Socio-Economic Position and Suicidal Ideation in Men

Physiotherapists often encounter clients disclosing suicidal thoughts and behaviors: a cross-sectional survey of Australian physiotherapists

BACKGROUND

All health professionals have a role in suicide prevention, although little is known about physiotherapists' contact with clients experiencing suicidal thoughts and behaviors.

OBJECTIVE

The aims of this study were to investigate physiotherapists' self-reported frequency of contact with clients who disclose suicidal thoughts and behaviors and to identify potential factors associated with frequency of contact.

METHODS

Three-hundred and thirty-eight Australian physiotherapists were surveyed using an online questionnaire, with an estimated response rate of 6.1%. Data were analyzed using descriptive analysis and logistic regression.

RESULTS

Over half the respondents (52.1%) reported encountering clients at least once a year who disclosed suicidal thoughts, and nearly half (49.4%) reported having received at least one disclosure of a suicide plan at some point in their career. Among those working in the public sector, 67.5% of respondents reported having received a disclosure of a suicide plan, and almost all physiotherapists working in pain management reported having received such a disclosure (93.8%). The binary logistic regression model explained approximately 39.7% of the variance in whether a physiotherapist had a client disclose a plan for suicide at some point in their career or not.

CONCLUSION

The results highlight that all physiotherapists should receive training in suicide prevention.

Socio-economic and demographic patterns of mental health complaints among the employed adults in Estonia

Background

Mental health problems follow a distinct socio-economic gradient and contribute to the health inequalities. The study aims to analyse the socio-economic and demographic factors of self-reported mental health complaints (stress, depressiveness, overtiredness, suicidal thoughts) among employed adult population in Estonia.

Methods

Data on 4041 employed respondents (2064 men and 1977 women) aged 20–64 years from nationally representative health surveys from years 2016 and 2018 in Estonia were used for the study. Dependent variables included self-reported stress, depressiveness, overtiredness, and suicidal thoughts. Descriptive statistics and both log-binomial and Poisson regression analysis were used to describe the socio-economic and demographic variations in these mental health complaints.

Results

More than half of the respondents had either stress, depressiveness, overtiredness or suicidal thoughts with 25% reporting two or more of mental health complaints. Lower personal income was associated with higher rates of all mental health complaints (stress, depressiveness, overtiredness, and suicidal thoughts) among employed adults in Estonia. Additionally, lower education was associated with higher prevalence of depressiveness and lower job skills predicted higher prevalence of suicidal thoughts. Higher prevalence ratios for depressiveness and overtiredness were found for women compared to men whereas Estonians had higher prevalence ratios for stress and suicidal thoughts compared to non-Estonians. All mental health complaints were more frequently reported at younger ages (compared to 50-64-year olds) and by not married or cohabiting respondents.

Conclusion

High prevalence of mental health complaints and their socio-economic and demographic patterning refer to considerable inequalities in mental health among employed adults. Policy actions targeting especially younger adults and those with financial difficulties are needed to address these early manifestations of mental health problems.

Suicidality among adult survivors of childhood cancer: A report from the St. Jude Lifetime Cohort Study

BACKGROUND

Suicide is a serious public health concern. An increased risk of suicide ideation previously has been reported among survivors of childhood cancer.

METHODS

Suicide mortality was assessed for all potentially eligible survivors (those aged ≥18 years who were ≥5 years after their cancer diagnosis; 7312 survivors). Risk factors for acute suicidal ideation were assessed among clinically evaluated survivors (3096 survivors) and the prevalence of acute ideation was compared with that of community controls (429 individuals). The prevalence of 12-month suicidality was assessed among survivors who could be compared with population data (1255 survivors). Standardized mortality ratios compared rates of suicide mortality among survivors with those of the general population. Risk ratios (RRs) and 95% confidence intervals (95% CIs) derived from generalized linear models identified risk factors associated with acute suicidal ideation. Standardized incidence ratios (SIRs) compared the prevalence of 12-month suicidality among survivors with that of a matched sample from the general population.

RESULTS

Survivors reported a similar 12-month prevalence of ideation compared with the general population (SIR, 0.68; 95% CI, 0.35-1.01) and a lower prevalence of suicidal behaviors (planning: SIR, 0.17 [95% CI, 0.07-0.27]; attempts: SIR, 0.07 [95% CI, 0.00-0.15]) and mortality (standardized mortality ratio, 0.60; 95% CI, 0.34-0.86). Among survivors, depression (RR, 12.30; 95% CI, 7.89-19.11), anxiety (RR, 2.19; 95% CI, 1.40-3.40), and financial stress (RR, 1.47; 95% CI, 1.00-2.15) were found to be associated with a higher prevalence of acute suicidal ideation.

CONCLUSIONS

Survivors of childhood cancer were found to be at a lower risk of suicidal behaviors and mortality, yet endorsed a prevalence of ideation similar to that of the general population. These results are in contrast to previous findings of suicidal ideation among survivors and support the need for further research to inform screening strategies and interventions.

LAY SUMMARY

The purpose of the current study was to compare the risk of suicidal ideation, behaviors, and mortality in adult survivors of childhood cancer with those of the general population. Risk factors associated with suicidal ideation among survivors of childhood cancer also were examined. Survivors of childhood cancer reported a similar risk of ideation compared with the general population, but a lower risk of suicidal behaviors and mortality. Psychological health and financial stressors were found to be risk factors associated with suicidal ideation. Although adult survivors of childhood cancer did not report a greater risk of suicidality compared with the general population, psychosocial care in survivorship remains essential.

Self-rated health inequalities in the intersection of gender, social class and regional development in Spain: exploring contributions of material and psychosocial factors

Background

Inequalities in health across social class, gender and regional context in Spain are well-known; however, there is a lack of research examining how these dimensions of inequality interact. This study explores self-rated health (SRH) inequalities across intersectional positions of gender, social class and region, and the contribution of material and psychosocial factors to these inequalities.

Methods

Participants were drawn from the cross-sectional 2015 National Living Conditions Survey of Spanish residents aged 19–88 years (N = 27,215; 77% response rate). Eight intersectional positions were formed by combining dichotomous variables of gender, social class and regional development. Poisson regression was used to estimate intersectional inequalities in SRH as prevalence ratios, and the contributions of material and psychosocial factors.

Results

Results showed both cumulative and heterogeneous inequalities within and across intersectional positions. Inequalities in the intersection of social class and regional development were best explained by the joint contributions of material and psychosocial factors, while gender inequalities within non-manual social class were better explained by material factors alone.

Conclusions

The results illustrate the complexity of interacting inequalities in health and their underpinnings in Spain. Local and national policies taking this complexity into account are needed to broadly improve equity in health in Spain.

Expressions of masculinity and associations with suicidal ideation among young males

BACKGROUND

Adolescent boys and young men are at particular risk of suicide. Suicidal ideation is an important risk factor for suicide, but is poorly understood among adolescent males. Some masculine behaviors have been associated with deleterious effects on health, yet there has been little quantitative examination of associations between masculinity and suicide or suicidal ideation, particularly among boys/young men. This study aimed to examine associations between conformity to masculine norms and suicidal ideation in a sample of adolescents.

METHODS

A prospective cohort design, this study drew on a sample of 829 Australian boys/young men from the Australian Longitudinal Study on Male Health. Boys were 15-18 years at baseline, and 17-20 years at follow-up. Masculine norms (Wave 1), were measured using the Conformity to Masculine Norms Inventory (CMNI-22). Suicidal ideation (Wave 2) was a single-item from the Youth Risk Behavior Survey. Logistic regression analysis was conducted, adjusting for available confounders including parental education, Indigenous Australian identity and area disadvantage.

RESULTS

In adjusted models, greater conformity to violent norms (OR = 1.23, 95% Confidence Interval [CI]: 1.03-1.47) and self-reliance norms (OR = 1.40, 95% CI: 1.15-1.70) was associated with higher odds of reporting suicidal ideation. Greater conformity to norms regarding heterosexuality was associated with reduced odds of reporting suicidal ideation (OR = 0.80, 95% CI: 0.68-0.91).

CONCLUSIONS

These results suggest that conforming to some masculine norms may be deleterious to the mental health of young males, placing them at greater risk of suicidal ideation. The results highlight the importance of presenting young males with alternative and multiple ways of being a male. Facilitating a relaxation of norms regarding self-reliance, and encouraging help-seeking, is vital. Furthermore, dismantling norms that rigidly enforce masculine norms, particularly in relation to heteronormativity, is likely to benefit the broad population of males, not only those who do not conform to heterosexual and other masculine norms.

Geographical Patterns in Drug-Related Mortality and Suicide: Investigating Commonalities in English Small Areas

There are increasing concerns regarding upward trends in drug-related deaths in a number of developed societies. In some countries, these have been paralleled by upward trends in suicide. Of frequent concern to public health policy are local variations in these outcomes, and the factors underlying them. In this paper, we consider the geographic pattern of drug-related deaths and suicide for 2012-2016 across 6791 small areas in England. The aim is to establish the extent of commonalities in area risk factors between the two outcomes, with a particular focus on impacts of deprivation, fragmentation and rurality.

A Look at Culture and Stigma of Suicide: Textual Analysis of Community Theatre Performances

Stigma against suicidal ideation and help-seeking is a significant barrier to prevention. Little detail is provided on what types of stigma interfere with help-seeking, how stigma is expressed, and how to reduce it. Five groups of two ethnically diverse community theatre programs were formed to analyze differences in Eastern Montana Caucasian and Native American adolescents and young adults’ experiences with stigma about mental illness and mental health treatment that affect help-seeking for suicidal thoughts and experiences. Over a ten-week period, a grassroots theatre project was used to recruit members from the same population as the audience to write and perform a play on suicide and depression (n = 33; 10 males, 23 females; 12 Native American, 21 Caucasian, ages 14–24). Using textual analysis, the community- and campus-based performance scripts were coded for themes related to stigma. Both ethnic groups reported that stigma is a barrier to expressing emotional vulnerability, seeking help, and acknowledging mental illness. We found that Caucasians’ experiences were more individually oriented and Native Americans’ experiences were more collectively oriented. Understanding the cultural bases of experiences with stigma related to mental health treatment for suicide is necessary to create educational programs to reduce stigma for diverse groups of adolescents and young adults.

Contextual Socioeconomic Disadvantage and Adolescent Suicide Attempts: A Multilevel Investigation

Multilevel research on whether and how contextual socioeconomic disadvantage affects adolescent suicidal behaviors is scarce. Using data from the first two waves (1994/95 and 1996) of the National Longitudinal Study of Adolescent to Adult Health (N = 13,335; 49.63% girls; M_age = 15.02 years), this study examined (1) the association between area-level socioeconomic disadvantage and adolescent suicide attempts over and above individual-level socioeconomic factors, (2) the moderating role of gender, and (3) the mediating roles of contextually relevant stressors and available psychosocial resources. The results revealed that area-level socioeconomic disadvantage increased the risk of attempting suicide even after adjusting for individual-level socioeconomic status, especially for boys. Consistent with the stress process perspective, reports of exposure to violence and lack of safety explain this contextual effect. National suicidal behavior prevention strategies across the U.S. should recognize the strong association with the socioeconomic context, along with individual-level risk factors.

Association between socioeconomic attainments and suicidal ideation by age groups in Korea

BACKGROUND:

Suicidal ideation is a strong antecedent of suicidal behavior, associated with increased likelihood of suicide. Thus, suicidal ideation serves to identify which groups are at more risk of suicide and has policy implications for targeting groups to prevent suicide.

AIMS:

A substantial body of research has addressed potential determinants of suicide ideation in Korea. Little attention has been paid, however, to analyzing the extent to which socioeconomic attainments (education, household income, and employment status) are associated with risk of suicidal ideation, drawing on nationally representative data.

METHODS:

Data were drawn from the 2012 Korea Welfare Panel Study (KOWEPS). Among the 12,606 respondents, the findings are based on 1,500 young adults (age 18-35) and 3,469 middle-aged adults (age 36-55) who answered a question about suicidal ideation.

RESULTS:

For young adults, respondents from 2-year and 4-year colleges and higher had lower probabilities of suicidal ideation compared with respondents from high school. People out of the labor force also exhibited an elevated risk of suicidal ideation compared with those in waged employment. Middle-aged adults displayed different patterns. Middle-aged respondents from 4-year colleges or higher had an increased likelihood of suicidal ideation. The likelihood of reporting suicidal ideation was predicted to decrease as household income increased only for middle-aged adults.

CONCLUSIONS:

The information about suicidal ideation was obtained from only one question of self-response, which limits the validity of the suicidal ideation measurement. The cross-sectional setting of the data prevents us from estimating causal relationships. Nevertheless, the findings imply that age-specific policy should be implemented to ameliorate differential risk for suicidal ideation and benefit public mental health in the long run.

Mental health by gender-specific occupational groups: Profiles, risks and dominance of predictors

BACKGROUND

We defined gender-specific profiles of mental ill-health for the main occupational groups using three outcomes; antidepressant use, sickness absence (SA) due to depression, and suicides. We also examined which occupational groups had the highest risk of the outcomes, and compared the importance of their predictors.

METHODS

From a random register cohort of Finnish working age population, individuals in the six largest occupational groups in 2004 for men and women were included (N = 414 357). We used register data to define the first antidepressant purchase (i.e. use), the first long-term SA spell for depression, and suicide between Jan 1st 2005 and Dec 31st 2014. We assessed the risk of each outcome by occupational group with logistic regression models, and used dominance analysis to compare the relative importance of predictors.

RESULTS

In all six occupational groups for women, the prevalence of antidepressant use and SA for depression was higher than in the men's occupational groups. The opposite was observed for suicides. The risk of antidepressant use was lower, but the risk of suicide was 2-times higher among men in low vs. high-skilled occupations. Among women, a lower skill-level was associated with a higher risk of SA due to depression. Gender was the most important predictor of all outcomes.

LIMITATIONS

We lacked information on history of medication use or health problems prior to follow-up.

CONCLUSIONS

Gendered occupational status was an underlying factor explaining distinctive mental health profiles in the working population. Occupational class-dependent behavioural patterns related to mental health existed among men.

Physical activity behaviours of persons living with HIV of low socioeconomic status: domain, intensity and sociodemographic correlates

Physical activity (PA) is healthy for People Living with HIV and AIDS (PLWHA). This study examined the PA profile of 978 PLWHA based on PA domains and PA intensity. The study also sought to determine whether employment status and level of education can predict PA among PLWHA of low SES. PA and sociodemographic data of 978 PLWHA of mean age 35 (8.77) years were collected using the global physical activity questionnaire and a sociodemographic questionnaire. Results showed that, participants engaged more in work-related PA [160.11 (346.95) min/wk], followed by transport related PA [115.21(SD = 142.04) min/wk], and lastly in leisure related PA [40.84 (SD = 110.37) min/wk]. Participants also engaged more in moderate PA [265.86 (SD = 335.45) min/wk], than in vigorous PA [50.29 (SD = 205.30) min/wk]. Employment was a significant predictor of overall PA controlling for age, CD4 count and education level. The model explained 2.5% of the variance (R²= 0.025) on overall PA and tested significant at a 0.01 alpha level (p < 0.01). PA interventions for this population should be domain- and intensity-specific. Researchers promoting healthy lifestyle behaviour change can benefit from determining the factors that facilitate domain-specific PA.

Suicidal ideation among Chinese methadone-maintained patients: prevalence and correlates

Heroin users are at high risk for suicide. However, the epidemiological profile of suicidal behaviors in Chinese methadone-maintained patients remains largely unknown. This study determined the prevalence and correlates of suicidal ideation among Chinese methadone-maintained patients. A total of 603 methadone-maintained patients were consecutively recruited from three methadone maintenance treatment (MMT) clinics in Wuhan, China, and administered with standardized questionnaires to collect sociodemographic, clinical, and psychological data. Suicidal ideation was measured with a single self-report question “Have you ever thought about committing suicide?”. Depression and anxiety were assessed with Zung’s Self-rating Depression Scale and Zung’s Self-rating Anxiety Scale, respectively. The one-month and lifetime prevalence rates of suicidal ideation were 17.9% and 58.9%, respectively. In multiple logistic regression, lifetime suicidal ideation was significantly associated with female (OR: 1.69), an educational attainment of primary school and below (OR: 1.47), fair and poor interpersonal relationship (OR: 2.20), a history of injecting heroin (OR: 1.60), depression (OR: 1.38), and anxiety (OR: 4.00). Methadone-maintained patients of MMT clinics have a high prevalence of suicidal ideation and therefore at high risk for suicide. Suicide prevention efforts at MMT clinics should include periodic evaluation of suicidality, psychosocial supports, and, when necessary, psychiatric treatment and crisis intervention.