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Stockner M, Plattner B, Innamorati M, Hofer A, Burian I, Fronthaler M, Giupponi G, Huber M, Macina C, Perwanger V, Pycha R, Schaller G, Conca A. How Mental Health and Suicidality Changed during the COVID-19 Pandemic: A Longitudinal Study in the General and Psychiatric Population Illustrating Risk and Protective Factors. Behav Sci (Basel) 2024; 14:386. [PMID: 38785877 PMCID: PMC11117826 DOI: 10.3390/bs14050386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/20/2024] [Accepted: 04/28/2024] [Indexed: 05/25/2024] Open
Abstract
The COVID-19 pandemic has led to an increase in psychological distress in the general population, but contrasting results have been shown regarding its impact on psychological symptoms in clinical and non-clinical samples. Consequently, the aim of the present study was to compare in a longitudinal design (September-November 2020 and February-April 2021) the mental health outcomes of a clinical and a control sample and to determine the implications of various risk and protective factors in this regard. A total of 234 participants from the general population and 80 psychiatric patients took part in the present online study using the following measurements: the Brief Symptom Checklist (BSCL); Three-Item Loneliness Scale (TILS); Resilience Scale-13 (RS-13); and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-Non-Illness (FACIT-Sp Non-Illness). The results show an overall decrease in active suicidal ideation as well as "peace", a subscale of spiritual well-being, as well as increases in passive suicidal activation in the clinical sample, which did not change in the control sample. Psychological symptoms did not significantly change in either group. Significant group effects show an increase in resilience in the clinical sample. Resilience and peace turned out to be protective factors for negative mental health outcomes. However, loneliness, which interestingly increased only in the control sample, was shown to be an overall potential risk factor. Our results highlight the complex implications of the COVID-19 pandemic on the mental health outcomes of different groups in the population, demonstrating the necessity of further research, specifically regarding the risk of active and passive suicidal activation. Highlighted protective factors are discussed in regards to spirituality (i.e., peace), which is not strictly related to religion but rather personal spirituality related to the meaning of situations of one's life, as well as in terms of mental health interventions.
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Affiliation(s)
- Mara Stockner
- Faculty of Medicine and Psychology, Sapienza University of Rome, 00185 Rome, Italy;
| | - Barbara Plattner
- Department of Psychiatry, Sanitary Agency of South Tyrol, General Hospital of Bolzano, 39100 Bolzano, Italy; (B.P.); (A.C.)
| | - Marco Innamorati
- Department of Human Sciences, European University of Rome, 00163 Rome, Italy
| | - Alex Hofer
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Medical University Innsbruck, 6020 Innsbruck, Austria
| | - Iuliia Burian
- Department of Psychiatry, General Hospital of Merano, Sanitary Agency of South Tyrol, 39012 Merano, Italy
| | - Martin Fronthaler
- Therapy Center Bad Bachgart, Sanitary Agency of South Tyrol, 39037 Rodengo, Italy
| | - Giancarlo Giupponi
- Department of Psychiatry, Sanitary Agency of South Tyrol, General Hospital of Bolzano, 39100 Bolzano, Italy; (B.P.); (A.C.)
| | - Markus Huber
- Department of Psychiatry, General Hospital of Brunico, Sanitary Agency of South Tyrol, 39031 Brunico, Italy
| | - Christian Macina
- Department of Psychiatry, General Hospital of Brunico, Sanitary Agency of South Tyrol, 39031 Brunico, Italy
| | - Verena Perwanger
- Department of Psychiatry, General Hospital of Merano, Sanitary Agency of South Tyrol, 39012 Merano, Italy
| | - Roger Pycha
- Department of Psychiatry, General Hospital of Bressanone, Sanitary Agency of South Tyrol, 39042 Bressanone, Italy
| | - Gerd Schaller
- Department of Psychiatry, General Hospital of Bressanone, Sanitary Agency of South Tyrol, 39042 Bressanone, Italy
| | - Andreas Conca
- Department of Psychiatry, Sanitary Agency of South Tyrol, General Hospital of Bolzano, 39100 Bolzano, Italy; (B.P.); (A.C.)
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Kim AW. Psychosocial stress, adult suicidal ideation, and the mediating effect of poor sleep quality during the COVID-19 pandemic in South Africa. Am J Hum Biol 2024; 36:e24038. [PMID: 38174783 DOI: 10.1002/ajhb.24038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/28/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVES South Africa instituted one of the world's strictest lockdowns during the COVID-19 pandemic, which generated heightened conditions of psychosocial stress and posed widespread mental health risks. Despite the elevated burdens of suicidal behaviors and risk of psychiatric disease in the country, few studies have examined the impacts of psychosocial stress from the pandemic on suicidal ideation in South Africa. This study examined the association between psychosocial stress experienced under the COVID-19 pandemic and adult suicidal ideation, as well as degree to which sleep quality and duration mediated this relationship. METHODS An online survey assessed experiences of COVID-19 psychosocial stress, sleep quality and duration, and suicidal ideation in a sample of 189 South African adults during the second and third waves of the COVID-19 pandemic. A causal inference framework for mediation analysis was used to assess the degree to which sleep quality and duration explained the association between COVID-19 psychosocial stress and suicidal ideation. RESULTS Suicidal ideation was reported in 21% of adults. Adults described having moderate sleep quality and an average of 6.9 hours of sleep per night. COVID-19 psychosocial stress significantly predicted adult suicidal ideation in fully adjusted models. Sleep quality, but not sleep duration, significantly mediated the association between COVID-19 psychosocial stress and suicidal ideation, accounting for 25.9% of the total effect. CONCLUSIONS Poor sleep quality may play an important role in exacerbating the alarming stress-induced mental health effects of the COVID-19 pandemic. Further research is necessary to understand the underlying sleep dynamics and associated psychological and neurobiological processes that perpetuate adult suicidal ideation.
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Affiliation(s)
- Andrew Wooyoung Kim
- Department of Anthropology, University of California, Berkeley, California, USA
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Troya MI, Corcoran P, Arensman E, Kavalidou K. Patterns of Hospital Presenting Suicide-Related Ideation in Older Adults before and during COVID-19: Findings from a National Clinical Service in Ireland 2018-2021. Arch Suicide Res 2024:1-12. [PMID: 38269575 DOI: 10.1080/13811118.2024.2307882] [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: 01/26/2024]
Abstract
OBJECTIVE To examine changes in trends of hospital-presenting suicide-related ideation in older adults living in Ireland, during the first 24 months of the COVID-19 pandemic and 2018-2019. METHODS Data on presentations of patients aged 60 and older from participating hospitals of the National Clinical Programme for Self-Harm and Suicide-related Ideation were used to compare trends during the first two years of the COVID-19 pandemic (2020-2021) with the preceding period (2018-2019). Poisson regression models were used to estimate trends in the pre-pandemic and pandemic periods. RESULTS There were 1531 presentations for suicide-related ideation to hospital emergency departments in older adults between January 1, 2018-December 31, 2021, with most presentations involving males (57.2%, n = 876). There was a 27% increase in suicide-related ideation presentations during the pandemic years (2020-2021) when compared to 2018-2019 (RR: 1.27, p = .001, 95%CI: 1.14-1.40), with females showing a 29% increase (RR: 1.29, p = .001, 95%CI: 1.11-1.51) and males a 23% increase (RR: 1.23, p = .002, 95%CI: 1.08-1.40). When examining these trends by years, there were only significant increases in 2021, and no significant increases were observed in 2020. CONCLUSIONS The study findings show that in the second year following the start of the pandemic, significant increases were observed in suicide-related ideation hospital-presentations in older adults. While immediate changes in trends were not observed in the first year of the pandemic, it is important to consider the pandemic's medium and long-term impact on older adults' mental health, to provide adequate support and reduce suicide risk among those presenting with suicide-related ideation.
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Husky MM, Pic O, Callahan S, Navarro-Mateu F. Twelve-month suicidal ideation, incidence and persistence among college students pre-pandemic and during the pandemic: A longitudinal study. Psychiatry Res 2024; 331:115669. [PMID: 38091895 DOI: 10.1016/j.psychres.2023.115669] [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] [Received: 05/05/2023] [Revised: 09/18/2023] [Accepted: 12/05/2023] [Indexed: 01/02/2024]
Abstract
The present study explored whether there had been significant changes in 12-month suicidal thoughts, incidence, and persistence of suicidal ideation among college students prior to and during the COVID-19 pandemic. Data were drawn from the French portion of the World Mental Health International College student Survey Initiative (WMH-ICS), a prospective cohort survey initiated in 2017. Students who completed both the baseline and one-year follow-up surveys were included (n = 1,216). Lifetime suicidal ideation and behaviors and mental disorders were assessed at baseline, and 12-month suicidal ideation and behaviors were also assessed at one-year follow-up. Logistic regressions were used to determine whether the odds of 12-month suicidal ideation at follow-up was associated with COVID-19 pandemic period while adjusting for lifetime psychopathology. No significant change in the odds of 12-month suicidal ideation was observed during the pandemic when compared to pre-pandemic times. Adjusting for prior psychopathology, 12-month suicidal ideation was not significantly associated with pandemic times, nor was incidence or persistence. No evidence of a significant increase in suicidal thoughts during the pandemic was observed. Longer follow-up periods and larger samples are needed in order to determine whether suicidal ideation and behaviors remain stable in the future.
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Affiliation(s)
- Mathilde M Husky
- Bordeaux Population Health Research Center, ACTIVE Team, INSERM U1219, Université de Bordeaux, 3 ter, place de la Victoire, Bordeaux 33076, France.
| | - Océane Pic
- Bordeaux Population Health Research Center, ACTIVE Team, INSERM U1219, Université de Bordeaux, 3 ter, place de la Victoire, Bordeaux 33076, France
| | - Stacey Callahan
- Centre d'études et de recherche en psychopathologie et psychologie de la santé (CERPPS), EA 7411, Université de Toulouse 2-Jean Jaurès, Toulouse, France
| | - Fernando Navarro-Mateu
- Unidad de Docencia, Investigación y Formación en Salud Mental (UDIF-SM), Servicio Murciano de Salud. Murcia. Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid. Spain; IMIB-Arrixaca. Murcia, Spain
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5
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Dai Y, Jiang T, Gaer W, Poon KT. Workplace Objectification Leads to Self-Harm: The Mediating Effect of Depressive Moods. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2023:1461672231213898. [PMID: 38047443 DOI: 10.1177/01461672231213898] [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: 12/05/2023]
Abstract
In the current research, we aimed to extend the literature on workplace objectification and contribute to employees' well-being by exploring whether and how workplace objectification increases self-harm as well as the coping strategy that may weaken the effect. Employing archive data analytic, correlational, longitudinal, and experimental designs, we found that workplace objectification was associated with, or led to, self-harm, irrespective of whether such actions provided an escape from work. This effect could not be simply ascribed to the negative nature of workplace objectification. We further found that depressive moods mediated this effect. The detrimental effect of workplace objectification on self-harm was lessened when employees perceived higher alternatives in life. Theoretical and managerial implications were discussed.
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Affiliation(s)
- Yuwan Dai
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| | - Tonglin Jiang
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| | - Wangchu Gaer
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| | - Kai-Tak Poon
- Department of Psychology and Centre for Psychosocial Health, The Educational University of Hong Kong, Hong Kong, China
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Kar SK, Singh S. Anomic suicides on rise during recently emerging crises: revisiting Durkheim's model. CNS Spectr 2023; 28:655-656. [PMID: 37424313 DOI: 10.1017/s1092852923002341] [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: 07/11/2023]
Abstract
Suicide is a global public health issue, with behavior differing across genders, age groups, places, and sociopolitical settings. Emile Durkheim characterized anomic suicide as occurring when social standards fail, resulting in purposelessness and directionlessness. Young people who are experiencing social issues are in danger, even if they do not voice suicidal ideas. Prevention interventions should target these people by strengthening resilience, minimizing social dysregulation stress, and fostering the development of life skills, coping resources, and social support. Anomic suicide has important psychological and societal implications, emphasizing the importance of fostering social cohesion and assisting persons experiencing purposelessness or a lack of direction in life.
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Affiliation(s)
- Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Uttar Pradesh, India
| | - Shivangini Singh
- Department of Psychiatry, King George's Medical University, Uttar Pradesh, India
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Vidyasagaran AL, McDaid D, Faisal MR, Nasir M, Muliyala KP, Thekkumkara S, Wright J, Huque R, Benkalkar S, Siddiqi N. Prevalence of mental disorders in South Asia: A systematic review of reviews. Glob Ment Health (Camb) 2023; 10:e78. [PMID: 38161740 PMCID: PMC10755414 DOI: 10.1017/gmh.2023.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/24/2023] [Accepted: 11/02/2023] [Indexed: 01/03/2024] Open
Abstract
Mental disorders are increasing in South Asia (SA), but their epidemiological burden is under-researched. We carried out a systematic umbrella review to estimate the prevalence of mental disorders and intentional self-harm in the region. Multiple databases were searched and systematic reviews reporting the prevalence of at least one mental disorder from countries in SA were included. Review data were narratively synthesised; primary studies of common mental disorders (CMDs) among adults were identified from a selected subset of reviews and pooled. We included 124 reviews. The majority (n = 65) reported on mood disorders, followed by anxiety disorders (n = 45). High prevalence of mental disorders and intentional self-harm was found in general adult and vulnerable populations. Two reviews met our pre-defined criteria for identifying primary studies of CMDs. Meta-analysis of 25 primary studies showed a pooled prevalence of 16.0% (95% CI = 11.0-22.0%, I 2 = 99.9%) for depression, 12.0% (5.0-21.0%, I 2 = 99.9%) for anxiety, and 14.0% (10.0-19.0, I 2 = 99.9%) for both among the general adult population; pooled estimates varied by country and assessment tool used. Overall, reviews suggest high prevalence for mental disorders in SA, but evidence is limited on conditions other than CMDs.
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Affiliation(s)
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - Muhammad Nasir
- Department of Economics, Institute of Business Administration (IBA), Karachi, Pakistan
| | - Krishna P. Muliyala
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | | | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | | | - Najma Siddiqi
- Department of Health Sciences, University of York, Heslington, UK
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Ramalle-Gómara E, Palacios-Castaño MI, Martínez-Ochoa E, Quiñones-Rubio C. Trends in suicide mortality in Spain from 1998 to 2021 and its relationship with the COVID-19 pandemic: A joinpoint regression analysis. Psychiatry Res 2023; 329:115520. [PMID: 37797441 DOI: 10.1016/j.psychres.2023.115520] [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] [Received: 07/11/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 10/07/2023]
Abstract
In the European Union, a rate of 11.9 cases per 100,000 was estimated in 2019.In Spain, suicide is the leading cause of external death. Social crises can have an impact on suicide rates. We analyzed changes in suicide mortality trends in Spain following the COVID-19 pandemic. We used statistical data from the National Institute of Statistics of Spain (1998-2021). We calculated age-specific rates, age and sex-adjusted rates, and analyzed trends and changes using joinpoint-regression models. Rates decrease in both sexes at the ages of 65 and older. In women, they increase in the ages of 1-29 years and 45-59 years. In men, they decrease in the ages of 15-39 years. Among women, age-adjusted rates remained stable between 1998 and 2021, with a non-significant annual decrease of 0.4 %. Among men, there was a significant annual decrease of 0.7 %. The years 2020 and 2021 had 8 % higher mortality compared to the two years prior to the COVID-19 pandemic. Suicide mortality in Spain slightly decreased among men and remained stable among women between 1998 and 2021, but there seems to be an increase following the COVID-19 pandemic.
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Affiliation(s)
- Enrique Ramalle-Gómara
- Epidemiology and Health Promotion Department, Directorate General of Public Health, Vara de Rey, 8, 26071 Logroño, La Rioja, Spain.
| | - María-Isabel Palacios-Castaño
- Epidemiology and Health Promotion Department, Directorate General of Public Health, Vara de Rey, 8, 26071 Logroño, La Rioja, Spain
| | - Eva Martínez-Ochoa
- Epidemiology and Health Promotion Department, Directorate General of Public Health, Vara de Rey, 8, 26071 Logroño, La Rioja, Spain
| | - Carmen Quiñones-Rubio
- Epidemiology and Health Promotion Department, Directorate General of Public Health, Vara de Rey, 8, 26071 Logroño, La Rioja, Spain
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Groenewald P, Kallis N, Holmgren C, Glass T, Anthony A, Maud P, Akhalwaya Y, Afonso E, Niewoudt I, Martin LJ, De Vaal C, Cheyip M, Morof D, Prinsloo M, Matzopoulos R, Bradshaw D. Further evidence of misclassification of the injury deaths in South Africa: When will the barriers to accurate injury death statistics be removed? S Afr Med J 2023; 113:30-35. [PMID: 37882130 PMCID: PMC11017197 DOI: 10.7196/samj.2023.v113i9.836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Contrary to the World Health Organization's internationally recommended medical certificate of cause of death, the South African (SA) death notification form (DNF) does not allow for the reporting of the manner of death to permit accurate coding of external causes of injury deaths. OBJECTIVES To describe the injury cause-of-death profile from forensic pathology records collected for the National Cause-of-Death Validation (NCoDV) Project and compare it with profiles from other sources of injury mortality data. In particular, the recording of firearm use in homicides is compared between sources. METHODS The NCoDV Project was a cross-sectional study of deaths that occurred during a fixed period in 2017 and 2018, from a nationally representative sample of 27 health subdistricts in SA. Trained fieldworkers scanned forensic records for all deaths investigated at the forensic mortuaries serving the sampled subdistricts during the study period. Forensic practitioners reviewed the records and completed a medical certificate of cause of death for each decedent. Causes of death were coded to the International Statistical Classification of Diseases, 10th revision (ICD-10), using Iris automated coding software. Cause-specific mortality fractions for injury deaths were compared with Injury Mortality Survey 2017 (IMS 2017) and Statistics South Africa 2017 (Stats SA 2017) datasets. The cause profile for all firearm-related deaths was compared between the three datasets. RESULTS A total of 5 315 records were available for analysis. Males accounted for 77.6% of cases, and most decedents were aged between 25 and 44 years. Homicide was the leading cause of death (34.7%), followed by transport injuries (32.6%) and suicide (14.7%). This injury cause profile was similar to IMS 2017 but differed markedly from the official statistics, which showed markedly lower proportions of these three causes (15.0%, 11.6% and 0.7%, respectively), and a much higher proportion of other unintentional causes. Investigation of firearm-related deaths revealed that most were homicides in NCoDV 2017/18 (88.5%) and IMS 2017 (93.1%), while in the Stats SA 2017 data, 98.7% of firearm deaths were classified as accidental. Approximately 7% of firearm-related deaths were suicides in NCoDV 2017/18 and IMS 2017, with only 0.3% in Stats SA 2017. CONCLUSION The official cause-of-death data for injuries in SA in 2017 differed substantially from findings from the NCoDV 2017/18 study and IMS 2017. Accurate data sources would ensure that public health interventions are designed to reduce the high injury burden. Inclusion of the manner of death on the DNF, as is recommended internationally, is critically important to enable more accurate, reliable and valid reporting of the injury profile.
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Affiliation(s)
- P Groenewald
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - N Kallis
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - C Holmgren
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - T Glass
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - A Anthony
- Department of Health and Wellness, Western Cape Department of Health, Cape Town, South Africa.
| | - P Maud
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - Y Akhalwaya
- Family Centre for Research with Ubuntu (FAM-CRU), Department of Paediatrics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - E Afonso
- Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - I Niewoudt
- Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - L J Martin
- Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Forensic Pathology Service, Western Cape Department of Health, Cape Town, South Africa.
| | - C De Vaal
- Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - M Cheyip
- US Centers for Disease Control and Prevention, Pretoria, South Africa.
| | - D Morof
- US Centers for Disease Control and Prevention, Pretoria, South Africa.
| | - M Prinsloo
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; Institute for Lifecourse Development, Faculty of Education, Health and Human Sciences, University of Greenwich, London, UK; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - R Matzopoulos
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - D Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
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Abstract
PURPOSE OF REVIEW We review recent research on the epidemiology and etiology of suicide in the global context. We focus on data from low- and middle-income countries (LMIC), with the goal of highlighting findings from these under-researched, over-burdened settings. RECENT FINDINGS Prevalence of suicide in LMIC adults varies across region and country income-level, but is, on average, lower than in high-income countries. Recent gains in suicide reduction, however, have been smaller in LMIC compared to global rates. LMIC youth have much higher rates of suicide attempts than youth from high-income countries. Females as well as people with psychiatric disorders, those living with HIV, those who are LGBTQ + , and those with poor socioeconomic status are highly vulnerable populations in LMIC. Limited and low-quality data from LMIC hinder clear interpretation and comparison of results. A greater body of more rigorous research is needed to understand and prevent suicide in these settings.
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Affiliation(s)
- Kathryn L Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | | | - Amalio X Come
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Milton L Wainberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 200, Philadelphia, PA, 19104, USA.
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11
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Lund JJ, Tomsich E, Schleimer JP, Pear VA. Changes in suicide in California from 2017 to 2021: a population-based study. Inj Epidemiol 2023; 10:19. [PMID: 36973826 PMCID: PMC10041498 DOI: 10.1186/s40621-023-00429-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/18/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Suicide is a major public health problem with immediate and long-term effects on individuals, families, and communities. In 2020 and 2021, stressors wrought by the COVID-19 pandemic, stay-at-home mandates, economic turmoil, social unrest, and growing inequality likely modified risk for self-harm. The coinciding surge in firearm purchasing may have increased risk for firearm suicide. In this study, we examined changes in counts and rates of suicide in California across sociodemographic groups during the first two years of the COVID-19 pandemic relative to prior years. METHODS We used California-wide death data to summarize suicide and firearm suicide across race/ethnicity, age, education, gender, and urbanicity. We compared case counts and rates in 2020 and 2021 with 2017-2019 averages. RESULTS Suicide decreased overall in 2020 (4123 deaths; 10.5 per 100,000) and 2021 (4104; 10.4 per 100,000), compared to pre-pandemic (4484; 11.4 per 100,000). The decrease in counts was driven largely by males, white, and middle-aged Californians. Conversely, Black Californians and young people (age 10 to 19) experienced increased burden and rates of suicide. Firearm suicide also decreased following the onset of the pandemic, but relatively less than overall suicide; as a result, the proportion of suicides that involved a firearm increased (from 36.1% pre-pandemic to 37.6% in 2020 and 38.1% in 2021). Females, people aged 20 to 29, and Black Californians had the largest increase in the likelihood of using a firearm in suicide following the onset of the pandemic. The proportion of suicides that involved a firearm in 2020 and 2021 decreased in rural areas compared to prior years, while there were modest increases in urban areas. CONCLUSIONS The COVID-19 pandemic and co-occurring stressors coincided with heterogeneous changes in risk of suicide across the California population. Marginalized racial groups and younger people experienced increased risk for suicide, particularly involving a firearm. Public health intervention and policy action are necessary to prevent fatal self-harm injuries and reduce related inequities.
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Affiliation(s)
- Julia J Lund
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA, USA.
| | - Elizabeth Tomsich
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Julia P Schleimer
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Veronica A Pear
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
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12
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Leveraging research, community and collaboration towards robust COVID-19 mental health response in the Caribbean. LANCET REGIONAL HEALTH. AMERICAS 2023; 19:100440. [PMID: 36743346 PMCID: PMC9887469 DOI: 10.1016/j.lana.2023.100440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 01/05/2023] [Accepted: 01/16/2023] [Indexed: 02/01/2023]
Abstract
The CARICOM region has experienced significant challenges during the COVID-19 pandemic, one being issues surrounding mental health. This article seeks to highlight that mental health was a major issue prior to the pandemic and the situation could be potentially worst. Therefore we suggest supporting communities remains a pivotal tool in the armamentarium in dealing with diseases that have psychosocial aspects. Collaboration with regional bodies, transnational organizations and philanthropic entities and the process of health diplomacy will open the means through which valuable resources can become available. CARICOM as a Regional health body should be empowered to recognize population mental health challenges as a real and present danger to the well-being of the persons under its care and have an actionable plan that is realistic and sustainable.
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Yan Y, Hou J, Li Q, Yu NX. Suicide before and during the COVID-19 Pandemic: A Systematic Review with Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3346. [PMID: 36834037 PMCID: PMC9960664 DOI: 10.3390/ijerph20043346] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/09/2023] [Accepted: 02/11/2023] [Indexed: 06/01/2023]
Abstract
Synthesizing evidence to examine changes in suicide-related outcomes before and during the pandemic can inform suicide management during the COVID-19 crisis. We searched 13 databases as of December 2022 for studies reporting both the pre- and peri-pandemic prevalence of suicidal ideation, suicide attempts, or rate of death by suicide. A random-effects model was used to pool the ratio of peri- and pre-pandemic prevalence of suicidal ideation and attempt (Prevalence Ratio-PR) and rate of death by suicide (Rate Ratio; RR). We identified 51, 55, and 25 samples for suicidal ideation, attempt, and death by suicide. The prevalence of suicidal ideation increased significantly among non-clinical (PR = 1.142; 95% CI: 1.018-1.282; p = 0.024; k = 28) and clinical (PR = 1.134; 95% CI: 1.048-1.227; p = 0.002; k = 23) samples, and pooled estimates differed by population and study design. Suicide attempts were more prevalent during the pandemic among non-clinical (PR = 1.14; 95% CI: 1.053-1.233; p = 0.001; k = 30) and clinical (PR = 1.32; 95% CI: 1.17-1.489; p = 0.000; k = 25) participants. The pooled RR for death by suicide was 0.923 (95% CI: 0.84-1.01; p = 0.092; k = 25), indicating a nonsignificant downward trend. An upward trend of suicidal ideation and suicide attempts was observed during the COVID-19 pandemic, despite suicide rate remaining stable. Our findings suggest that timely prevention and intervention programs are highly needed for non-clinical adult population and clinical patients. Monitoring the real-time and long-run suicide risk as the pandemic evolves is warranted.
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Affiliation(s)
- Yifei Yan
- Department of Social and Behavioural Sciences, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong SAR, China
| | - Jianhua Hou
- Department of Social and Behavioural Sciences, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong SAR, China
| | - Qing Li
- Department of Computing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Nancy Xiaonan Yu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong SAR, China
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Rajapakse T, Silva T, Hettiarachchi NM, Gunnell D, Metcalfe C, Spittal MJ, Knipe D. The Impact of the COVID-19 Pandemic and Lockdowns on Self-Poisoning and Suicide in Sri Lanka: An Interrupted Time Series Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1833. [PMID: 36767200 PMCID: PMC9914278 DOI: 10.3390/ijerph20031833] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/11/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
Evidence from high-income countries suggests that the impact of COVID-19 on suicide and self-harm has been limited, but evidence from low- and middle-income countries is lacking. Using data from a hospital-based self-poisoning register (January 2019-December 2021) and data from national records (2016-2021) of suicide in Sri Lanka, we aimed to assess the impact of the pandemic on both self-poisoning and suicide. We examined changes in admissions for self-poisoning and suicide using interrupted time series (ITS) analysis. For the self-poisoning hospital admission ITS models, we defined the lockdown periods as follows: (i) pre-lockdown: 01/01/2019-19/03/2020; (ii) first lockdown: 20/03/2020-27/06/2020; (iii) post-first lockdown: 28/06/2020-11/05/2021; (iv) second lockdown: 12/05/2021-21/06/2021; and (v) post-second lockdown: 22/06/2021-31/12/2021. For suicide, we defined the intervention according to the pandemic period. We found that during lockdown periods, there was a reduction in hospital admissions for self-poisoning, with evidence that admission following self-poisoning remained lower during the pandemic than would be expected based on pre-pandemic trends. In contrast, there was no evidence that the rate of suicide in the pandemic period differed from that which would be expected. As the long-term socioeconomic impacts of the pandemic are realised, it will be important to track rates of self-harm and suicide in LMICs to inform prevention.
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Affiliation(s)
- Thilini Rajapakse
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya 20400, Sri Lanka
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya 20400, Sri Lanka
| | - Tharuka Silva
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya 20400, Sri Lanka
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya 20400, Sri Lanka
| | | | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
- National Institute of Health Research Biomedical Research Centre, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
| | - Chris Metcalfe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
| | - Matthew J. Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Duleeka Knipe
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya 20400, Sri Lanka
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
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Lund JJ, Tomsich E, Schleimer JP, Pear VA. Changes in self-harm and suicide in California from 2017-2021: a population-based study. RESEARCH SQUARE 2023:rs.3.rs-2395128. [PMID: 36711840 PMCID: PMC9882613 DOI: 10.21203/rs.3.rs-2395128/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background : Self-harm and suicide are major public health problems with immediate and long-term effects on individuals, families, and communities. In 2020 and 2021, stressors wrought by the COVID-19 pandemic, stay-at-home mandates, economic turmoil, social unrest, and growing inequality likely modified risk for self-harm. The coinciding surge in firearm purchasing may have increased risk for firearm suicide. In this study, we examined changes in counts and rates of fatal and nonfatal intentional self-harm in California across sociodemographic groups during the first two years of the COVID-19 pandemic relative to prior years. Methods: We used California-wide death data and University of California (UC)-wide hospital data to summarize fatal and nonfatal instances of intentional self-harm across race/ethnicity, age, education, gender, region, and method of harm. We compared case counts and rates in 2020 and 2021 with 2017-2019 averages. Results : Suicide decreased overall in 2020 (4123 deaths; 10.5 per 100,000) and 2021 (4104; 10.4 per 100,000), compared to pre-pandemic (4484; 11.4 per 100,000). The decrease in counts was driven largely by males, white, and middle-aged Californians. Conversely, Black Californians and young people (age 10-19) experienced increased burden and rates of suicide. Firearm suicide also decreased following the onset of the pandemic, but relatively less than overall suicide; as a result, the proportion of suicides that involved a firearm increased (from 36.1% pre-pandemic to 37.6% in 2020 and 38.1% in 2021). Females, people aged 20-29, and Black Californians had the largest increase in the likelihood of using a firearm in suicide following the onset of the pandemic. Counts and rates of nonfatal, intentional self-harm in UC hospitals increased in 2020 (2160; 30.7 per 100,000) and 2021 (2175; 30.9 per 100,000) compared to pre-pandemic (2083; 29.6 per 100,000), especially among young people (age 10-19), females, and Hispanic Californians. Conclusions : The COVID-19 pandemic and co-occurring stressors coincided with heterogeneous changes in risk of self-harm and suicide across the California population. Marginalized racial groups, females, and younger people experienced increased risk for self-harm, particularly involving a firearm. Public health intervention and policy action are necessary to prevent fatal and nonfatal self-harm injuries and reduce related inequities.
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Farajzadeh N, Sadeghzadeh N. NSSI questionnaires revisited: A data mining approach to shorten the NSSI questionnaires. PLoS One 2023; 18:e0284588. [PMID: 37083960 PMCID: PMC10121061 DOI: 10.1371/journal.pone.0284588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/02/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Non-suicidal self-injury (NSSI) is a psychological disorder that the sufferer consciously damages their body tissues, often too severe that requires intensive care medicine. As some individuals hide their NSSI behaviors, other people can only identify them if they catch them while injuring, or via dedicated questionnaires. However, questionnaires are long and tedious to answer, thus the answers might be inconsistent. Hence, in this study for the first time, we abstracted a larger questionnaire (of 662 items in total) to own only 22 items (questions) via data mining techniques. Then, we trained several machine learning algorithms to classify individuals based on their answers into two classes. METHODS Data from 277 previously-questioned participants is used in several data mining methods to select features (questions) that highly represent NSSI, then 245 different people were asked to participate in an online test to validate those features via machine learning methods. RESULTS The highest accuracy and F1 score of the selected features-via the Genetics algorithm-are 80.0% and 74.8% respectively for a Random Forest algorithm. Cronbach's alpha of the online test (validation on the selected features) is 0.82. Moreover, results suggest that an MLP can classify participants into two classes of NSSI Positive and NSSI Negative with 83.6% accuracy and 83.7% F1-score based on the answers to only 22 questions. CONCLUSION While previously psychologists used many combined questionnaires to see whether someone is involved in NSSI, via various data mining methods, the present study showed that only 22 questions are enough to predict if someone is involved or not. Then different machine learning algorithms were utilized to classify participants based on their NSSI behaviors, among which, an MLP with 10 hidden layers had the best performance.
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Affiliation(s)
- Nacer Farajzadeh
- Faculty of Information Technology and Computer Engineering, Azarbaijan Shahid Madani University, Tabriz, Iran
- Artificial Intelligence and Machine Learning Research Laboratory, Azarbaijan Shahid Madani University, Tabriz, Iran
| | - Nima Sadeghzadeh
- Faculty of Information Technology and Computer Engineering, Azarbaijan Shahid Madani University, Tabriz, Iran
- Artificial Intelligence and Machine Learning Research Laboratory, Azarbaijan Shahid Madani University, Tabriz, Iran
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Has the COVID-19 pandemic influenced suicide rates differentially according to socioeconomic indices and ethnicity? More evidence is needed globally. Epidemiol Psychiatr Sci 2022; 31:e72. [PMID: 36217667 PMCID: PMC9579839 DOI: 10.1017/s2045796022000543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The COVID-19 pandemic has harmed many people's mental health globally. Whilst the evidence generated thus far from high-income countries regarding the pandemic's impact on suicide rates is generally reassuring, we know little about its influence on this outcome in lower- and middle-income countries or among marginalised and disadvantaged people. There are some signals for concern regarding the pandemic's potentially unequal impact on suicide rates, with some of the affected demographic subgroups and regions being at elevated risk before the pandemic began. However, the evidence-base for this topic is currently sparse, and studies conducted to date have generally not taken account of pre-pandemic temporal trends. The collection of accurate, complete and comparable data on suicide rate trends in ethnic minority and low-income groups should be prioritised. The vulnerability of low-income groups will likely be exacerbated further by the current energy supply and cost-of-living crises in many countries. It is therefore crucial that reassuring messaging highlighting the stability of suicide rates during the pandemic does not lead to complacency among policymakers.
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Steeg S, John A, Gunnell DJ, Kapur N, Dekel D, Schmidt L, Knipe D, Arensman E, Hawton K, Higgins JPT, Eyles E, Macleod-Hall C, McGuiness LA, Webb RT. The impact of the COVID-19 pandemic on presentations to health services following self-harm: systematic review. Br J Psychiatry 2022; 221:603-612. [PMID: 35816104 DOI: 10.1192/bjp.2022.79] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Evidence on the impact of the pandemic on healthcare presentations for self-harm has accumulated rapidly. However, existing reviews do not include studies published beyond 2020. AIMS To systematically review evidence on presentations to health services following self-harm during the COVID-19 pandemic. METHOD A comprehensive search of databases (WHO COVID-19 database; Medline; medRxiv; Scopus; PsyRxiv; SocArXiv; bioRxiv; COVID-19 Open Research Dataset, PubMed) was conducted. Studies published from 1 January 2020 to 7 September 2021 were included. Study quality was assessed with a critical appraisal tool. RESULTS Fifty-one studies were included: 57% (29/51) were rated as 'low' quality, 31% (16/51) as 'moderate' and 12% (6/51) as 'high-moderate'. Most evidence (84%, 43/51) was from high-income countries. A total of 47% (24/51) of studies reported reductions in presentation frequency, including all six rated as high-moderate quality, which reported reductions of 17-56%. Settings treating higher lethality self-harm were overrepresented among studies reporting increased demand. Two of the three higher-quality studies including study observation months from 2021 reported reductions in self-harm presentations. Evidence from 2021 suggests increased numbers of presentations among adolescents, particularly girls. CONCLUSIONS Sustained reductions in numbers of self-harm presentations were seen into the first half of 2021, although this evidence is based on a relatively small number of higher-quality studies. Evidence from low- and middle-income countries is lacking. Increased numbers of presentations among adolescents, particularly girls, into 2021 is concerning. Findings may reflect changes in thresholds for help-seeking, use of alternative sources of support and variable effects of the pandemic across groups.
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Affiliation(s)
- Sarah Steeg
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester, UK; and Manchester Academic Health Science Centre, UK
| | - Ann John
- Medical School, Swansea University, UK; and Public Health Wales NHS Trust, UK
| | - David J Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, UK; and National Institute for Health Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, UK
| | - Nav Kapur
- Division of Psychology and Mental Health, University of Manchester, UK;NIHR Greater Manchester Patient Safety Translational Research Centre, UK; and Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Dana Dekel
- Department of Population Psychiatry, Suicide and Informatics, Swansea University, UK
| | - Lena Schmidt
- Sciome LLC, North Carolina, USA; Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Ella Arensman
- School of Public Health and National Suicide Research Foundation, University College Cork, Ireland; and Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Australia
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, UK; and Warneford Hospital, Oxford Health NHS Foundation Trust, UK
| | - Julian P T Higgins
- National Institute for Health Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, UK; National Institute for Health Research Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, UK; and Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Emily Eyles
- National Institute for Health Research Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, UK; and Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | | | - Luke A McGuiness
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Roger T Webb
- Division of Psychology and Mental Health, University of Manchester, UK; and NIHR Greater Manchester Patient Safety Translational Research Centre, UK
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