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McHugh CM, Iorfino F, Zmicerevska N, Song YJC, Skinner A, Scott EM, Hickie IB. Premature mortality in young people accessing early intervention youth mental healthcare: data-linkage cohort study. BJPsych Open 2023; 9:e76. [PMID: 37092680 PMCID: PMC10134286 DOI: 10.1192/bjo.2023.43] [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: 04/25/2023] Open
Abstract
BACKGROUND Understanding premature mortality risk from suicide and other causes in youth mental health cohorts is essential for delivering effective clinical interventions and secondary prevention strategies. AIMS To establish premature mortality risk in young people accessing early intervention mental health services and identify predictors of mortality. METHOD State-wide data registers of emergency departments, hospital admissions and mortality were linked to the Brain and Mind Research Register, a longitudinal cohort of 7081 young people accessing early intervention care, between 2008 and 2020. Outcomes were mortality rates and age-standardised mortality ratios (SMR). Cox regression was used to identify predictors of all-cause mortality and deaths due to suicide or accident. RESULTS There were 60 deaths (male 63.3%) during the study period, 25 (42%) due to suicide, 19 (32%) from accident or injury and eight (13.3%) where cause was under investigation. All-cause SMR was 2.0 (95% CI 1.6-2.6) but higher for males (5.3, 95% CI 3.8-7.0). The mortality rate from suicide and accidental deaths was 101.56 per 100 000 person-years. Poisoning, whether intentional or accidental, was the single greatest primary cause of death (26.7%). Prior emergency department presentation for poisoning (hazard ratio (HR) 4.40, 95% CI 2.13-9.09) and psychiatric admission (HR 4.01, 95% CI 1.81-8.88) were the strongest predictors of mortality. CONCLUSION Premature mortality in young people accessing early intervention mental health services is greatly increased relative to population. Prior health service use and method of self-harm are useful predictors of future mortality. Enhanced care pathways following emergency department presentations should not be limited to those reporting suicidal ideation or intent.
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Affiliation(s)
- Catherine M McHugh
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; and Discipline of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Frank Iorfino
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | | | | | - Adam Skinner
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; and School of Medicine, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
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Tanahashi I, Shiganami T, Iwayama T, Wake T, Kobayashi S, Yoshimasu H. Association between psychotropic prescriptions and the total amount of psychotropics ingested during an intentional overdose: A single-center retrospective study. Neuropsychopharmacol Rep 2022; 42:166-173. [PMID: 35174671 PMCID: PMC9216370 DOI: 10.1002/npr2.12242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 11/17/2022] Open
Abstract
Aim To investigate the association between psychotropic prescriptions and the total amount of psychotropics ingested during a subsequent intentional overdose and to examine factors related to the number of psychotropic prescriptions. Methods The initial sample comprised 69 patients who were admitted to the emergency department of a general hospital in Japan following an intentional overdose via psychotropic medications. We performed retrospective hierarchical multiple regression analysis with the total amount of psychotropics ingested at the overdose as a dependent variable and factors related to deliberate self‐harm or overdose identified in previous studies as independent variables. We compared two models, one that did not (Step 1) and one that did (Step 2) include the number of different prescribed psychotropic medications as an independent variable in the analysis. Results Forty‐seven patients were eligible for the analysis. The number of different prescribed psychotropic medications was associated with the total amount of psychotropics ingested at the overdose in Step 2 (β = 0.40, P = .01). There was a trend toward an association between the past number of deliberate self‐harm events and the total amount of psychotropics ingested at the overdose in Step 1 (β = 0.30, P = .05), but this trend was weakened in Step 2 (β = 0.15, P = .33). Conclusion The number of different prescribed psychotropics appeared to influence the risk of subsequent intentional overdose through increasing the total amount of psychotropics ingested. Cumulative psychotropic prescriptions, particularly those delivered after deliberate self‐harm, might be indirectly related to this risk. The number of different prescribed psychotropics appeared to influence the risk of subsequent intentional overdose through increasing the total amount of psychotropics ingested. Cumulative psychotropic prescriptions, particularly those delivered after deliberate self‐harm, might be indirectly related to this risk.![]()
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Affiliation(s)
- Iori Tanahashi
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.,The Maruki Memorial Medical and Social Welfare Center, Iruma, Japan
| | - Takafumi Shiganami
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Takayuki Iwayama
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.,Department of Psychology, Showa Women's University, Setagaya, Japan
| | - Taisei Wake
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Sayaka Kobayashi
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Haruo Yoshimasu
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
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A Comparison of Presentations with Self-Harm to Hospital in Lithuania and Ireland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052418. [PMID: 33801303 PMCID: PMC7967553 DOI: 10.3390/ijerph18052418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/20/2021] [Accepted: 02/24/2021] [Indexed: 12/03/2022]
Abstract
Suicide is a serious problem globally, especially in Europe, with suicide rates varying between different countries. Self-harm is a known risk factor for dying by suicide and represents an opportunity to intervene in order to treat any associated mental illness and reduce risk. This study aimed to compare the characteristics of people presenting to hospital with self-harm at two clinical sites: Galway, Ireland and Kaunas, Lithuania. Data were obtained from the services’ database and anonymised for analysis. Over a 5-month period, 89 patients presented with self-harm at the Lithuanian site and 224 patients presented with self-harm at the Irish site. This study found significant differences in presentation, diagnosis and treatment between the two sites. All patients at the Lithuanian site were admitted to psychiatry, compared to 22% of patients at the Irish site (p < 0.001). In Lithuania, the main clinical diagnoses were adjustment disorder (37.1%) and major depression (20.2%), compared to substance misuse being the main clinical diagnosis (33.8%) in Ireland (p < 0.001). There were significant differences in the prescription of psychotropic medications (which were three times more commonly prescribed at the Lithuanian site) after controlling for age, gender and psychiatric history (p < 0.001). Further research is required to understand the cultural context behind and further association between hospitalisation and future death by suicide.
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Kõlves K, Koo YW, de Leo D. A drink before suicide: analysis of the Queensland Suicide Register in Australia. Epidemiol Psychiatr Sci 2020; 29:e94. [PMID: 31973775 PMCID: PMC7214701 DOI: 10.1017/s2045796020000062] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/30/2019] [Accepted: 12/31/2019] [Indexed: 01/06/2023] Open
Abstract
AIMS Previous studies analysing blood alcohol concentration (BAC) at the time of suicide have primarily focused on sociodemographic factors. Limited research has focused on psychosocial factors and co-ingestion of other substances to understand the mechanisms of how alcohol contributes to death by suicide. The aim was to examine time trends, psychosocial factors related to acute alcohol use and co-ingestion of alcohol and other substances before suicide. METHODS The Queensland Suicide Register in 2004-2015 was utilised and analysed in 2019. The cut-off point for positive BAC was set at ⩾0.05 g/dl. Substances were categorised as medicines, illegal drugs and other. Medicines were coded by the Anatomical Therapeutic Chemical (ATC) classification system. Joinpoint regression, univariate odds ratios, age and sex-adjusted odds ratios and Forward Stepwise logistic regression were performed. RESULTS BAC information was available for 6744 suicides, 92% of all cases in 2004-2015. The final model showed that independent factors distinguishing BAC+ from BAC- were: age group 25-44 years, Australian Indigenous background, being separated or divorced, hanging, diagnosis of substance use, lifetime suicidal ideation, relationship and interpersonal conflict, not having psychotic and other psychiatric disorder, and no nervous system drugs or any other substances in blood at the time of suicide. CONCLUSIONS Our findings suggest that people who die by suicide while under the influence of alcohol are more likely to be under acute stress (e.g. separation) and not have earlier psychiatric conditions, except substance use. This highlights the importance of more strict alcohol policies, but also the need to improve substance use treatment.
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Affiliation(s)
- Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Mount Gravatt, Queensland, Australia
| | - Yu Wen Koo
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Mount Gravatt, Queensland, Australia
| | - Diego de Leo
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Mount Gravatt, Queensland, Australia
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Chick J, Drummond C, Sinclair J. Does prescribing psychiatric medication really make it less likely that alcohol is involved in a self-poisoning? Br J Psychiatry 2017; 211:52-53. [PMID: 28673948 DOI: 10.1192/bjp.211.1.52a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jonathan Chick
- Jonathan Chick, Medical Director, Castle Craig Hospital, and visiting Professor, School of Health and Social Care, Napier University, Edinburgh. ; Colin Drummond, Professor of Addiction Psychiatry; Julia Sinclair, Senior Lecturer
| | - Colin Drummond
- Jonathan Chick, Medical Director, Castle Craig Hospital, and visiting Professor, School of Health and Social Care, Napier University, Edinburgh. ; Colin Drummond, Professor of Addiction Psychiatry; Julia Sinclair, Senior Lecturer
| | - Julia Sinclair
- Jonathan Chick, Medical Director, Castle Craig Hospital, and visiting Professor, School of Health and Social Care, Napier University, Edinburgh. ; Colin Drummond, Professor of Addiction Psychiatry; Julia Sinclair, Senior Lecturer
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Witt K, Lubman D, Lloyd B, Smith K. Co-consumption of alcohol and psychotropic medications in episodes of non-fatal self-poisoning attended by ambulance services in Victoria, Australia: evidence of potential modification by medical severity. Br J Psychiatry 2017; 211:53. [PMID: 28673949 DOI: 10.1192/bjp.211.1.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Katrina Witt
- Katrina Witt, Post-Doctoral Research Fellow, Turning Point, Eastern Health Clinical School, Monash University, Australia. ; Dan Lubman, Professor of Addiction Studies and Services; Belinda Lloyd, Associate Professor of Addiction Studies and Services; Karen Smith, Manager, Research and Evaluation and Adjunct Professor, Monash University, Australia
| | - Dan Lubman
- Katrina Witt, Post-Doctoral Research Fellow, Turning Point, Eastern Health Clinical School, Monash University, Australia. ; Dan Lubman, Professor of Addiction Studies and Services; Belinda Lloyd, Associate Professor of Addiction Studies and Services; Karen Smith, Manager, Research and Evaluation and Adjunct Professor, Monash University, Australia
| | - Belinda Lloyd
- Katrina Witt, Post-Doctoral Research Fellow, Turning Point, Eastern Health Clinical School, Monash University, Australia. ; Dan Lubman, Professor of Addiction Studies and Services; Belinda Lloyd, Associate Professor of Addiction Studies and Services; Karen Smith, Manager, Research and Evaluation and Adjunct Professor, Monash University, Australia
| | - Karen Smith
- Katrina Witt, Post-Doctoral Research Fellow, Turning Point, Eastern Health Clinical School, Monash University, Australia. ; Dan Lubman, Professor of Addiction Studies and Services; Belinda Lloyd, Associate Professor of Addiction Studies and Services; Karen Smith, Manager, Research and Evaluation and Adjunct Professor, Monash University, Australia
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Chitty KM, Isbister GK, Dawson AH, Buckley NA. Authors' reply. Br J Psychiatry 2017; 211:53-54. [PMID: 28673950 DOI: 10.1192/bjp.211.1.53a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Kate M Chitty
- Kate M. Chitty, Research Fellow, Translational Australian Clinical Toxicology Research Group, Discipline of Pharmacology, University of Sydney, Australia. ; Geoffrey K. Isbister, Andrew H. Dawson, Nicholas A. Buckley, University of Sydney, Australia
| | - Geoffrey K Isbister
- Kate M. Chitty, Research Fellow, Translational Australian Clinical Toxicology Research Group, Discipline of Pharmacology, University of Sydney, Australia. ; Geoffrey K. Isbister, Andrew H. Dawson, Nicholas A. Buckley, University of Sydney, Australia
| | - Andrew H Dawson
- Kate M. Chitty, Research Fellow, Translational Australian Clinical Toxicology Research Group, Discipline of Pharmacology, University of Sydney, Australia. ; Geoffrey K. Isbister, Andrew H. Dawson, Nicholas A. Buckley, University of Sydney, Australia
| | - Nicholas A Buckley
- Kate M. Chitty, Research Fellow, Translational Australian Clinical Toxicology Research Group, Discipline of Pharmacology, University of Sydney, Australia. ; Geoffrey K. Isbister, Andrew H. Dawson, Nicholas A. Buckley, University of Sydney, Australia
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