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Adoboi F, Mohammed A, Duodu PA, Aboagye RG, Seidu AA, Wongnaah FG, Ahinkorah BO. Sex-related inequalities in crude and age-standardized suicide rates: trends in Ghana from 2000 to 2019. BMC Public Health 2024; 24:1070. [PMID: 38632578 PMCID: PMC11022425 DOI: 10.1186/s12889-024-18516-8] [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: 09/23/2023] [Accepted: 04/03/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Suicide represents a major public health concern, affecting a significant portion of individuals. However, there remains a gap in understanding the age and sex disparities in the occurrence of suicide. Therefore, this study aimed to investigate the sex-related inequalities in suicide rates in Ghana from 2000 to 2019. METHODS We utilized data from the WHO Health Equity Assessment Toolkit (HEAT) online software. We analysed sex differences in both crude and age-standardized suicide rates in Ghana spanning from 2000 to 2019. Crude and age-adjusted suicide rates were calculated based on the International Classification of Diseases (ICD) definition and coding of suicide mortality. We measured inequality in terms of sex. Two inequality indicators were used to examine the suicide rates: the difference (D) and the ratio (R). RESULTS Age-standardized and crude suicide rates in Ghana were higher among men from 2000 to 2019. Between 2000 and 2007, the age-standardized suicide rate for women rose steadily and declined slightly between 2008 and 2019. Age-standardized suicide rates for men increased consistently from 2000 to 2010, then declined steadily from 2011 to 2019. The crude suicide rates among men and women followed similar patterns. The widest absolute inequality in crude suicide rates (D) was recorded in 2013 (D=-11.91), while the smallest difference was observed in 2000 (D=-7.16). We also found the greatest disparity in age-standardized rates in 2011 (D=-21.46) and the least in 2000 (D=-14.32). The crude suicide rates increased with age for both men and women aged 15-54 years and 55-85+ years respectively. However, the increased rate was higher in men than in women across all age groups surveyed. A similar pattern was observed for relative inequality in both crude and age-standardized rates of suicide. CONCLUSION The suicide rate in Ghana has declined over time. Suicide is more common among older men. Inequalities in suicide rates, in both absolute and relative terms, are similar. There is a need to monitor suicide trends in Ghana, especially among older men. Moreover, the findings could serve as a basis for future studies on suicide in Ghana.
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Affiliation(s)
- Faustina Adoboi
- Cape Coast Nursing and Midwifery Training College, Cape Coast, Ghana
| | - Aliu Mohammed
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Precious Adade Duodu
- Department of Nursing, School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, England, UK
| | - Richard Gyan Aboagye
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, 2052, Sydney, NSW, Australia.
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana.
| | - Abdul-Aziz Seidu
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, 4811, Queensland, QLD, Australia
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, P.O. Box 256, Ghana
- REMS Consultancy Services Limited, Sekondi-Takoradi, Western Region, Ghana
| | | | - Bright Opoku Ahinkorah
- REMS Consultancy Services Limited, Sekondi-Takoradi, Western Region, Ghana
- School of Clinical Medicine, University of New South Wales Sydney, Sydney, Australia
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Protective Factors against Self-Harm and Suicidality among Australian Indigenous Adolescents: A Strengths-Based Analysis of the Longitudinal Study of Indigenous Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159131. [PMID: 35897497 PMCID: PMC9330702 DOI: 10.3390/ijerph19159131] [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: 06/17/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 12/10/2022]
Abstract
Background: Understanding and encouraging social and emotional well-being (SEWB) among Indigenous adolescents is vital in countering the impacts of colonisation and intergenerational trauma. As self-harm and suicidality are considered markers of poor SEWB among Indigenous communities, we aimed to identify the individual-level and community-level factors protecting Indigenous adolescents from self-harm and suicidality. Methods: Data came from Footprints in Time—The Longitudinal Study of Indigenous Children (waves 10 and 11), conducted among Indigenous families across Australia. A strengths-based analysis fitted multilevel logistic regression to explore associations with factors proposed as protective against self-reported self-harm and suicidality among Indigenous adolescents. Results: Our study cohort included 365 adolescents with complete data for the variables of interest. Adolescents had a mean (SD) age of 14.04 (0.45) years and a sex ratio of almost 1:1, and most were attending school (96.2%). Previous self-harm was reported by 8.2% (n = 30); previous suicidality was reported by 4.1% (n = 15). Individual-level factors protecting against self-harm and suicidality were being male, living in a cohesive family, and having low total Strengths and Difficulty Questionnaire scores (p < 0.05 for all). Residing in major cities compared with regional/remote areas was protective against self-harm (OR 5.94, 95% CI 1.31−26.81). Strong cultural identity was not found to be a protective factor against self-harm and/or suicidality in the sample. Conclusions: This study identified key individual- and community-level factors that can protect Australian Indigenous adolescents against self-harm and suicidality, particularly family cohesion. Identifying strengths for this at-risk population can inform prevention strategies, particularly for rural living adolescents with high distress.
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Fitzpatrick SJ, Handley T, Powell N, Read D, Inder KJ, Perkins D, Brew BK. Suicide in rural Australia: A retrospective study of mental health problems, health-seeking and service utilisation. PLoS One 2021; 16:e0245271. [PMID: 34288909 PMCID: PMC8294514 DOI: 10.1371/journal.pone.0245271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/02/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Suicide rates are higher in rural Australia than in major cities, although the factors contributing to this are not well understood. This study highlights trends in suicide and examines the prevalence of mental health problems and service utilisation of non-Indigenous Australians by geographic remoteness in rural Australia. METHODS A retrospective study of National Coronial Information System data of intentional self-harm deaths in rural New South Wales, Queensland, South Australia and Tasmania for 2010-2015 from the National Coronial Information System. RESULTS There were 3163 closed cases of intentional self-harm deaths by non-Indigenous Australians for the period 2010-2015. The suicide rate of 12.7 deaths per 100,000 persons was 11% higher than the national Australian rate and increased with remoteness. Among people who died by suicide, up to 56% had a diagnosed mental illness, and a further 24% had undiagnosed symptoms. Reported diagnoses of mental illness decreased with remoteness, as did treatment for mental illness, particularly in men. The most reported diagnoses were mood disorders (70%), psychotic disorders (9%) and anxiety disorders (8%). In the six weeks before suicide, 22% of cases had visited any type of health service at least once, and 6% had visited two or more services. Medication alone accounted for 76% of all cases treated. CONCLUSIONS Higher suicide rates in rural areas, which increase with remoteness, may be attributable to decreasing diagnosis and treatment of mental disorders, particularly in men. Less availability of mental health specialists coupled with socio-demographic factors within more remote areas may contribute to lower mental health diagnoses and treatment. Despite an emphasis on improving health-seeking and service accessibility in rural Australia, research is needed to determine factors related to the under-utilisation of services and treatment by specific groups vulnerable to death by suicide.
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Affiliation(s)
- Scott J. Fitzpatrick
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia
| | - Tonelle Handley
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia
| | - Nic Powell
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia
| | - Donna Read
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia
| | - Kerry J. Inder
- School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia
| | - David Perkins
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia
| | - Bronwyn K. Brew
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women and Children’s Health, University of New South Wales, Sydney, Australia
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Peden AE, Franklin RC. Exploring the Impact of Remoteness and Socio-Economic Status on Child and Adolescent Injury-Related Mortality in Australia. CHILDREN (BASEL, SWITZERLAND) 2020; 8:5. [PMID: 33374211 PMCID: PMC7824025 DOI: 10.3390/children8010005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/18/2020] [Accepted: 12/20/2020] [Indexed: 01/01/2023]
Abstract
Injuries are a leading cause of harm for children. This study explores the impact of determinants of health on children (0-19 years) injury-related mortality (namely remoteness and socio-economic disadvantage, calculated using the index of relative socio-economic advantage and disadvantage (IRSAD)). Cause of death data from the Australian Bureau of Statistics were sourced for children in Australia between 1 July 2007 to 30 June 2017. Fifteen injury categories (ICD-10-AM external cause codes) were used. Burden and trends by injury mechanism were explored. A total of 5153 children died; with road traffic incidents (3.39 per 100,000 population), intentional self-harm (2.46) and drowning (0.72) being the leading mechanisms. Female fatality rates in very remote areas (8.73) were nine times higher than in major cities (Relative Risk [RR] = 8.73; 95% Confidence Interval [95% CI]: 4.23-18.00). Fatality rates increased with remoteness; very remote areas recording an injury-related fatality rated six times (RR = 5.84; 95% CI: 3.76-9.12) that of major city residents. Accidental poisoning and intentional self-harm fatalities were more likely in high IRSAD areas, while road traffic fatalities were more likely in low and mid socio-economic areas (X2 = 69.1; p < 0.001). People residing in regional and remote areas and from low socio-economic backgrounds already face significant health and lifestyle challenges associated with disadvantage. It is time to invest in injury prevention interventions for these populations, as well as upstream policy strategies to minimize any further preventable loss of life.
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Affiliation(s)
- Amy E. Peden
- School of Population Health, UNSW Sydney, Kensington, NSW 2052, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia;
| | - Richard C. Franklin
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia;
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Lee S, Dwyer J, Paul E, Clarke D, Treleaven S, Roseby R. Differences by age and sex in adolescent suicide. Aust N Z J Public Health 2019; 43:248-253. [PMID: 30786107 DOI: 10.1111/1753-6405.12877] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 11/01/2018] [Accepted: 01/01/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To compare demographic and psychosocial characteristics of completed suicide between younger and older adolescents, and by sex. METHODS Data was collected from the Victorian Suicide Register, which contains information on suicides reported to the Coroners Court of Victoria. RESULTS Between 2006 and 2015, there were 273 completed suicides aged 10-19 years, with none aged 10-12 years. There were 171 (63%) suicides in the older adolescent group (17-19 years), and 102 (37%) in the younger group (13-16 years). Males comprised 184 cases (67%) and females 89 (33%). A higher proportion of both younger and female adolescents had experienced abuse, peer conflict and bullying. There was also a higher incidence of previous self-harm in younger and female adolescents. Older adolescents were more likely to not be in formal education, employment or training. CONCLUSION Suicide in younger adolescents and females appear to share characteristics, and differ from older and male adolescents. Negative interpersonal relationships and previous self-harm with possible co-existenting mental illness appear to be key differentiating features. Implications for public health: Understanding completed suicide is an important step towards prevention, and our results suggest a need for developmentally and sex-specific suicide prevention strategies.
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Affiliation(s)
- Stephanie Lee
- Monash Children's Hospital, Victoria.,Coroners Prevention Unit, Coroners Court of Victoria
| | - Jeremy Dwyer
- Coroners Prevention Unit, Coroners Court of Victoria.,Melbourne School of Population and Global Health, The University of Melbourne
| | - Eldho Paul
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Victoria
| | - David Clarke
- Department of Psychiatry, School of Clinical Sciences, Monash University, Victoria.,Monash Health, Victoria
| | - Sophie Treleaven
- Monash Children's Hospital, Victoria.,Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM), Victoria
| | - Robert Roseby
- Monash Children's Hospital, Victoria.,Department of Paediatrics, School of Clinical Sciences, Monash University, Victoria
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McAlpine R, Hillin A, Montague R. The NSW School-Link Training Program: The Impact of Training on Mental Health Service Provision to Adolescents in New South Wales, Australia. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2012. [DOI: 10.1080/14623730.2008.9721758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Deliberate self-harm in rural and urban regions: A comparative study of prevalence and patient characteristics. Soc Sci Med 2011; 73:274-81. [DOI: 10.1016/j.socscimed.2011.05.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Revised: 04/19/2011] [Accepted: 05/09/2011] [Indexed: 11/18/2022]
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Maggi S, Ostry A, Callaghan K, Hershler R, Chen L, D'Angiulli A, Hertzman C. Rural-urban migration patterns and mental health diagnoses of adolescents and young adults in British Columbia, Canada: a case-control study. Child Adolesc Psychiatry Ment Health 2010; 4:13. [PMID: 20465838 PMCID: PMC2877002 DOI: 10.1186/1753-2000-4-13] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 05/13/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The identification of mental health problems early in life can increase the well-being of children and youth. Several studies have reported that youth who experience mental health disorders are also at a greater risk of developing psychopathological conditions later in life, suggesting that the ability of researchers and clinicians to identify mental health problems early in life may help prevent adult psychopathology. Using large-scale administrative data, this study examined whether permanent settlement and within-province migration patterns may be linked to mental health diagnoses among adolescents (15 to 19 years old), young adults (20 to 30 years old), and adults (30 years old and older) who grew up in rural or urban communities or migrated between types of community (N = 8,502). METHODS We conducted a nested case-control study of the impact of rural compared to urban residence and rural-urban provincial migration patterns on diagnosis of mental health. Conditional logistic regression models were run with the following International Classification of Diseases, 9th Revision (ICD-9) mental health diagnoses as the outcomes: neurotic disorders, personality disorder, acute reaction to stress, adjustment reaction, depression, alcohol dependence, and nondependent drug abuse. Analyses were conducted controlling for paternal mental health and sociodemographic characteristics. RESULTS Mental health diagnoses were selectively associated with stability and migration patterns. Specifically, adolescents and young adults who were born in and grew up in the same rural community were at lower risk of being diagnosed with acute reaction to stress (OR = 0.740) and depression (OR = 0.881) compared to their matched controls who were not born in and did not grow up in the same rural community. Furthermore, adolescents and young adults migrating between rural communities were at lower risk of being diagnosed with adjustment reaction (OR = 0.571) than those not migrating between rural communities. No differences were found for diagnoses of neurotic disorders, personality disorder, alcohol dependence, and nondependent drug abuse. CONCLUSIONS This study provides some compelling evidence of the protective role of rural environments in the development of specific mental health conditions (i.e., depression, adjustment reaction, and acute reaction to stress) among the children of sawmill workers in Western Canada.
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Affiliation(s)
- Stefania Maggi
- Institute of Interdisciplinary Studies and Department of Psychology, Dunton Tower Room 2210, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada.
| | - Aleck Ostry
- Department of Geography, University of Victoria, PO BOX 3060 STN CSC, Victoria, BC, V8W 3R4, Canada
| | - Kristy Callaghan
- Thompson Rivers University, Box 3010, 900 McGill Road, Kamloops, BC, V2C 5N3, Canada
| | - Ruth Hershler
- Human Early Learning Program, University of British Columbia, 4th Floor, Library Processing Centre, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Lisa Chen
- Human Early Learning Program, University of British Columbia, 4th Floor, Library Processing Centre, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Amedeo D'Angiulli
- Institute of Interdisciplinary Studies and Department of Psychology, Dunton Tower Room 2210, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada
| | - Clyde Hertzman
- Human Early Learning Program, University of British Columbia, 4th Floor, Library Processing Centre, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
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Paul LA, Gray MJ, Elhai JD, Massad PM, Stamm BH. Promotion of evidence-based practices for child traumatic stress in rural populations: identification of barriers and promising solutions. TRAUMA, VIOLENCE & ABUSE 2006; 7:260-73. [PMID: 17065547 DOI: 10.1177/1524838006292521] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Child physical abuse, child sexual abuse, and other forms of traumatic stress in childhood are unfortunately quite prevalent. Although most children exhibit striking resiliency in the face of such harrowing experiences, the ubiquity of childhood trauma translates into a significant number of children in need of clinical services to address resultant unremitting distress. Encouragingly, a number of effective interventions for child traumatic stress have been developed in the past several years, and these services are increasingly available in urban areas. Unfortunately, residents of rural and frontier regions may remain underserved despite the existence of effective treatments. This article briefly reviews the prevalence and sequelae of childhood trauma and depicts the numerous barriers to effective treatment faced by rural populations. The authors then briefly review promising evidence-based interventions for child traumatic stress and conclude by enumerating mechanisms for increasing rural populations' access to these services.
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Aleck O, Stefania M, James T, James D, Ruth H, Lisa C, Amber L, Clyde H. The impact of fathers' physical and psychosocial work conditions on attempted and completed suicide among their children. BMC Public Health 2006; 6:77. [PMID: 16566815 PMCID: PMC1435887 DOI: 10.1186/1471-2458-6-77] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Accepted: 03/27/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adverse employment experiences, particularly exposure to unemployment and the threat of unemployment, have been strongly associated with several adverse mental and physical health outcomes including suicide. However, virtually no research has been conducted on the trans-generational impact of parental working conditions on attempted or completed suicide among their children. METHODS We conducted a nested case control study based on a cohort, gathered in the western Canadian province of British Columbia, of male sawmill workers and a second cohort of their children. Physical and psychosocial work conditions to which fathers were exposed during the first 16 years of their children's lives, measured using the demand/control model, were linked to hospital suicide records (attempted and completed) among their children. RESULTS Two hundred and fifty children in the cohort attempted or committed suicide between 1985 and 2001. Multivariate models, with partial control for father's mental health outcomes prior to their child's suicide demonstrate, 1) a strong association between low duration of father's employment at a study sawmill and attempted suicide for their male children, 2) elevated odds for attempted suicide among female children of fathers' employed in a sawmill job with low control and, 3) a strong association between fathers in jobs with low psychological demand and completed suicides among male children. CONCLUSION Exposure of fathers to adverse psychosocial work conditions during the first 16 years of their children's life was associated with greater odds for attempted and completed suicide among their children.
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Affiliation(s)
- Ostry Aleck
- Department of Health Care and Epidemiology, University of British Columbia, Vancouver, Canada
| | - Maggi Stefania
- University College of the Cariboo-Thompson Rivers University, Kamloops, Canada
| | | | | | - Hershler Ruth
- Department of Health Care and Epidemiology, University of British Columbia, Vancouver, Canada
| | - Chen Lisa
- Department of Health Care and Epidemiology, University of British Columbia, Vancouver, Canada
| | - Louie Amber
- Department of Health Care and Epidemiology, University of British Columbia, Vancouver, Canada
| | - Hertzman Clyde
- Department of Health Care and Epidemiology, University of British Columbia, Vancouver, Canada
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Xifró-Collsamata A, Pujol-Robinat A, Medalla-Muñiz J, Arimany-Manso J. [Impact of data used in forensic medicine on public health]. Med Clin (Barc) 2006; 126:389-96. [PMID: 16750131 DOI: 10.1157/13086051] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Alexandre Xifró-Collsamata
- Institut de Medicina Legal de Catalunya, Departament de Justícia, Generalitat de Catalunya, Barcelona, Spain.
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Bennewith O, Hawton K, Simkin S, Sutton L, Kapur N, Turnbull P, Gunnell D. The usefulness of coroners' data on suicides for providing information relevant to prevention. Suicide Life Threat Behav 2005; 35:607-14. [PMID: 16552976 DOI: 10.1521/suli.2005.35.6.607] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Coroners' records are an accessible source of information on suicides. To assess their usefulness in relation to the investigation of specific methods of suicide, we examined coroners' records for 492 suicides across 24 jurisdictions in England. Generally data on demographic variables were well recorded. Information on contact with general practitioner and psychiatric services was less commonly available. Where those who had self-poisoned died in hospital, information on treatment and blood levels of drugs taken were not routinely available. For suicides by hanging, information on the source of ligature was frequently missing. Where firearms were used, information about licensing and storage were not routinely recorded. Generally there was wide variation across coroners in information relevant to specific methods. The use of standardized forms by coroners would assist studies of factors associated with suicide and potentially provide a representative source of information relevant to suicide prevention.
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Affiliation(s)
- Olive Bennewith
- Academic Unit of Psychiatry, Cotham House, in Bristol, England.
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Fleischmann A, Bertolote JM, Belfer M, Beautrais A. Completed suicide and psychiatric diagnoses in young people: a critical examination of the evidence. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2005; 75:676-83. [PMID: 16262523 DOI: 10.1037/0002-9432.75.4.676] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Suicide rates of young people are increasing in many geographic areas. There is a need to recognize more precisely the role of specific mental disorders and their comparative importance for understanding suicide and its prevention. The authors reviewed the published English-language research, where psychiatric diagnoses that met diagnostic criteria were reported, to reexamine the presence and distribution of mental disorders in cases of completed suicide among young people worldwide. The number and geographical distribution of cases were limited (N = 894 cases). The majority of cases (88.6%) had a diagnosis of at least 1 mental disorder. Mood disorders were most frequent (42.1%), followed by substance-related disorders (40.8%) and disruptive behavior disorders (20.8%). Those strategies focusing exclusively on the prevention and treatment of depression in young people need to be reconsidered. A comprehensive suicide prevention strategy among young people should target mental disorders as a whole, not depression alone, and consider contextual factors.
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Affiliation(s)
- Alexandra Fleischmann
- Department of Mental Health and Substance Dependence, World Health Organization, Geneva, Switzerland.
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Middleton N, Gunnell D, Frankel S, Whitley E, Dorling D. Urban-rural differences in suicide trends in young adults: England and Wales, 1981-1998. Soc Sci Med 2003; 57:1183-94. [PMID: 12899903 DOI: 10.1016/s0277-9536(02)00496-3] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Suicide rates amongst young people, particularly males, have increased in many industrialised countries since the 1960s. There is evidence from some countries that the steepest rises have occurred in rural areas. We have investigated whether similar geographical differences in trends in suicide exist in England and Wales by examining patterns of suicide between 1981 and 1998 in relation to rurality. We used two complementary population-based indices of rurality: (1) population density and (2) population potential (a measure of geographic remoteness from large concentrations of population). We used the electoral ward (n=9264, median population aged 15-44: 1829) as the unit of analysis. To assess whether social and economic factors underlie rural-urban differences in trends we used negative binomial regression models to investigate changes in suicide rates between the years for which detailed national census data were available (1981 and 1991). Over the years studied, the most unfavourable trends in suicide in 15-44-year olds generally occurred in areas remote from the main centres of population; this effect was most marked in 15-24-year-old females. Observed patterns were not explained by changes in age- and sex-specific unemployment, socio-economic deprivation or social fragmentation. The mental health of young adults or other factors influencing suicide risk may have deteriorated more in rural than urban areas in recent years. Explanations for these trends require further investigation.
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Affiliation(s)
- Nicos Middleton
- Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, BS8 2PR Bristol, UK
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15
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Runyan CW, Moracco KE, Dulli L, Butts J. Suicide among North Carolina women, 1989-93: information from two data sources. Inj Prev 2003; 9:67-72. [PMID: 12642563 PMCID: PMC1730920 DOI: 10.1136/ip.9.1.67] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To characterize the events and examine suicide precursors among women and to examine gaps in surveillance. SETTING A statewide study in North Carolina. METHODS Suicides of women age 15 and older for the time period 1989-93, as identified from the Office of the Chief Medical Examiner, were included. All case files were reviewed by hand and telephone interviews were attempted with investigating law enforcement officials for every case in 1993. RESULTS Altogether 882 suicides met the case definition, for an age adjusted rate that fluctuated between 5.53 and 7.26 per 100 000 women across the period. Interviews with law enforcement officials were completed for 135 of the 177 cases from 1993. White women had rates nearly three times those of racial minorities. Women under age 45 were proportionally more likely than older women to have recently experienced the breakup of an intimate relationship. Information about precursors was not as consistently reported as had been hoped. Medical examiner records were variable in completeness. Law enforcement interviews frequently did not yield information about the factors we had hoped to examine, probably because the investigations were conducted primarily to rule out homicide. CONCLUSIONS This study suggests somewhat different precursor patterns by age group. It also points to the need for reconsidering how suicide surveillance is accomplished as a strategy to guide intervention.
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Affiliation(s)
- C W Runyan
- University of North Carolina Injury Prevention Research Center and Department of Health Behavior and Health Education, School of Public Health, University of North Carolina, NC 27599-7505, USA.
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Abstract
OBJECTIVE The suicide rate in Australia is cause for concern, especially the increase in attempted and completed suicides in rural and regional locations. The present study examined reasons for choosing not to commit suicide as a function of residential location. METHOD The study involved 655 Victorian residents from four population-based strata; urban, regional city, regional town, and rural. RESULTS Results from the Reasons for Living Inventory revealed significant differences as a function of residential location. Overall, residents in rural locations reported having significantly more to live for than their urban counterparts. Further analysis of six reasons for living (child, family, moral, social, coping and death-related concerns) showed a pattern whereby residents in rural locations reported having the most to live for, followed by regional residents, and urban residents who reported having the least to live for. CONCLUSIONS These findings are in contrast to increase of suicide rates in rural areas, and highlight the need for a greater understanding of the mechanisms underlying suicidal behaviour.
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Affiliation(s)
- Suzanne McLaren
- School of Behavioural and Social Sciences and Humanities, University of Ballarat, PO Box 663, Ballarat 3353, Victoria, Australia.
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17
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Page A, Morrell S, Taylor R. Suicide differentials in Australian males and females by various measures of socio-economic status, 1994-98. Aust N Z J Public Health 2002; 26:318-24. [PMID: 12233951 DOI: 10.1111/j.1467-842x.2002.tb00178.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To investigate Australian suicide differentials in males and females by three area-based measures of socio-economic status (SES). METHODS Suicide data for 1994-98 were used to investigate area-based gradients of SES for the Index of Relative Socio-Economic Disadvantage (IRSED) (an overall measure of SES), the Index of Economic Resources (IER), and the Index of Education and Occupation (IEO), using Poisson regression models adjusting for age, country-of-birth and urban-rural residence. RESULTS After adjusting for age, country-of-birth and urban-rural residence, significant increasing linear trends in suicide risk from high to low quintiles of SES were evident in males for the IRSED (an average multiplicative increase in suicide risk of 8% per quintile), IER (9% increase) and IEO (5% increase). For females, there was no evident SES gradient for the IRSED after adjusting for age, country-of-birth and urban-rural residence, but a significant positive linear trend from high to low quintiles of SES was found for the IER (6% increase per quintile). A significant decreasing linear trend (increasing suicide risk with increasing SES) was evident for the IEO (30% per quintle). CONCLUSION Male suicide is positively associated with all three measures of SES examined. Female suicide is significantly associated with the IER (positive association) and IEO (negative), and because of this is not associated with the overall measure of SES. These findings partly explain why female suicide has been found to be poorly correlated with area-based measures of SES. IMPLICATIONS Specific components of area-based socio-economic status provide a clearer picture of socio-economic suicide differentials in Australian females, with implications for population-based preventive strategies.
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Affiliation(s)
- Andrew Page
- School of Public Health, University of Sydney, New South Wales
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18
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Abstract
Using the National Center of Health Statistics' mortality statistics databases for 1991 through 1996 (12,430,473 deaths), we isolated 144,364 individuals 40 years of age or older with a primary diagnosis of Parkinson's disease (PD). Of these, 122 died by suicide. The rate of suicide in the general population was about 10 times higher than in patients with PD (0.8% compared with only 0.08%, respectively). These different rates of suicide cannot be attributed to differences in age, gender, race, education, or marital status. Compared with patients with suicidal PD, patients with PD who died from other causes manifested significantly lower rates of affective disorders. The referent population exhibited a higher rate of malignancy and a lower rate of depression. The findings suggest that marital status, mood disorder, and somatic comorbidity provide only a limited understanding of completed suicide.
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Affiliation(s)
- M Myslobodsky
- Department of Psychology, Howard University, Washington, DC, USA
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Abstract
OBJECTIVES To identify and describe suicide data for occupational classifications relating to farm managers and agricultural labourers for Australia for the period 1988 to 1997, and to relate resultant suicide rates to farmers' terms of trade. METHOD Descriptive and linear regression analysis of aggregated mortality data. RESULTS In the period 1988 to 1997, 921 suicides were identified. The majority of these suicides were farm managers (67.4%). Farm manager suicides occurred predominantly in older age groups (55 + years). In comparison agricultural labourer suicides were younger, with the majority of suicides occurring in the 15-39 years age group. The most common methods for both groups were firearms (particularly hunting rifles and shot guns), hanging and motor vehicle exhaust gas. These methods accounted for approximately 81% of all male farm suicides. Firearms accounted for 51% of male farm suicide, in comparison to 23% for the wider Australian male population for the same period. Estimated age standardized rates per 100 000 for male farm managers for the 10-year period ranged from 24.8 to 51.4. For male agricultural labourers these rates ranged from 23.5 to 41.9. Analyses also revealed a negative correlation (r = -0.75, p < 0.01) between farm manager suicide rates and farmers' terms of trade. CONCLUSION Male farm manager and agricultural labourer suicide rates are higher than male national rates and rates in the wider rural population, particularly in the later years of the period investigated. Firearms prefigure as the most common method of suicide, despite decreases in this method in the wider rural population. Establishing more accurate denominator data for the farming community is a priority, as is preventative action that accounts for unique aspects of farm life.
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Affiliation(s)
- Andrew N Page
- Department of Public Health and Community Medicine, Edward Ford Building, A27, The University of Sydney, Sydney, New South Wales 2066, Australia.
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20
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Abstract
This paper discusses health issues among Filipinas (women born in the Philippines) living in remote and rural environments in Queensland. The sample was recruited as part of the University of Queensland component of the Australian Longitudinal Study of Women's Health (ALSWH). Most of the women lived in an urban or semi-urban area (391), whereas 90 lived in rural or remote areas. Community perceptions had a much greater impact on health service utilisation in rural and remote areas than in urban areas. The transition between newcomer and old-timer is more difficult for Filipinas than for other rural women because they are visibly different from other members of the community and suffer from stigmatisation associated with perceptions of Filipinas as mail order brides. For these women, concerns about confidentiality and a reluctance to ask for support are major barriers to health service utilisation. The area of greatest concern is mental health, particularly in relation to parenting issues. Improving access may involve providing a greater awareness of what services are available and allowing women to access services in a way that does not require them to label themselves or be labelled by others.
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Affiliation(s)
- M Kelaher
- School of Public Health, Columbia University, New York, USA.
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21
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Abstract
OBJECTIVE Suicide rates in young people have increased during the past three decades, particularly among young males, and there is increasing public and policy concern about the issue of youth suicide in Australia and New Zealand. This paper summarises current knowledge about risk factors for suicide and suicide attempts in young people. METHOD Evidence about risk factors for suicidal behaviour in young people was gathered by review of relevant English language articles and other papers, published since the mid-1980s. RESULTS The international literature yields a generally consistent account of the risk factors and life processes that lead to youth suicide and suicide attempts. Risk factor domains which may contribute to suicidal behaviour include: social and educational disadvantage; childhood and family adversity; psychopathology; individual and personal vulnerabilities; exposure to stressful life events and circumstances; and social, cultural and contextual factors. Frequently, suicidal behaviours in young people appear to be a consequence of adverse life sequences in which multiple risk factors from these domains combine to increase risk of suicidal behaviour. CONCLUSIONS Current research evidence suggests that the strongest risk factors for youth suicide are mental disorders (in particular, affective disorders, substance use disorders and antisocial behaviours) and a history of psychopathology, indicating that priorities for intervening to reduce youth suicidal behaviours lie with interventions focused upon the improved recognition, treatment and management of young people with mental disorders.
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Affiliation(s)
- A L Beautrais
- Canterbury Suicide Project, Christchurch School of Medicine, New Zealand.
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Byard RW, Markopoulos D, Prasad D, Eitzen D, James RA, Blackbourne B, Krous HF. Early adolescent suicide: a comparative study. ACTA ACUST UNITED AC 2000; 7:6-9. [PMID: 16083642 DOI: 10.1054/jcfm.2000.0354] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A study was undertaken of suicides in children and adolescents aged 16 years and under in South Australia, (Australia), and in San Diego County (USA) from January 1985 to December 1997. In South Australia there were 48 cases of youth suicide, representing 2% of the total number of 2251 suicides over that time. There were 34 males and 14 females (age range 13 to 16 years; mean = 15.3 years), with 22 hangings (46%), six gunshot wounds (13%), five train deaths (10%), four drug overdoses (8%), four jumping deaths (8%), three self immolations (6%), three carbon-monoxide inhalations (6%) and one electrocution (2%). In San Diego County there were 70 cases, representing 1.6% of the total number of 4492 suicides. There were 48 males and 22 females (age range 11 to 16 years; mean = 14.7 years), with 41 gunshot wounds (59%), 21 hangings (30%), six drug overdoses (9%), and two jumping deaths (3%). Preferred methods of suicide differed between the two areas, with significantly more gunshot suicides in San Diego compared to South Australia. The methods of suicide also differed in South Australia from older age groups, with more hangings, jumping deaths and self immolations, and fewer firearm and carbon monoxide inhalation deaths. Suicides in adolescents under the age of 17 years in both populations were, however, rare, with no demonstrable increase in numbers over the time of the study.
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Affiliation(s)
- R W Byard
- Forensic Science Centre, Adelaide, Australia
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