructs when examined independently compared to living controls. When examined simultaneously while also controlling for Major Depression, greater perceived burdensomeness and painful and provocative experiences were associated with suicide case status (vs. control). The interpersonal theory is a comprehensive framework that may be useful in understanding risk for death by suicide in the second half of life. Clinical management of suicide risk for adults in the second half of life could include a focus on perceived burdensomeness, as the IPTS proposes that this psychological state is amenable to change via therapeutic intervention.
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Tyson P, Law C, Reed S, Johnsey E, Aruna O, Hall S. Preventing Suicide and Self-Harm. CRISIS 2016; 37:353-360. [PMID: 27278572 DOI: 10.1027/0227-5910/a000390] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Telephone helplines are considered to play an important role in preventing suicide and self-harm among callers in distress. However, inconsistency in the methods of evaluating such services has limited the firm conclusions that can be drawn. AIMS To evaluate the efficacy of a UK-based helpline from a service user and helpline worker perspective. METHOD Callers were asked about their mental state at the beginning and end of the call with a short questionnaire. Helpline workers were surveyed about their experiences of using the questionnaire as part of routine service provision. RESULTS The helpline was successful at reducing suicidal and self-harming ideation. The short questionnaire method was also successfully integrated into routine practice. CONCLUSION Evaluating the efficacy of helplines can be successfully achieved using the short questionnaire method.
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Affiliation(s)
- Philip Tyson
- 1 School of Psychology, University of South Wales, Treforest, UK
| | - Claire Law
- 1 School of Psychology, University of South Wales, Treforest, UK
| | | | | | - Olusola Aruna
- 3 Public Health Medicine, Gloucestershire County Council, Gloucester, UK
| | - Sue Hall
- 4 Public Health Improvement, Plymouth Community Healthcare, Plymouth, UK
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Chung RY, Yip BHK, Chan SSM, Wong SYS. COHORT EFFECTS OF SUICIDE MORTALITY ARE SEX SPECIFIC IN THE RAPIDLY DEVELOPED HONG KONG CHINESE POPULATION, 1976-2010. Depress Anxiety 2016; 33:558-66. [PMID: 26414148 DOI: 10.1002/da.22431] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 09/04/2015] [Accepted: 09/04/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND To examine temporal variations of age, period, and cohort on suicide mortality rate in Hong Kong (HK) from 1976 to 2010, and speculate the macroenvironmental mechanisms of the observed trends. METHODS Poisson age-period-cohort modeling was used to delineate the effects of age, period, and cohort on suicide mortality. Analysis by sex was also conducted to examine if gender difference exists for suicidal behaviours. RESULTS Age-cohort model provides the best fit to the mortality data, implying that the cohort effect is likely to explain more of the contributions to HK's suicide mortality pattern than the period effect. Risk of suicide mortality increases nonlinearly with age and accelerates after age 65-69 for both sexes. Moreover, the cohort effects differ between the sexes-risk of mortality increases continually for men born after 1961, but no change is observed for women since the 1941 cohort. CONCLUSIONS With increased risk of suicide mortality in younger cohorts and the age effect of suicide mortality, we may see future increase in suicide mortality as these younger cohorts age. Further studies are needed to clarify plausible associations between broader sociohistorical changes in the population impacting psychological risk factors and suicidal behaviour to better inform suicide prevention strategies.
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Affiliation(s)
- Roger Y Chung
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Benjamin H K Yip
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Sandra S M Chan
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong
| | - Samuel Y S Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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Vancayseele N, Portzky G, van Heeringen K. Increase in Self-Injury as a Method of Self-Harm in Ghent, Belgium: 1987-2013. PLoS One 2016; 11:e0156711. [PMID: 27249421 PMCID: PMC4889035 DOI: 10.1371/journal.pone.0156711] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/18/2016] [Indexed: 11/24/2022] Open
Abstract
Background Self-harm is a major health care problem and changes in its prevalence and characteristics can have important implications for suicide prevention. The objective was to describe trends in the epidemiology of self-harm based on emergency department (A&E departments) visits over a 26-year period in Ghent, Belgium. Methods We analyzed data on all self-harm presentations from the three large general hospitals in Ghent between 1987 and 2013. We investigated trends in prevalence (events by year per 100.000), methods and alcohol use. Results Rates of self-harm steadily decreased during the 26-year study period. In general female rates of self-harm were higher than male rates. The mean patient age was 35 years. The most commonly used method of self-harm was self-poisoning by means of an overdose of medication (80.8%), followed by cutting (10.2%) and hanging (4.2%). Psychotropics (including antidepressants, benzodiazepines, barbiturates and other tranquilizers) were the most frequently used drugs (74.5%). A proportional increase in the use of self-injurious methods in self-harm was highly significant, more specifically in the use of hanging, jumping from heights and the use of other violent methods such as the use of firearms, jumping before a moving object or other traffic related injury. Conclusion This epidemiological study showed an increase in the use of high-lethality methods in self-harm which has important implications for suicide prevention. As restrictions in the availability of these methods are difficult or impossible to achieve, prevention programmes will have to emphasize the role of thorough psychosocial assessment and adequate follow-up care of self-harm patients.
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Affiliation(s)
- Nikita Vancayseele
- Department of psychiatry and medical psychology, Ghent University, Ghent, Belgium
- * E-mail:
| | - Gwendolyn Portzky
- Department of psychiatry and medical psychology, Ghent University, Ghent, Belgium
| | - Kees van Heeringen
- Department of psychiatry and medical psychology, Ghent University, Ghent, Belgium
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Oyama H, Sakashita T. Long-Term Effects of a Screening Intervention for Depression on Suicide Rates among Japanese Community-Dwelling Older Adults. Am J Geriatr Psychiatry 2016; 24:287-96. [PMID: 26796924 DOI: 10.1016/j.jagp.2015.10.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 10/05/2015] [Accepted: 10/13/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To explore the long-term impact of a universal screening intervention for depression on suicide rates among older community-dwelling adults, with gender as an effect modifier. DESIGN Controlled cohort study reporting long-term follow-up of previous research. SETTING Two sets of three municipalities in Japan were assigned as intervention and control regions and compared with the surrounding zone and prefecture. PARTICIPANTS Intervention area residents aged 60 years and older (14,291) were invited to participate in a 2-year intervention (2005-2006). Four population-based dynamic cohorts of residents aged 65 years and older (1999-2010) were included as subjects, 6 years before and after the intervention started. INTERVENTION At-risk residents within the intervention region (4,918) were invited for a two-step screening program; 2,552 participated in the program linked with care/support services for 2 years. An education program open to the public was held. MEASUREMENTS Changes in suicide from a 6-year baseline to the 2-year intervention and a 4-year follow-up in the intervention region (11,700 adults ≥65 years) were compared with a matched control and two comparison areas using mixed-effects negative binomial regression models. Suicide rates among older adults exposed to screening were compared with those of the control region. RESULTS Suicide rates in the intervention region decreased by 48%, which was significantly greater than in the three comparison areas. The program's benefits lasted longer for women than men. Screening exposure may be associated with decreased suicide risk over the 4-year follow-up. CONCLUSIONS Universal screening may decrease suicide rates among older adults, with potential gender differences in treatment response.
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Affiliation(s)
- Hirofumi Oyama
- Department of Social Welfare, Faculty of Health Sciences, Aomori University of Health and Welfare, Aomori, Japan.
| | - Tomoe Sakashita
- Department of Social Welfare, Faculty of Health Sciences, Aomori University of Health and Welfare, Aomori, Japan
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Sinyor M, Tan LPL, Schaffer A, Gallagher D, Shulman K. Suicide in the oldest old: an observational study and cluster analysis. Int J Geriatr Psychiatry 2016; 31:33-40. [PMID: 25809553 DOI: 10.1002/gps.4286] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 02/20/2015] [Accepted: 02/23/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The older population are at a high risk for suicide. This study sought to learn more about the characteristics of suicide in the oldest-old and to use a cluster analysis to determine if oldest-old suicide victims assort into clinically meaningful subgroups. METHODS Data were collected from a coroner's chart review of suicide victims in Toronto from 1998 to 2011. We compared two age groups (65-79 year olds, n = 335, and 80+ year olds, n = 191) and then conducted a hierarchical agglomerative cluster analysis using Ward's method to identify distinct clusters in the 80+ group. RESULTS The younger and older age groups differed according to marital status, living circumstances and pattern of stressors. The cluster analysis identified three distinct clusters in the 80+ group. Cluster 1 was the largest (n = 124) and included people who were either married or widowed who had significantly more depression and somewhat more medical health stressors. In contrast, cluster 2 (n = 50) comprised people who were almost all single and living alone with significantly less identified depression and slightly fewer medical health stressors. All members of cluster 3 (n = 17) lived in a retirement residence or nursing home, and this group had the highest rates of depression, dementia, other mental illness and past suicide attempts. CONCLUSIONS This is the first study to use the cluster analysis technique to identify meaningful subgroups among suicide victims in the oldest-old. The results reveal different patterns of suicide in the older population that may be relevant for clinical care.
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Affiliation(s)
- Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Lynnette Pei Lin Tan
- Department of Psychological Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Damien Gallagher
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Kenneth Shulman
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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Grimholt TK, Jacobsen D, Haavet OR, Sandvik L, Jorgensen T, Norheim AB, Ekeberg O. Effect of Systematic Follow-Up by General Practitioners after Deliberate Self-Poisoning: A Randomised Controlled Trial. PLoS One 2015; 10:e0143934. [PMID: 26629812 PMCID: PMC4667913 DOI: 10.1371/journal.pone.0143934] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 11/09/2015] [Indexed: 11/18/2022] Open
Abstract
Objective To assess whether systematic follow-up by general practitioners (GPs) of cases of deliberate self-poisoning (DSP) by their patients decreases psychiatric symptoms and suicidal behaviour compared with current practice. Design Randomised clinical trial with two parallel groups. Setting General practices in Oslo and the eastern part of Akershus County. Participants Patients aged 18–75 years admitted to hospital for DSP. We excluded patients diagnosed with psychoses, without a known GP, those not able to complete a questionnaire, and patients admitted to psychiatric in-patient care or other institutions where their GP could not follow them immediately after discharge. Intervention The GPs received a written guideline, contacted the patients and scheduled a consultation within one week after discharge, and then provided regular consultations for six months. We randomised the patients to either intervention (n = 78) or treatment as usual (n = 98). Main Outcome Measures Primary outcome measure was the Beck Scale for Suicide Ideation (SSI). Secondary outcomes were Beck Depression Inventory (BDI) and Beck Hopelessness Scale (BHS), self-reported further self-harm and treatment for DSP in a general hospital or an emergency medical agency (EMA). We assessed patients on entry to the trial and at three and six months. We collected data from interviews, self-report questionnaires, and hospital and EMA medical records. Results There were no significant differences between the groups in SSI, BDI, or BHS mean scores or change from baseline to three or six months. During follow-up, self-reported DSP was 39.5% in the intervention group vs. 15.8% in controls (P = 0.009). Readmissions to general hospitals were similar (13% in both groups (P = 0.963), while DSP episodes treated at EMAs were 17% in the intervention group and 7% in the control group (P = 0.103). Conclusion Structured follow-up by GPs after an episode of DSP had no significant effect on suicide ideation, depression or hopelessness. There was no significant difference in repeated episodes of DSP in hospitals or EMAs. However, the total number of incidents of deliberate self-harm reported by the patients was significantly higher in the intervention group. Trial registration Trial registration ClinicalTrials.gov Identifier: NCT01342809
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Affiliation(s)
- Tine K. Grimholt
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
- Regional Centre of Violence, Traumatic Stress and Suicide Prevention Eastern Norway, Oslo, Norway
- * E-mail:
| | - Dag Jacobsen
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - Ole Rikard Haavet
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Leiv Sandvik
- Department of Biostatistics, Oslo University Hospital, Oslo, Norway
| | - Trond Jorgensen
- Psychiatric Consultation Team, Akershus University Hospital, Akershus,Norway
| | - Astrid Berge Norheim
- Regional Centre of Violence, Traumatic Stress and Suicide Prevention Eastern Norway, Oslo, Norway
- Diakonhjemmet Hospital, Oslo,Norway
| | - Oivind Ekeberg
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
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