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Kim E, Kim S. Spatially clustered patterns of suicide mortality rates in South Korea: a geographically weighted regression analysis. BMC Public Health 2024; 24:2380. [PMID: 39223483 PMCID: PMC11367767 DOI: 10.1186/s12889-024-19899-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Suicide mortality remains a global health concern, and community characteristics affect regional variations in suicide. This study investigated spatially clustered patterns of suicide mortality rates in South Korea and evaluated the impact of community factors on suicide. METHODS Suicide mortality rates were estimated by sex, age group, and district, using the 2021 Cause of Death Statistics in South Korea from the MicroData Integrated Service. Community-determinant data for 2021 or the nearest year were collected from the Korean Statistical Information Service. The spatial autocorrelation of suicide by sex and age was examined based on Global Moran's I index. Geographically weighted regression (GWR) was used to discern the influence of community determinants on suicide. RESULTS Suicide mortality rates were significantly higher among men (40.64 per 100,000) and adults over the age of 65 years (43.18 per 100,000). The male suicide mortality rates exhibited strong spatial dependence, as indicated by a high global Moran's I with p < 0.001, highlighting the importance of conducting spatial analysis. In the GWR model calibration, a subset of the community's age structure, single-person household composition, access to mental healthcare centers, and unmet medical needs were selected to explain male suicide mortality. These determinants disproportionately increased the risk of male suicide, varying by region. The GWR coefficients of each variable vary widely across 249 districts: aging index (Q1:0.06-Q3:0.46), single-person households (Q1:0.22-Q3:0.35), psychiatric clinics (Q1:-0.20-Q3:-0.01), and unmet medical needs (Q1:0.09-Q3:0.14). CONCLUSIONS Community cultural and structural factors exacerbate regional disparities in suicide among men. The influencing factors exhibit differential effects and significance depending on the community, highlighting the need for efficient resource allocation for suicide. A regionally tailored approach is crucial for the effective control of the community's mental health management system.
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Affiliation(s)
- Eunah Kim
- Institute of Health and Environment, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.
- Institute of Health Policy and Management, Seoul National University Medical Research Center, 71 Ihwajang-gil, Jongno-gu, Seoul, 03087, Republic of Korea.
| | - Seulgi Kim
- Institute of Health and Environment, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.
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Snowden J, Weakley K. Diagnosing, managing, and studying long-COVID syndromes in children and adolescents in rural and underserved populations. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00540-4. [PMID: 39187064 DOI: 10.1016/j.anai.2024.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Accepted: 08/21/2024] [Indexed: 08/28/2024]
Abstract
The COVID-19 pandemic has arguably had its greatest impact in rural and other historically hard-to-reach populations. Families in rural and underserved communities experienced COVID-19 infections at a higher rate than did their peers in other groups and experienced disproportionate morbidity and mortality. Without careful design and implementation of resources, children in these areas are also at risk of being disproportionately affected by long-term sequelae of SARS-CoV-2 infections, such as "long COVID" syndromes. Increased frequency and severity of COVID-19 infections, decreased access to health care and supporting services, environmental and social structure factors that exacerbate post-acute sequelae of COVID-19, and increased baseline frequency of health disorders that may complicate post-COVID issues, such as higher rates of obesity, asthma, diabetes, and mental health disorders, all place children and adolescents in under-resourced areas at significant risk. Unfortunately, children and adolescents in these areas have been historically under-represented in clinical research. Not only are fewer studies published with participants in rural and underserved communities, but these studies more often exhibit lower quality, with fewer randomized controlled trials and multicenter studies. This gap not only deprives people in rural and underserved areas of the country of access to cutting-edge therapy, but it also risks "evidence-based" solutions that are not generalizable because they cannot be implemented in the areas disproportionately affected by many health conditions such as long COVID. These factors significantly impede our ability to provide appropriate medical care for underserved communities. This review will discuss the impact of COVID-19 in rural and underserved communities and the factors that must be considered in designing evidence-based long-COVID solutions for children and adolescents in these areas.
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Affiliation(s)
- Jessica Snowden
- University of Tennessee Health Science Center, Memphis, Tennessee.
| | - Kathryn Weakley
- University of Louisville and Norton Children's Hospital, Louisville, Kentucky
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3
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Prazak M, Bacigalupi R, Hamilton SC. Rural Suicide: Demographics, Causes, and Treatment Implications. Community Ment Health J 2024:10.1007/s10597-024-01327-x. [PMID: 39102059 DOI: 10.1007/s10597-024-01327-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 07/16/2024] [Indexed: 08/06/2024]
Abstract
Suicide rates in rural areas are higher than urban areas and growing, with current treatment developments only exacerbating this discrepancy. Within individual factors, both age and gender relate to and intersect with personal values related to self-reliance and attitudes toward mental health difficulties and treatment to increase suicide risk. The lethality ubiquitous in rural environments and occupations is a leading factor in rural suicide rates, with other factors such as race alternately noted to be a key factor but with more mixed findings. The cultural values of rural communities as typically negative toward mental health disclosure and treatment contribute to the disengagement of rural communities from treatment that may otherwise prevent suicides, exacerbating the physical lack of treatment access many rural communities experience. Working within the primary care system alongside increased telehealth utilization are suggested to reduce rural suicide rates.
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Affiliation(s)
- Michael Prazak
- Department of Counseling Psychology and Community Services, University of North Dakota, 231 Centennial Drive Stop 8255, Grand Forks, ND, USA.
| | - Rachel Bacigalupi
- Department of Counseling Psychology and Community Services, University of North Dakota, 231 Centennial Drive Stop 8255, Grand Forks, ND, USA
| | - Stephen C Hamilton
- Department of Counseling Psychology and Community Services, University of North Dakota, 231 Centennial Drive Stop 8255, Grand Forks, ND, USA
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Miller-Matero LR, Knowlton G, Vagnini KM, Yeh HH, Rossom RC, Penfold RB, Simon GE, Akinyemi E, Abdole L, Hooker SA, Owen-Smith AA, Ahmedani BK. The rapid shift to virtual mental health care: Examining psychotherapy disruption by rurality status. J Rural Health 2024; 40:500-508. [PMID: 38148485 DOI: 10.1111/jrh.12818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/12/2023] [Accepted: 12/17/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Given the low usage of virtual health care prior to the COVID-19 pandemic, it was unclear whether those living in rural locations would benefit from increased availability of virtual mental health care. The rapid transition to virtual services during the COVID-19 pandemic allowed for a unique opportunity to examine how the transition to virtual mental health care impacted psychotherapy disruption (i.e., 45+ days between appointments) among individuals living in rural locations compared with those living in nonrural locations. METHODS Electronic health record and insurance claims data were collected from three health care systems in the United States including rurality status and psychotherapy disruption. Psychotherapy disruption was measured before and after the COVID-19 pandemic onset. RESULTS Both the nonrural and rural cohorts had significant decreases in the rates of psychotherapy disruption from pre- to post-COVID-19 onset (32.5-16.0% and 44.7-24.8%, respectively, p < 0.001). The nonrural cohort had a greater reduction of in-person visits compared with the rural cohort (96.6-45.0 vs. 98.0-66.2%, respectively, p < 0.001). Among the rural cohort, those who were younger and those with lower education had greater reductions in psychotherapy disruption rates from pre- to post-COVID-19 onset. Several mental health disorders were associated with experiencing psychotherapy disruption. CONCLUSIONS Though the rapid transition to virtual mental health care decreased the rate of psychotherapy disruption for those living in rural locations, the reduction was less compared with nonrural locations. Other strategies are needed to improve psychotherapy disruption, especially among rural locations (i.e., telephone visits).
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Affiliation(s)
- Lisa R Miller-Matero
- Henry Ford Health, Center for Health Policy & Health Services Research, Detroit, Michigan, USA
- Henry Ford Health, Behavioral Health Services, Detroit, Michigan, USA
| | - Gregory Knowlton
- Health Partners Institute, Research and Evaluation Division, Bloomington, Minnesota, USA
| | - Kaitlyn M Vagnini
- Henry Ford Health, Center for Health Policy & Health Services Research, Detroit, Michigan, USA
- Henry Ford Health, Behavioral Health Services, Detroit, Michigan, USA
| | - Hsueh-Han Yeh
- Henry Ford Health, Center for Health Policy & Health Services Research, Detroit, Michigan, USA
| | - Rebecca C Rossom
- Health Partners Institute, Research and Evaluation Division, Bloomington, Minnesota, USA
| | - Robert B Penfold
- Kaiser Permanente Washington, Health Research Institute, Seattle, Washington, USA
| | - Gregory E Simon
- Kaiser Permanente Washington, Health Research Institute, Seattle, Washington, USA
| | - Esther Akinyemi
- Henry Ford Health, Behavioral Health Services, Detroit, Michigan, USA
| | - Lana Abdole
- Henry Ford Health, Behavioral Health Services, Detroit, Michigan, USA
| | - Stephanie A Hooker
- Health Partners Institute, Research and Evaluation Division, Bloomington, Minnesota, USA
| | - Ashli A Owen-Smith
- Georgia State University, School of Public Health, Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, Georgia, USA
| | - Brian K Ahmedani
- Henry Ford Health, Center for Health Policy & Health Services Research, Detroit, Michigan, USA
- Henry Ford Health, Behavioral Health Services, Detroit, Michigan, USA
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5
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VanWormer JJ, Berg RL, VanWormer A, Weichelt BP. Race, Rurality, and Suicidality in Children and Adolescents. Am J Prev Med 2024; 66:883-887. [PMID: 38072296 DOI: 10.1016/j.amepre.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/05/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Suicide is among the leading causes of death in U.S. youth. Rural residency is a risk factor, but suicide variability by race/ethnicity is more nuanced. Early detection of suicidal ideation and intent are key components of prevention, but to the authors' knowledge, few prior studies have examined how rurality and race interact on youth suicidality. This study examined suicidality between White non-Hispanic versus non-White or Hispanic youth, as well as those who lived in rural versus non-rural areas. METHODS Cross-sectional analyses were conducted using data from youth age 5-17 years who had complete capture of their medical care in a Wisconsin healthcare system. Suicidality was extracted from medical records by screening for diagnoses indicative of suicidal attempt or ideation between 2017 and 2022. Race/ethnicity and rural residence were extracted from administrative records. Analyses were done in 2023. RESULTS The sample included 27,392 rural and 20,370 non-rural youth, with suicidality observed in 2% of participants. There was a significant interaction between rural residence and race/ethnicity (p=0.015). Non-White or Hispanic youth in rural areas had the highest risk of suicidality at 75 (CI: 57, 97) per 10,000. Non-White or Hispanic youth in non-rural areas had the lowest risk of suicidality at 38 (CI: 28, 52) per 10,000. CONCLUSIONS Racial/ethnic minority youth who lived in rural areas were more likely to experience suicidality as compared to their non-rural counterparts. Larger prospective studies are needed to identify causal elements of the rural environment that may hasten racial disparities in youth suicidality.
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Affiliation(s)
- Jeffrey J VanWormer
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin.
| | - Richard L Berg
- Office of Research Computing and Analytics, Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Arin VanWormer
- Department of Nursing, University of Wisconsin - Eau Claire, Eau Claire, Wisconsin
| | - Bryan P Weichelt
- National Farm Medicine Center, Marshfield Clinic Research Institute, Marshfield, Wisconsin
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6
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Koch EC, Ward MJ, Jeffery AD, Reese TJ, Dorn C, Pugh S, Rubenstein M, Ellen Wilson J, Campbell C, Han JH. Factors Associated with Acute Telemental Health Consultations in Older Veterans. West J Emerg Med 2024; 25:312-319. [PMID: 38801035 PMCID: PMC11112672 DOI: 10.5811/westjem.17996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 11/17/2023] [Accepted: 01/10/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction The United States Veterans Health Administration is a leader in the use of telemental health (TMH) to enhance access to mental healthcare amidst a nationwide shortage of mental health professionals. The Tennessee Valley Veterans Affairs (VA) Health System piloted TMH in its emergency department (ED) and urgent care clinic (UCC) in 2019, with full 24/7 availability beginning March 1, 2020. Following implementation, preliminary data demonstrated that veterans ≥65 years old were less likely to receive TMH than younger patients. We sought to examine factors associated with older veterans receiving TMH consultations in acute, unscheduled, outpatient settings to identify limitations in the current process. Methods This was a retrospective cohort study conducted within the Tennessee Valley VA Health System. We included veterans ≥55 years who received a mental health consultation in the ED or UCC from April 1, 2020-September 30, 2022. Telemental health was administered by a mental health clinician (attending physician, resident physician, nurse practitioner, or physician assistant) via iPad, whereas in-person evaluations were performed in the ED. We examined the influence of patient demographics, visit timing, chief complaint, and psychiatric history on TMH, using multivariable logistic regression. Results Of the 254 patients included in this analysis, 177 (69.7%) received TMH. Veterans with high-risk chief complaints (suicidal ideation, homicidal ideation, or agitation) were less likely to receive TMH consultation (adjusted odds ratio [AOR]: 0.47, 95% confidence interval [CI] 0.24-0.95). Compared to attending physicians, nurse practitioners and physician assistants were associated with increased TMH use (AOR 4.81, 95% CI 2.04-11.36), whereas consultation by resident physicians was associated with decreased TMH use (AOR 0.04, 95% CI 0.00-0.59). The UCC used TMH for all but one encounter. Patient characteristics including their visit timing, gender, additional medical complaints, comorbidity burden, and number of psychoactive medications did not influence use of TMH. Conclusion High-risk chief complaints, location, and type of mental health clinician may be key determinants of telemental health use in older adults. This may help expand mental healthcare access to areas with a shortage of mental health professionals and prevent potentially avoidable transfers in low-acuity situations. Further studies and interventions may optimize TMH for older patients to ensure safe, equitable mental health care.
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Affiliation(s)
- Erica C. Koch
- Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee
- Tennessee Valley Healthcare System, Geriatric Research, Education, and Clinical Center, Nashville, Tennessee
- Veterans Affairs Quality Scholars Program, Nashville, Tennessee
| | - Michael J. Ward
- Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee
- Tennessee Valley Healthcare System, Geriatric Research, Education, and Clinical Center, Nashville, Tennessee
- Vanderbilt University Medical Center, Department of Biomedical Informatics, Nashville, Tennessee
| | - Alvin D. Jeffery
- Vanderbilt University School of Nursing, Nashville, Tennessee
- Vanderbilt University Medical Center, Department of Biomedical Informatics, Nashville, Tennessee
- Tennessee Valley Healthcare System, Nursing Services, Nashville, Tennessee
| | - Thomas J. Reese
- Vanderbilt University Medical Center, Department of Biomedical Informatics, Nashville, Tennessee
| | - Chad Dorn
- Vanderbilt University Medical Center, Department of Biomedical Informatics, Nashville, Tennessee
| | - Shannon Pugh
- Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee
| | - Melissa Rubenstein
- Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee
| | - Jo Ellen Wilson
- Tennessee Valley Healthcare System, Geriatric Research, Education, and Clinical Center, Nashville, Tennessee
- Vanderbilt University Medical Center, Department of Psychiatry, Nashville, Tennessee
| | - Corey Campbell
- Tennessee Valley Healthcare System, Psychiatric Services, Nashville, Tennessee
| | - Jin H. Han
- Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee
- Tennessee Valley Healthcare System, Geriatric Research, Education, and Clinical Center, Nashville, Tennessee
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7
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Bartkowski JP, Klee K, Xu X. Youth Suicide Prevention Programming among the Mississippi Band of Choctaw Indians: Effects of the Lifelines Student Curriculum. CHILDREN (BASEL, SWITZERLAND) 2024; 11:488. [PMID: 38671705 PMCID: PMC11049181 DOI: 10.3390/children11040488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024]
Abstract
Suicide continues to be a leading cause of mortality for young people. Given persistent intersecting forms of disadvantage, Native American adolescents are especially vulnerable to mental health adversities and other suicide risk factors. The Mississippi Band of Choctaw Indians (MBCI) implemented the Choctaw Youth Resilience Initiative (CYRI), a five-year SAMHSA-funded project that began in 2019. This study uses Choctaw student pre-test/post-test survey data to examine the effectiveness of the Hazelden Lifelines Suicide Prevention Training curriculum for youth. A lagged post-test design was used, whereby post-surveys were administered at least one month after program completion. Several intriguing results were observed. First, the lagged post-test model was subject to some pre-to-post attrition, although such attrition was comparable to a standard pre/post design. Second, analyses of completed surveys using means indicated various beneficial effects associated with the Lifelines curriculum implementation. The greatest benefit of the program was a significant change in student perceptions concerning school readiness in response to a suicidal event. Some opportunities for program improvement were also observed. Our study sheds new light on suicide prevention training programs that can be adapted according to Native American youth culture. Program implementation and evaluation implications are discussed in light of these findings.
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Affiliation(s)
- John P. Bartkowski
- Department of Sociology and Demography, University of Texas at San Antonio, San Antonio, TX 78249, USA;
| | - Katherine Klee
- Bartkowski & Associates Research Team, San Antonio, TX 78258, USA;
| | - Xiaohe Xu
- Department of Sociology and Demography, University of Texas at San Antonio, San Antonio, TX 78249, USA;
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8
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VanWormer JJ, Berg RL, Wieckhorst M, Burke RR, Weichelt BP. Medically Attended Suicidality in Youth Who Live on Farms. J Agromedicine 2024; 29:144-149. [PMID: 37772979 DOI: 10.1080/1059924x.2023.2264287] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Suicides are increasing in U.S. youth, particularly in rural areas. The influence of farming, however, is unclear, as suicide rates are higher in individual adult farm workers, but lower in farming-reliant counties. Early recognition of suicidality (suicidal ideation, intent, or attempt) is a key element of prevention, but there are no prior studies comparing suicidality in farm vs. non-farm youth. The purpose of this study was to examine associations between farm/rural residence and suicidality. Medical records were reused from an existing cohort of child and adolescent patients under surveillance for agricultural injuries in a Wisconsin healthcare system. The sample included 2,010 youth who lived on farms and 51,900 youth who did not live on farms (57% rural). The outcome was medically attended suicidality in 2017-2022 per a composite of diagnoses for suicidal ideation, attempt, or intentional self-harm that presented to ambulatory, emergency, or inpatient care settings. Suicidality was observed in 0.8% of farm, 1.8% of non-farm rural, and 1.6% of non-farm non-rural youth. After covariate adjustment, farm youth had significantly lower odds of suicidality (adjusted odds ratio [aOR] [95% confidence interval; CI] = 0.55 [0.33, 0.91], P = .019), while non-farm rural youth had significantly greater odds of suicidality (aOR [CI] = 1.21 [1.05, 1.40], P = .007), relative to non-farm non-rural youth. Children and adolescents who live on farms are about half as likely to (medically) present for suicidality as compared to their non-farm counterparts, both rural and non-rural. Future research should identify causal suicide protection factors in farm youth.
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Affiliation(s)
- Jeffrey J VanWormer
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Richard L Berg
- Office of Research Support Services, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Matthew Wieckhorst
- National Farm Medicine Center, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Richard R Burke
- National Farm Medicine Center, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Bryan P Weichelt
- National Farm Medicine Center, Marshfield Clinic Research Institute, Marshfield, WI, USA
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9
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Jia M, Ju R, Zhu J. Understanding Mental Health Organizations' Instagram Through Visuals: A Content Analysis. HEALTH COMMUNICATION 2024; 39:767-777. [PMID: 36856059 DOI: 10.1080/10410236.2023.2185350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This study analyzed the content, visual features, and audience engagement data of Instagram posts from two mental health organizations over one year (N = 725). For content features, mental health literacy and communicative strategies were examined. Posts that promoted knowledge of mental disorders and treatments, used information and community strategy were more likely to receive higher audience engagement. Visual features of demographic segments, visual composition, and visual framing topics were analyzed. Images that covered an unspecific population, used illustrated images, and focused on anti-stigma topical frames obtained more engagement. Theoretical contributions and practical applications regarding visual message design and management on social media to promote mental health are also offered.
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Affiliation(s)
- Moyi Jia
- Communication and Media Studies Department, State University of New York at Cortland
| | - Ran Ju
- Department of Public Relations, Mount Royal University
| | - Jian Zhu
- Department of Psychology, Eastern Illinois University
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10
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Scott KA, Elliott KC, Lincoln J, Flynn MA, Hill R, Hall DM. Rural health and rural industries: Opportunities for partnership and action. J Rural Health 2024; 40:401-405. [PMID: 37669228 PMCID: PMC10912364 DOI: 10.1111/jrh.12791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/18/2023] [Accepted: 08/20/2023] [Indexed: 09/07/2023]
Affiliation(s)
- Kenneth A. Scott
- National Institute for Occupational Safety and Health, Denver, Colorado, USA
| | - K. C. Elliott
- National Institute for Occupational Safety and Health, Anchorage, Alaska, USA
| | - Jennifer Lincoln
- National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Michael A. Flynn
- National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Ryan Hill
- National Institute for Occupational Safety and Health, Spokane, Washington, USA
| | - Diane M. Hall
- Office of Rural Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Ghadipasha M, Talaie R, Mahmoodi Z, Karimi SE, Forouzesh M, Morsalpour M, Mahdavi SA, Mousavi SS, Ashrafiesfahani S, Kordrostami R, Dadashzadehasl N. Spatial, geographic, and demographic factors associated with adolescent and youth suicide: a systematic review study. Front Psychiatry 2024; 15:1261621. [PMID: 38404471 PMCID: PMC10893588 DOI: 10.3389/fpsyt.2024.1261621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 01/26/2024] [Indexed: 02/27/2024] Open
Abstract
Background Suicide is a public health issue and a main cause of mortality among adolescents and the youth worldwide, particularly in developing countries. Objectives The present research is a systematic review aiming to investigate the spatial, geographical, and demographic factors related to suicide among adolescents and the youth. Methods In this systematic review, two researchers examined PsycINFO, Web of Science, Scopus, and PubMed databases on December 7th, 2022 with no time limits from the beginning of publication until 2022 to identify the primary studies on spatial and geographic analysis on adolescent and youth suicides. Once duplicate studies were identified and removed, the titles and abstracts of studies were examined and irrelevant studies were also removed. Finally, 22 studies were reviewed based on the inclusion criteria. Results Our findings show that suicide rates are generally higher among men, residents of rural and less densely populated regions, coastal and mountainous regions, natives, 15-29 age group, less privileged populations with social fragmentation, unemployed, divorced or lonely people, those who live in single parent families, people with mental health issues, and those with low levels of education. Conclusions Stronger evidence supports the effects of geographic and demographic variables on youth and adolescent suicide rates as compared with spatial variables. These findings suggest that policy makers take spatial and demographic factors into consideration when health systems allocate resources for suicide prevention, and that national policymakers integrate demographic and geographic variables into health service programs. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier CRD42023430994.
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Affiliation(s)
- Masoud Ghadipasha
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | - Ramin Talaie
- Department of Gastroenterology and Hepatology, School of Medicine, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zohreh Mahmoodi
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Salah Eddin Karimi
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehdi Forouzesh
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | - Masoud Morsalpour
- Department of Criminal Law and Criminology, Islamic Azad University, Tehran, Iran
| | | | | | | | - Roya Kordrostami
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
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12
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Keyes KM, Kandula S, Martinez-Ales G, Gimbrone C, Joseph V, Monnat S, Rutherford C, Olfson M, Gould M, Shaman J. Geographic Variation, Economic Activity, and Labor Market Characteristics in Trajectories of Suicide in the United States, 2008-2020. Am J Epidemiol 2024; 193:256-266. [PMID: 37846128 DOI: 10.1093/aje/kwad205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023] Open
Abstract
Suicide rates in the United States have increased over the past 15 years, with substantial geographic variation in these increases; yet there have been few attempts to cluster counties by the magnitude of suicide rate changes according to intercept and slope or to identify the economic precursors of increases. We used vital statistics data and growth mixture models to identify clusters of counties by their magnitude of suicide growth from 2008 to 2020 and examined associations with county economic and labor indices. Our models identified 5 clusters, each differentiated by intercept and slope magnitude, with the highest-rate cluster (4% of counties) being observed mainly in sparsely populated areas in the West and Alaska, starting the time series at 25.4 suicides per 100,000 population, and exhibiting the steepest increase in slope (0.69/100,000/year). There was no cluster for which the suicide rate was stable or declining. Counties in the highest-rate cluster were more likely to have agricultural and service economies and less likely to have urban professional economies. Given the increased burden of suicide, with no clusters of counties improving over time, additional policy and prevention efforts are needed, particularly targeted at rural areas in the West.
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Miller-Matero LR, Yeh HH, Maffett A, Mooney JT, Sala-Hamrick K, Frank CB, Simon GE, Rossom R, Owen-Smith AA, Lynch FL, Beck A, Waring S, Daida YG, Lu CY, Ahmedani BK. Racial-Ethnic Differences in Receipt of Past-Year Health Care Services Among Suicide Decedents: A Case-Control Study. Psychiatr Serv 2024; 75:124-130. [PMID: 37554000 PMCID: PMC10840630 DOI: 10.1176/appi.ps.20220578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
OBJECTIVE Suicide remains an urgent public health crisis. Although some sociodemographic characteristics are associated with greater suicide risk in the general population, it is unclear whether individuals utilizing health care in the United States have similar suicide incidence patterns. The authors examined whether race-ethnicity is associated with suicide death among patients seeking health care and investigated health care utilization patterns. METHODS Data were collected from electronic health records and government mortality records for patients seeking health care across nine health care systems in the United States. Patients who died by suicide (N=1,935) were matched with patients in a control group (N=19,350) within each health care system. RESULTS Patients who died by suicide were significantly more likely to be White, older, male, living in low-education areas, living in rural areas, or diagnosed as having mental health conditions or were significantly less likely to have commercial insurance (p<0.05). Among most racial-ethnic groups, those who died by suicide had a higher number of past-year mental health, primary care, and total health care visits; for American Indian/Alaska Native patients, the number of health care visits tended to be lower among suicide decedents. CONCLUSIONS These findings suggest that higher past-year health care utilization was associated with increased likelihood of suicide death across several racial-ethnic groups. This observation underscores the need for identifying and managing suicide risk in health care settings, including outside of mental health visits, among most racial-ethnic groups.
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Affiliation(s)
- Lisa R Miller-Matero
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Hsueh-Han Yeh
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Anissa Maffett
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Jan T Mooney
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Kelsey Sala-Hamrick
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Cathrine B Frank
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Gregory E Simon
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Rebecca Rossom
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Ashli A Owen-Smith
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Frances L Lynch
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Arne Beck
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Stephen Waring
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Yihe G Daida
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Christine Y Lu
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Brian K Ahmedani
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
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Patel D, Sumner SA, Bowen D, Zwald M, Yard E, Wang J, Law R, Holland K, Nguyen T, Mower G, Chen Y, Johnson JI, Jespersen M, Mytty E, Lee JM, Bauer M, Caine E, De Choudhury M. Predicting state level suicide fatalities in the united states with realtime data and machine learning. NPJ MENTAL HEALTH RESEARCH 2024; 3:3. [PMID: 38609512 PMCID: PMC10956008 DOI: 10.1038/s44184-023-00045-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 11/20/2023] [Indexed: 04/14/2024]
Abstract
Digital trace data and machine learning techniques are increasingly being adopted to predict suicide-related outcomes at the individual level; however, there is also considerable public health need for timely data about suicide trends at the population level. Although significant geographic variation in suicide rates exist by state within the United States, national systems for reporting state suicide trends typically lag by one or more years. We developed and validated a deep learning based approach to utilize real-time, state-level online (Mental Health America web-based depression screenings; Google and YouTube Search Trends), social media (Twitter), and health administrative data (National Syndromic Surveillance Program emergency department visits) to estimate weekly suicide counts in four participating states. Specifically, per state, we built a long short-term memory (LSTM) neural network model to combine signals from the real-time data sources and compared predicted values of suicide deaths from our model to observed values in the same state. Our LSTM model produced accurate estimates of state-specific suicide rates in all four states (percentage error in suicide rate of -2.768% for Utah, -2.823% for Louisiana, -3.449% for New York, and -5.323% for Colorado). Furthermore, our deep learning based approach outperformed current gold-standard baseline autoregressive models that use historical death data alone. We demonstrate an approach to incorporate signals from multiple proxy real-time data sources that can potentially provide more timely estimates of suicide trends at the state level. Timely suicide data at the state level has the potential to improve suicide prevention planning and response tailored to the needs of specific geographic communities.
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Affiliation(s)
- Devashru Patel
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, USA
| | - Steven A Sumner
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Daniel Bowen
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marissa Zwald
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ellen Yard
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jing Wang
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Royal Law
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristin Holland
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Gary Mower
- Utah Department of Health and Human Services, Salt Lake City, UT, USA
| | - Yushiuan Chen
- Tri-County Health Department, Greenwood Village, CO, USA
| | | | | | | | | | - Michael Bauer
- New York State Department of Health, Albany, NY, USA
| | - Eric Caine
- University of Rochester Medical Center, Rochester, NY, USA
| | - Munmun De Choudhury
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, USA.
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15
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Arif AA, Adeyemi O, Laditka SB, Laditka JN. Suicide Rates and Risks Across U.S. Industries: A 29-Year Population-Based Survey. Arch Suicide Res 2024:1-26. [PMID: 38193926 DOI: 10.1080/13811118.2023.2300324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
OBJECTIVE Suicide rates in the working-age U.S. population have increased by over 40% in the last two decades. Although suicide may be linked with characteristics of workplaces and their industries, few studies have reported industry-level suicide rates. No study has reported suicide rates by industry using nationally representative data. This study estimates suicide risks across industries in the U.S. working population. METHODS Industry-level estimates of suicide risks require substantial data; we combined 29 years of U.S. suicide data using the National Health Interview Survey (NHIS)-Mortality Linked data from 1986 through 2014, with mortality follow-up through 2015. We conducted survey-weighted Poisson regression analyses to estimate suicide mortality rates and rate ratios across all populations and stratified by gender. All analyses were adjusted first for age, and then for age, employment status, marital status, race/ethnicity, and rurality/urbanicity (demographic-adjusted). Rate ratios compared results for workers in each industry to those for all industries, accounting for the NHIS survey design. RESULTS A total of 1,943 suicide deaths were recorded. Age-adjusted suicide rates per 100,000 were highest in the furniture, lumber, and wood industry group (29.3), the fabricated metal industry (26.3), and mining (25.8). Demographic-adjusted rates were higher among men than women in most industries. Demographic-adjusted rate ratios were significantly elevated in the furniture, lumber, and wood industries (Rate Ratio, RR = 1.60, 95% confidence interval, CI = 1.18-2.18); chemicals and allied products (RR = 1.49, 95%CI = 1.04-2.13); and construction (RR = 1.21, 95% CI = 1.03-1.41). CONCLUSION Several industries had significantly high suicide rates. Suicide prevention efforts may be particularly useful for workers in those industries.
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16
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Roth KB, Gaveras E, Ghiathi F, Shaw EK, Shoemaker MS, Howard NA, Dhir M, Caiza GR, Szlyk HS. A Community-Engaged Approach to Understanding Suicide in a Small Rural County in Georgia: A Two-Phase Content Analysis of Individual and Focus Group Interviews. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7145. [PMID: 38131697 PMCID: PMC10743163 DOI: 10.3390/ijerph20247145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/10/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023]
Abstract
Suicide is a significant public health problem, with disproportionate rates in rural areas. Rural communities face substantial structural and cultural barriers to suicide prevention. This study aimed to gain a deeper understanding of the need for suicide prevention and gauge the appropriateness of prevention efforts in the context of a rural Georgia county by leveraging existing community resources and knowledge. Twenty one-on-one, semi-structured interviews and two focus groups were conducted, with participants recruited via purposive snowball sampling. Data analysis included qualitative deductive and inductive content analysis from individual interviews and focus groups with community stakeholders. The findings highlight how rural contexts exacerbate drivers of death by suicide and how the substantial loss of community members to suicide contributes to the ongoing crisis and reduces available support. Access to mental health care often depended on a connection to an established public system such as schools, a military base, or Veterans Administration. There were perceived gaps in crisis and post-crisis services, with participants actively trying to address these gaps and build community support through coalition building. This study contributes knowledge to contextual drivers of suicide in rural areas beyond individual-level risk factors. Community-engaged suicide prevention research in rural areas is promising, but there is a need to develop interventions to best support coalition building and capacity development.
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Affiliation(s)
- Kimberly Beth Roth
- Department of Community Medicine, School of Medicine, Mercer University, 1250 E 66th Street, Savannah, GA 31404, USA; (F.G.); (E.K.S.); (M.S.S.); (N.A.H.); (M.D.); (G.R.C.)
| | - Eleni Gaveras
- Brown School of Social Work, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130, USA;
| | - Fatima Ghiathi
- Department of Community Medicine, School of Medicine, Mercer University, 1250 E 66th Street, Savannah, GA 31404, USA; (F.G.); (E.K.S.); (M.S.S.); (N.A.H.); (M.D.); (G.R.C.)
| | - Eric Kendall Shaw
- Department of Community Medicine, School of Medicine, Mercer University, 1250 E 66th Street, Savannah, GA 31404, USA; (F.G.); (E.K.S.); (M.S.S.); (N.A.H.); (M.D.); (G.R.C.)
| | - Melanie Shanlin Shoemaker
- Department of Community Medicine, School of Medicine, Mercer University, 1250 E 66th Street, Savannah, GA 31404, USA; (F.G.); (E.K.S.); (M.S.S.); (N.A.H.); (M.D.); (G.R.C.)
| | - Nicholas Adam Howard
- Department of Community Medicine, School of Medicine, Mercer University, 1250 E 66th Street, Savannah, GA 31404, USA; (F.G.); (E.K.S.); (M.S.S.); (N.A.H.); (M.D.); (G.R.C.)
| | - Meena Dhir
- Department of Community Medicine, School of Medicine, Mercer University, 1250 E 66th Street, Savannah, GA 31404, USA; (F.G.); (E.K.S.); (M.S.S.); (N.A.H.); (M.D.); (G.R.C.)
| | - Genesis Rebeca Caiza
- Department of Community Medicine, School of Medicine, Mercer University, 1250 E 66th Street, Savannah, GA 31404, USA; (F.G.); (E.K.S.); (M.S.S.); (N.A.H.); (M.D.); (G.R.C.)
| | - Hannah Selene Szlyk
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, 660 South Euclid Avenue, St. Louis, MO 63110, USA;
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17
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Daniels CL, Ellison CG, DeAngelis RT, Klee K. Is Irreligion a Risk Factor for Suicidality? Findings from the Nashville Stress and Health Study. JOURNAL OF RELIGION AND HEALTH 2023; 62:3801-3819. [PMID: 37702852 PMCID: PMC10757271 DOI: 10.1007/s10943-023-01906-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/14/2023]
Abstract
Suicide is a public health problem and one of the leading causes of death in the United States. Research exploring the linkages between religion and spirituality has received intermittent attention. Data was derived from the Nashville Stress and Health Study (2011-2014), a cross-sectional probability survey of black and white adults from Davidson County, Tennessee (n = 1252). Results indicate that those with no perceived belief in divine control had a higher likelihood of suicidality. This study provides a fresh perspective on the links between religious factors and suicidality by (a) considering multiple religious and spiritual domains and (b) focusing on the association between irreligion and suicidality.
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Affiliation(s)
- Colton L Daniels
- Department of Criminal Justice and Criminology, St. Mary's University, San Antonio, TX, USA.
| | | | - Reed T DeAngelis
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
| | - Katherine Klee
- Department of Sociology, University of Texas at San Antonio, San Antonio, TX, USA
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18
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McCall WV, Thomas A, Miller BJ, Rosenquist PB. The Role of the Autonomic Nervous System in the Mediation of the Resolution of Suicidal Ideation With Electroconvulsive Therapy: A Hypothesis and Review of Heart Rate Variability Over a Course of Electroconvulsive Therapy. J ECT 2023; 39:214-219. [PMID: 37530701 DOI: 10.1097/yct.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
ABSTRACT Longitudinal observational studies have shown a meaningful decrease in suicidal thinking and suicidal behavior after receipt of electroconvulsive therapy (ECT). The antisuicide effect of ECT may be related to success in the global relief of the presenting syndrome such as depressive or psychotic illness. However, it is possible that the antisuicide effect is specific to ECT per se, over and above the relief of the clinical syndrome. Electroconvulsive therapy is associated with many observable neurochemical and physiologic effects, and some of these may plausibly be specifically linked to an antisuicide effect. The phenomenon of physiologic hyperarousal has been named as a candidate mechanism driving the risk for suicide. Hyperarousal is associated with decreased neuropsychological executive function responsible for response inhibition and can lead to impulsive action. The level of arousal within the autonomic nervous system (ANS) can be assayed with the pupillary light reflex, electrodermal activity, or with heart rate variability (HRV). This article summarizes the literature on the effects of ECT on HRV 24 to 72 hours after a course of ECT and finds evidence for increases in HRV, which indicates lower levels of arousal in the ANS. This finding suggests that ECT-related reductions in ANS arousal, presumably with corresponding improvements in response inhibition, may be one mechanism whereby ECT reduces risk for suicide.
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Affiliation(s)
| | - Alvin Thomas
- Medical College of Georgia at Augusta University, Augusta, GA
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19
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Molock SD, Boyd RC, Alvarez K, Cha C, Denton EG, Glenn CR, Katz CC, Mueller AS, Meca A, Meza JI, Miranda R, Ortin-Peralta A, Polanco-Roman L, Singer JB, Zullo L, Miller AB. Culturally responsive assessment of suicidal thoughts and behaviors in youth of color. AMERICAN PSYCHOLOGIST 2023; 78:842-855. [PMID: 36913280 PMCID: PMC10497725 DOI: 10.1037/amp0001140] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
The significance of youth suicide as a public health concern is underscored by the fact that it is the second-leading cause of death for youth globally. While suicide rates for White groups have declined, there has been a precipitous rise in suicide deaths and suicide-related phenomena in Black youth; rates remain high among Native American/Indigenous youth. Despite these alarming trends, there are very few culturally tailored suicide risk assessment measures or procedures for youth from communities of color. This article attempts to address this gap in the literature by examining the cultural relevancy of currently widely used suicide risk assessment instruments, research on suicide risk factors, and approaches to risk assessment for youth from communities of color. It also notes that researchers and clinicians should consider other, nontraditional but important factors in suicide risk assessment, including stigma, acculturation, and racial socialization, as well as environmental factors like health care infrastructure and exposure to racism and community violence. The article concludes with recommendations for factors that should be considered in suicide risk assessment for youth from communities of color. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Sherry D Molock
- Department of Psychological and Brain Sciences, George Washington University
| | - Rhonda C Boyd
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia
| | - Kiara Alvarez
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Christine Cha
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University
| | - Ellen-Ge Denton
- Department of Psychology, College of Staten Island, City University of New York
| | | | - Colleen C Katz
- Silberman School of Social Work, Hunter College, City University of New York
| | | | - Alan Meca
- Department of Psychology, University of Texas at San Antonio
| | - Jocelyn I Meza
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Regina Miranda
- Department of Psychology, Hunter College, City University of New York
| | - Ana Ortin-Peralta
- Department of Psychology, Hunter College, City University of New York
| | | | | | - Lucas Zullo
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
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Forrest LN, Beccia AL, Exten C, Gehman S, Ansell EB. Intersectional Prevalence of Suicide Ideation, Plan, and Attempt Based on Gender, Sexual Orientation, Race and Ethnicity, and Rurality. JAMA Psychiatry 2023; 80:1037-1046. [PMID: 37466933 PMCID: PMC10357364 DOI: 10.1001/jamapsychiatry.2023.2295] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/07/2023] [Indexed: 07/20/2023]
Abstract
Importance Suicidal thoughts and behaviors (STBs) are major public health problems, and some social groups experience disproportionate STB burden. Studies assessing STB inequities for single identities (eg, gender or sexual orientation) cannot evaluate intersectional differences and do not reflect that the causes of inequities are due to structural-level (vs individual-level) processes. Objective To examine differences in STB prevalence at the intersection of gender, sexual orientation, race and ethnicity, and rurality. Design, Setting, and Participants This cross-sectional study used adult data from the 2015-2019 National Survey on Drug Use and Health (NSDUH), a population-based sample of noninstitutionalized US civilians. Data were analyzed from July 2022 to March 2023. Main Outcomes and Measures Outcomes included past-year suicide ideation, plan, and attempt, each assessed with a single question developed for the NSDUH. Intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) models were estimated, in which participants were nested within social strata defined by all combinations of gender, sexual orientation, race and ethnicity, and rurality; outcome prevalence estimates were obtained for each social stratum. Social strata were conceptualized as proxies for exposure to structural forms of discrimination that contribute to health advantages or disadvantages (eg, sexism, racism). Results The analytic sample included 189 800 adults, of whom 46.5% were men; 53.5%, women; 4.8%, bisexual; 93.0%, heterosexual; 2.2%, lesbian or gay; 18.8%, Hispanic; 13.9%, non-Hispanic Black; and 67.2%, non-Hispanic White. A total of 44.6% were from large metropolitan counties; 35.5%, small metropolitan counties; and 19.9%, nonmetropolitan counties. There was a complex social patterning of STB prevalence that varied across social strata and was indicative of a disproportionate STB burden among multiply marginalized participants. Specifically, the highest estimated STB prevalence was observed among Hispanic (suicide ideation: 18.1%; 95% credible interval [CrI], 13.5%-24.3%) and non-Hispanic Black (suicide plan: 7.9% [95% CrI, 4.5%-12.1%]; suicide attempt: 3.3% [95% CrI, 1.4%-6.2%]) bisexual women in nonmetropolitan counties. Conclusions and Relevance In this cross-sectional study, intersectional exploratory analyses revealed that STB prevalence was highest among social strata including multiply marginalized individuals (eg, Hispanic and non-Hispanic Black bisexual women) residing in more rural counties. The findings suggest that considering and intervening in both individual-level (eg, psychiatric disorders) and structural-level (eg, structural discrimination) processes may enhance suicide prevention and equity efforts.
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Affiliation(s)
- Lauren N. Forrest
- Department of Psychiatry and Behavioral Health, College of Medicine, Pennsylvania State University, Hershey
| | - Ariel L. Beccia
- Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Cara Exten
- Ross and Carol Nese College of Nursing, Pennsylvania State University, State College
| | - Sarah Gehman
- College of Medicine, Pennsylvania State University, Hershey
| | - Emily B. Ansell
- Department of Biobehavioral Health, Pennsylvania State University, State College
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21
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Johnson B, Szilagyi N. Supporting Transgender Youth Across Psychosocial Systems. Child Adolesc Psychiatr Clin N Am 2023; 32:815-837. [PMID: 37739637 DOI: 10.1016/j.chc.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
Transgender children and adolescents are at an elevated risk for negative mental health outcomes due to exposure to stigma and discrimination regarding their identity. While various environments may perpetuate this stigma, many supports also exist that can bolster safety, affirmation, and resilience in this population. Opportunities for support exist within schools, broader communities, religious organizations, and with medical professionals who practice gender-affirming care. Clinicians who are familiar with resources in their communities can effectively guide transgender youth and their families to these affirming spaces.
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Affiliation(s)
- Brandon Johnson
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1090 Amsterdam Avenue 16th Floor, New York, NY 10025, USA.
| | - Nathalie Szilagyi
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA; Aurora Psychiatric Associates, Greenwich, CT, USA
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22
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Molitor D, Mullins JT, White C. Air pollution and suicide in rural and urban America: Evidence from wildfire smoke. Proc Natl Acad Sci U S A 2023; 120:e2221621120. [PMID: 37695917 PMCID: PMC10515164 DOI: 10.1073/pnas.2221621120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/27/2023] [Indexed: 09/13/2023] Open
Abstract
Air pollution poses well-established risks to physical health, but little is known about its effects on mental health. We study the relationship between wildfire smoke exposure and suicide risk in the United States in 2007 to 2019 using data on all deaths by suicide and satellite-based measures of wildfire smoke and ambient fine particulate matter (PM2.5) concentrations. We identify the causal effects of wildfire smoke pollution on suicide by relating year-over-year fluctuations in county-level monthly smoke exposure to fluctuations in suicide rates and compare the effects across local areas and demographic groups that differ considerably in their baseline suicide risk. In rural counties, an additional day of smoke increases monthly mean PM2.5 by 0.41 μg/m3 and suicide deaths by 0.11 per million residents, such that a 1-μg/m3 (13%) increase in monthly wildfire-derived fine particulate matter leads to 0.27 additional suicide deaths per million residents (a 2.0% increase). These effects are concentrated among demographic groups with both high baseline suicide risk and high exposure to outdoor air: men, working-age adults, non-Hispanic Whites, and adults with no college education. By contrast, we find no evidence that smoke pollution increases suicide risk among any urban demographic group. This study provides large-scale evidence that air pollution elevates the risk of suicide, disproportionately so among rural populations.
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Affiliation(s)
- David Molitor
- Gies College of Business, University of Illinois, Champaign, IL61820
- National Bureau of Economic Research, Cambridge, MA02138
| | - Jamie T. Mullins
- Department of Resource Economics, University of Massachusetts, Amherst, MA01003
| | - Corey White
- Department of Economics, Monash University, Caulfield East, VIC3145, Australia
- IZA Institute of Labor Economics, 53113Bonn, Germany
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23
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Sahraian A, Sepehrtaj SN, Sepehrtaj SS, Kamyab P. Characteristics and related factors of suicide attempts among patients admitted to an Iranian poisoning center: Implications for suicide prevention. Heliyon 2023; 9:e20083. [PMID: 37809387 PMCID: PMC10559819 DOI: 10.1016/j.heliyon.2023.e20083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 09/09/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023] Open
Abstract
Background Suicide is a major public health concern worldwide. Iran is no exception, with suicide rates increasing in recent years. Understanding the characteristics and related factors of suicide attempts can help inform suicide prevention efforts in Iran. Methods A cross-sectional study was conducted on patients who attempted suicide and were admitted to the poisoning emergency of an intoxication center in Shiraz, Iran, between November 2019 and January 2020. Data were collected using data sheets containing study variables completed by oral interviewers and analyzed using descriptive and inferential statistics. Results The study included 302 individuals, with the majority being females (63.6%), and the mean age was 28.19 (SD 19.25) years. The majority of patients were living in urban areas (82.5%) and unmarried (60.9%). Medical drug abuse was the most common method of self-poisoning (76.5%), followed by narcotics (15.6%). Suicide attempts were predominantly carried out at night (59.9%) and on working days (78.5%). Most patients had no history of previous suicidal attempts (64.2%), psychiatric problems (64.6%), or physical illnesses (84.8%). Female gender (P = 0.017) and the presence of an underlying disease (P = 0.016) were the two risk factors significantly associated with suicide on non-working days. Conclusion Our study highlights the need for comprehensive suicide prevention strategies that consider the complex interplay of individual, sociocultural, and environmental factors that contribute to suicidal behaviors. The high proportion of female suicide attempters and the timing of suicide attempts suggest the need for gender-specific suicide prevention programs and focused suicide prevention efforts during high-risk periods. Additionally, the association between physical illnesses and suicide attempts underscores the importance of integrated mental and physical health care services.
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Affiliation(s)
- Ali Sahraian
- Research Center for Psychiatry and Behavioral Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Parnia Kamyab
- Research Center for Psychiatry and Behavioral Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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24
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Hoopsick RA, Yockey RA. A national examination of suicidal ideation, planning, and attempts among United States adults: Differences by military veteran status, 2008-2019. J Psychiatr Res 2023; 165:34-40. [PMID: 37459776 DOI: 10.1016/j.jpsychires.2023.07.009] [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: 03/08/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 09/03/2023]
Abstract
There is a widening disparity in suicide deaths between United States (U.S.) military veterans and nonveterans. However, it is unclear if there are similar differences in suicidal ideation, planning, and attempts that often precipitate these deaths. A better understanding of trends in suicidal thoughts and behaviors could illuminate opportunities for prevention. We examined pooled cross-sectional data (N = 479,801 adults) from the 2008 to 2019 National Survey on Drug Use and Health. We examined differences in past-year suicidal ideation, suicide planning, and suicide attempts between U.S. veterans (n = 26,508) and nonveterans (n = 453,293). We conducted post hoc analyses to examine for differences in these relationships by race/ethnicity and sex. Lastly, we examined trends in these outcomes over time and tested for differences in trends by veteran status. Overall, veterans had significantly greater odds of past-year suicidal ideation (aOR = 1.33, 95% CI 1.20 to 1.47) and suicide planning (aOR = 1.52, 95% CI 1.30 to 1.78) compared to nonveterans. However, the association between veteran status and past-year suicide attempt was not statistically significant (aOR = 1.29, 95% CI 1.00 to 1.68). These relationships did not differ by race/ethnicity or sex (ps > 0.05). Among all adults, there were significant linear increases in past-year suicidal ideation, planning, and attempts (ps < 0.001). However, these trends did not differ between veterans and nonveterans (ps > 0.05). Veterans may be more likely to experience suicidal thoughts and behaviors than nonveteran adults. Upward trends in suicidal thoughts and behaviors among both veterans and nonveterans from 2008 to 2019 highlight opportunities for intervention.
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Affiliation(s)
- Rachel A Hoopsick
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, 1206 S. Fourth St., 2017 Khan Annex, Huff Hall, Champaign, IL, 61820, USA.
| | - R Andrew Yockey
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, School of Public Health, 709C, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA.
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25
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Arisoyin AE, Adeyemi AH, Okobi OE, Alaga AH, Adekunle OJ, Ajayi OO, Aladeniyi F, Oni EO, Okobi E, Okeaya-Inneh M, Young CL. Analyzing Trends in Suicide Attempts Among the Pediatric Population in the United States: A Study Using CDC's Youth Risk Behavior Surveillance System (YRBSS) Database. Cureus 2023; 15:e44099. [PMID: 37753036 PMCID: PMC10518429 DOI: 10.7759/cureus.44099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
Background Suicide is a significant public health concern among the pediatric population in the United States. This study aims to comprehensively analyze suicide attempts among adolescents using data from the Youth Risk Behavior Surveillance System (YRBSS) maintained by the Centers for Disease Control and Prevention (CDC). Methods The pediatric population of grades 9-12 students (13-17 years old) was included in the study population, and data were collected from multiple cycles of the YRBSS survey. Descriptive statistics and time-trend analyses were conducted to examine attempted suicide rates based on location, gender, race/ethnicity, school grade level, and sexual orientation. Results Significant variations in attempted suicide rates were observed among different demographic groups. In 2021, of the subset with suicide attempt, females reported a higher prevalence of attempted suicide (13.3%, n=211), while males exhibited a lower rate (6.6%, n=104). Of the total studied population in 2021, Palau had the highest attempted suicide rate (25.2%, n=3924), followed by the Northern Mariana Islands (17.6%, n=2740). Over 1991-2021, no significant location-based variations were observed. In 2021, American Indian/Alaska Native adolescents had the highest attempted suicide rate at 16% (n=2491), followed by Black adolescents (14.5%, n=2258). Ninth-grade students reported higher rates in 2021 (11.6%, n=1806). Adolescents reporting both opposite-sex (36.7%, n=5715) and same-sex-only sexual contacts or both (32.9%, n=5123) exhibited notably higher rates in 2021. Conclusion This study highlights alarming attempted suicide rates in the US pediatric population, emphasizing the need for tailored prevention efforts and mental health support. It offers essential guidance for policymakers, researchers, and mental health professionals in developing evidence-based strategies to promote youth well-being and combat the impact of suicide attempts.
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Affiliation(s)
| | | | - Okelue E Okobi
- Family Medicine, Larkin Community Hospital Palm Springs Campus, Miami, USA
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | | | | | - Olamide O Ajayi
- Internal Medicine, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu, NGA
| | - Funmi Aladeniyi
- Department of Medicine, American University of Antigua, Antigua, ATG
| | - Esther O Oni
- General Practice, Ladoke Akintola University of Technology, Ogbomoso, NGA
| | - Emeka Okobi
- Dentistry, Ahmadu Bello University Teaching Hospital, Abuja, NGA
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Pavicic M, Walker AM, Sullivan KA, Lagergren J, Cliff A, Romero J, Streich J, Garvin MR, Pestian J, McMahon B, Oslin DW, Beckham JC, Kimbrel NA, Jacobson DA. Using iterative random forest to find geospatial environmental and Sociodemographic predictors of suicide attempts. Front Psychiatry 2023; 14:1178633. [PMID: 37599888 PMCID: PMC10433206 DOI: 10.3389/fpsyt.2023.1178633] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/21/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Despite a recent global decrease in suicide rates, death by suicide has increased in the United States. It is therefore imperative to identify the risk factors associated with suicide attempts to combat this growing epidemic. In this study, we aim to identify potential risk factors of suicide attempt using geospatial features in an Artificial intelligence framework. Methods We use iterative Random Forest, an explainable artificial intelligence method, to predict suicide attempts using data from the Million Veteran Program. This cohort incorporated 405,540 patients with 391,409 controls and 14,131 attempts. Our predictive model incorporates multiple climatic features at ZIP-code-level geospatial resolution. We additionally consider demographic features from the American Community Survey as well as the number of firearms and alcohol vendors per 10,000 people to assess the contributions of proximal environment, access to means, and restraint decrease to suicide attempts. In total 1,784 features were included in the predictive model. Results Our results show that geographic areas with higher concentrations of married males living with spouses are predictive of lower rates of suicide attempts, whereas geographic areas where males are more likely to live alone and to rent housing are predictive of higher rates of suicide attempts. We also identified climatic features that were associated with suicide attempt risk by age group. Additionally, we observed that firearms and alcohol vendors were associated with increased risk for suicide attempts irrespective of the age group examined, but that their effects were small in comparison to the top features. Discussion Taken together, our findings highlight the importance of social determinants and environmental factors in understanding suicide risk among veterans.
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Affiliation(s)
- Mirko Pavicic
- Oak Ridge National Laboratory, Computational and Predictive Biology, Oak Ridge, TN, United States
| | - Angelica M. Walker
- The Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee Knoxville, Knoxville, TN, United States
| | - Kyle A. Sullivan
- Oak Ridge National Laboratory, Computational and Predictive Biology, Oak Ridge, TN, United States
| | - John Lagergren
- Oak Ridge National Laboratory, Computational and Predictive Biology, Oak Ridge, TN, United States
| | - Ashley Cliff
- The Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee Knoxville, Knoxville, TN, United States
| | - Jonathon Romero
- The Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee Knoxville, Knoxville, TN, United States
| | - Jared Streich
- Oak Ridge National Laboratory, Computational and Predictive Biology, Oak Ridge, TN, United States
| | - Michael R. Garvin
- Oak Ridge National Laboratory, Computational and Predictive Biology, Oak Ridge, TN, United States
| | - John Pestian
- Oak Ridge National Laboratory, Computational and Predictive Biology, Oak Ridge, TN, United States
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - Benjamin McMahon
- Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, NM, United States
| | - David W. Oslin
- VISN 4 Mental Illness Research, Education, and Clinical Center, Center of Excellence, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jean C. Beckham
- Durham Veterans Affairs Health Care System, Durham, NC, United States
- VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Seattle, WA, United States
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Nathan A. Kimbrel
- Durham Veterans Affairs Health Care System, Durham, NC, United States
- VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Seattle, WA, United States
- Duke University School of Medicine, Duke University, Durham, NC, United States
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, United States
| | - Daniel A. Jacobson
- Oak Ridge National Laboratory, Computational and Predictive Biology, Oak Ridge, TN, United States
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El-Qawaqzeh K, Colosimo C, Bhogadi SK, Magnotti LJ, Hosseinpour H, Castanon L, Nelson A, Ditillo M, Anand T, Joseph B. Unequal Treatment? Confronting Racial, Ethnic, and Socioeconomic Disparity in Management of Survivors of Violent Suicide Attempt. J Am Coll Surg 2023; 237:68-78. [PMID: 37057829 DOI: 10.1097/xcs.0000000000000716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
BACKGROUND Psychiatric inpatient hospitalization is nearly always indicated for patients with recent suicidal behavior. We aimed to assess the factors associated with receiving mental health services during hospitalization or on discharge among survivors of suicide attempts in trauma centers. STUDY DESIGN A 3-year analysis of the 2017 to 2019 American College of Surgeons TQIP. Adults (≥18 years) presenting after suicide attempts were included. Patients who died, those with emergency department discharge disposition, those with superficial lacerations, and those who were transferred to nonpsychiatric care facilities were excluded. Backward stepwise regression analyses were performed to identify predictors of receiving mental health services (inpatient psychiatric consultation/psychotherapy, discharge/transfer to a psychiatric hospital, or admission to a distinct psychiatric unit of a hospital). RESULTS We identified 18,701 patients, and 56% received mental health services. The mean age was 40 ± 15 years, 72% were males, 73% were White, 57% had a preinjury psychiatric comorbidity, and 18% were uninsured. Of these 18,701 patients, 43% had moderate to severe injuries (Injury Severity Score > 8), and the most common injury was cut/stab (62%), followed by blunt mechanisms (falls, lying in front of a moving object, and intentional motor vehicle collisions) (18%) and firearm injuries (16%). On regression analyses, Black race, Hispanic ethnicity, male sex, younger age, and positive admission alcohol screen were associated with lower odds of receiving mental health services (p < 0.05). Increasing injury severity, being insured, having preinjury psychiatric diagnosis, and positive admission illicit drug screen were associated with higher odds of receiving mental health services (p < 0.05). CONCLUSIONS Significant disparities exist in the management of survivors of suicide attempts. There is a desperate need for improved access to mental health services. Further studies should focus on delineating the cause of these disparities, identifying the barriers, and finding solutions.
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Affiliation(s)
- Khaled El-Qawaqzeh
- From the Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ
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Mpofu JJ, Crosby A, Flynn MA, LaFromboise T, Iskander J, Hall JE, Penman-Aguilar A, Thorpe P. Preventing Suicidal Behavior Among American Indian and Alaska Native Adolescents and Young Adults. Public Health Rep 2023; 138:593-601. [PMID: 35856445 PMCID: PMC10291156 DOI: 10.1177/00333549221108986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
From 2009 to 2018, overall suicide rates in the United States increased by 20.3% and increased by 43.5% among non-Hispanic American Indian and Alaska Native (AI/AN) communities. Combining years 2009 through 2018, suicide rates per 100 000 population among non-Hispanic AI/AN adolescents and young adults aged 15 to 34 years were 2 to 4 times higher than those of adolescents and young adults of other races and ethnicities. An estimated 14% to 27% of non-Hispanic AI/AN adolescents attempted suicide during that time. The elevated rates of suicidal behavior among non-Hispanic AI/AN adolescents and young adults reflect inequities in the conditions that create health. In this topical review, we describe school-based educational efforts that are driven by local AI/AN communities, such as the American Indian Life Skills curriculum, that teach stress and coping skills and show promise in reducing suicidal ideation attempts and fatalities among AI/AN adolescents. Using a social-determinants-of-health lens, we review the availability and quality of employment as an important influencer of suicidal behavior, as well as the role of the workplace as an environment for suicide prevention in AI/AN communities. Working with tribal, state, local, and federal colleagues, the public health community can implement programs known to be effective and create additional comprehensive strategies to reduce inequities and ultimately reduce suicide rates.
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Affiliation(s)
- Jonetta J. Mpofu
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
- US Public Health Service Commissioned Corps, Rockville, MD, USA
| | - Alex Crosby
- Morehouse School of Medicine, Department of Community Health and Preventative Medicine, Atlanta, GA, USA
| | - Michael A. Flynn
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
| | | | - John Iskander
- US Public Health Service Commissioned Corps, Rockville, MD, USA
- Office of Science, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jeffrey E. Hall
- Office of Minority Health and Health Equity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ana Penman-Aguilar
- Office of Minority Health and Health Equity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Phoebe Thorpe
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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McGuier EA, Aarons GA, Wright JD, Fortney JC, Powell BJ, Rothenberger SD, Weingart LR, Miller E, Kolko DJ. Team-focused implementation strategies to improve implementation of mental health screening and referral in rural Children's Advocacy Centers: study protocol for a pilot cluster randomized hybrid type 2 trial. Implement Sci Commun 2023; 4:58. [PMID: 37237302 PMCID: PMC10214641 DOI: 10.1186/s43058-023-00437-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Children's Advocacy Centers (CACs) use multidisciplinary teams to investigate and respond to maltreatment allegations. CACs play a critical role in connecting children with mental health needs to evidence-based mental health treatment, especially in low-resourced rural areas. Standardized mental health screening and referral protocols can improve CACs' capacity to identify children with mental health needs and encourage treatment engagement. In the team-based context of CACs, teamwork quality is likely to influence implementation processes and outcomes. Implementation strategies that target teams and apply the science of team effectiveness may enhance implementation outcomes in team-based settings. METHODS We will use Implementation Mapping to develop team-focused implementation strategies to support the implementation of the Care Process Model for Pediatric Traumatic Stress (CPM-PTS), a standardized screening and referral protocol. Team-focused strategies will integrate activities from effective team development interventions. We will pilot team-focused implementation in a cluster-randomized hybrid type 2 effectiveness-implementation trial. Four rural CACs will implement the CPM-PTS after being randomized to either team-focused implementation (n = 2 CACs) or standard implementation (n = 2 CACs). We will assess the feasibility of team-focused implementation and explore between-group differences in hypothesized team-level mechanisms of change and implementation outcomes (implementation aim). We will use a within-group pre-post design to test the effectiveness of the CPM-PTS in increasing caregivers' understanding of their child's mental health needs and caregivers' intentions to initiate mental health services (effectiveness aim). CONCLUSIONS Targeting multidisciplinary teams is an innovative approach to improving implementation outcomes. This study will be one of the first to test team-focused implementation strategies that integrate effective team development interventions. Results will inform efforts to implement evidence-based practices in team-based service settings. TRIAL REGISTRATION Clinicaltrials.gov, NCT05679154 . Registered on January 10, 2023.
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Affiliation(s)
- Elizabeth A McGuier
- Department of Psychiatry, School of Medicine, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA.
| | - Gregory A Aarons
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- UC San Diego ACTRI Dissemination and Implementation Science Center, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Jaely D Wright
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - John C Fortney
- Division of Population Health, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Department of Veterans Affairs, HSR&D Center of Innovation for Veteran-Centered and Value Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
- Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, USA
| | - Scott D Rothenberger
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Laurie R Weingart
- Tepper School of Business, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Elizabeth Miller
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David J Kolko
- Department of Psychiatry, School of Medicine, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
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Schmidt RD, Horigian VE, Shmueli-Blumberg D, Hefner K, Feinberg J, Kondapaka R, Feaster DJ, Duan R, Gonzalez S, Davis C, Vena A, Marín-Navarrete R, Tross S. High suicidality predicts overdose events among people with substance use disorder: A latent class analysis. Front Public Health 2023; 11:1150062. [PMID: 37261240 PMCID: PMC10228506 DOI: 10.3389/fpubh.2023.1150062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/14/2023] [Indexed: 06/02/2023] Open
Abstract
Introduction Suicide is the tenth leading cause of death in the United States and continues to be a major public health concern. Suicide risk is highly prevalent among individuals with co-occurring substance use disorders (SUD) and mental health disorders, making them more prone to adverse substance use related outcomes including overdose. Identifying individuals with SUD who are suicidal, and therefore potentially most at risk of overdose, is an important step to address the synergistic epidemics of suicides and overdose fatalities in the United States. The current study assesses whether patterns of suicidality endorsement can indicate risk for substance use and overdose. Methods Latent class analysis (LCA) was used to assess patterns of item level responses to the Concise Health Risk Tracking Self-Report (CHRT-SR), which measures thoughts and feelings associated with suicidal propensity. We used data from 2,541 participants with SUD who were enrolled across 8 randomized clinical trials in the National Drug Abuse Treatment Clinical Trials Network from 2012 to 2021. Characteristics of individuals in each class were assessed, and multivariable logistic regression was performed to examine class membership as a predictor of overdose. LCA was also used to analyze predictors of substance use days. Results Three classes were identified and discussed: Class (1) Minimal Suicidality, with low probabilities of endorsing each CHRT-SR construct; Class (2) Moderate Suicidality, with high probabilities of endorsing pessimism, helplessness, and lack of social support, but minimal endorsement of despair or suicidal thoughts; and Class (3) High Suicidality with high probabilities of endorsing all constructs. Individuals in the High Suicidality class comprise the highest proportions of males, Black/African American individuals, and those with a psychiatric history and baseline depression, as compared with the other two classes. Regression analysis revealed that those in the High Suicidality class are more likely to overdose as compared to those in the Minimal Suicidality class (p = 0.04). Conclusion Suicidality is an essential factor to consider when building strategies to screen, identify, and address individuals at risk for overdose. The integration of detailed suicide assessment and suicide risk reduction is a potential solution to help prevent suicide and overdose among people with SUD.
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Affiliation(s)
- Renae D. Schmidt
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Viviana E. Horigian
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | | | | | - Judith Feinberg
- Departments of Behavioral Medicine and Psychiatry and Medicine/Infectious Diseases, West Virginia University School of Medicine, Morgantown, WV, United States
| | | | - Daniel J. Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Rui Duan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Sophia Gonzalez
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Carly Davis
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Ashley Vena
- The Emmes Company, LLC, Rockville, MD, United States
| | - Rodrigo Marín-Navarrete
- Division of Research and Translational Education, Centros de Integración Juvenil A.C, Mexico City, Mexico
| | - Susan Tross
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
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Clark V, Ming H, Kim SJ. Location, age, and race matter: a path model of emotional distress in the U.S. during COVID-19. BMC Public Health 2023; 23:762. [PMID: 37098517 PMCID: PMC10126571 DOI: 10.1186/s12889-023-15640-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 04/10/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND We aim to identify factors that explain emotional distress among underserved populations during the COVID-19 pandemic. METHODS Starting in August 2020, we conducted an online epidemiological survey among 947 U.S. adults. The survey asked a wide array of constructs, including demographics, past-month substance use, and psychological distress. We developed a path model to understand how financial strain, age, and substance use are associated with emotional distress among People of Color (POC) and those living in rural areas. RESULTS 22.6% (n = 214) of participants were POC; 114 (12%) resided in rural areas; 17.2% (n = 163) made between $50,000 and $74,999 annually; and the emotional distress average was 1.41 (SD = 0.78). POC, especially those younger, experienced higher rates of emotional distress (p < .05). People living in rural contexts reported lower rates of emotional distress through low alcohol intoxication and less financial strain (p < .05). CONCLUSIONS We found mediating factors related to emotional distress among vulnerable populations during the COVID-19 pandemic. Younger POC experienced higher rates of emotional distress. People in rural communities had less emotional distress when they had fewer days spent intoxicated by alcohol, which was associated with lower financial strain. We conclude with a discussion of important unmet needs and future research directions.
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Affiliation(s)
- Viktor Clark
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, 830 East Main Street, 4th Floor, Richmond, VA, 23298-0430, USA
| | - Hannah Ming
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, 830 East Main Street, 4th Floor, Richmond, VA, 23298-0430, USA
| | - Sunny Jung Kim
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, 830 East Main Street, 4th Floor, Richmond, VA, 23298-0430, USA.
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, 23298, USA.
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He Z, Lei Q, Hu X, Xiong M, Liu J, Wen J, Shi X, Wang Z. Moral injury and suicidal ideation among health professionals: The role of mental health. J Affect Disord 2023; 333:58-64. [PMID: 37080491 PMCID: PMC10111858 DOI: 10.1016/j.jad.2023.04.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/23/2023] [Accepted: 04/14/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND The prolonged COVID-19 pandemic has burdened health professionals mentally and physically. This study aims to explore the relationship between moral injury (MI) and suicidal ideation (SI), and the role of mental health conditions in this relationship. METHODS Three-wave repeated online cross-sectional study with a total of 10,388 health professionals were conducted in different stages (2020-2022) of the COVID-19 pandemic in mainland China. Participants completed the Chinese version of the Moral Injury Symptoms Scale-Health Professional, Post-Traumatic Stress Disorder (PTSD) Checklist for DSM-5 coupled with a blanket of scales. RESULTS The prevalence of SI and MI among health professionals was 9.8 % and 40.2 %, respectively. The prevalence risk of SI was lower in wave 2 (OR = 0.64, 95 % CI: 0.54-0.77) and wave 3 (OR = 0.71, 95 % CI: 0.60-0.84) when compared with wave 1. MI (OR = 4.66, 95 % CI: 3.99-5.43), medical error (OR = 1.15, 95 % CI: 1.00-1.32), workplace violence (OR = 1.13, 95 % CI: 0.97-1.32), depression (OR = 94.08, 95 % CI: 63.37-139.69), anxiety (OR = 25.54, 95 % CI: 21.22-30.74), PTSD (OR = 24.51, 95 % CI: 19.01-31.60) were associated with a higher risk of SI. The mediation model revealed that depressive, anxiety, and PTSD symptoms explained 90.6 % of the total variance in the relationship between MI and SI. CONCLUSIONS The risk of SI has reduced among health professionals since the first peak of the COVID-19 pandemic in China. MI may contribute to prevalent SI, and mental health conditions, especially depressive symptoms, play a significant role as mediators. LIMITATIONS Cross-sectional design precludes the investigation of casual relationships. The nonrandom sampling method limits the generalization.
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Affiliation(s)
- Zhehao He
- Department of Epidemiology and Health Statistics, School of Public Health at Guangdong Medical University, Dongguan 560001, China
| | - Qiuhui Lei
- Department of Epidemiology and Health Statistics, School of Public Health at Guangdong Medical University, Dongguan 560001, China
| | - Xue Hu
- Department of Epidemiology and Health Statistics, School of Public Health at Guangdong Medical University, Dongguan 560001, China
| | - Mengyun Xiong
- Department of Epidemiology and Health Statistics, School of Public Health at Guangdong Medical University, Dongguan 560001, China
| | - Jun Liu
- Department of Preventive Medicine, School of Public Health at Zunyi Medical University, Zunyi 56006, China
| | - Jing Wen
- Department of Epidemiology and Health Statistics, School of Public Health and Management at Ningxia Medical University, China
| | - Xiuquan Shi
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China.
| | - Zhizhong Wang
- Department of Epidemiology and Health Statistics, School of Public Health at Guangdong Medical University, Dongguan 560001, China; The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan 523808, China.
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Hemenway D, Azrael D, Zhang W, Miller M. Black Household gun ownership and black suicide rates across U.S. States. J Natl Med Assoc 2023:S0027-9684(23)00043-3. [PMID: 37069017 DOI: 10.1016/j.jnma.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 04/19/2023]
Abstract
INTRODUCTION Ecologic studies have examined the relationship across states between levels of household gun ownership and suicide rates using household gun ownership data from the Behavioral Risk Factor Surveillance System (BFRSS) or proxies. However, no study has examined how race-specific survey-based or proxy measures of gun ownership are related to race-specific suicide rates. METHODS We use cross-sectional state-level race-specific data to examine how well various proxies correlate with race-specific BRFSS gun ownership rates. We examine whether BRFSS measures of household gun ownership are correlated with firearm suicide, non-firearm suicide, and total suicide rates, for Black and for White adults, and repeat these assessments with select proxies. The core BRFSS only included gun questions in 2001, 2002, and 2004, but not since; mortality data are collapsed 2001-2010. RESULTS Among a set of proxies, the race-specific fraction of suicides that are firearm suicides (FS/S) is the measure most highly correlated with BRFSS household gun ownership. Across states, White adult BFRSS household gun ownership levels are highly correlated with White adult firearm suicide rates (correlation coefficient .82) and moderately correlated with White overall suicide rates (.63). However, for Black adults, we find that while the state-level Black gun ownership levels are moderately correlated with Black firearm suicide rates (.67)-more strongly for older (.70) than for younger (.47) Black adults-Black BRFSS gun ownership levels are only weakly correlated with Black overall suicide rates (.17) owing to a moderate inverse correlation with Black non-firearm suicide rates (-.45). For Black adults, the relationship between FS/S and suicide is similar to the relation between BRFSS and suicide. CONCLUSION For White adults, states with higher levels of measured household gun ownership have higher overall suicide rates. This relationship does not hold for Black adults, largely due to a more attenuated correlation between these measures of firearm availability and firearm suicide rates coupled with a more substantial countervailing (inverse) relationship between these measures and non-firearm suicide rates. Future efforts using individual level data might help determine why this puzzling difference exists, especially for young Black adults.
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Affiliation(s)
- David Hemenway
- Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA.
| | - Deborah Azrael
- Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
| | - Wilson Zhang
- Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
| | - Matthew Miller
- Northeastern University, 360 Huntington Avenue, Boston, MA 02115 USA
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Yao Z, McCall WV. Designing Clinical Trials to Assess the Impact of Pharmacological Treatment for Suicidal Ideation/Behavior: Issues and Potential Solutions. Pharmaceut Med 2023; 37:221-232. [PMID: 37046135 PMCID: PMC10097518 DOI: 10.1007/s40290-023-00467-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 04/14/2023]
Abstract
Suicide is a serious and growing public health concern yet randomized controlled trials (RCTs) that inform pharmacologic treatment remain limited. We emphasize the overall need for such trials and review the literature to highlight examples of trials that have aimed to study patients at elevated risk of suicide. We discuss key examples of existing psychotropic medication trials as well as psychotherapy intervention studies that can yield important design insights. Medications that have been studied in individuals at risk for suicide include lithium, clozapine, zolpidem, prazosin, ketamine, esketamine, and aripiprazole. While important design challenges should be considered-RCTs to study suicide are feasible and much needed. Issues such as overall trial design, patient-selection criteria, and the scales/tools used to assess suicidality are discussed.
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Affiliation(s)
- Zhixing Yao
- Department of Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - William V McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA, USA.
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Posamentier J, Seibel K, DyTang N. Preventing Youth Suicide: A Review of School-Based Practices and How Social-Emotional Learning Fits Into Comprehensive Efforts. TRAUMA, VIOLENCE & ABUSE 2023; 24:746-759. [PMID: 35139714 DOI: 10.1177/15248380211039475] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Schools in the United States increasingly incorporate social-emotional learning (SEL) as a part of comprehensive youth suicide prevention programs in schools. We reviewed the literature to investigate the inclusion of SEL in youth suicide prevention efforts. We identified several known risk factors to youth suicide, namely, hopelessness, anxiety, substance use, and child sexual abuse, then cross-walked that review to SEL competencies shown to mitigate each of those known risk factors. We found all SEL competencies, to some extent, across all the evidence-based, school-based youth suicide prevention programs we identified. Further, we found that all five SEL competencies are shown directly to address and mitigate the major, known risk factors for youth suicide. These findings suggest that SEL can play a productive role in upstream youth suicide prevention. State-level policy makers and school administrators should consider the inclusion of evidence-based SEL in efforts to address youth suicide prevention.
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Rajkumar RP. The association between nation-level social and economic indices and suicide rates: A pilot study. FRONTIERS IN SOCIOLOGY 2023; 8:1123284. [PMID: 37066069 PMCID: PMC10102579 DOI: 10.3389/fsoc.2023.1123284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
Ever since the pioneering work of Emile Durkheim, it has been known that regional or national suicide rates can be influenced by a variety of social and economic factors. Recent research has found a robust association between two country-level economic indices-gross national product and unemployment rate-and suicide rates, particularly in men. However, the association between other country-level social indices-such as measures of social integration, inequality, environmental preservation and political freedom-and suicide rates has not been studied at the cross-national level. In the current study, national suicide rates for men and women were examined in relation to seven indices measuring subjective wellbeing, sustainable development, type of political regime, economic and gender inequality, and social capital. It was found that the Happy Planet Index, a composite measure of subjective wellbeing and sustainable development, was negatively associated with suicide rates independent of gender, and even after adjusting for possible confounding factors. Economic inequality was associated with suicide in men, and social capital was associated with suicide in women. Moreover, the strength and direction of the associations observed between socioeconomic indices and suicide varied across income groups. These results highlight the need for a closer evaluation of the link between large-scale ("macro") social factors and individual ("micro") psychological factors, as well as the importance of integrating these factors into suicide prevention programmes at the national level.
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Brenes F, Henriquez F, Cachon P. Call for Inclusive and Diverse Suicide Prevention Strategies Among Cuban Americans: A Brief Report. HISPANIC HEALTH CARE INTERNATIONAL 2023; 21:4-8. [PMID: 35291845 DOI: 10.1177/15404153221085959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Suicide is a leading cause of death in Hispanics globally and nationally. Intentional death rates were higher in Cuba than Mexico in 2016. In the United States (US), suicide mortality rates were greater among Hispanics in rural than urban areas from 2001 to 2015. Although the US lacks suicide research in undocumented Hispanics, few studies have reported increased risk in immigrants. Limited research also indicates higher intentional death rates in Cuban Americans compared with other Hispanic American subgroups. However, suicide prevention strategies for at-risk Cuban Americans are lacking due to a scarcity of research among diverse Hispanics. Researchers could collaborate with health care providers to develop effective suicide prevention methods for Cuban Americans with suicidal problems. This report provides an overview of suicidal behavior in Hispanic Americans with a focus on Cuban Americans. Gaps related to the research topic, as well as recommendations for practice, research, and health policy, are provided in this report.
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Affiliation(s)
- Francisco Brenes
- Florida International University, Nicole Wertheim College of Nursing and Health Sciences, North Miami, FL, USA
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Brenes F, Beason F, Koncsol S, Umadhay T, Chin C, Cachon P, Scaccianoce M. Hispanic Suicides in Miami-Dade County, Florida, 2008-2018. HISPANIC HEALTH CARE INTERNATIONAL 2023; 21:9-13. [PMID: 36320167 DOI: 10.1177/15404153221137339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Suicide is a leading cause of death in Hispanic Americans. Although this population is growing rapidly, particularly in geographic areas such as Miami-Dade County, Florida, few studies have examined suicide in Hispanics. The purpose of this cross-sectional study was to examine associations between suicide and demographic characteristics among Hispanics in Miami-Dade County, Florida, between 2008 and 2018. A total of 1,601 Hispanics died from suicide. Cubans (n = 1,145) represented nearly three quarters of the suicides, while Central or South Americans (n = 119), Puerto Ricans (n = 59), and Mexicans (n = 29) accounted for lower intentional deaths. Furthermore, although no correlation between suicide and age was found, significantly more than half of the suicides were men, X2 (1, N = 1,600) = 361.894, p < .001 (p = .000). Hispanic male suicides were 4.52 more frequent than Hispanic female firearm suicides. Men were more likely to use firearms, while women were more likely to choose drugs, substances, or some other form of method. Intentional deaths were unequal across locations, Χ2 (3, N = 1,601) = 603.764, p < .001 (p = .000), with increased incidence occurring at the Hispanic's home. The second most common suicide location was health care facilities for drugs. Researchers should collaborate with health care providers to increase suicide research and eliminate disparities in at-risk Hispanic Americans.
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Affiliation(s)
- Francisco Brenes
- 15803Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL, USA
| | - Ferrona Beason
- 15695College of Nursing and Health Sciences, Barry University, Miami, Florida, USA
| | - Stephen Koncsol
- 218640Department of Psychology, Barry University, Miami, Florida, USA
| | - Tony Umadhay
- 15695College of Nursing and Health Sciences, Barry University, Miami, Florida, USA
| | - Claudette Chin
- 15695College of Nursing and Health Sciences, Barry University, Miami, Florida, USA
| | | | - Monica Scaccianoce
- 15803Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL, USA
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Efird CR, Matthews DD, Muessig KE, Barrington CL, Metzl JM, Lightfoot AF. Rural and nonrural racial variation in mentally unhealthy days: Findings from the behavioral risk factor surveillance system in North Carolina, 2015–2019. SSM - MENTAL HEALTH 2023. [DOI: 10.1016/j.ssmmh.2023.100199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Graves JM, Abshire DA, Mackelprang JL, Dilley JA, Amiri S, Chacon CM, Mason A. Geographic Disparities in the Availability of Mental Health Services in U.S. Public Schools. Am J Prev Med 2023; 64:1-8. [PMID: 36283908 PMCID: PMC9772127 DOI: 10.1016/j.amepre.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The purpose of this study was to examine geographic variation in the availability of and barriers to school-based mental health services. METHODS A weighted, nationally representative sample of U.S. public schools from the 2017-2018 School Survey on Crime and Safety was used. Schools reported the provision of diagnostic mental health assessments and/or treatment as well as factors that limited the provision of mental health services. Availability of mental health services and factors limiting service provision were examined across rurality, adjusting for school enrollment and grade level. The analysis was conducted in December 2021. RESULTS Half (51.2%) of schools reported providing mental health assessments, and 38.3% reported providing treatment. After adjusting for enrollment and grade level, rural schools were 19% less likely, town schools were 21% less likely, and suburban schools were 11% less likely to report providing mental health assessments than city schools. Only suburban schools were less likely than city schools to provide mental health treatment (incidence rate ratio=0.85; 95% CI=0.72, 1.00). Factors limiting the provision of services included inadequate access to professionals (70.9%) and inadequate funding (77.0%), which were most common among rural schools. CONCLUSIONS Significant inequities in school-based mental health services exist outside of urban areas.
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Affiliation(s)
- Janessa M Graves
- College of Nursing, Washington State University, Spokane, Washington.
| | | | | | - Julia A Dilley
- Program Design and Evaluation Services, Multnomah County/Oregon Public Health Division, Portland, Oregon
| | - Solmaz Amiri
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
| | - Christina M Chacon
- College of Nursing, Washington State University, Tri-Cities, Richland, Washington
| | - Anne Mason
- College of Nursing, Washington State University, Spokane, Washington
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Trends in suicide rates by race and ethnicity among members of the United States Army. PLoS One 2023; 18:e0280217. [PMID: 36649302 PMCID: PMC9844903 DOI: 10.1371/journal.pone.0280217] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/08/2022] [Indexed: 01/18/2023] Open
Abstract
Efforts were focused on identifying differences in suicide rates and time-dependent hazard rate trends, overall and within age groups, by race and ethnicity among United States Army members who returned from an index deployment (October 2007 to September 2014). This retrospective cohort study was conducted using an existing longitudinal database, the Substance Use and Psychological Injury Combat Study (SUPIC). Demographic (e.g., race and ethnicity) and military data from the Department of Defense compiled within SUPIC, as well as Department of Veterans Affairs data were linked with National Death Index records (through 2018) to identify deaths by suicide including those that occurred after military service. The cohort included 860,930 Army Service members (Active Duty, National Guard, and Reserve). Age-adjusted (using the direct standardization method) and age-specific suicide rates per 100,000 person years were calculated and rate ratios (RR) were used for comparisons. Trends were evaluated using hazard rates over time since the end of individuals' index deployments. Among those aged 18-29 at the end of their index deployment, the suicide rate for American Indian/Alaskan Native (AI/AN) individuals was 1.51 times higher (95% confidence interval [CI]: 1.03, 2.14) compared to White non-Hispanic individuals (WNH), and lower for Hispanic and Black non-Hispanic (BNH) than for WNH individuals (RR = 0.65 [95% CI: 0.55, 0.77] and RR = 0.71 [95% CI: 0.61, 0.82], respectively). However, analyses revealed increasing trends in hazard rates post-deployment (≤ 6.5 years) within groups of Hispanic and BNH individuals (Average Annual Percent Change [APC]: 12.1% [95% CI: 1.3%, 24.1%] and 11.4% [95% CI: 6.9%, 16.0%], respectively) with a smaller, increase for WNH individuals (APC: 3.1%; 95% CI: 0.1%, 6.1%). Findings highlight key subgroups at risk for post-deployment suicide (i.e., WNH, AI/AN and younger individuals), as well as heterogeneous trends overtime, with rates and trends varying within race and ethnic groups by age groups. Post-deployment suicide prevention efforts that address culturally relevant factors and social determinants of health associated with health inequities are needed.
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Anthony KM, Ertl A, Leavitt RA, Crosby AE, Diduk-Smith RM, Matthews KA. Detection of Suicide Clusters using Small-Area Geographic Data from the Virginia Violent Death Reporting System, 2010 - 2015. VIRGINIA JOURNAL OF PUBLIC HEALTH 2023; 8:5. [PMID: 38873403 PMCID: PMC11174135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Introduction From 1999 to 2020, the suicide rate in Virginia increased from 13.1 to 15.9 per 100,000 persons aged 10 years and older. Few studies have examined spatial patterns of suicide geographies smaller than the county level. Methods We analyzed data from suicide decedents aged ≥10 years from 2010 through 2015 in the Virginia Violent Death Reporting System. We identified spatial clusters of high suicide rates using spatially adaptive filtering with standardized mortality ratio (SMR) significantly higher than the state SMR (p < 0.001). We compared demographic characteristics, method of injury, and suicide circumstances of decedents within each cluster to decedents outside any cluster. Results We identified 13 high-risk suicide clusters (SMR between 1.7 and 2.0). Suicide decedents in the clusters were more likely to be older (40+ years), non-Hispanic white, widowed/divorced/separated, and less likely to have certain precipitating suicide circumstances than decedents outside the clusters. Suicide by firearm was more common in four clusters, and suicide by poisoning was more common in two clusters compared to the rest of the state. Conclusions There are important differences between geographic clusters of suicide in Virginia. These results suggest that place-specific risk factors for suicide may be relevant for targeted suicide prevention.
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Affiliation(s)
- Kurtis M. Anthony
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control
| | - Allison Ertl
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control
| | - Rachel A. Leavitt
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control
| | - Alexander E. Crosby
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control
| | | | - Kevin A. Matthews
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control
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Larson AE, Zahnd WE, Davis MM, Stange KC, Yoon J, Heintzman JD, Harvey SM. Before and During Pandemic Telemedicine Use: An Analysis of Rural and Urban Safety-Net Clinics. Am J Prev Med 2022; 63:1031-1036. [PMID: 36096960 PMCID: PMC9462940 DOI: 10.1016/j.amepre.2022.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/16/2022] [Accepted: 06/01/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Differences in face-to-face and telemedicine visits before and during the COVID-19 pandemic among rural and urban safety-net clinic patients were evaluated. In addition, this study investigated whether rural patients were as likely to utilize telemedicine for primary care during the pandemic as urban patients. METHODS Using electronic health record data from safety-net clinics, patients aged ≥18 years with ≥1 visit before or during the COVID-19 pandemic, March 1, 2019-March 31, 2021, were identified, and trends in face-to-face and telemedicine (phone and video) visits for patients by rurality using Rural‒Urban Commuting Area codes were characterized. Multilevel mixed-effects regression models compared service delivery method during the pandemic by rurality. RESULTS Included patients (N=1,015,722) were seen in 446 safety-net clinics: 83% urban, 10.3% large rural, 4.1% small rural, and 2.6% isolated rural. Before COVID-19, little difference in the percentage of encounters conducted face-to-face versus through telemedicine by rurality was found. Telemedicine visits significantly increased during the pandemic by 27.2 percentage points among patients in isolated rural areas to 52.3 percentage points among patients in urban areas. Rural patients overall had significantly lower odds of using telemedicine for a visit during the pandemic than urban patients. CONCLUSIONS Despite the increased use of telemedicine in response to the pandemic, rural patients had significantly fewer telemedicine visits than those in more urban areas. Equitable access to telemedicine will depend on continued reimbursement for telemedicine services, but additional efforts are warranted to improve access to and use of health care among rural patients.
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Affiliation(s)
| | - Whitney E Zahnd
- Department of health management and policy, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Melinda M Davis
- Oregon Rural Practice-based Research Network, Oregon Health & Sciences University, Portland, Oregon; Department of Family Medicine, Oregon Health & Sciences University, Portland, Oregon; School of Public Health, OHSU-Portland State Uuniversity, Portland, Oregon
| | - Kurt C Stange
- Center for community health integration, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Jangho Yoon
- Department of Preventive Medicine and Biostatistics, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - John D Heintzman
- Research department, OCHIN, Portland, Oregon; Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - S Marie Harvey
- College of public health and human sciences, Oregon State University, Corvallis, Oregon
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44
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Peterson AB, Zhou H, Thomas KE. Disparities in traumatic brain injury-related deaths-United States, 2020. JOURNAL OF SAFETY RESEARCH 2022; 83:419-426. [PMID: 36481035 PMCID: PMC9795830 DOI: 10.1016/j.jsr.2022.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/06/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Traumatic brain injury (TBI) affects how the brain functions and remains a prominent cause of death in the United States. Although preventable, anyone can experience a TBI and epidemiological research suggests some groups have worse health outcomes following the injury. METHODS We analyzed 2020 multiple-cause-of-death data from the National Vital Statistics System to describe TBI mortality by geography, sociodemographic characteristics, mechanism of injury (MOI), and injury intent. Deaths were included if they listed an injury International Classification of Diseases, Tenth Revision (ICD-10) underlying cause of death code and a TBI-related ICD-10 code in one of the multiple-cause-of-death fields. RESULTS During 2020, 64,362 TBI-related deaths occurred and age-adjusted rates, per 100,000 population, were highest among persons residing in the South (20.2). Older adults (≥75) displayed the highest number and rate of TBI-related deaths compared with other age groups and unintentional falls and suicide were the leading external causes among this older age group. The age-adjusted rate of TBI-related deaths in males was more than three times the rate of females (28.3 versus 8.4, respectively); further, males displayed higher numbers and age-adjusted rates compared with females for all the principal MOIs that contributed to a TBI-related death. American Indian or Alaska Native, Non-Hispanic (AI/AN) persons had the highest age-adjusted rate (29.0) of TBI-related deaths when compared with other racial and ethnic groups. Suicide was the leading external cause of injury contributing to a TBI-related death among AI/AN persons. PRACTICAL APPLICATION Prevention efforts targeting older adult falls and suicide are warranted to reduce disparities in TBI mortality among older adults and AI/AN persons. Effective strategies are described in CDC's Stopping Elderly Accidents, Deaths, & Injuries (STEADI) initiative to reduce older adult falls and CDC's Preventing Suicide: A Technical Package of Policy, Programs, and Practices for the best available evidence in suicide prevention.
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Affiliation(s)
- Alexis B Peterson
- Applied Sciences Branch, Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, United States.
| | - Hong Zhou
- Data Analytics Branch, Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, United States
| | - Karen E Thomas
- Data Analytics Branch, Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, United States
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45
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Ornell F, Benzano D, Borelli WV, Narvaez JCDM, Moura HF, Passos IC, Sordi AO, Schuch JB, Kessler FHP, Scherer JN, von Diemen L. Differential impact on suicide mortality during the COVID-19 pandemic in Brazil. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2022; 44:628-634. [PMID: 35839315 PMCID: PMC9851756 DOI: 10.47626/1516-4446-2022-2581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 03/12/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To compare suicide rates observed in Brazil after the onset of the COVID-19 pandemic with the estimated rate based on suicide deaths between 2010 and 2020, and identify sociodemographic variables associated with this outcome. METHODS Ecological time-series study. Data were obtained from Brazilian Unified Health System Department of Information Technology (DATASUS), with the structural break of the data set in March 2020. The number of actual suicides observed and the number of expected suicides if there were no COVID-19 pandemic were analyzed through bayesian structural time series modeling. RESULTS The overall incidence of suicides in Brazil remained stable after the start of the COVID-19 pandemic compared to what would be expected. However, there was a significant increase in suicide deaths among women (6.9%) and older adult (9.1%). Analysis by macro-regions of the country showed significant increases in suicide deaths in the Center-West (7.4%), Northeast (5.7%), and Southeast (10%). Stratified analyses revealed differences according to age, sex, education, and skin color. CONCLUSIONS Despite stability in the overall number of suicides, this phenomenon occurs heterogeneously among different population groups and regions of Brazil. Rates have increased in populations with a history of poor access to health, which may have been more severely impacted by the pandemic.
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Affiliation(s)
- Felipe Ornell
- Centro de Pesquisa em Álcool e Drogas, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil,Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Faculdade de Medicina, UFRGS, Porto Alegre, RS, Brazil,Correspondence: Felipe Ornell, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa em Álcool e Drogas, Rua Ramiro Barcelos, 2350, Santa Cecilia, CEP 90410-004, Porto Alegre, RS, Brazil. E-mail:
| | - Daniela Benzano
- Centro de Pesquisa em Álcool e Drogas, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil,Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Faculdade de Medicina, UFRGS, Porto Alegre, RS, Brazil
| | | | | | - Helena Ferreira Moura
- Centro de Pesquisa em Álcool e Drogas, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil,Departamento de Clínica Médica, Faculdade de Medicina, Universidade de Brasília, Brasília, DF, Brazil
| | - Ives Cavalcante Passos
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Faculdade de Medicina, UFRGS, Porto Alegre, RS, Brazil
| | - Anne Orgler Sordi
- Centro de Pesquisa em Álcool e Drogas, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Jaqueline Bohrer Schuch
- Centro de Pesquisa em Álcool e Drogas, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil,Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Faculdade de Medicina, UFRGS, Porto Alegre, RS, Brazil
| | - Felix Henrique Paim Kessler
- Centro de Pesquisa em Álcool e Drogas, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil,Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Faculdade de Medicina, UFRGS, Porto Alegre, RS, Brazil
| | - Juliana Nichterwitz Scherer
- Centro de Pesquisa em Álcool e Drogas, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil,Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Faculdade de Medicina, UFRGS, Porto Alegre, RS, Brazil,Programa de Pós-Graduação em Saúde Coletiva, Universidade do Vale do Rio dos Sinos, São Leopoldo, RS, Brazil
| | - Lisia von Diemen
- Centro de Pesquisa em Álcool e Drogas, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil,Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Faculdade de Medicina, UFRGS, Porto Alegre, RS, Brazil
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Abreu LCC, Conceição SDS, de Carvalho DSB, Machado AC, Lyrio AO, Souza ES, Souza CS, de Matos PJDS, Batista JET, Gomes JDA, Hintz AM, Pereira PPDS, da Cruz SS, Gomes-Filho IS, Figueiredo ACMG. Factors Associated with Cocaine Consumption among Suicide Victim. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14309. [PMID: 36361188 PMCID: PMC9654489 DOI: 10.3390/ijerph192114309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 10/14/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
Cocaine use is an increasingly frequent event, especially in young people, and can cause irreversible consequences, such as suicide. To evaluate the factors associated with cocaine use in the moments preceding to suicide. This is a population-based, cross-sectional, and analytical study conducted in the Brazilian Federal District by researchers from the Department of Health and the Civil Police Institute of Criminalistics. All people who died due to suicide in 2018 were included in the survey. Cocaine use was considered the dependent variable, and robust Poisson regression was performed to estimate the crude and adjusted prevalence ratios and their respective population confidence intervals. In 2018, 12,157 deaths were recorded, of which suicide accounted for 1.56% of all deaths. It was observed that being between 25 and 44 years old, male, and under the influence of alcohol or cannabis, had a strong positive association with cocaine consumption among suicide victims. Males, people with black skin, with lower level of education, with employment, and who were under the effect of the use of cannabis and/or alcohol in the previous hours of death had a higher propensity to consume cocaine immediately before suicide, with a moderate to strong magnitude of prevalence ratio. The findings of this research indicated the need for monitoring, by health services, of people most vulnerable to suicide through the consumption of psychoactive substances.
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Affiliation(s)
| | | | | | - Ana Cristina Machado
- Department of Public Health of the Federal District, Brasília 70390-125, Federal District, Brazil
| | - Amanda Oliveira Lyrio
- Department of Health of University of Brasilia, Brasília 70910-900, Federal District, Brazil
| | - Elivan Silva Souza
- Department of Health of University of Brasilia, Brasília 70910-900, Federal District, Brazil
| | - Cauê Silva Souza
- Health Sciences Teaching and Research Foundation’s, Brasília 70710-907, Federal District, Brazil
| | | | | | | | - Alexandre Marcelo Hintz
- Department of Health, Feira de Santana State University, Feira de Santana 44036-900, Bahia, Brazil
| | | | - Simone Seixas da Cruz
- Department of Epidemiology, Federal University of Recôncavo of Bahia, Santo Antônio de Jesus 44430-622, Bahia, Brazil
| | - Isaac Suzart Gomes-Filho
- Department of Health, Feira de Santana State University, Feira de Santana 44036-900, Bahia, Brazil
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47
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Hung P, Probst JC, Shih Y, Ranganathan R, Brown MJ, Crouch E, Eberth JM. Rural-Urban Disparities in Quality of Inpatient Psychiatric Care. Psychiatr Serv 2022; 74:446-454. [PMID: 36321319 DOI: 10.1176/appi.ps.20220277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
OBJECTIVE Rural residents have higher rates of serious mental illness than urban residents, but little is known about the quality of inpatient psychiatric care available to them locally or how quality may have changed in response to federal initiatives. This study aimed to examine differences and changes in the quality of inpatient psychiatric care in rural and urban hospitals. METHODS This national retrospective study of 1,644 facilities examined facility-level annual quality-of-care data from the Inpatient Psychiatric Facility Quality Reporting program, 2015-2019. Facility location was categorized as urban, large rural, or small or isolated rural on the basis of zip code-level rural-urban commuting area codes. Generalized regression models were used to assess rural-urban differences in care quality (five continuity-of-care and two patient experience measures) and changes over time. RESULTS Rural inpatient psychiatric units performed better than urban units in nearly all domains. Improvements in quality of care (excluding follow-up care) were similar in rural and urban units. Rates of 30- and 7-day postdischarge follow-up care decreased in all hospitals but faster in rural units. Timely transmission of transition records was more frequent in small or isolated rural versus urban units (mean marginal difference=22.5, 95% CI=6.3-38.8). Physical restraint or seclusion use was less likely in rural than in urban units (OR=0.6, 95% CI=0.5-0.8). CONCLUSIONS Rural psychiatric units had better care quality at baseline (better follow-up care, better timely transmission of transition records, and lower rates of physical restraint use) than urban units, but during 2015-2019, follow-up care performance decreased overall and more in rural than urban units.
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Affiliation(s)
- Peiyin Hung
- Rural and Minority Health Research Center (Hung, Probst, Ranganathan, Brown, Crouch, Eberth), Department of Health Services Policy and Management (Hung, Probst, Shih, Crouch), and Department of Epidemiology and Biostatistics (Ranganathan, Brown, Eberth), University of South Carolina Arnold School of Public Health, Columbia; Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Eberth)
| | - Janice C Probst
- Rural and Minority Health Research Center (Hung, Probst, Ranganathan, Brown, Crouch, Eberth), Department of Health Services Policy and Management (Hung, Probst, Shih, Crouch), and Department of Epidemiology and Biostatistics (Ranganathan, Brown, Eberth), University of South Carolina Arnold School of Public Health, Columbia; Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Eberth)
| | - Yiwen Shih
- Rural and Minority Health Research Center (Hung, Probst, Ranganathan, Brown, Crouch, Eberth), Department of Health Services Policy and Management (Hung, Probst, Shih, Crouch), and Department of Epidemiology and Biostatistics (Ranganathan, Brown, Eberth), University of South Carolina Arnold School of Public Health, Columbia; Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Eberth)
| | - Radhika Ranganathan
- Rural and Minority Health Research Center (Hung, Probst, Ranganathan, Brown, Crouch, Eberth), Department of Health Services Policy and Management (Hung, Probst, Shih, Crouch), and Department of Epidemiology and Biostatistics (Ranganathan, Brown, Eberth), University of South Carolina Arnold School of Public Health, Columbia; Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Eberth)
| | - Monique J Brown
- Rural and Minority Health Research Center (Hung, Probst, Ranganathan, Brown, Crouch, Eberth), Department of Health Services Policy and Management (Hung, Probst, Shih, Crouch), and Department of Epidemiology and Biostatistics (Ranganathan, Brown, Eberth), University of South Carolina Arnold School of Public Health, Columbia; Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Eberth)
| | - Elizabeth Crouch
- Rural and Minority Health Research Center (Hung, Probst, Ranganathan, Brown, Crouch, Eberth), Department of Health Services Policy and Management (Hung, Probst, Shih, Crouch), and Department of Epidemiology and Biostatistics (Ranganathan, Brown, Eberth), University of South Carolina Arnold School of Public Health, Columbia; Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Eberth)
| | - Jan M Eberth
- Rural and Minority Health Research Center (Hung, Probst, Ranganathan, Brown, Crouch, Eberth), Department of Health Services Policy and Management (Hung, Probst, Shih, Crouch), and Department of Epidemiology and Biostatistics (Ranganathan, Brown, Eberth), University of South Carolina Arnold School of Public Health, Columbia; Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Eberth)
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48
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Dolsen EA, Byers AL, Flentje A, Goulet JL, Jasuja GK, Lynch KE, Maguen S, Neylan TC. Sleep disturbance and suicide risk among sexual and gender minority people. Neurobiol Stress 2022; 21:100488. [PMID: 36164391 PMCID: PMC9508603 DOI: 10.1016/j.ynstr.2022.100488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/01/2022] Open
Abstract
Sleep disturbance has emerged as an independent, mechanistic, and modifiable risk factor for suicide. Sexual and gender minority (SGM) people disproportionately experience sleep disturbance and are at higher risk of death by suicide relative to cisgender and/or heterosexual individuals. The present narrative review evaluates nascent research related to sleep disturbance and suicide-related thoughts and behaviors (STBs) among SGM populations, and discusses how experiences of minority stress may explain heightened risk among SGM people. Although there is a growing understanding of the link between sleep disturbance and STBs, most research has not been conducted in SGM populations or has not examined suicide as an outcome. Research is needed to examine whether and how aspects of sleep disturbances relate to STBs among SGM people in order to better tailor sleep treatments for SGM populations.
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Affiliation(s)
- Emily A Dolsen
- Mental Health Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.,Mental Illness Research Education and Clinical Centers, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA
| | - Amy L Byers
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.,Research Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.,Department of Medicine, Division of Geriatrics, University of California, San Francisco, CA, USA
| | - Annesa Flentje
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA.,Alliance Health Project, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, USA
| | - Joseph L Goulet
- Yale School of Medicine, Department of Emergency Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Guneet K Jasuja
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA.,Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Kristine E Lynch
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, Salt Lake City, UT, USA
| | - Shira Maguen
- Mental Health Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.,Mental Illness Research Education and Clinical Centers, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA
| | - Thomas C Neylan
- Mental Health Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.,Mental Illness Research Education and Clinical Centers, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA
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49
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Albano GD, Malta G, La Spina C, Rifiorito A, Provenzano V, Triolo V, Vaiano F, Bertol E, Zerbo S, Argo A. Toxicological Findings of Self-Poisoning Suicidal Deaths: A Systematic Review by Countries. TOXICS 2022; 10:toxics10110654. [PMID: 36355945 PMCID: PMC9698482 DOI: 10.3390/toxics10110654] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/06/2022] [Accepted: 10/26/2022] [Indexed: 05/15/2023]
Abstract
The use of illicit and non-illicit substances is widespread in suicides. The toxicological data may help in understanding the mechanism of death. This systematic review aimed to analyze autopsies related to suicides by consuming poison, focusing on the correlation between substance use and the country of origin to create an alarm bell to indicate that suicide maybe attempted and prevent it. The systematic review was conducted according to the PRISMA guidelines, with the primary objective of identifying autopsies conducted in cases of suicide by consuming poison in specific geographic areas. Significant differences in substances were observed between low-income and Western countries that confirm previous literature data. In rural areas and Asian countries, most suicides by consuming poison involve the use of pesticides, such as organophosphates and carbamates. In Western countries, illicit drugs and medically prescribed drugs are the leading cause of suicide by self-poisoning. Future research should shed light on the correlation between social, medical, and demographic characteristics and the autopsy findings in suicides by self-poisoning to highlight the risk factors and implement tailored prevention programs worldwide. Performing a complete autopsy on a suspected suicide by self-poisoning could be essential in supporting worldwide public health measures and policy makers. Therefore, complete autopsies in such cases must be vigorously promoted.
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Affiliation(s)
- Giuseppe Davide Albano
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
- Correspondence: ; Tel.: +39-3312264328
| | - Ginevra Malta
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Corinne La Spina
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Arianna Rifiorito
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Valeria Provenzano
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Valentina Triolo
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Fabio Vaiano
- Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Elisabetta Bertol
- Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Stefania Zerbo
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Antonina Argo
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
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50
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Fernandez JM, Jayawardhana J. The effect of pill mill legislation on suicides. Health Serv Res 2022; 57:1121-1135. [PMID: 35383935 PMCID: PMC9441289 DOI: 10.1111/1475-6773.13984] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/13/2022] [Accepted: 03/25/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To examine the effect of pill mill legislation on suicides and drug-related suicides in the United States. DATA SOURCES We use state-level restricted use mortality data from the National Vital Statistics System for the period 2000-2016, along with state level sociodemographic data from the US Census Bureau and Bureau of Labor Statistics and opioid-related state health policy data from publicly available sources for the analysis. STUDY DESIGN The analyses use a difference-in-differences regression approach. DATA COLLECTION/EXTRACTION METHODS Publicly available secondary data were collected and merged with restricted use mortality data files from the National Vital Statistics System for the analysis. PRINCIPAL FINDINGS Our results show that pill mill legislation is associated with an 8.5% (p < 0.01) reduction in the drug related suicide rate, a 4.9% (p < 0.05) reduction in suicides among females, and a 4.7% (p < 0.05) reduction in suicides among individuals between age 45 and 64 years. CONCLUSIONS The findings indicate that pill mill legislation has been effective in reducing total suicides among females in the age group 45-64, and drug-related suicides in the population resulting in 658 fewer drug-related suicides for a given year if pill mill laws are adopted by every state.
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Affiliation(s)
- Jose M. Fernandez
- Department of Economics, College of BusinessUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Jayani Jayawardhana
- Department of Clinical and Administrative Pharmacy, College of PharmacyUniversity of GeorgiaAthensGeorgiaUSA
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