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Raittila S, Kouvonen A, Koskinen A, Väänänen A. Occupational class differences in male suicide risk in Finland from 1970 to 2019. Eur J Public Health 2023; 33:1014-1019. [PMID: 37802915 PMCID: PMC10710325 DOI: 10.1093/eurpub/ckad176] [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] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND In the last few decades, suicide rates have decreased in most European countries. However, periodic changes in risk by occupational class have not been studied as much in detail. METHODS Representative cohorts of Finnish working-age men were followed for nine years on suicide mortality starting from five different census years (1970, 1980, 1990, 2000, 2010). Each cohort included between 300 970 and 332 318 men. Cox regression modelling was used to estimate hazard ratios by census year, occupational class and their interactions. Further models adjusted for age and its interactions with census year and occupational class. RESULTS The risk of male suicide has more than halved between 1991 and 2019. The relative hazard ratio of suicide in manual workers compared to managers and professionals was around 1.6 to 1.8 times higher. The period when the suicide risk started to decline differed by occupational class: a significant decrease compared to 1970s' levels was seen for managers and professionals already in the 1990s and for lower non-manual employees around 10 years later (in the 2000s). Manual workers only reached the 1970s suicide risk of managers and professionals in the 2000s and 2010s. CONCLUSION A delayed reduction of suicide rates among lower occupational classes suggests that the impact of social changes can occur at different speed in different population groups.
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Affiliation(s)
- Simo Raittila
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - Aki Koskinen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Ari Väänänen
- Finnish Institute of Occupational Health, Helsinki, Finland
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Culbreth R, Swahn MH, Osborne M, Brandenberger K, Kota K. Substance use and deaths by suicide: A latent class analysis of the National Violent Death Reporting System. Prev Med 2021; 150:106682. [PMID: 34119594 DOI: 10.1016/j.ypmed.2021.106682] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/02/2021] [Accepted: 06/08/2021] [Indexed: 02/04/2023]
Abstract
Substance use is strongly associated with suicide completions. However, little is known about the patterns of substances used in suicide deaths. The purpose of this analysis is to determine latent classes of toxicology-reported substances among individuals who completed suicide. The sample consists of suicide victims in the National Violent Death Reporting System (NVDRS) during years 2003-2017 (n = 202,838). Toxicology reports were used to construct latent class analyses of substance use among suicide victims. Correlates for latent class membership included sex, race/ethnicity, previous experiences of child abuse, homelessness, and intimate partner violence (IPV) victimization. The majority of suicide victims were male (77.7%), straight/heterosexual (99.5%) and white (88.3%). The final unconditional model yielded a four-class model, including a "No substance/single substance use" class, an "Alcohol and other substance" class, a "Marijuana and other substance" class, and an "Opiate use" class. Compared to the reference class of "No substance/single substance," females were more likely than males to be classified in the "Alcohol and other substance" class, the "Multi-substance use" class, and the "Opiate use" class. Homelessness was associated with classification in the "Marijuana and other substance" class and the "Opiate use" class compared to the "No substance/single substance" class. IPV was associated with both polysubstance use classes ("Alcohol plus other substance" and "Marijuana plus other substance") along with the "Opiate use" class compared to the "No substance/single substance" class. These classes highlight profiles of suicide descendants and emphasize the importance of polysubstance use prevention among females, homeless individuals, and those who experience IPV.
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Affiliation(s)
- Rachel Culbreth
- Department of Respiratory Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA.
| | - Monica H Swahn
- Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, GA, USA.
| | - Melissa Osborne
- School of Nursing, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA.
| | - Kyle Brandenberger
- Department of Respiratory Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA.
| | - Krishna Kota
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
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Chitty KM, Kirby K, Osborne NJ, Isbister GK, Buckley NA. Co-ingested alcohol and the timing of deliberate self-poisonings. Aust N Z J Psychiatry 2018; 52:271-278. [PMID: 28762278 DOI: 10.1177/0004867417722639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Investigating diurnal variation in the timing of suicidal behaviours offers opportunity to better understand its various proximal risk factors. Acute use of alcohol is a potent proximal risk factor for suicidal behaviour, though the nature of this risk is poorly understood. The aim of this study was to compare the diurnal variation in time of poison ingestion between deliberate self-poisonings that involve alcohol versus those that do not. METHODS A retrospective analysis of consecutive presentations to a toxicology service following deliberate self-poisoning, 1996-2016. An independent samples Kolmogorov-Smirnov test was performed to test the null hypothesis that the diurnal distribution of poison ingestion time was equal across self-poisonings that did and did not involve alcohol co-ingestion. Presence of circadian rhythmicity was established using cosinor analysis. RESULTS A total of 11,088 deliberate self-poisoning records, for 7467 patients (60.8% females), were included in the analysis. In all, 31.3% of the total records involved alcohol co-ingestion. Distribution of exposure time was significantly different between deliberate self-poisonings that did and did not involve alcohol ( p < 0.001). The alcohol co-ingestion group showed a significantly greater prominent peak with poisoning occurring later in the evening (~20:00 hours) compared to poisonings that did not involve alcohol (~18:00 hours). CONCLUSION This study exposed the differential diurnal patterns in deliberate self-poisoning according to the presence of alcohol co-ingestion. This analysis adds to the accumulating evidence that suicidal behaviour that involves alcohol co-ingestion represents a distinct subtype, which may be driven by alcohol consumption patterns in society. This also means that this large proportion of deliberate self-poisonings may not otherwise have occurred if it were not for alcohol consumption, underscoring the importance of drug and alcohol services for alcohol-related self-harm.
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Affiliation(s)
- Kate M Chitty
- 1 Translational Australian Clinical Toxicology (TACT) Research Group, Discipline of Pharmacology, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Katharine Kirby
- 1 Translational Australian Clinical Toxicology (TACT) Research Group, Discipline of Pharmacology, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Nicholas J Osborne
- 1 Translational Australian Clinical Toxicology (TACT) Research Group, Discipline of Pharmacology, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia.,2 European Centre for Environment and Human Health, Medical School, University of Exeter, Truro, UK
| | - Geoffrey K Isbister
- 3 Clinical Toxicology Research Group, University of Newcastle, Newcastle, NSW, Australia
| | - Nicholas A Buckley
- 1 Translational Australian Clinical Toxicology (TACT) Research Group, Discipline of Pharmacology, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
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4
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Blüml V, Helbich M, Mayr M, Turnwald R, Vyssoki B, Lewitzka U, Hartung S, Plener PL, Fegert JM, Kapusta ND. Antidepressant sales and regional variations of suicide mortality in Germany. J Psychiatr Res 2017; 87:88-94. [PMID: 28024215 DOI: 10.1016/j.jpsychires.2016.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 12/08/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
Abstract
Suicides account for over one million deaths per year worldwide with depression among the most important risk factors. Epidemiological research into the relationship between antidepressant utilization and suicide mortality has shown heterogeneous and contradictory results. Different methodological approaches and limitations could at least partially explain varying results. This is the first study assessing the association of suicide mortality and antidepressant sales across Germany using complex statistical approaches in order to control for possible confounding factors including spatial dependency of data. German suicide counts were analyzed on a district level (n = 402) utilizing ecological Poisson regressions within a hierarchical Bayesian framework. Due to significant spatial effects between adjacent districts spatial models were calculated in addition to a baseline non-spatial model. Models were adjusted for several confounders including socioeconomic variables, quality of psychosocial care, and depression prevalence. Separate analyses were performed for Eastern and Western Germany and for different classes of antidepressants (SSRIs and TCAs). Overall antidepressant sales were significantly negatively associated with suicide mortality in the non-spatial baseline model, while after adjusting for spatially structured and unstructured effects the association turned out to be insignificant. In sub-analyses, analogue results were found for SSRIs and TCAs separately. Suicide risk shows a distinct heterogeneous pattern with a pronounced relative risk in Southeast Germany. In conclusion, the results reflect the heterogeneous findings of previous studies on the association between suicide mortality and antidepressant sales and point to the complexity of this hypothesized link. Furthermore, the findings support tailored suicide preventive efforts within high risk areas.
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Affiliation(s)
- Victor Blüml
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria.
| | - Marco Helbich
- Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, The Netherlands
| | - Michael Mayr
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Roland Turnwald
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Benjamin Vyssoki
- Department of Psychiatry and Psychotherapy, Clinical Division for Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Ute Lewitzka
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | | | - Paul L Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Jörg M Fegert
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Nestor D Kapusta
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
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Novak SP, Håkansson A, Martinez-Raga J, Reimer J, Krotki K, Varughese S. Nonmedical use of prescription drugs in the European Union. BMC Psychiatry 2016; 16:274. [PMID: 27488186 PMCID: PMC4972971 DOI: 10.1186/s12888-016-0909-3] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 06/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nonmedical prescription drug use (NMPDU) refers to the self-treatment of a medical condition using medication without a prescriber's authorization as well as use to achieve euphoric states. This article reports data from a cross-national investigation of NMPDU in five European Countries, with the aim to understand the prevalence and characteristics of those engaging in NMPDU across the EU. METHODS A parallel series of self-administered, cross-sectional, general population surveys were conducted in 2014. Data were collected using multi-stage quota sampling and then weighted using General Exponential Model. A total of 22,070 non-institutionalized participants, aged 12 to 49 years, in 5 countries: Denmark, Germany, Great Britain, Spain, and Sweden. Lifetime and past-year nonmedical use of prescription medications such as stimulants, opioids, and sedatives were ascertained via a modified version of the World Health Organization's Composite International Diagnostic Interview. Information about how the medications were acquired for NMPDU were also collected from the respondent. RESULTS Lifetime and past-year prevalence of nonmedical prescription drug use was estimated for opioids (13.5 and 5.0 %), sedatives (10.9 and 5.8 %), and stimulants (7.0 and 2.8 %). Germany exhibited the lowest levels of NMPDU, with Great Britain, Spain, and Sweden having the highest levels. Mental and sexual health risk factors were associated with an increased likelihood of past-year nonmedical prescription drug use. Among past-year users, about 32, 28, and 52 % of opioid, sedative, and stimulant nonmedical users, respectively, also consumed illicit drugs. Social sources (sharing by friends/family) were the most commonly endorsed methods of acquisition, ranging from 44 % (opioids) to 62 % (sedatives). Of interest is that Internet pharmacies were a common source of medications for opioids (4.1 %), stimulants (7.6 %), and sedatives (2.7 %). CONCLUSIONS Nonmedical prescription drug use was reported across the five EU countries we studied, with opioids and sedatives being the most prevalent classes of prescription psychotherapeutics. International collaborations are needed for continued monitoring and intervention efforts to target population subgroups at greatest risk for NMDU.
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Affiliation(s)
- Scott P. Novak
- Behavioral Epidemiology, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709 USA
| | - Anders Håkansson
- Division of Psychiatry, Lund University, Malmö, Sweden ,Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund, Sweden
| | | | - Jens Reimer
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf Martinistrasse, Hamburg, Germany
| | - Karol Krotki
- Statistical Sciences, RTI International, Washington DC, USA
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Moustgaard H, Joutsenniemi K, Martikainen P. A longitudinal study of educational differences in antidepressant use before and after hospital care for depression. Eur J Public Health 2016; 26:1034-1039. [PMID: 27335324 DOI: 10.1093/eurpub/ckw092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Despite social inequalities in depression various studies report small or even reversed social gradients for antidepressant treatment, suggesting unmet need for treatment among those with low social position. However, few studies assess need for treatment or compare longitudinal antidepressant use patterns between socioeconomic groups. METHODS We used a nationally representative register cohort of Finnish adults with hospital care for depression in 1998-2007 (n = 7249). We compared the prevalence of any use and daily use of antidepressants across educational groups in consecutive 3-month periods up to 5 years before admission and 5 years after discharge, adjusting for important confounders. RESULTS We found no educational differences in any antidepressant use in the 5 years leading to hospital care for depression but a 3-4 percentage-point higher prevalence among those with high education in the 3-month periods immediately preceding and following hospital care for depression. Furthermore, decline in the prevalence of antidepressant use after discharge was more rapid in low education resulting in a significant 4-6 percentage-point higher prevalence among the highly educated lasting until 2.5 years after discharge. Daily use was significantly more common among the highly educated for a year before admission, immediately after discharge and for 2.5 years thereafter, the excess being 3-8 percentage-points. CONCLUSION Our results suggest rather equitable access to antidepressant treatment at the time of evident need, i.e. immediately after discharge from hospital care for depression. However, early discontinuation of treatment as well as below guideline use of antidepressants were more common among the low educated.
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Affiliation(s)
- Heta Moustgaard
- Department of Social Research, Population Research Unit, University of Helsinki, Helsinki, Finland
| | | | - Pekka Martikainen
- Department of Social Research, Population Research Unit, University of Helsinki, Helsinki, Finland.,Laboratory of Population Health, Max Planck Institute for Demographic Research, Rostock, Germany.,Centre for Health Equity Studies (CHESS), Stockholm University and Karolinska Institutet, Stockholm, Sweden
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Sher L, Rihmer Z, Didia-Attas J, de Leon J, Lin SK, Roncero C, Szerman N, Rice T. Future Research and Clinical Directions in the Field of Men's Mental Health: The Madrid Declaration. Front Public Health 2014; 2:242. [PMID: 25478555 PMCID: PMC4237033 DOI: 10.3389/fpubh.2014.00242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 11/03/2014] [Indexed: 11/13/2022] Open
Affiliation(s)
- Leo Sher
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J. Peters Veterans’ Administration Medical Center, Bronx, NY, USA
| | | | | | | | - Shih-Ku Lin
- Taipei Medical University, Taipei, Taiwan
- Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Carlos Roncero
- University Hospital Vall Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | - Timothy Rice
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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