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Clapperton A, Spittal MJ, Dwyer J, Nicholas A, Pirkis J. Suicide within five years of hospital-treated self-harm: A data linkage cohort study. J Affect Disord 2024; 356:528-534. [PMID: 38657761 DOI: 10.1016/j.jad.2024.04.092] [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: 02/25/2024] [Revised: 04/17/2024] [Accepted: 04/21/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Hospital-treated self-harm is a strong predictor of suicide and hospital contacts may include missed opportunities for suicide prevention. We conducted a data linkage study to identify factors associated with suicide in people treated in hospital for self-harm in Victoria, Australia. METHOD We undertook a cohort study following 14,307 people treated in hospital for an episode of self-harm (i.e., either admitted or non-admitted ED presentations) over the period 2011 and 2012 and used data from the Victorian Suicide Register to identify suicides within 5 years. We estimated unadjusted hazard ratios (HRs) for suicide using survival analysis for each exposure variable and then computed adjusted HRs using a multivariate model that included all exposure variables. RESULTS Among females, the risk of suicide was higher in those aged 50-74 years (HR 1.78; Cl: 1.02, 3.10), residing in areas of least disadvantage (HR 2.58; Cl: 1.21, 5.50), who used hanging as a method of self-harm (HR 5.17; Cl: 1.86, 14.35) and with organic disorders (HR 6.71; Cl: 2.61, 17.23) or disorders of adult personality and behaviour (HR 2.10; Cl: 1.03, 4.27). In males, the risk of suicide was higher in those who used motor vehicle exhaust gas (MVEG) as a method of self-harm (HR 3.48; Cl: 1.73, 7.01), and with disorders due to psychoactive substance abuse (HR 1.75; Cl: 1.14, 2.67). CONCLUSION Although all patients should be routinely assessed for risk and needs following hospital-treated self-harm including appropriate follow-up care, people who use MVEG or hanging as methods of self-harm are obvious candidates for close follow-up.
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Affiliation(s)
- Angela Clapperton
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Matthew J Spittal
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Jeremy Dwyer
- Coroners Prevention Unit, Coroners Court of Victoria, Melbourne, VIC, Australia
| | - Angela Nicholas
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Jane Pirkis
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Arya V, Page A, Vijayakumar L, Onie S, Tapp C, John A, Pirkis J, Armstrong G. Changing profile of suicide methods in India: 2014-2021. J Affect Disord 2023; 340:420-426. [PMID: 37573889 DOI: 10.1016/j.jad.2023.08.010] [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: 06/27/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Restricting access to suicide methods is one of the most effective suicide prevention approaches. METHODS Trends in method specific suicide rates (2014-2021) in India were calculated using National Crime Records Bureau data (NCRB) by sex and geographical region. Joinpoint regression analysis was used to empirically identify any changes in suicide trends. RESULTS Suicide rates by hanging increased from 6.08 to 10.0 per 100,000 population among males and from 2.55 to 3.56 per 100,000 among females over the study period. Insecticide poisoning suicide rates also increased from 1.51 to 2.73 per 100,000 among males and from 0.74 to 1.14 per 100,000 among females. Suicide by self-immolation decreased over the study period among both sexes. In general, these national trends were mirrored among different regions. Joinpoint regression indicated an increase in suicide by hanging (annual percentage change (APC) of 12.3 among males between 2018 and 2021 and 4.9 among females between 2014 and 2021) and an increase in male suicide by insecticide poisoning between 2014 and 2021 (APC of 4.2) while a decrease in self-immolation rates was noted among males (APC of -12.7 between 2014 and 2021) and females (APC of -16.5 between 2016 and 2021). LIMITATION The NCRB data might underestimate true suicide rates. CONCLUSION Hanging suicides and insecticides poisoning suicides observed an increasing trend between 2014 and 2021. Self-immolation rates decreased during the study period which might be, in part, associated with the initiative to provide clean cooking fuel to households. Ban on lethal pesticides must be prioritised which might help lower insecticide poisoning suicide rates.
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Affiliation(s)
- Vikas Arya
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Australia.
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Australia
| | | | | | - Caley Tapp
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia; Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
| | - Ann John
- Swansea University Medical School, UK
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Gregory Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Australia
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Leckning B, Borschmann R, Guthridge S, Silburn SR, Hirvonen T, Robinson GW. Suicides in Aboriginal and non-Aboriginal people following hospital admission for suicidal ideation and self-harm: A retrospective cohort data linkage study from the Northern Territory. Aust N Z J Psychiatry 2023; 57:391-400. [PMID: 35642543 PMCID: PMC9950595 DOI: 10.1177/00048674221099822] [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] [Indexed: 11/15/2022]
Abstract
PURPOSE This study aimed to explore risk factors for suicide in Aboriginal and non-Aboriginal people following hospital admission for suicidal ideation and self-harm in the Northern Territory, Australia to help clarify opportunities for improved care and intervention for these population groups. METHODS Individuals with at least one hospital admission involving suicidal ideation and/or self-harm between 1 July 2001 and 31 December 2013 were retrospectively recruited and followed up using linked mortality records to 31 December 2014. Survival analyses stratified by Indigenous status identified socio-demographic and clinical characteristics from index hospital admissions associated with suicide. RESULTS Just over half of the 4391 cohort members identified as Aboriginal (n = 2304; 52.4%). By 2014, 281 deaths were observed comprising 68 suicides, representing a 2.6% and 2.0% probability of suicide for Aboriginal and non-Aboriginal people, respectively. After adjusting for other characteristics, a higher risk of suicide was associated with male sex (Aboriginal adjusted hazard ratio: 4.14; 95% confidence interval: [1.76, 9.75]; non-Aboriginal adjusted hazard ratio: 5.96; 95% confidence interval: [1.98, 17.88]) and repeat hospital admissions involving self-harm (Aboriginal adjusted hazard ratio: 1.37; 95% confidence interval: [1.21, 1.55]; non-Aboriginal adjusted hazard ratio: 1.29; 95% confidence interval: [1.10, 1.51]). Severe mental disorders were associated with a four times higher risk of suicide (adjusted hazard ratio: 4.23; 95% confidence interval: [1.93, 9.27]) in Aboriginal people only. CONCLUSION The findings highlight non-clinical risk factors for suicide that suggest the need for comprehensive psychosocial assessment tailored to Aboriginal and non-Aboriginal people hospitalised with suicidal ideation or self-harm. Implementing appropriate management and aftercare within a broader public health framework is needed to support recovery and reduce long-term suicide risk in the community, especially for Aboriginal people and males.
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Affiliation(s)
- Bernard Leckning
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.,Black Dog Institute, University of New South Wales Sydney, Randwick, NSW, Australia
| | - Rohan Borschmann
- Justice Health Unit, Centre for Health Equity, The University of Melbourne, Victoria, Australia.,Department of Psychiatry, University of Oxford, Oxford, UK.,The Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Steven Guthridge
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
| | - Sven R Silburn
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
| | - Tanja Hirvonen
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Gary W Robinson
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
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Cai Z, Junus A, Chang Q, Yip PSF. The lethality of suicide methods: A systematic review and meta-analysis. J Affect Disord 2022; 300:121-129. [PMID: 34953923 DOI: 10.1016/j.jad.2021.12.054] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/08/2021] [Accepted: 12/18/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The use of suicide methods largely determines the outcome of suicide acts. However, no existing meta-analysis has assessed the case fatality rates (CFRs) by different suicide methods. The current study aimed to fill this gap. METHODS We searched Scopus, Web of Science, PubMed, ProQuest and Embase for studies reporting method-specific CFRs in suicide, published from inception to 31 December 2020. A random-effect model meta-analysis was applied to compute pooled estimates. RESULTS Of 10,708 studies screened, 34 studies were included in the meta-analysis. Based on the suicide acts that resulted in death or hospitalization, firearms were found to be the most lethal method (CFR:89.7%), followed by hanging/suffocation (84.5%), drowning (80.4%), gas poisoning (56.6%), jumping (46.7%), drug/liquid poisoning (8.0%) and cutting (4.0%). The rank of the lethality for different methods remained relatively stable across study setting, sex and age group. Method-specific CFRs for males and females were similar for most suicide methods, while method-CFRs were specifically higher in older adults. CONCLUSIONS This study is the first meta-analysis that provides significant evidence for the wide variation of the lethality of suicide methods. Restricting highly lethal methods based on local context is vital in suicide prevention.
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Affiliation(s)
- Ziyi Cai
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China
| | - Alvin Junus
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China
| | - Qingsong Chang
- School of Sociology and Anthropology, Xiamen University, Xiamen, China.
| | - Paul S F Yip
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China; Hong Kong Jockey Club Center for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China.
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Knipe D, Silva T, Aroos A, Senarathna L, Hettiarachchi NM, Galappaththi SR, Spittal MJ, Gunnell D, Metcalfe C, Rajapakse T. Hospital presentations for self-poisoning during COVID-19 in Sri Lanka: an interrupted time-series analysis. Lancet Psychiatry 2021; 8:892-900. [PMID: 34332697 PMCID: PMC8445699 DOI: 10.1016/s2215-0366(21)00242-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is widespread concern over the impact of public health measures, such as lockdowns, associated with COVID-19 on mental health, including suicide. High-quality evidence from low-income and middle-income countries, where the burden of suicide and self-harm is greatest, is scarce. We aimed to determine the effect of the pandemic on hospital presentations for self-poisoning. METHODS In this interrupted time-series analysis, we established a new self-poisoning register at the tertiary care Teaching Hospital Peradeniya in Sri Lanka, a lower-middle-income country. Using a standard extraction sheet, data were gathered for all patients admitted to the Toxicology Unit with self-poisoning between Jan 1, 2019, and Aug 31, 2020. Only patients classified by the treating clinician as having intentionally self-poisoned were included. Data on date of admission, age or date of birth, sex, and poisoning method were collected. No data on ethnicity were available. We used interrupted time-series analysis to calculate weekly hospital admissions for self-poisoning before (Jan 1, 2019-March 19, 2020) and during (March 20-Aug 31, 2020) the pandemic, overall and by age (age <25 years vs ≥25 years) and sex. Individuals with missing date of admission were excluded from the main analysis. FINDINGS Between Jan 1, 2019, and Aug 31, 2020, 1401 individuals (584 [41·7%] males, 761 [54·3%] females, and 56 [4·0%] of unknown sex) presented to the hospital with self-poisoning and had date of admission data. A 32% (95% CI 12-48) reduction in hospital presentations for self-poisoning in the pandemic period compared with pre-pandemic trends was observed (rate ratio 0·68, 95% CI 0·52-0·88; p=0·0032). We found no evidence that the impact of the pandemic differed by sex (rate ratio 0·64, 95% CI 0·44-0·94, for females vs 0·85, 0·57-1·26, for males; pinteraction=0·43) or age (0·64, 0·44-0·93, for patients aged <25 years vs 0·81, 0·57-1·16, for patients aged ≥25 years; pinteraction=0·077). INTERPRETATION This is the first study from a lower-middle-income country to estimate the impact of the pandemic on self-harm (non-fatal) accounting for underlying trends. If the fall in hospital presentations during the pandemic reflects a reduction in the medical treatment of people who have self-poisoned, rather than a true fall in incidence, then public health messages should emphasise the importance of seeking help early. FUNDING Elizabeth Blackwell Institute University of Bristol, Wellcome Trust, and Centre for Pesticide Suicide Prevention. TRANSLATIONS For the Sinhalese and Tamil translations of the abstract see Supplementary Materials section.
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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, Peradeniya, Sri Lanka.
| | - Tharuka Silva
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Azra Aroos
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Lalith Senarathna
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; Department of Health Promotion, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | | | | | - Matthew J Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Chris Metcalfe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Thilini Rajapakse
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Robinson J, Witt K, Lamblin M, Spittal MJ, Carter G, Verspoor K, Page A, Rajaram G, Rozova V, Hill NTM, Pirkis J, Bleeker C, Pleban A, Knott JC. Development of a Self-Harm Monitoring System for Victoria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249385. [PMID: 33333970 PMCID: PMC7765445 DOI: 10.3390/ijerph17249385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/28/2020] [Accepted: 12/10/2020] [Indexed: 12/18/2022]
Abstract
The prevention of suicide and suicide-related behaviour are key policy priorities in Australia and internationally. The World Health Organization has recommended that member states develop self-harm surveillance systems as part of their suicide prevention efforts. This is also a priority under Australia’s Fifth National Mental Health and Suicide Prevention Plan. The aim of this paper is to describe the development of a state-based self-harm monitoring system in Victoria, Australia. In this system, data on all self-harm presentations are collected from eight hospital emergency departments in Victoria. A natural language processing classifier that uses machine learning to identify episodes of self-harm is currently being developed. This uses the free-text triage case notes, together with certain structured data fields, contained within the metadata of the incoming records. Post-processing is undertaken to identify primary mechanism of injury, substances consumed (including alcohol, illicit drugs and pharmaceutical preparations) and presence of psychiatric disorders. This system will ultimately leverage routinely collected data in combination with advanced artificial intelligence methods to support robust community-wide monitoring of self-harm. Once fully operational, this system will provide accurate and timely information on all presentations to participating emergency departments for self-harm, thereby providing a useful indicator for Australia’s suicide prevention efforts.
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Affiliation(s)
- Jo Robinson
- Orygen, Parkville, VIC 3052, Australia; (K.W.); (M.L.); (G.R.); (N.T.M.H.); (C.B.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
- Correspondence: ; Tel.: +61-393-420-2866
| | - Katrina Witt
- Orygen, Parkville, VIC 3052, Australia; (K.W.); (M.L.); (G.R.); (N.T.M.H.); (C.B.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Michelle Lamblin
- Orygen, Parkville, VIC 3052, Australia; (K.W.); (M.L.); (G.R.); (N.T.M.H.); (C.B.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Matthew J. Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010 Australia; (M.J.S.); (J.P.)
| | - Greg Carter
- Centre for Brain and Mental Health Research, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia;
- Calvary Mater Newcastle, Callaghan, NSW 2308, Australia
| | - Karin Verspoor
- School of Computing and Information Systems, The University of Melbourne, Parkville, VIC 3052, Australia; (K.V.); (V.R.)
- Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, VIC 3000, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia;
| | - Gowri Rajaram
- Orygen, Parkville, VIC 3052, Australia; (K.W.); (M.L.); (G.R.); (N.T.M.H.); (C.B.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Vlada Rozova
- School of Computing and Information Systems, The University of Melbourne, Parkville, VIC 3052, Australia; (K.V.); (V.R.)
| | - Nicole T. M. Hill
- Orygen, Parkville, VIC 3052, Australia; (K.W.); (M.L.); (G.R.); (N.T.M.H.); (C.B.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
- Telethon Kids Institute, Nedlands, WA 6009, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010 Australia; (M.J.S.); (J.P.)
| | - Caitlin Bleeker
- Orygen, Parkville, VIC 3052, Australia; (K.W.); (M.L.); (G.R.); (N.T.M.H.); (C.B.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Alex Pleban
- Mid-West Area Mental Health Service, Emergency Department, Sunshine Hospital, Sunshine, VIC 3021, Australia;
| | - Jonathan C. Knott
- Centre for Integrated Critical Care, Melbourne Medical School, The University of Melbourne, Parkville, VIC 3010, Australia;
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Abstract
Background: Some shooting ranges have adopted policies to prevent suicides at their facilities. Little data have been available to guide them. Aim: We aimed to describe the incidence and characteristics of suicides at public shooting ranges. Method: We conducted text searches of 63,710 firearm suicides in the 16 states participating in the National Violent Death Reporting System from 2004 to 2015 to identify those occurring at public shooting ranges. Results: A total of 118 (or 0.18%) occurred at a shooting range, or 0.12 per million population. If that rate held for the nation as a whole, there would have been roughly 35 shooting range suicides per year during the study period. In total, 88% of decedents arrived alone. When gun ownership was noted, 86% of guns were rented from the range. In some cases, people drove to the range and took their lives in the parking lot with their own gun. Limitations: Our search strategy may have missed cases, and the data may not be nationally representative. Conclusion: Suicides at shooting ranges are rare. Policies that some ranges have adopted - such as allowing rentals only if the person is not alone - are responsive to the actual characteristics of these deaths and could potentially prevent most.
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Affiliation(s)
- Catherine Barber
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Hannah Walters
- Department of Sociology, Boston University, Boston, MA, USA
| | | | - David Hemenway
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Are young female suicides increasing? A comparison of sex-specific rates and characteristics of youth suicides in Australia over 2004-2014. BMC Public Health 2019; 19:1389. [PMID: 31660926 PMCID: PMC6819336 DOI: 10.1186/s12889-019-7742-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 10/03/2019] [Indexed: 12/11/2022] Open
Abstract
Background Australian mortality statistics suggest that young female suicides have increased since 2004 in comparison to young males, a pattern documented across other Western high-income countries. This may indicate a need for more targeted and multifaceted youth suicide prevention efforts. However, sex-based time trends are yet to be tested empirically within a comprehensive Australian sample. The aim of this study was to examine changes over time in sex-based rates and characteristics of all suicides among young people in Australia (2004–2014). Methods National Coronial Information System and Australian Bureau of Statistics data provided annual suicide counts and rates for 10–24-year-olds in Australia (2004–2014), stratified by sex, age group, Indigenous status and methods. Negative binomial regressions estimated time trends in population-stratified rates, and multinomial logistic regressions estimated time trends by major suicide methods (i.e., hanging, drug poisoning). Results Between 2004 and 2014, 3709 young Australians aged 10–24 years died by suicide. Whilst, overall, youth suicide rates did not increase significantly in Australia between 2004 and 2014, there was a significant increase in suicide rates for females (incident rate ratio [IRR] 1.03, 95% confidence interval [CI] 1.01 to 1.06), but not males. Rates were consistently higher among Aboriginal/Torres Strait Islander youth, males, and in older (20–24-years) as compared to younger (15–19 years) age groups. Overall, the odds of using hanging as a method of suicide increased over time among both males and females, whilst the odds of using drug-poisoning did not change over this period. Conclusions We showed that suicide rates among young females, but not young males, increased over the study period. Patterns were observed in the use of major suicide methods with hanging the most frequently used method among both sexes and more likely among younger and Aboriginal/Torres Strait Islander groups. Findings highlight the need to broaden current conceptualizations of youth suicide to one increasingly involving young females, and strengthen the case for a multifaceted prevention approach that capitalize on young females’ greater help-seeking propensity.
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9
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Suicide by hanging is a priority for suicide prevention: method specific suicide in India (2001-2014). J Affect Disord 2019; 257:1-9. [PMID: 31299398 DOI: 10.1016/j.jad.2019.07.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/02/2019] [Accepted: 07/02/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND India accounts for over a quarter of the global burden of suicide. One of the most effective population level suicide prevention strategies has been restricting access to suicide means. METHOD Trends in method specific suicide rates (2001-14) were calculated using National Crime Records Bureau data stratified by sex, age-group, and geographical region. Multilevel negative binomial regression models stratified by sex and suicide method were specified to investigate associations between state-level indicators of economic development, education, agricultural pesticide use and religious factors. RESULTS Suicide by hanging increased by 56% (from 3.9 to 6.1 per 100,000) among males and by 24% (from 2.1 to 2.6 per 100,000) among females over the study period while incidence of insecticide poisoning decreased by 44% (from 2.7 to 1.5 per 100,000) among males and by 52% (from 1.7 to 0.8 per 100,000) among females. In general, states with higher levels of development, higher agricultural employment and higher literacy had higher rates of suicide for each suicide method. States with higher levels of agricultural pesticide use had higher rates of insecticide poisoning suicides. LIMITATION Reported rates might be an underestimation of the true rates as the official data used for the analysis likely underestimates the actual number of suicide deaths in India. CONCLUSION Responsible reporting of suicide by hanging in the media, and limiting fictional portrayals of this method may be useful areas for prevention. Further restrictions on production and sales of highly hazardous pesticides may also help with further reductions in suicide by pesticide poisoning.
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Atkinson JA, Page A, Heffernan M, McDonnell G, Prodan A, Campos B, Meadows G, Hickie IB. The impact of strengthening mental health services to prevent suicidal behaviour. Aust N Z J Psychiatry 2019; 53:642-650. [PMID: 30541332 DOI: 10.1177/0004867418817381] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Successive suicide prevention frameworks and action plans in Australia and internationally have called for improvements to mental health services and enhancement of workforce capacity. However, there is debate regarding the priorities for resource allocation and the optimal combination of mental health services to best prevent suicidal behaviour. This study investigates the potential impacts of service capacity improvements on the incidence of suicidal behaviour in the Australian context. METHODS A system dynamics model was developed to investigate the optimal combination of (1) secondary (acute) mental health service capacity, (2) non-secondary (non-acute) mental health service capacity and (3) resources to re-engage those lost to services on the incidence of suicidal behaviour over the period 2018-2028 for the Greater Western Sydney (Australia) population catchment. The model captured population and behavioural dynamics and mental health service referral pathways and was validated using population survey and administrative data, evidence syntheses and an expert stakeholder group. RESULTS Findings suggest that 28% of attempted suicide and 29% of suicides could be averted over the forecast period based on a combination of increases in (1) hospital staffing (with training in trauma-informed care), (2) non-secondary health service capacity, (3) expansion of mental health assessment capacity and (4) re-engagement of at least 45% of individuals lost to services. Reduction in the number of available psychiatric beds by 15% had no substantial impact on the incidence of attempted suicide and suicide over the forecast period. CONCLUSION This study suggests that more than one-quarter of suicides and attempted suicides in the Greater Western Sydney population catchment could potentially be averted with a combination of increases to hospital staffing and non-secondary (non-acute) mental health care. Reductions in tertiary care services (e.g. psychiatric hospital beds) in combination with these increases would not adversely affect subsequent incidence of suicidal behaviour.
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Affiliation(s)
- Jo-An Atkinson
- 1 Decision Analytics, Sax Institute, Haymarket, NSW, Australia.,2 Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia.,3 Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Andrew Page
- 2 Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | | | - Geoff McDonnell
- 1 Decision Analytics, Sax Institute, Haymarket, NSW, Australia
| | - Ante Prodan
- 5 School of Computing, Engineering and Mathematics, Western Sydney University, Penrith, NSW, Australia
| | - Bill Campos
- 6 Western Sydney Primary Health Network, WentWest, Blacktown, NSW, Australia
| | - Graham Meadows
- 7 Department of Psychiatry, Monash University, Dandenong, VIC, Australia.,8 Adult Mental Health Services, Monash Health, Dandenong, VIC, Australia
| | - Ian B Hickie
- 9 Brain and Mind Centre, Camperdown, NSW, Australia
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Beck B, Smith K, Mercier E, Gabbe B, Bassed R, Mitra B, Teague W, Siedenburg J, McLellan S, Cameron P. Differences in the epidemiology of out-of-hospital and in-hospital trauma deaths. PLoS One 2019; 14:e0217158. [PMID: 31163036 PMCID: PMC6548370 DOI: 10.1371/journal.pone.0217158] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 05/06/2019] [Indexed: 11/30/2022] Open
Abstract
Background Trauma is a leading cause of mortality. Holistic views of trauma systems consider injury as a public health problem that requires efforts in primary, secondary and tertiary prevention. However, the performance of trauma systems is commonly judged on the in-hospital mortality rate. Such a focus misses opportunities to consider all deaths within a population, to understand differences in in-hospital and out-of-hospital trauma deaths and to inform population-level injury prevention efforts. The aim of this study was to provide an epidemiological overview of out-of-hospital and in-hospital trauma deaths in a geographically-defined area over a 10-year period. Methods We performed a population-based review of out-of-hospital and in-hospital trauma deaths over the period of 01 July 2006 to 30 June 2016 in Victoria, Australia, using data from the National Coronial Information System and the Victorian State Trauma Registry. Temporal trends in population-based incidence rates were evaluated. Results Over the study period, there were 11,246 trauma deaths, of which 71% were out-of-hospital deaths. Out-of-hospital trauma deaths commonly resulted from intentional self-harm events (50%) and transport events (35%), while in-hospital trauma deaths commonly resulted from low falls (≤1 metre) (50%). The incidence of overall trauma deaths did not change over the study period (incidence rate ratio 0.998; 95%CI: 0.991, 1.004; P = 0.56). Conclusions Out-of-hospital deaths accounted for most trauma deaths. Given the notable differences between out-of-hospital and in-hospital trauma deaths, monitoring of all trauma deaths is necessary to inform injury prevention activities and to reduce trauma mortality. The absence of a change in the incidence of both out-of-hospital and in-hospital trauma deaths demonstrates the need for enhanced activities across all aspects of injury prevention.
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Affiliation(s)
- Ben Beck
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- * E-mail:
| | - Karen Smith
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
- Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia
| | - Eric Mercier
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Laval University, Quebec City, Quebec, Canada
- Emergency and Trauma Centre, The Alfred, Melbourne, Victoria, Australia
| | - Belinda Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Richard Bassed
- Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia
| | - Biswadev Mitra
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, The Alfred, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
| | - Warwick Teague
- Trauma Service, The Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Surgical Research Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Josine Siedenburg
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susan McLellan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, The Alfred, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
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Too LS, Law PCF, Spittal MJ, Page A, Milner A. Widening socioeconomic inequalities in Australian suicide, despite recent declines in suicide rates. Soc Psychiatry Psychiatr Epidemiol 2018; 53:969-976. [PMID: 29713729 DOI: 10.1007/s00127-018-1527-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 04/25/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE This study aims to investigate trends in socioeconomic inequalities of suicide from 1979 to 2013 for Australian males and females aged 15-34 years and 35-64 years. METHODS Data on suicides and population were obtained from national registries. An area-based measure of socioeconomic status (SES) was used, and categorized into low, middle, and high SES areas. Suicide rates for each SES groups were estimated using a negative binomial regression model, adjusted for confounders. Socioeconomic inequalities in suicide were assessed using absolute and relative risk of low-to-high SES areas. Secular changes in socioeconomic inequalities were assessed using trend tests for relative risk. RESULTS For young males, there was an increase in socioeconomic inequality driven by a significant decrease in suicide rates in high SES areas. For older males, inequality in suicide increased by 29%, which was related to a marked increase in suicide rates in low SES areas. Inequalities in both young and older female suicides also increased. These increases occurred when corresponding suicide rates in high SES areas decreased. CONCLUSIONS Recent widening socioeconomic inequalities in Australian suicide have been primarily associated with declines in suicide rates in high SES areas. However, an increasing inequality in older male suicide is linked with low SES. Efforts targeting people from poor areas, especially older males, should be considered when developing suicide prevention strategy.
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Affiliation(s)
- Lay San Too
- Melbourne School of Population and Global Health, Centre for Mental Health, The University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Phillip C F Law
- Melbourne School of Population and Global Health, Centre for Health Equity, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Matthew J Spittal
- Melbourne School of Population and Global Health, Centre for Mental Health, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Andrew Page
- Centre for Health Research, University of Western Sydney, Kingswood, NSW, 2747, Australia
| | - Allison Milner
- Melbourne School of Population and Global Health, Centre for Health Equity, The University of Melbourne, Parkville, VIC, 3010, Australia
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Taylor R, Page A, Wodak A, Dudley M, Munot S, Morrell S. Confluence of suicide and drug overdose epidemics in young Australian males: common causality? BMC Public Health 2018; 18:965. [PMID: 30075719 PMCID: PMC6090755 DOI: 10.1186/s12889-018-5875-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 07/23/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Young adult (aged 20-34) males experience higher mortality than females, and in age groups immediately younger and older, and with considerable variation in death rates over time. Trends in mortality and the cause structure of deaths among young adult Australian males over 1979-2011 are investigated, with a focus on suicide and drug overdose. METHODS Mortality data by age for the period 1979 to 2011 and Australian population figures were obtained from the Australian Bureau of Statistics (ABS). Cause of death was investigated using relevant International Classification of Diseases (ICD) codes, and mortality by cause was examined graphically over time according to various ICD aggregations. Mortality trends were contextualised in relation to labour market changes occurring in Australia from the 1980s to early 2000s. RESULTS Although motor vehicle accident (MVA) mortality declined by half between 1980 and 1998 in males, this did not translate into a reduction in total young male mortality because of simultaneous increases in suicide, and drug-related deaths classified as either poisoning (external cause) or drug dependence (mental disorders). When both suicide and drug-related deaths declined concurrently after 1998, total 20-34 year male mortality declined by almost half (46%) over 1998-2011. Declines in external cause mortality accounted for 63% of the total mortality decline in 20-34 year males over 1998-2011. The close temporal coincidence (statistically significant) of increases and declines in suicide and drug-related deaths over a decade suggests related causality. CONCLUSIONS The coincidence of young male suicide and drug overdose mortality epidemics over the study period (excess deaths: 5000) suggest related causality such as exposure to common factors, including the labour market liberalisation and de-regulation of the 1990s, and deserves further investigation.
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Affiliation(s)
- Richard Taylor
- School of Public Health and Community Medicine (SPHCM), Faculty of Medicine, University of New South Wales (UNSW), Kensington Campus, Samuels Building, Level 2, Room 223, Botany St, Gate 11, Randwick (Sydney), 2052 NSW Australia
| | - Andrew Page
- School of Population Health, Western Sydney University, Sydney, Australia
| | - Alex Wodak
- Emeritus Consultant, St Vincent’s Hospital, Darlinghurst, Sydney, 2010 NSW Australia
| | - Michael Dudley
- School of Psychiatry, University of NSW, Sydney, Australia
| | - Sonali Munot
- Faculty of Medicine, Macquarie University, Sydney, Australia
| | - Stephen Morrell
- School of Public Health and Community Medicine (SPHCM), Faculty of Medicine, University of New South Wales (UNSW), Kensington Campus, Samuels Building, Level 2, Room 223, Botany St, Gate 11, Randwick (Sydney), 2052 NSW Australia
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14
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Torok M, Konings P, Batterham PJ, Christensen H. Spatial clustering of fatal, and non-fatal, suicide in new South Wales, Australia: implications for evidence-based prevention. BMC Psychiatry 2017; 17:339. [PMID: 28985736 PMCID: PMC5639600 DOI: 10.1186/s12888-017-1504-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 10/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rates of suicide appear to be increasing, indicating a critical need for more effective prevention initiatives. To increase the efficacy of future prevention initiatives, we examined the spatial distribution of suicide deaths and suicide attempts in New South Wales (NSW), Australia, to identify where high incidence 'suicide clusters' were occurring. Such clusters represent candidate regions where intervention is critically needed, and likely to have the greatest impact, thus providing an evidence-base for the targeted prioritisation of resources. METHODS Analysis is based on official suicide mortality statistics for NSW, provided by the Australian Bureau of Statistics, and hospital separations for non-fatal intentional self-harm, provided through the NSW Health Admitted Patient Data Collection at a Statistical Area 2 (SA2) geography. Geographical Information System (GIS) techniques were applied to detect suicide clusters occurring between 2005 and 2013 (aggregated), for persons aged over 5 years. The final dataset contained 5466 mortality and 86,017 non-fatal intentional self-harm cases. RESULTS In total, 25 Local Government Areas were identified as primary or secondary likely candidate regions for intervention. Together, these regions contained approximately 200 SA2 level suicide clusters, which represented 46% (n = 39,869) of hospital separations and 43% (n = 2330) of suicide deaths between 2005 and 2013. These clusters primarily converged on the Eastern coastal fringe of NSW. CONCLUSIONS Crude rates of suicide deaths and intentional self-harm differed at the Local Government Areas (LGA) level in NSW. There was a tendency for primary suicide clusters to occur within metropolitan and coastal regions, rather than rural areas. The findings demonstrate the importance of taking geographical variation of suicidal behaviour into account, prior to development and implementation of prevention initiatives, so that such initiatives can target key problem areas where they are likely to have maximal impact.
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Affiliation(s)
- Michelle Torok
- Black Dog Institute, University of NSW, Sydney, Australia.
| | - Paul Konings
- 0000 0001 2180 7477grid.1001.0National Centre for Geographic Resources & Analysis in Primary Health Care, Australian National University, Canberra, Australia
| | - Philip J. Batterham
- 0000 0001 2180 7477grid.1001.0Centre for Mental Health Research, Australian National University, Canberra, Australia
| | - Helen Christensen
- 0000 0004 4902 0432grid.1005.4Black Dog Institute, University of NSW, Sydney, Australia
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Nakanishi M, Endo K, Ando S. The Basic Act for Suicide Prevention: Effects on Longitudinal Trend in Deliberate Self-Harm with Reference to National Suicide Data for 1996-2014. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14010104. [PMID: 28117707 PMCID: PMC5295354 DOI: 10.3390/ijerph14010104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/27/2016] [Accepted: 01/17/2017] [Indexed: 11/25/2022]
Abstract
A suicide prevention strategy was launched in Japan in 2006 to address the high suicide rate, which had increased considerably since 1998. The national strategy from 2007 involved the enhancement of psychiatric treatment services at emergency medical facilities and supportive observation by individuals close to patients. The national suicide rate has decreased gradually since 2008; however, national information regarding the number of patients who had engaged in deliberate self-harm was absent. Therefore, the present study examined the longitudinal trend in hospital admissions due to deliberate self-harm in Japan. Data from the National Patient Survey between 1996 and 2014—a nationally representative cross-sectional survey of inpatient care every 3 years—were used. Data for 13,014 patients were included in the estimation of the number of hospital admissions due to deliberate self-harm. The results show that the estimated number of admissions due to deliberate self-harm increased from 2078 in September 1996 to 3189 in September 2008, when the national number of suicide cases peaked, and decreased to 1783 in 2014. Approximately half of the patients were admitted to hospital because of self-harm via means other than drug poisoning, which had a high mortality rate (5.6%). The proportion of patients receiving public assistance was higher in those who had engaged in deliberate self-harm (8.5%) relative to that observed in the general population. Overall, the trend in deliberate self-harm was synchronous with the number of suicide cases over time. As economic poverty has been associated with suicidal ideation and behavior and some recipients of public assistance tend to abuse psychotropic medication, the public assistance program should provide mental health support for recipients of social benefit schemes.
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Affiliation(s)
- Miharu Nakanishi
- Mental Health and Nursing Research Team, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan.
| | - Kaori Endo
- Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan.
| | - Shuntaro Ando
- Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan.
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Page A, Liu S, Gunnell D, Astell-Burt T, Feng X, Wang L, Zhou M. Suicide by pesticide poisoning remains a priority for suicide prevention in China: Analysis of national mortality trends 2006-2013. J Affect Disord 2017; 208:418-423. [PMID: 27842298 DOI: 10.1016/j.jad.2016.10.047] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 10/23/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Despite recent declines, suicide remains a priority for China. Ease of availability of high-lethality suicide methods, such as pesticides and firearms, contributes to the overall incidence and is an important target for suicide prevention. This study investigates whether changes in the distribution of methods of suicide have contributed to the recent reduction in suicide in China. METHOD Suicide rates (2006-2013) were calculated using the Chinese Disease Surveillance Points system, stratified by gender, age group, and urban-rural residence, to investigate trends in suicide over the study period. Multilevel negative binomial regression models were used to investigate associations between socio-demographic factors and method-specific suicide. RESULTS The most common method of suicide in China for both males and females was pesticide poisoning, followed by hanging. All methods declined over the study period, with the exception of suicide by jumping in males. Suicide rates for pesticide poisoning and for hanging increased exponentially with age in those aged over ≥45 years in both sexes. Pesticide poisoning declined from 55% to 49% of all suicides, while hanging increased from 27% to 31%. LIMITATIONS This was an ecological study of a time series of suicide rates, with risk factor adjustment being limited to population-level point estimates derived from a single census. CONCLUSIONS Suicide by pesticide poisoning and hanging remain the leading methods of suicide in China. Changes to the safe use of pesticides and targeted prevention initiatives to restrict access, along with socio-economic development and urbanisation, are likely contributors to declines in suicide by pesticide poisoning.
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Affiliation(s)
- Andrew Page
- Centre for Health Research, Western Sydney University, Penrith, NSW, Australia.
| | - Shiwei Liu
- National Center for Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - David Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Thomas Astell-Burt
- School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Xiaoqi Feng
- School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Lijun Wang
- National Center for Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Maigeng Zhou
- National Center for Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Jamison EC, Bol KA. Previous Suicide Attempt and Its Association With Method Used in a Suicide Death. Am J Prev Med 2016; 51:S226-S233. [PMID: 27745611 DOI: 10.1016/j.amepre.2016.07.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/17/2016] [Accepted: 07/28/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Non-fatal suicide attempts are a risk factor for suicide, but less is known about its effect on the method of injury used in an eventual suicide death. This study examines the association between history of non-fatal suicide attempt and the risk of a poisoning suicide versus firearm or hanging suicide in Colorado. METHODS Nine years (2004-2012, N=7,020) of suicide deaths in Colorado were compiled through the National Violent Death Reporting System. With these data, a retrospective cohort study was conducted in 2015, examining the risk associated with a history of suicide attempt and an eventual suicide death by poisoning versus a firearm or hanging suicide death. Multivariable log-binomial regression modeling was used to analyze the possible confounders of age and county type and gender as an effect modifier. RESULTS Suicide decedents with evidence of prior suicide attempt were twice as likely to eventually die by suicide via self-poisoning rather than by firearm injury (relative risk=1.94, 95% CI=1.8, 2.1, p<0.001). A significant interaction (p<0.001) between prior attempt and gender was identified and the relationship between prior attempt and method (poisoning versus firearm) was stronger among male than female suicides (female attempt history, 1.16, 95% CI=1.07, 1.27, p<0.001; male attempt history, 1.91, 95% CI=1.69, 2.16, p<0.001). CONCLUSIONS Individuals with a history of non-fatal suicide attempt are more likely to die by suicide via poisoning rather than firearm. Gender has a significant effect on this association. This information can be useful when discussing means restriction and suicide prevention efforts.
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Affiliation(s)
- Ethan C Jamison
- Center for Health and Environmental Data, Colorado Department of Public Health and Environment, Denver, Colorado.
| | - Kirk A Bol
- Center for Health and Environmental Data, Colorado Department of Public Health and Environment, Denver, Colorado
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Leckning BA, Li SQ, Cunningham T, Guthridge S, Robinson G, Nagel T, Silburn S. Trends in hospital admissions involving suicidal behaviour in the Northern Territory, 2001-2013. Australas Psychiatry 2016; 24:300-4. [PMID: 26858241 DOI: 10.1177/1039856216629838] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate trends in hospital admissions involving suicidal behaviour in the Northern Territory (NT) resident population over the period 2001-2013. METHODS Estimates of age-standardised rates and average changes in the annual rate of hospital admissions involving suicidal behaviour were calculated by socio-demographic characteristics and types of suicidal behaviour. RESULTS Overall rates for Indigenous admissions were 2.7 times higher than non-Indigenous admissions and had increased by almost twice as much. While male and female rates of admission were similar for both Indigenous and non-Indigenous residents, the average annual change in rates was greater for Indigenous females (13.4%) compared to males (8.8%) and for non-Indigenous males (7.7%) compared to females (5.2%). Younger and middle-aged Indigenous admissions experienced increasing rates of admissions, whilst trends were similar across age groups for non-Indigenous admissions. Admissions with a diagnosis of suicidal ideation increased the most across all groups. Trends in intentional self-harm admissions differed according to Indigenous status and sex. CONCLUSIONS There have been substantial increases in hospital admissions involving suicidal behaviour in the NT, most markedly for Indigenous residents. Indigenous females and youth appear to be at increasing risk. The steep increase in suicidal ideation across all groups warrants further investigation.
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Affiliation(s)
- Bernard A Leckning
- Research Associate, Centre for Child Development and Education, Menzies School of Health Research, Darwin, NT, Australia
| | - Shu Qin Li
- Senior Epidemiologist, Health Gains Planning Branch, Department of Health, Darwin, NT, Australia
| | - Teresa Cunningham
- Research Fellow, Centre for Child Development and Education, Menzies School of Health Research, Darwin, NT, Australia
| | - Steven Guthridge
- Director, Health Gains Planning Branch, Northern Territory Department of Health, Darwin, NT, Australia
| | - Gary Robinson
- Professor and Director, Centre for Child Development and Education, Menzies School of Health Research, Darwin, NT, Australia
| | - Tricia Nagel
- Associate Professor and Program Leader, Healing and Resilience, Menzies School of Health Research, Darwin, NT, Australia
| | - Sven Silburn
- Professor and Head of Child Education and Development, Centre for Child Development and Education, Menzies School of Health Research, Darwin, NT, Australia
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Abstract
Involvement of personality traits in susceptibility to suicidal behaviour has attracted considerable research interest over the past decades. This study was motivated by reports that emotionality may play a potentially confounding role in the association between the personality profile and suicidal behaviour. We assessed the association between personality traits, as measured using the Temperament and Character Inventory (TCI), and suicidal behaviour, while controlling for the effects of Affective Temperaments, measured using the Temperament Evaluation of the Memphis, Pisa, Paris and San Diego auto-questionnaire (TEMPS-A) in a sample of 140 consecutive self-poisoning nonlethal suicide (SNS) attempters admitted to the Emergency Toxicology Clinic, comparing them with a sample of 140 age and sex matched healthy controls. After controlling for Affective Temperaments, the temperament dimension of Novelty Seeking (NS) and the character dimensions of Self-directedness and Self-transcendence remained significantly associated with SNS attempts. NS, in particular, was most consistently and uniquely associated with suicidal behaviour. The present study conveys the difficulty in disentangling the personality profile of SNS attempters from their emotionality. We conclude that the risk associated with certain personality traits is often entirely mediated by Affective Temperaments and few dimensions independently contribute to the risk of self-poisoning nonlethal suicidal behaviour.
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Kalesan B, Galea S. The relation of depression to in-hospital outcomes among adults hospitalized for firearm-related injury. J Affect Disord 2015; 183:166-72. [PMID: 26021965 DOI: 10.1016/j.jad.2015.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 05/07/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Firearm injuries are a major health problem contributing to significant morbidity and mortality. Depression is associated with increased risk of adverse health outcomes in trauma patients and those hospitalized for serious disorders. We examined the relation between preexisting depression and adverse hospital outcomes and related injury severity among adult (>16-years) firearm hospitalizations (FH). METHODS Using nationally representative Nationwide Inpatient Sample (2005 to 2011) and survey weighted multinomial logistic regression, we calculated odds ratios (OR) and 95% confidence intervals (95%CI) to determine the risk of care facility discharge and in-hospital mortality by pre-existing depression. RESULTS Pre-existing depression was associated with a 3-fold risk of discharge to care facility (OR=2.91, 95%CI=2.57-3.30) and a 2-fold risk of in-hospital mortality (OR=2.05, 95%CI=1.69-2.47). ORs for risk of care facility discharge compared to routine discharge associated with depression among assault/legal-FH, unintentional-FH, suicide-FH and undetermined-FH was 2.73 (95%CI=2.23-3.33), 1.90 (95%CI=1.50-2.41), 1.52 (95%CI=1.26-1.83) and 2.42 (95%CI=1.60-3.67), while risk of inhospital mortality was 0.17 (95%CI=0.05-0.54), 0.60 (95%CI=0.28-1.29), 0.79 (95%CI=0.63-0.98) and 0.74 (95%CI=0.36-1.52). LIMITATIONS Lack of information regarding re-hospitalization due to the cross-sectional data. CONCLUSION Persons with depression who were hospitalized due to firearm-related injury were less likely to survive than those without depression, and those discharged alive were at higher risk of discharge to a facility. Depression was associated with greater risk of discharge to facility among all intents, and lower risk of in-hospital mortality among assault- and suicide-FH. These findings are important considering the increasing numbers of non-fatal firearm hospitalizations and the associated increase in healthcare expenditure.
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Affiliation(s)
- Bindu Kalesan
- Columbia University, Mailman School of Public Health, New York, NY, USA; Gun Violence Survivors Foundation, Philadelphia, PA, USA.
| | - Sandro Galea
- Columbia University, Mailman School of Public Health, New York, NY, USA; Boston University School of Public Health, Boston, MA 02118, USA
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Atkinson JA, Page A, Wells R, Milat A, Wilson A. A modelling tool for policy analysis to support the design of efficient and effective policy responses for complex public health problems. Implement Sci 2015; 10:26. [PMID: 25889919 PMCID: PMC4351685 DOI: 10.1186/s13012-015-0221-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 02/17/2015] [Indexed: 11/19/2022] Open
Abstract
Background In the design of public health policy, a broader understanding of risk factors for disease across the life course, and an increasing awareness of the social determinants of health, has led to the development of more comprehensive, cross-sectoral strategies to tackle complex problems. However, comprehensive strategies may not represent the most efficient or effective approach to reducing disease burden at the population level. Rather, they may act to spread finite resources less intensively over a greater number of programs and initiatives, diluting the potential impact of the investment. While analytic tools are available that use research evidence to help identify and prioritise disease risk factors for public health action, they are inadequate to support more targeted and effective policy responses for complex public health problems. Discussion This paper discusses the limitations of analytic tools that are commonly used to support evidence-informed policy decisions for complex problems. It proposes an alternative policy analysis tool which can integrate diverse evidence sources and provide a platform for virtual testing of policy alternatives in order to design solutions that are efficient, effective, and equitable. The case of suicide prevention in Australia is presented to demonstrate the limitations of current tools to adequately inform prevention policy and discusses the utility of the new policy analysis tool. Summary In contrast to popular belief, a systems approach takes a step beyond comprehensive thinking and seeks to identify where best to target public health action and resources for optimal impact. It is concerned primarily with what can be reasonably left out of strategies for prevention and can be used to explore where disinvestment may occur without adversely affecting population health (or equity). Simulation modelling used for policy analysis offers promise in being able to better operationalise research evidence to support decision making for complex problems, improve targeting of public health policy, and offers a foundation for strengthening relationships between policy makers, stakeholders, and researchers.
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Affiliation(s)
- Jo-An Atkinson
- Research Fellow, The Australian Prevention Partnership Centre, Sax Institute, PO Box K617, Haymarket, Sydney, NSW 1240, Australia.
| | - Andrew Page
- Professor of Public Health, School of Science and Health, University of Western Sydney, Campbelltown Campus, Penrith, NSW 2571, Australia.
| | - Robert Wells
- Deputy CEO, Sax Institute, PO Box K617, Haymarket, Sydney, NSW 1240, Australia.
| | - Andrew Milat
- School of Public Health, University of Sydney, Edward Ford Building (A27), Camperdown, NSW 2059, Australia.
| | - Andrew Wilson
- Director, The Australian Prevention Partnership Centre, Sax Institute, PO Box K617, Haymarket, Sydney, NSW 1240, Australia.
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Milner AJ, Carter G, Pirkis J, Robinson J, Spittal MJ. Letters, green cards, telephone calls and postcards: systematic and meta-analytic review of brief contact interventions for reducing self-harm, suicide attempts and suicide. Br J Psychiatry 2015; 206:184-90. [PMID: 25733570 DOI: 10.1192/bjp.bp.114.147819] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND There is growing interest in brief contact interventions for self-harm and suicide attempt. AIMS To synthesise the evidence regarding the effectiveness of brief contact interventions for reducing self-harm, suicide attempt and suicide. METHOD A systematic review and random-effects meta-analyses were conducted of randomised controlled trials using brief contact interventions (telephone contacts; emergency or crisis cards; and postcard or letter contacts). Several sensitivity analyses were conducted to examine study quality and subgroup effects. RESULTS We found 14 eligible studies overall, of which 12 were amenable to meta-analyses. For any subsequent episode of self-harm or suicide attempt, there was a non-significant reduction in the overall pooled odds ratio (OR) of 0.87 (95% CI 0.74-1.04, P = 0119) for intervention compared with control. The number of repetitions per person was significantly reduced in intervention v. control (incidence rate ratio IRR = 066, 95% CI 0.54-0.80, P<0001). There was no significant reduction in the odds of suicide in intervention compared with control (OR = 0.58, 95% CI 0.24-1.38). CONCLUSIONS A non-significant positive effect on repeated self-harm, suicide attempt and suicide and a significant effect on the number of episodes of repeated self-harm or suicide attempts per person (based on only three studies) means that brief contact interventions cannot yet be recommended for widespread clinical implementation. We recommend further assessment of possible benefits in well-designed trials in clinical populations.
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Affiliation(s)
- Allison J Milner
- Allison J. Milner, BPsych (Hons), MEpi, PhD, McCaughey VicHealth Centre for Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne; Greg Carter, MBBS, FRANZCP, Cert Child Psych, PhD, Centre for Translational Neuroscience and Mental Health, Faculty of Health and Medicine, University of Newcastle, Callaghan; Jane Pirkis, BA (Hons), MPsych, MAppEpid, PhD, Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne; Jo Robinson, BSc (Hons) Master Psych, Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Melbourne; Matthew J. Spittal, BSc (Hons), MBio, PhD, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Greg Carter
- Allison J. Milner, BPsych (Hons), MEpi, PhD, McCaughey VicHealth Centre for Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne; Greg Carter, MBBS, FRANZCP, Cert Child Psych, PhD, Centre for Translational Neuroscience and Mental Health, Faculty of Health and Medicine, University of Newcastle, Callaghan; Jane Pirkis, BA (Hons), MPsych, MAppEpid, PhD, Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne; Jo Robinson, BSc (Hons) Master Psych, Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Melbourne; Matthew J. Spittal, BSc (Hons), MBio, PhD, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Jane Pirkis
- Allison J. Milner, BPsych (Hons), MEpi, PhD, McCaughey VicHealth Centre for Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne; Greg Carter, MBBS, FRANZCP, Cert Child Psych, PhD, Centre for Translational Neuroscience and Mental Health, Faculty of Health and Medicine, University of Newcastle, Callaghan; Jane Pirkis, BA (Hons), MPsych, MAppEpid, PhD, Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne; Jo Robinson, BSc (Hons) Master Psych, Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Melbourne; Matthew J. Spittal, BSc (Hons), MBio, PhD, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Jo Robinson
- Allison J. Milner, BPsych (Hons), MEpi, PhD, McCaughey VicHealth Centre for Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne; Greg Carter, MBBS, FRANZCP, Cert Child Psych, PhD, Centre for Translational Neuroscience and Mental Health, Faculty of Health and Medicine, University of Newcastle, Callaghan; Jane Pirkis, BA (Hons), MPsych, MAppEpid, PhD, Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne; Jo Robinson, BSc (Hons) Master Psych, Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Melbourne; Matthew J. Spittal, BSc (Hons), MBio, PhD, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Matthew J Spittal
- Allison J. Milner, BPsych (Hons), MEpi, PhD, McCaughey VicHealth Centre for Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne; Greg Carter, MBBS, FRANZCP, Cert Child Psych, PhD, Centre for Translational Neuroscience and Mental Health, Faculty of Health and Medicine, University of Newcastle, Callaghan; Jane Pirkis, BA (Hons), MPsych, MAppEpid, PhD, Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne; Jo Robinson, BSc (Hons) Master Psych, Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Melbourne; Matthew J. Spittal, BSc (Hons), MBio, PhD, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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Abstract
OBJECTIVE This study explores the spatiotemporal variations of suicide across Australia from 1986 to 2005, discusses the reasons for dynamic changes, and considers future suicide research and prevention strategies. DESIGN Suicide (1986-2005) and population data were obtained from the Australian Bureau of Statistics. A series of analyses were conducted to examine the suicide pattern by sex, method and age group over time and geography. RESULTS Differences in suicide rates across sex, age groups and suicide methods were found across geographical areas. Male suicides were mainly completed by hanging, firearms, gases and self-poisoning. Female suicides were primarily completed by hanging and self-poisoning. Suicide rates were higher in rural areas than in urban areas (capital cities and regional centres). Suicide rates by firearms were higher in rural areas than in urban areas, while the pattern for self-poisoning showed the reverse trend. Suicide rates had relatively stable trend for the total population and those aged between 15 and 54, while suicide decreased among 55 years and over during the study period. There was a decrease in suicides by firearms during the study period especially after 1996 when a new firearm control law was implemented, while suicide by hanging continued to increase. Areas with a high proportion of indigenous population (eg, northwest of Queensland and top north of the Northern Territory) had shown a substantial increase in suicide incidence after 1995. CONCLUSIONS Suicide rates varied over time and space and across sexes, age groups and suicide methods. This study provides detailed patterns of suicide to inform suicide control and prevention strategies for specific subgroups and areas of high and increased risk.
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Affiliation(s)
- Xin Qi
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Wenbiao Hu
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Andrew Page
- School of Science and Health, University of Western Sydney, Penrith, New South Wales, Australia
| | - Shilu Tong
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia
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Spittal MJ, Pirkis J, Miller M, Carter G, Studdert DM. The Repeated Episodes of Self-Harm (RESH) score: A tool for predicting risk of future episodes of self-harm by hospital patients. J Affect Disord 2014; 161:36-42. [PMID: 24751305 DOI: 10.1016/j.jad.2014.02.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 02/25/2014] [Accepted: 02/26/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Repetition of hospital-treated deliberate self-harm is common. Several recent studies have used emergency department data to develop clinical tools to assess risk of self-harm or suicide. Longitudinal, linked inpatient data is an alternative source of information. METHODS We identified all individuals admitted to hospital for deliberate self-harm in two Australian states (~350 hospitals). The outcome of interest was a repeated episode of self-harm (non-fatal or fatal) within 6 months. Logistic regression was used to identify a set of predictors of repetition. A risk calculator (RESH: Repeated Episodes of Self-Harm) was derived directly from model coefficients. RESULTS There were 84,659 episodes of self-harm during the study period. Four variables - number of prior episodes, time between episodes, prior psychiatric diagnoses and recent psychiatric hospital stay - strongly predicted repetition. The RESH score showed good discrimination (AUC=0.75) and had high specificity. Patients with scores of 0-3 had 14% risk of repeat episodes, whereas patients with scores of 20-25 had over 80% risk. We identified five thresholds where the RESH score could be used for prioritising interventions. LIMITATIONS The trade-off of a highly specific test is that the instrument has poor sensitivity. As a consequence, the RESH score cannot be used reliably for "ruling out" those who score below the thresholds. CONCLUSIONS The RESH score could be useful for prioritising patients to interventions to reduce readmission for deliberate self-harm. The five thresholds, representing the continuum from low to high risk, enable a stepped care model of overlapping or sequential interventions to be deployed to patients at risk of self-harm.
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Affiliation(s)
- Matthew J Spittal
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia.
| | - Jane Pirkis
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Matthew Miller
- Department of Health Policy and Management, Harvard School of Public Health, MA, United States
| | - Gregory Carter
- Centre for Translational Neuroscience and Mental Health (CTNMH), Faculty of Health and Medicine, University of Newcastle, NSW, Australia
| | - David M Studdert
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia
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Baker SP, Hu G, Wilcox HC, Baker TD. Increase in suicide by hanging/suffocation in the U.S., 2000-2010. Am J Prev Med 2013; 44:146-9. [PMID: 23332330 PMCID: PMC3553495 DOI: 10.1016/j.amepre.2012.10.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 10/16/2012] [Accepted: 10/18/2012] [Indexed: 12/24/2022]
Abstract
BACKGROUND Recently, suicide exceeded motor vehicle crashes as the leading cause of injury death in the U.S. However, details of this change in suicide methods and the relationship to individual demographics, such as age and societal influences, have not been reported. PURPOSE To determine the characteristics of the changes in suicide rates between 2000 and 2010. METHODS Data came from CDC's Web-Based Injury Statistics Query and Reporting System (WISQARS™). Line charts were plotted to reveal changes in suicide rates by firearm, poisoning, and hanging/suffocation (ICD-10 codes: X72-X74, X60-X69, and X70). The measure of change used is the percentage change in suicide rate between 2000 and 2010. RESULTS The overall suicide rate increased from 10.4 to 12.1 per 100,000 population between 2000 and 2010, a 16% increase. The majority of the increase was attributable to suicide by hanging/suffocation (52%) and by poisoning (19%). Subgroup analysis showed: (1) suicide by hanging/suffocation increased by 104% among those aged 45-59 years and rose steadily in all age groups except those aged ≥70 years; (2) the largest increase in suicide by poisoning (85%) occurred among those aged 60-69 years; and (3) suicide by firearm decreased by 24% among those aged 15-24 years but increased by 22% among those aged 45-59 years. The case fatality rates for suicide by hanging/suffocation during 2000-2010 ranged from 69% to 84%, close to those for suicide by firearm. Analyses were conducted in 2012. CONCLUSIONS Substantial increases in suicide by hanging/suffocation and poisoning merit attention from policymakers and call for innovations and changes in suicide prevention approaches.
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Affiliation(s)
- Susan P Baker
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland, USA
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Cheung YTD, Spittal MJ, Williamson MK, Tung SJ, Pirkis J. Application of scan statistics to detect suicide clusters in Australia. PLoS One 2013; 8:e54168. [PMID: 23342098 PMCID: PMC3544808 DOI: 10.1371/journal.pone.0054168] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 12/07/2012] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Suicide clustering occurs when multiple suicide incidents take place in a small area or/and within a short period of time. In spite of the multi-national research attention and particular efforts in preparing guidelines for tackling suicide clusters, the broader picture of epidemiology of suicide clustering remains unclear. This study aimed to develop techniques in using scan statistics to detect clusters, with the detection of suicide clusters in Australia as example. METHODS AND FINDINGS Scan statistics was applied to detect clusters among suicides occurring between 2004 and 2008. Manipulation of parameter settings and change of area for scan statistics were performed to remedy shortcomings in existing methods. In total, 243 suicides out of 10,176 (2.4%) were identified as belonging to 15 suicide clusters. These clusters were mainly located in the Northern Territory, the northern part of Western Australia, and the northern part of Queensland. Among the 15 clusters, 4 (26.7%) were detected by both national and state cluster detections, 8 (53.3%) were only detected by the state cluster detection, and 3 (20%) were only detected by the national cluster detection. CONCLUSIONS These findings illustrate that the majority of spatial-temporal clusters of suicide were located in the inland northern areas, with socio-economic deprivation and higher proportions of indigenous people. Discrepancies between national and state/territory cluster detection by scan statistics were due to the contrast of the underlying suicide rates across states/territories. Performing both small-area and large-area analyses, and applying multiple parameter settings may yield the maximum benefits for exploring clusters.
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