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Lundahl A. Suicide-preventive compulsory admission is not a proportionate measure - time for clinicians to recognise the associated risks. Monash Bioeth Rev 2024:10.1007/s40592-024-00190-6. [PMID: 38615159 DOI: 10.1007/s40592-024-00190-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 04/15/2024]
Abstract
Suicide is considered a global public health issue and compulsory admission is a commonly used measure to prevent suicide. However, the practice has been criticised since several studies indicate that the measure lacks empirical support and may even increase suicide risk. This paper investigates whether the practice has enough empirical support to be considered proportionate. To that end, arguments supporting compulsory admission as a suicide-preventive measure for most suicidal patients are scrutinized. The ethical point of departure is that the expected benefits of compulsory admission should outweigh the potential harms of the measure to be proportionate and defensible. It is concluded that, for most suicidal patients, suicide-preventive compulsory admission cannot be presumed to be a proportionate measure. To be so, the expected medical benefits of the measure should be greater than the potential increase in suicide risk and other harms that compulsory admission could entail. Instead of using compulsory admission as a suicide-preventive measure, extra safety measures may be needed during and after compulsory admission to prevent the risk of hospitalisation-induced suicide.
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Affiliation(s)
- Antoinette Lundahl
- Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
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Joshi E, Bhatta S, Joshi SK, Mytton J. Identification of research priorities for suicide prevention in Nepal: a Delphi study. BMC Psychiatry 2022; 22:429. [PMID: 35752774 PMCID: PMC9233798 DOI: 10.1186/s12888-022-04074-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 06/13/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Suicide is a significant public health concern in Nepal and there is a need for an evidence-based suicide prevention programme to facilitate stakeholders working towards suicide prevention in Nepal. Collaborative research between stakeholders focussing on shared priorities can help to prevent and control suicide. Hence, we aimed to develop a consensus list of research priorities for suicide prevention in Nepal. METHODS The Delphi expert consensus method was used to elicit the prioritized research questions for suicide prevention in Nepal. Participants comprised suicide prevention experts (psychologists, psychiatrists, psychiatric nurses, researchers and advocates) and people with lived experience. Three rounds of Delphi were conducted; round 1: one to one interviews involving open ended questions used to generate research questions; round 2: ranking of the research questions using a 5-point Likert scale, and round 3: re-ranking of research questions in light of individual and group responses. RESULTS Forty-two participants participated in round 1 followed by 38 in round 2 and 39 in round 3 . 522 research questions were generated through round 1 which were grouped together and reduced to 33 research questions sent for ranking in round 2. Using a cut off of at least 70% of the panel ranking questions as 'very important' or 'important', 22 questions were retained. These research questions were sent for re-rating in round 3 resulting in a final list of prioritized questions. CONCLUSIONS This is the first expert consensus study to identify the top research priorities for suicide prevention in Nepal, and used experts in suicide prevention and those with lived experience. A consensus was reached regarding the studies needed to improve suicide data quality, assess the burden and identify factors associated with suicide. A priority driven approach to suicide prevention research may ensure that the research endeavour provides the most useful information for those whose day-to-day work involves trying to prevent suicide.
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Affiliation(s)
- Elisha Joshi
- Nepal Injury Research Centre, Kathmandu Medical College Public Limited, P O Box 21266, Kathmandu, Nepal.
| | - Santosh Bhatta
- grid.6518.a0000 0001 2034 5266Centre for Public Health and Wellbeing, University of the West of England, Bristol, UK ,grid.6518.a0000 0001 2034 5266Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Sunil Kumar Joshi
- grid.415089.10000 0004 0442 6252Nepal Injury Research Centre, Kathmandu Medical College Public Limited, P O Box 21266, Kathmandu, Nepal ,grid.415089.10000 0004 0442 6252Department of Community Medicine, Kathmandu Medical College Public Limited, Kathmandu, Nepal
| | - Julie Mytton
- grid.6518.a0000 0001 2034 5266Centre for Public Health and Wellbeing, University of the West of England, Bristol, UK ,grid.6518.a0000 0001 2034 5266Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
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Knipe D, Padmanathan P, Newton-Howes G, Chan LF, Kapur N. Suicide and self-harm. Lancet 2022; 399:1903-1916. [PMID: 35512727 DOI: 10.1016/s0140-6736(22)00173-8] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/23/2021] [Accepted: 12/20/2021] [Indexed: 12/21/2022]
Abstract
Suicide and self-harm are major health and societal issues worldwide, but the greatest burden of both behaviours occurs in low-income and middle-income countries. Although rates of suicide are higher in male than in female individuals, self-harm is more common in female individuals. Rather than having a single cause, suicide and self-harm are the result of a complex interplay of several factors that occur throughout the life course, and vary by gender, age, ethnicity, and geography. Several clinical and public health interventions show promise, although our understanding of their effectiveness has largely originated from high-income countries. Attempting to predict suicide is unlikely to be helpful. Intervention and prevention must include both a clinical and community focus, and every health professional has a crucial part to play.
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Affiliation(s)
- Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka.
| | - Prianka Padmanathan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Lai Fong Chan
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Nav Kapur
- Centre for Mental Health and Safety, University of Manchester, Academic Health Science Centre, Manchester, UK; National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health National Health Service Foundation Trust, Manchester, UK
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Que JY, Shi L, Yan W, Chen SJ, Wu P, Sun SW, Yuan K, Liu ZC, Zhu Z, Fan JY, Lu Y, Hu B, Xiao H, Liu ZS, Li Y, Wang GH, Wang W, Ran MS, Shi J, Wing YK, Bao YP, Lu L. Nightmares mediate the association between traumatic event exposure and suicidal ideation in frontline medical workers exposed to COVID-19. J Affect Disord 2022; 304:12-19. [PMID: 35176338 PMCID: PMC8843324 DOI: 10.1016/j.jad.2022.02.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 12/04/2021] [Accepted: 02/13/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Trauma experience increases the risk of suicidal ideation, but little is known about potentially psychological mechanisms underlying this relationship. This study aims to examine the relationship between coronavirus disease 2019 (COVID-19)-related traumatic event (CTE) exposure and suicidal ideation among hospital workers, and identify mediating roles of sleep disturbances in this relationship. METHODS Workers in seven designated hospitals in Wuhan, China, were invited to participate in an online survey from May 27, 2020, to July 31, 2020. Participants completed a self-report questionnaire to evaluate demographic characteristics, level of CTE exposures, nightmare frequency, insomnia severity, symptoms of depression and anxiety, and suicidal ideation. A series of correlation analyses were performed, and a mediation model was generated to examine correlations between CTE exposure, sleep disturbances, and suicidal ideation. RESULTS A total of 16,220 hospital workers were included in the final analysis, 13.3% of them reported suicidal ideation in the past month. CTE exposure was significantly associated with insomnia severity, nightmare frequency, and suicidal ideation. After controlling potential confounders, nightmares but not insomnia, depression, or anxiety were shown to be independent risk factors for suicidal ideation. Pathway analyses showed that the relationship between CTE exposure and suicidal ideation was fully mediated by nightmares (proportion mediated 66.4%) after adjusting for demographic characteristics and psychological confounders. LIMITATIONS Cross-sectional design precluded the investigation of causal relationships. CONCLUSIONS CTE exposure increases risk of hospital workers' suicidal ideation that is mediated by nightmares, suggesting nightmares intervention might be considered as a component when developing suicide prevention strategies.
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Affiliation(s)
- Jian-Yu Que
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Sixth Hospital, Peking University Institute of Mental Health, 51 Huayuanbei Road, Beijing 100191, China
| | - Le Shi
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Sixth Hospital, Peking University Institute of Mental Health, 51 Huayuanbei Road, Beijing 100191, China
| | - Wei Yan
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Sixth Hospital, Peking University Institute of Mental Health, 51 Huayuanbei Road, Beijing 100191, China
| | - Si-Jing Chen
- Faculty of Medicine, Department of Psychiatry, Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, China
| | - Ping Wu
- National Institute on Drug Dependence and Beijing Key Laboratory on Drug Dependence Research, Peking University, 38 Xueyuan Road, Beijing 100191, China
| | - Si-Wei Sun
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Sixth Hospital, Peking University Institute of Mental Health, 51 Huayuanbei Road, Beijing 100191, China
| | - Kai Yuan
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Sixth Hospital, Peking University Institute of Mental Health, 51 Huayuanbei Road, Beijing 100191, China
| | - Zhong-Chun Liu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhou Zhu
- Department of Neurology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Jing-Yi Fan
- Department of Pediatrics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yu Lu
- Affiliated Wuchang Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Han Xiao
- Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhi-Sheng Liu
- Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Li
- Department of Psychiatry, Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Gao-Hua Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wei Wang
- Department of Neurology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Mao-Sheng Ran
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Jie Shi
- National Institute on Drug Dependence and Beijing Key Laboratory on Drug Dependence Research, Peking University, 38 Xueyuan Road, Beijing 100191, China
| | - Yun Kwok Wing
- Faculty of Medicine, Department of Psychiatry, Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, China
| | - Yan-Ping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory on Drug Dependence Research, Peking University, 38 Xueyuan Road, Beijing 100191, China.
| | - Lin Lu
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Sixth Hospital, Peking University Institute of Mental Health, 51 Huayuanbei Road, Beijing 100191, China; National Institute on Drug Dependence and Beijing Key Laboratory on Drug Dependence Research, Peking University, 38 Xueyuan Road, Beijing 100191, China; Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Beijing 100191, China.
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Castelpietra G, Guadagno S, Pischiutta L, Tossut D, Maso E, Albert U, Balestrieri M. Are patients improving during and after a psychiatric hospitalisation? Continuity of care outcomes of compulsory and voluntary admissions to an Italian psychiatric ward. J Public Health Res 2021; 11. [PMID: 34355553 PMCID: PMC8847955 DOI: 10.4081/jphr.2021.2382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background: To compare the characteristics of compulsory admissions (CAs) and voluntary admissions (VAs) in a General Hospital Psychiatric Unit (GHPU), and to assess whether CA and VA patients’ outcomes improved during hospitalisation and followup in mental health services (MHS) based on community continuity of care. Design and methods: Observational longitudinal study comparing 19 CAs and 83 VAs consecutively admitted to GHPU of Udine, Italy, and followed-up for six-months by MHS. Five psychometric scales assessed psychosocial and clinical characteristics for each patient at admission (T0), discharge (T1) and follow-up (T2). Statistical analyses were performed using: multivariate logistic regression for comparing CA and VA; Friedman χ2 and Mann-Whitney tests for outcomes’ improvement. Results: Being hospitalised for a psychotic crisis was the most significant predictor of CA (OR = 5.07). An outcomes’ improvement was observed from T0 to T1 in almost all psychometric tests, while from T1 to T2 only for PSP-A (useful social activities), CGI-S (severity of illness) and CGI-EI (drug’s efficacy related to side effects). CA was associated to lower performances in all scales at T0, in GAF and CGI-S at T1, while no difference with VA was observed at T2. Conclusions: CA and VA patients improved to a same extent during hospitalisation and follow-up, particularly in relation to social functioning. This fosters the hypothesis that communitybased MHS using a longitudinal continuity of care model might achieve recovery in a long-term perspective. Future research may benefit by considering patients’ subjective experiences and assessing long-term improvement in those who received personcentred interventions. Significance for public health This study demonstrates that patients voluntarily or involuntarily admitted to an inpatient psychiatric service improve to a same extent during hospitalisation, and this improvement is maintained during a six-month follow-up by outpatient mental health services. Moreover, the greatest improvement after discharge from hospital is observed in social functioning. To our knowledge, this is also the first study analysing psychiatric patients’ outcomes in a longitudinal continuity of care model, allowing preliminary scientific evidences valuable for mental health policy. The study also shed a light on the hypothesis that a mental health system strongly community-based and applying a whole-system continuity of care approach might achieve recovery in a long-term perspective, particularly with regard to psychosocial outcomes in more severely-ill patients.
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Affiliation(s)
- Giulio Castelpietra
- Outpatient and Inpatient Care Service, Central Health Directorate, Friuli Venezia Giulia Region, Trieste.
| | - Silvia Guadagno
- Udine Nord Community Mental Health Centre, Mental Health Department, Friuli Centrale Healthcare Agency, Udine.
| | - Livia Pischiutta
- Department of Medicine, Surgery and Health Sciences, University of Trieste.
| | - Davide Tossut
- Welfare Area, Giuliano Isontina Healthcare Agency, Palmanova (UD).
| | - Elisa Maso
- Psychiatric Unit, Mental Health Department, Friuli Centrale Healthcare Agency, Udine.
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, University of Trieste.
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Carranza Navarro F, Álvarez Villalobos NA, Contreras Muñoz AM, Guerrero Medrano AF, Tamayo Rodríguez NS, Saucedo Uribe E. Predictors of the length of stay of psychiatric inpatients: protocol for a systematic review and meta-analysis. Syst Rev 2021; 10:65. [PMID: 33653413 PMCID: PMC7927412 DOI: 10.1186/s13643-021-01616-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 02/22/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Length of stay (LOS) for inpatient psychiatric services is an important factor with serious drawbacks when it is extended more than needed. Impacts on economy, social functioning, and stigma can hamper improvement and affect the patients' experiences on future mental healthcare. Predictions of which patients have a higher chance for prolonged LOS have been extensively researched. Previous systematic reviews found consistent predictors of both longer and shorter LOS. However, they do not provide an estimate from the pooled effect sizes. Furthermore, to our knowledge, there is no meta-analysis on the influence of these factors. The primary objective of this study will be to provide point estimates on the effect sizes of all studied predictors of the LOS of psychiatric inpatients. METHODS We will conduct a systematic search in PubMed, MEDLINE, EMBASE, and PsycINFO for observational studies evaluating the effect size of independent factors on the length of stay of psychiatric inpatients. Prospective and retrospective cohorts that assess the influence of predictors through the reporting of standardized regression coefficients will be included. We will provide a qualitative synthesis of the findings from each study and perform a meta-analysis from pooled regression coefficients that were adjusted for other variables or confounders in order to obtain a point estimate and confidence interval for all factors extracted from the included studies. DISCUSSION The results from this study may provide more accurate predictions for mental health institutions, psychiatrists, mental health service providers, patients, and families on the prognosis regarding the length of stay for needed inpatient care. This information may be used to anticipate individuals with a higher chance for prolonged hospitalization to plan the necessary interventions for these specific situations. Considering both the benefits and disadvantages of longer and shorter stays, the pooled estimates for independent factors may be used by mental healthcare providers and patients for informed decision-making. The results from this study will also update results presented in previous studies and identify the strengths and limitations from the current available evidence. SYSTEMATIC REVIEW REGISTRATION PROSPERO ID CRD42020172840.
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Affiliation(s)
- Farid Carranza Navarro
- Department of Psychiatry, Hospital Universitario “Dr. José E. González”, Av. Francisco I. Madero & Av. Gonzalitos, Mitras Centro, 64460 Monterrey, Mexico
| | - Neri Alejandro Álvarez Villalobos
- Plataforma INVEST KER Medicina UANL KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Av. Francisco I. Madero & Av. Gonzalitos, Mitras Centro, Monterrey, Mexico
| | - Andrea Muriel Contreras Muñoz
- Department of Psychiatry, Hospital Universitario “Dr. José E. González”, Av. Francisco I. Madero & Av. Gonzalitos, Mitras Centro, 64460 Monterrey, Mexico
| | - Andrea Fernanda Guerrero Medrano
- Department of Psychiatry, Hospital Universitario “Dr. José E. González”, Av. Francisco I. Madero & Av. Gonzalitos, Mitras Centro, 64460 Monterrey, Mexico
| | - Natalia Sofía Tamayo Rodríguez
- Department of Psychiatry, Hospital Universitario “Dr. José E. González”, Av. Francisco I. Madero & Av. Gonzalitos, Mitras Centro, 64460 Monterrey, Mexico
| | - Erasmo Saucedo Uribe
- Department of Psychiatry, Hospital Universitario “Dr. José E. González”, Av. Francisco I. Madero & Av. Gonzalitos, Mitras Centro, 64460 Monterrey, Mexico
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Walker S, Mackay E, Barnett P, Sheridan Rains L, Leverton M, Dalton-Locke C, Trevillion K, Lloyd-Evans B, Johnson S. Clinical and social factors associated with increased risk for involuntary psychiatric hospitalisation: a systematic review, meta-analysis, and narrative synthesis. Lancet Psychiatry 2019; 6:1039-1053. [PMID: 31777340 PMCID: PMC7029280 DOI: 10.1016/s2215-0366(19)30406-7] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Use of involuntary psychiatric hospitalisation varies widely within and between countries. The factors that place individuals and populations at increased risk of involuntary hospitalisation are unclear, and evidence is needed to understand these disparities and inform development of interventions to reduce involuntary hospitalisation. We did a systematic review, meta-analysis, and narrative synthesis to investigate risk factors at the patient, service, and area level associated with involuntary psychiatric hospitalisation of adults. METHODS We searched MEDLINE, PsycINFO, Embase, and the Cochrane Controlled Clinical Register of Trials from Jan 1, 1983, to Aug 14, 2019, for studies comparing the characteristics of voluntary and involuntary psychiatric inpatients, and studies investigating the characteristics of involuntarily hospitalised individuals in general population samples. We synthesised results using random effects meta-analysis and narrative synthesis. Our review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and is registered on PROSPERO, CRD42018095103. FINDINGS 77 studies were included from 22 countries. Involuntary rather than voluntary hospitalisation was associated with male gender (odds ratio 1·23, 95% CI 1·14-1·32; p<0·0001), single marital status (1·47, 1·18-1·83; p<0·0001), unemployment (1·43, 1·07-1·90; p=0·020), receiving welfare benefits (1·71, 1·28-2·27; p<0·0001), being diagnosed with a psychotic disorder (2·18, 1·95-2·44; p<0·0001) or bipolar disorder (1·48, 1·24-1·76; p<0·0001), and previous involuntary hospitalisation (2·17, 1·62-2·91; p<0·0001). Using narrative synthesis, we found associations between involuntary psychiatric hospitalisation and perceived risk to others, positive symptoms of psychosis, reduced insight into illness, reduced adherence to treatment before hospitalisation, and police involvement in admission. On a population level, some evidence was noted of a positive dose-response relation between area deprivation and involuntary hospitalisation. INTERPRETATION Previous involuntary hospitalisation and diagnosis of a psychotic disorder were factors associated with the greatest risk of involuntary psychiatric hospitalisation. People with these risk factors represent an important target group for preventive interventions, such as crisis planning. Economic deprivation on an individual level and at the population level was associated with increased risk for involuntary hospitalisation. Mechanisms underpinning the risk factors could not be identified using the available evidence. Further research is therefore needed with an integrative approach, which examines clinical, social, and structural factors, alongside qualitative research into clinical decision-making processes and patients' experiences of the detention process. FUNDING Commissioned by the Department of Health and funded by the National Institute of Health Research (NIHR) via the NIHR Mental Health Policy Research Unit.
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Affiliation(s)
- Susan Walker
- Division of Psychiatry, University College London, London, UK; Great Ormond Street Institute of Child Health, University College London, London, UK.
| | - Euan Mackay
- Department of Clinical Educational and Health Psychology, Centre for Outcomes Research and Effectiveness, University College London, London, UK
| | - Phoebe Barnett
- Department of Clinical Educational and Health Psychology, Centre for Outcomes Research and Effectiveness, University College London, London, UK
| | - Luke Sheridan Rains
- Division of Psychiatry, University College London, London, UK; National Institute of Health Research Mental Health Policy Research Unit, University College London, London, UK
| | - Monica Leverton
- Division of Psychiatry, University College London, London, UK
| | - Christian Dalton-Locke
- Division of Psychiatry, University College London, London, UK; National Institute of Health Research Mental Health Policy Research Unit, University College London, London, UK
| | - Kylee Trevillion
- National Institute of Health Research Mental Health Policy Research Unit, University College London, London, UK; Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Brynmor Lloyd-Evans
- Division of Psychiatry, University College London, London, UK; National Institute of Health Research Mental Health Policy Research Unit, University College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK; National Institute of Health Research Mental Health Policy Research Unit, University College London, London, UK
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Convoy SP, Westphal RJ, Convoy DW. Concordant Actions in Suicide Assessment Model. Nurs Clin North Am 2019; 54:533-539. [PMID: 31703778 DOI: 10.1016/j.cnur.2019.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article offers an alternative conceptualization from which a health care provider can consider and respond to client-based suicidal ideation and behavior. Pragmatically explored through the prism of locus of control, Rogerian psychotherapy principles, Peplau's theory of interpersonal relations, and the work of Kay Redfield Jamison, the Concordant Actions in Suicide Assessment (CASA) model frames clinical decision making along a continuum defined by concordant and state-based action. Therein, cognitive reframes are offered to illustrate how to apply the CASA model in clinical practice.
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Affiliation(s)
| | - Richard J Westphal
- University of Virginia at Charlottesville, P.O. Box 800782, McLeod Hall, Charlottesville, VA, USA
| | - Dana W Convoy
- United States Navy Reserve, Naval Operation Support Center, 3617 Carolina Beach Road, Wilmington, NC 28412, USA
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Kar N, Prasad T. Suicide by psychiatric patients: Nature of risk, risk categorisation and preventability. MEDICINE, SCIENCE, AND THE LAW 2019; 59:255-264. [PMID: 31378145 DOI: 10.1177/0025802419867507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study considers risk factors associated with suicide by psychiatric patients, the perceived risk at last contact and risk categorisation and reflects upon the potential for prevention. Information regarding 63 consecutive suicides known to mental health services in Wolverhampton, UK, over a 15-year period was collected as part of an audit using a semi-structured questionnaire covering sociodemographic and clinical risk factors, along with information about preventability. A complex mixture of historical, enduring and current risk factors was observed. In addition to common risk factors, a considerable proportion had histories of multiple co-morbid psychiatric (52.5%) and physical diagnoses (27.6%) and psychiatric admission (70.5%). Common suicide methods included hanging (36.5%) and poisoning (36.5%). Most suicides occurred in the post-discharge months up to around two years (75.8%). Although a range of psychopathologies and suicidal cognitions were observed at the last clinical contact, the immediate suicide risk was considered low (46.2%) or not present (38.5%) in the majority of cases. Clinicians suggested various factors that could have made suicides less likely. Clinical assessment can identify risk factors, but categorisation may not be indicative of the outcome. A focus on modifiable factors, with support for psychosocial and clinical issues, may assist with prevention.
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Affiliation(s)
- Nilamadhab Kar
- Department of Psychiatry, Black Country Partnership NHS Foundation Trust, Steps to Health, UK
| | - Tulika Prasad
- Department of Psychiatry, Black Country Partnership NHS Foundation Trust, Penn Hospital, UK
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Huber CG, Borgwardt S, Lang UE, Schneeberger AR. Taking Off the Blinders: The Critical Phase of Suicidality Doesn't End With Discharge From Inpatient Treatment. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:93-94. [PMID: 31566493 DOI: 10.1080/15265161.2019.1654023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | | | | | - Andres R Schneeberger
- Psychiatrische Klinik der Universität Zürich, Psychiatrische Dienste Graubünden and Albert Einstein College of Medicine
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11
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Lin CE, Chung CH, Chen LF, Chien WC. Does Compulsory Admission Prevent Inpatient Suicide Among Patients with Schizophrenia? A Nationwide Cohort Study in Taiwan. Suicide Life Threat Behav 2019; 49:966-979. [PMID: 30079449 DOI: 10.1111/sltb.12497] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 04/25/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The aim of this study was to analyze the risk of inpatient suicide in patients with schizophrenia during 2007-2013 and to determine putative risk factors. METHODS We conducted a national population-based cohort study of 2,038 psychiatric inpatients in their first compulsory admission, matched with 8,152 controls who were voluntary inpatients. Only patients with schizophrenia were included in the study. We used data derived from the Taiwanese National Health Insurance Database 2005, comprising 1 million beneficiaries randomly selected from the entire population of Taiwan. RESULTS During the follow-up period, 23 and 75 inpatient suicides were observed in the compulsory and control groups, respectively. Kaplan-Meier curves showed that the cumulative incidence rate of inpatient suicide was not significantly different between compulsory and voluntary admissions (log-rank test, p = .206). CONCLUSIONS Our results suggest that compulsory admission has no protective effects on risk reduction of inpatient suicide for patients with schizophrenia who are compulsorily admitted compared with voluntarily admitted controls. Clinicians should be more alert for the prevention of inpatient suicide among patients with schizophrenia and consider the close monitoring of inpatient suicide risk in the first week of admission.
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Affiliation(s)
- Ching-En Lin
- Department of Psychiatry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.,School of Medicine, Tzu-Chi University, Hualien, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan.,School of Public Health, National Defense Medical Centre, Taipei, Taiwan
| | - Li-Fen Chen
- School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Department of Psychiatry, Tri-Service General Hospital, Penhu Branch, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan.,School of Public Health, National Defense Medical Centre, Taipei, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Centre, Taipei, Taiwan
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12
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Saya A, Brugnoli C, Piazzi G, Liberato D, Di Ciaccia G, Niolu C, Siracusano A. Criteria, Procedures, and Future Prospects of Involuntary Treatment in Psychiatry Around the World: A Narrative Review. Front Psychiatry 2019; 10:271. [PMID: 31110481 PMCID: PMC6501697 DOI: 10.3389/fpsyt.2019.00271] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/10/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anna Saya
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Psychiatry and Clinical Psychology Unit, Department of Neurosciences, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Chiara Brugnoli
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Psychiatry and Clinical Psychology Unit, Department of Neurosciences, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Gioia Piazzi
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Psychiatry and Clinical Psychology Unit, Department of Neurosciences, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Daniela Liberato
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Psychiatry and Clinical Psychology Unit, Department of Neurosciences, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Gregorio Di Ciaccia
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Psychiatry and Clinical Psychology Unit, Department of Neurosciences, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Cinzia Niolu
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Psychiatry and Clinical Psychology Unit, Department of Neurosciences, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Alberto Siracusano
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Psychiatry and Clinical Psychology Unit, Department of Neurosciences, Fondazione Policlinico Tor Vergata, Rome, Italy
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13
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Suicide Methods According to Age and Sex: An Analysis of Data of 239,565 Suicide Victims in the Republic of Korea From 1991 to 2015. J Nerv Ment Dis 2018; 206:770-775. [PMID: 30273273 DOI: 10.1097/nmd.0000000000000889] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Because suicide is irreversible, prevention is paramount. For the optimal strategy to reduce lethal means, we sought to investigate age- and sex-associated variations in suicide methods. Data on annual causes of death from 1991 to 2015 in the Republic of Korea were used. Major sociodemographic correlates of the five suicide methods were analyzed by multiple multinominal logistic regression analysis. Among a total of 239,565 suicides from 1991 to 2015, hanging was most common. Gas poisoning sharply increased from 2007 to 2015. The gap between hanging and the second most common method of suicide has increased from 659 in 2004 to 4,433 in 2015. Charcoal burning was most commonly used by males younger than 45 years of age, whereas pesticide was commonly used by both sexes ages 55 years and older. Our results suggest that age- and sex-specific suicide prevention strategies are needed, particularly for gas and pesticide poisoning.
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14
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Bachmann S. Epidemiology of Suicide and the Psychiatric Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1425. [PMID: 29986446 PMCID: PMC6068947 DOI: 10.3390/ijerph15071425] [Citation(s) in RCA: 651] [Impact Index Per Article: 108.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 06/28/2018] [Accepted: 07/01/2018] [Indexed: 12/12/2022]
Abstract
Suicide is a worldwide phenomenon. This review is based on a literature search of the World Health Organization (WHO) databases and PubMed. According to the WHO, in 2015, about 800,000 suicides were documented worldwide, and globally 78% of all completed suicides occur in low- and middle-income countries. Overall, suicides account for 1.4% of premature deaths worldwide. Differences arise between regions and countries with respect to the age, gender, and socioeconomic status of the individual and the respective country, method of suicide, and access to health care. During the second and third decades of life, suicide is the second leading cause of death. Completed suicides are three times more common in males than females; for suicide attempts, an inverse ratio can be found. Suicide attempts are up to 30 times more common compared to suicides; they are however important predictors of repeated attempts as well as completed suicides. Overall, suicide rates vary among the sexes and across lifetimes, whereas methods differ according to countries. The most commonly used methods are hanging, self-poisoning with pesticides, and use of firearms. The majority of suicides worldwide are related to psychiatric diseases. Among those, depression, substance use, and psychosis constitute the most relevant risk factors, but also anxiety, personality-, eating- and trauma-related disorders as well as organic mental disorders significantly add to unnatural causes of death compared to the general population. Overall, the matter at hand is relatively complex and a significant amount of underreporting is likely to be present. Nevertheless, suicides can, at least partially, be prevented by restricting access to means of suicide, by training primary care physicians and health workers to identify people at risk as well as to assess and manage respective crises, provide adequate follow-up care and address the way this is reported by the media. Suicidality represents a major societal and health care problem; it thus should be given a high priority in many realms.
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Affiliation(s)
- Silke Bachmann
- Clienia Littenheid AG, Hauptstrasse 130, 9573 Littenheid, Switzerland.
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, University Halle (Saale), Julius-Kühn-Strasse 7, 6112 Halle (Saale), Germany.
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