1
|
Meda N, Zammarrelli J, Sambataro F, De Leo D. Late-life suicide: machine learning predictors from a large European longitudinal cohort. Front Psychiatry 2024; 15:1455247. [PMID: 39355379 PMCID: PMC11442232 DOI: 10.3389/fpsyt.2024.1455247] [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: 06/26/2024] [Accepted: 08/23/2024] [Indexed: 10/03/2024] Open
Abstract
Background People in late adulthood die by suicide at the highest rate worldwide. However, there are still no tools to help predict the risk of death from suicide in old age. Here, we leveraged the Survey of Health, Ageing, and Retirement in Europe (SHARE) prospective dataset to train and test a machine learning model to identify predictors for suicide in late life. Methods Of more than 16,000 deaths recorded, 74 were suicides. We matched 73 individuals who died by suicide with people who died by accident, according to sex (28.8% female in the total sample), age at death (67 ± 16.4 years), suicidal ideation (measured with the EURO-D scale), and the number of chronic illnesses. A random forest algorithm was trained on demographic data, physical health, depression, and cognitive functioning to extract essential variables for predicting death from suicide and then tested on the test set. Results The random forest algorithm had an accuracy of 79% (95% CI 0.60-0.92, p = 0.002), a sensitivity of.80, and a specificity of.78. Among the variables contributing to the model performance, the three most important factors were how long the participant was ill before death, the frequency of contact with the next of kin and the number of offspring still alive. Conclusions Prospective clinical and social information can predict death from suicide with good accuracy in late adulthood. Most of the variables that surfaced as risk factors can be attributed to the construct of social connectedness, which has been shown to play a decisive role in suicide in late life.
Collapse
Affiliation(s)
- Nicola Meda
- Department of Neuroscience, University of Padova, Padova, Italy
| | | | - Fabio Sambataro
- Department of Neuroscience, University of Padova, Padova, Italy
- Padova University Hospital, Padova, Italy
- Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Diego De Leo
- De Leo Fund, Research Division, Padova, Italy
- Italian Psychogeriatric Association, Padova, Italy
- Australian Institute for Suicide Research and Prevention, Griffith University, Mt Gravatt Campus, Brisbane, QLD, Australia
- Slovene Centre for Suicide Research, Primorska University, Koper, Slovenia
| |
Collapse
|
2
|
Øien-Ødegaard C, Christiansen STG, Hauge LJ, Stene-Larsen K, Bélanger SM, Bjertness E, Reneflot A. Variations in healthcare utilization for mental health problems prior to suicide by socioeconomic status: a Norwegian register-based population study. BMC Health Serv Res 2024; 24:648. [PMID: 38773575 PMCID: PMC11110240 DOI: 10.1186/s12913-024-11113-w] [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: 12/21/2023] [Accepted: 05/14/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Suicide poses a major public health challenge, claiming around 650 lives annually in Norway. There is limited understanding of mental healthcare utilization patterns preceding suicide, particularly relating to socioeconomic status (SES). This study analyzes mental health service use among Norwegian citizens aged 20-64 from 2009 to 2021, emphasizing disparities related to SES. METHODS This is a population-wide registry-based study. We include mental health consultations with both primary and specialist healthcare services, and investigate patterns of service use regarding educational attainment, employment status and income and compare this to the population in general. All suicides in the period (N = 4731) are included in the study. The aim is to investigate potential discrepancies in service use the year and month preceding suicide, seeking to enhance targeted preventive interventions. RESULTS Our results show significant variations in healthcare use for mental health problems the last year preceding suicide, according to the components of SES, for both men and women. Those with higher education utilize the mental healthcare services prior to suicide to a higher degree than men and women with high school education or less, whereas employed men and men with high income level have significantly lower mental healthcare usage prior to suicide both the last year and month compared to the non-employed men and men with low-income level. Employed women also had a lower mental healthcare usage, whereas the results regarding income are not significant for women. CONCLUSION Mental healthcare use prior to suicide varies across the SES components. Notably, the SES groups exhibit heterogeneity, with gendered patterns. Targeted interventions for low consultation rates among employed men, and men with high income and lower education are needed, while women, and men in at-risk groups, such as the non-employed and those with low income, demonstrate higher mental healthcare utilization, warranting comprehensive suicide prevention measures.
Collapse
Affiliation(s)
- Carine Øien-Ødegaard
- Division of Mental and Physical Health, Norwegian Institute of Public Health, PO Box 222, Skøyen, Oslo, 0213, Norway.
| | | | - Lars Johan Hauge
- Division of Mental and Physical Health, Norwegian Institute of Public Health, PO Box 222, Skøyen, Oslo, 0213, Norway
| | - Kim Stene-Larsen
- Division of Mental and Physical Health, Norwegian Institute of Public Health, PO Box 222, Skøyen, Oslo, 0213, Norway
| | - Sissel Marguerite Bélanger
- Division of Mental and Physical Health, Norwegian Institute of Public Health, PO Box 222, Skøyen, Oslo, 0213, Norway
| | - Espen Bjertness
- Department of Community Medicine and Global Health, University of Oslo, Institute of Health and Society, PO Box 1130, Blindern, Oslo, 0318, Norway
| | - Anne Reneflot
- Division of Mental and Physical Health, Norwegian Institute of Public Health, PO Box 222, Skøyen, Oslo, 0213, Norway
| |
Collapse
|
3
|
Song A, Koh EJ, Lee WY, Chang S, Lim J, Choi M, Ki M. Suicide risk of chronic diseases and comorbidities: A Korean case-control study. J Affect Disord 2024; 349:431-437. [PMID: 38190857 DOI: 10.1016/j.jad.2024.01.037] [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: 09/28/2023] [Revised: 12/06/2023] [Accepted: 01/03/2024] [Indexed: 01/10/2024]
Abstract
OBJECTIVES Chronic diseases including mental disorders have been associated with suicide. This study broadens the approach by incorporating a comprehensive list of chronic diseases and a context of comorbidities and explored their associations with suicide. METHODS Data-linkage between death registry and Korean National Health Insurance data was conducted. Suicide cases (n = 64,099) between 2009 and 2013 were 1:4 matched for gender and age to an alive control (n = 256,396). A total of 92 individual diseases of 9 broad categories were identified from insurance claims data. Conditional logistic regression was applied to assess the associations, adjusting for mental and behavioral disorders and socioeconomic status. RESULTS Suicide cases frequently experienced chronic diseases (90.0 %) and comorbidities (74.6 %). Chronic diseases greatly increased suicide risk and, among these, mental and behavioral disorders showed the highest suicide risk (OR = 7.53, 95 % CI = 7.32-7.74) followed by cardiovascular (OR = 3.36, 95 % CI = 3.26-3.47). For individual diseases, gastritis and duodenitis were most prevalent (68.1 %) among suicide cases but depressive disorder showed the highest risk (OR = 4.95, 95 % CI = 4.79-5.12). Suicide risk was strong in comorbid status sometimes comparable to odds for mental and behavioral disorder alone (e.g., OR for cardiovascular and eye vision-related diseases = 4.01, 95 % CI = 3.86-4.17). LIMITATIONS Differentiation of comorbidity was limited to pairs between major disease categories, neglecting the heterogeneity within categories. CONCLUSION Chronic diseases, in particular comorbidity, showed strong associations with suicide. This suggests that those with comorbidities feel that they are pushed to the extreme line, supporting comprehensive interventions for them to address wider reasons including psychological and social problems, besides medical problems.
Collapse
Affiliation(s)
- Areum Song
- Program in Public Health, Graduate School, Korea University, 73 Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea
| | - Emily Jiali Koh
- Program in Public Health, Graduate School, Korea University, 73 Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea
| | - Weon-Young Lee
- Department of Preventive Medicine, Chung-Ang University College of Medicine, 84 Heukseok-Ro, Dongjak-Gu, Seoul 156-756, Republic of Korea
| | - Shusen Chang
- Department of Public Health, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Road, Zhongzheng Dist., Taipei, Taiwan
| | - Jiseun Lim
- Department of Preventive Medicine, Eulji University, 77 Gyeryong-ro 771beon-gil, Yongdu-dong, Jung-gu, Daejeon, Republic of Korea
| | - Minjae Choi
- Department of Preventive Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea
| | - Myung Ki
- Program in Public Health, Graduate School, Korea University, 73 Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea; Department of Preventive Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea; BK21FOUR R&E Center for Learning Health Systems, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul, Republic of Korea.
| |
Collapse
|
4
|
De Leo D. Late-life suicide in an aging world. NATURE AGING 2022; 2:7-12. [PMID: 37118360 DOI: 10.1038/s43587-021-00160-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/06/2021] [Indexed: 04/30/2023]
Abstract
Suicide is an important problem among older adults and in particular older men. Risk factors for suicide in older adults include the loss of a loved one, loneliness and physical illness. Suicide in older adults is often attributed to the development of depression due to bereavement or loss of physical health and independence. However, suicide prevention in old age requires avoiding overly simplistic therapeutic approaches. This Perspective discusses the impact of social determinants of health, cultural narratives and the coronavirus disease 2019 (COVID-19) pandemic on suicide among older adults and proposes strategies for a multifaceted approach to suicide prevention.
Collapse
Affiliation(s)
- Diego De Leo
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Queensland, Australia.
- Slovenian Center for Suicide Research, Primorska University, Koper, Slovenia.
| |
Collapse
|
5
|
Understanding the impact of clinical characteristics and healthcare utilizations on suicide among cancer sufferers: a case-control study in Hong Kong. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 17:100298. [PMID: 34734204 PMCID: PMC8551816 DOI: 10.1016/j.lanwpc.2021.100298] [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: 07/26/2021] [Revised: 09/16/2021] [Accepted: 09/19/2021] [Indexed: 11/20/2022]
Abstract
Background Few studies have investigated whether hospital utilization patterns of cancer sufferers are associated with their suicide. This study aims to explore whether clinical profiles and healthcare utilization patterns are related to suicide among cancer sufferers. Methods Verified suicide cases with cancer (2012-2016) were identified. Each case was matched with two non-suicide controls suffering cancer, by birthyear, sex, and admission year. Cancer-related information, physical and psychiatric comorbidities, opioid-based painkiller usage, the number and length of inpatient admissions, and the number of outpatient and Accident & Emergency (A&E) attendances, in the six months leading up to the suicide, were identified. Conditional logistic regression models were constructed to explore the influence of clinical profiles and hospital utilization on suicide. These models were stratified by age and cancer stage. Outcomes 383 cases and 766 controls were included in the analyses. Overall, younger age, metastasis/recurrent status, suffering head and neck cancer, having psychiatric comorbidities, using opioid-based painkillers, and high frequency of A&E attendances and inpatient admissions increased the odds of suicide. Being diagnosed with liver cancer, consuming high numbers of outpatient attendances, and high numbers of inpatient days decreased the odds of suicide. Stratified analyses confirmed the influence of young age and metastatic/recurrent cancer status on risk of suicide. Interpretations Suicidal cancer sufferers had distinctive clinical profiles and hospital utilization patterns. Detecting and mitigating suicidal risk should be incorporated as an important component in treatment of cancer sufferers in the clinical setting. Funding Li Ka Shing Foundation and Hong Kong Research Grants Council
Collapse
|
6
|
De Leo D, Giannotti AV. Suicide in late life: A viewpoint. Prev Med 2021; 152:106735. [PMID: 34538377 PMCID: PMC8443431 DOI: 10.1016/j.ypmed.2021.106735] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/06/2021] [Accepted: 07/16/2021] [Indexed: 01/07/2023]
Abstract
Suicide in old age represents a sad public health concern. Despite the global decline in rates of suicide and the general amelioration of quality of life and access to health care for older adults, their rates of suicide remain the highest virtually in every part of the world. With the aging of the world population and the growing number of mononuclear families, the risk of an increase in isolation, loneliness and dependency does not appear ungrounded. The Covid-19 pandemic is claiming the life of many older persons and creating unprecedented conditions of distress, particularly for this segment of the population. This article briefly examines the main characteristics of suicidal behavior in late life, including observations deriving from the spread of the Sars-2 coronavirus and possible strategies for prevention.
Collapse
|
7
|
de Mendonça Lima CA, De Leo D, Ivbijaro G, Svab I. Suicide prevention in older adults. Asia Pac Psychiatry 2021; 13:e12473. [PMID: 34114355 DOI: 10.1111/appy.12473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 04/26/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Suicide among older adults is a multifactorial problem with several interrelated factors involved that vary with age, gender and culture. The number of suicides is highest in those aged 70 years or older in almost all regions of the world. With the increase in life expectancy, and the decrease in mortality due to other causes of death, we could expect the absolute number of older adults' suicide continue increasing. METHODS Review of the literature on suicide protective factors of suicide among older adults. RESULTS Improvements on social determinants of health and the timely detection and early treatment of affective disorders are key interventions. Prevention based on community actions and training of gatekeepers may have positive impact. Community programs that promote a sense of usefulness, belonging and that contribute to preserve social integration should be encouraged. Governments should develop the improvement of retirement programs and the development of support systems. The access to general health and mental health services should be facilitated and Primary Care professionals should receive proper training to detect and manage older persons at risk. Actively promoting a culture of coping to different stages of life and to the changes imposed by the advancing of age should form the essential part of a process bringing to better successful aging avenues. CONCLUSIONS Suicide prevention in older adults should broaden its focus and pay attention to the many socio-environmental conditions that may be relevant in older age, especially social isolation, financial security and physical health.
Collapse
Affiliation(s)
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Australia.,Slovene Centre for Suicide Research, University of Primorska, Koper, Slovenia
| | - Gabriel Ivbijaro
- NOVA University, Lisbon, Portugal.,Faculty of Management, Law and Social Sciences, University of Bradford, Bradford, UK
| | - Igor Svab
- Department of Family Medicine, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
8
|
Szlyk HS, Tan J, Lengnick-Hall R. Innovating Technology-Enhanced Interventions for Youth Suicide: Insights for Measuring Implementation Outcomes. Front Psychol 2021; 12:657303. [PMID: 34149543 PMCID: PMC8210584 DOI: 10.3389/fpsyg.2021.657303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/29/2021] [Indexed: 11/30/2022] Open
Abstract
Technology is one medium to increase youth engagement, especially among underserved and minority groups, in suicide preventive interventions. Technology can be used to supplement or adjunct an in-person intervention, guide an in-person intervention, or be the stand-alone (automated) component of the intervention. This range in technological use is now called the continuum of behavioral intervention technologies (BITs). Overall, suicide intervention researchers do not use this terminology to categorize how the role of technology differs across technology-enhanced youth interventions. There is growing recognition that technology-enhanced interventions will not create substantial public health impact without an understanding of the individual (youth, families, and providers), mezzo (clinics and health systems of care), and contextual factors (society, culture, community) that are associated with their implementation. Implementation science is the study of methods to promote uptake of evidence-based practices and policies into the broader health care system. In this review, we incorporate work from implementation science and BIT implementation to illustrate how the study of technology-enhanced interventions for youth suicide can be advanced by specifying the role of technology and measuring implementation outcomes.
Collapse
Affiliation(s)
- Hannah S. Szlyk
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Jia Tan
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, United States
| | - Rebecca Lengnick-Hall
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, United States
| |
Collapse
|
9
|
Wasserman D, Iosue M, Wuestefeld A, Carli V. Adaptation of evidence-based suicide prevention strategies during and after the COVID-19 pandemic. World Psychiatry 2020; 19:294-306. [PMID: 32931107 PMCID: PMC7491639 DOI: 10.1002/wps.20801] [Citation(s) in RCA: 168] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Suicide is preventable. Nevertheless, each year 800,000 people die of suicide in the world. While there is evidence indicating that suicide rates de-crease during times of crises, they are expected to increase once the immediate crisis has passed. The COVID-19 pandemic affects risk and pro-tective factors for suicide at each level of the socio-ecological model. Economic downturn, augmented barriers to accessing health care, increased access to suicidal means, inappropriate media reporting at the societal level; deprioritization of mental health and preventive activities at the community level; interpersonal conflicts, neglect and violence at the relationship level; unemployment, poverty, loneliness and hopelessness at the individual level: all these variables contribute to an increase of depression, anxiety, post-traumatic stress disorder, harmful use of alcohol, substance abuse, and ultimately suicide risk. Suicide should be prevented by strengthening universal strategies directed to the entire population, including mitigation of unemployment, poverty and inequalities; prioritization of access to mental health care; responsible media reporting, with information about available support; prevention of increased alcohol intake; and restriction of access to lethal means of suicide. Selective interventions should continue to target known vulnerable groups who are socio-economically disadvantaged, but also new ones such as first responders and health care staff, and the bereaved by COVID-19 who have been deprived of the final contact with loved ones and funerals. Indicated preventive strategies targeting individuals who display suicidal behaviour should focus on available pharmacological and psychological treatments of mental disorders, ensuring proper follow-up and chain of care by increased use of telemedicine and other digital means. The scientific community, health care professionals, politicians and decision-makers will find in this paper a systematic description of the effects of the pandemic on suicide risk at the society, community, family and individual levels, and an overview of how evidence-based suicide preventive interventions should be adapted. Research is needed to investigate which adaptations are effective and in which con-texts.
Collapse
Affiliation(s)
- Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - Miriam Iosue
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - Anika Wuestefeld
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
10
|
Kellerman QD, Hartoonian N, Beier ML, Leipertz SL, Maynard C, Hostetter TA, Haselkorn JK, Turner AP. Risk Factors for Suicide in a National Sample of Veterans With Multiple Sclerosis. Arch Phys Med Rehabil 2020; 101:1138-1143. [PMID: 32325161 DOI: 10.1016/j.apmr.2020.03.013] [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: 01/30/2018] [Revised: 03/16/2020] [Accepted: 03/18/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To examine risk factors in the year before suicide in a national sample of United States veterans with multiple sclerosis (MS), as well as means of suicide and receipt of mental health services prior to death. DESIGN Case control study. Individuals in the Veterans Affairs MS National Data Repository were linked to the National Death Index Plus to obtain death records, including specific causes of death. Participants were veterans with MS who died by suicide and randomly selected nonsuicide MS controls (5 per participant) who were alive at the time of the index suicide. Mental health disorders and medical comorbidities were identified in the year before death for suicides and during the identical time period for controls. SETTING Veterans Health Administration. PARTICIPANTS Veterans (N=426) who received treatment for MS in the United States Veterans Health Administration between 1999 and 2011. There were 71 deaths by suicide and 355 randomly selected controls. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Suicide. RESULTS Results from the adjusted multivariable model suggest that the following factors were associated with an increased risk for suicide: male sex (odds ratio [OR], 3.60; 95% confidence interval [CI], 1.35-9.42), depression (OR, 1.82; 95% CI, 1.03-3.23), and alcohol use disorder (OR, 3.10; 95% CI, 1.38-6.96). Half (50.7%) had a mental health appointment in the year before suicide. The primary means of suicide was by firearm (62.0%). CONCLUSIONS Routine assessment of suicide risk in individuals with MS is warranted, particularly for those with recent history of depression or alcohol use disorder.
Collapse
Affiliation(s)
| | - Narineh Hartoonian
- VA Puget Sound Health Care System, Seattle, WA; VA Multiple Sclerosis Center of Excellence West, Seattle, WA
| | - Megan L Beier
- University of Washington Department of Rehabilitation Medicine, Seattle, WA
| | - Steven L Leipertz
- VA Puget Sound Health Care System, Seattle, WA; VA Multiple Sclerosis Center of Excellence West, Seattle, WA
| | | | - Trisha A Hostetter
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO
| | - Jodie K Haselkorn
- VA Puget Sound Health Care System, Seattle, WA; VA Multiple Sclerosis Center of Excellence West, Seattle, WA; University of Washington Department of Rehabilitation Medicine, Seattle, WA
| | - Aaron P Turner
- VA Puget Sound Health Care System, Seattle, WA; VA Multiple Sclerosis Center of Excellence West, Seattle, WA; University of Washington Department of Rehabilitation Medicine, Seattle, WA.
| |
Collapse
|
11
|
Øien-Ødegaard C, Reneflot A, Hauge LJ. Use of primary healthcare services prior to suicide in Norway: a descriptive comparison of immigrants and the majority population. BMC Health Serv Res 2019; 19:508. [PMID: 31331323 PMCID: PMC6647119 DOI: 10.1186/s12913-019-4246-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 06/12/2019] [Indexed: 11/16/2022] Open
Abstract
Background There is an increase in studies investigating the use of healthcare services prior to suicide. Although studies generally report high usage, there are no previous studies comparing immigrants’ use of primary healthcare (PHC) prior to suicide with that of majority populations. There is a strong influx of immigrants in Europe, and thus a growing demand for filling this knowledge gap and exploiting unused potential for suicide prevention. Method By linking three national registers, we examine contact with PHC prior to suicide in all suicide cases in Norway from 2007 to 2014 among individuals aged 15 years and over (N = 4341). We report the percentage of individuals in personal contact within the last 6 months, 1 month and 1 week prior to suicide, and use the chi square-test for association. Results Overall, immigrants have less contact with PHC prior to suicide. We find significantly lower rates of contact among immigrants, both 6 months and 1 month prior to suicide, for both sexes. The trend is similar in the last week prior to suicide, but less pronounced. The largest variance in contact with PHC prior to suicide is amongst 30–44 year olds. Young, male immigrant suicide victims have the lowest rates of contact with PHC prior to suicide. Contact rates increase with age for all men and women in the majority population, but not for female immigrant suicide victims. Conclusions There is a clear difference in rates of contact with PHC prior to suicide between the majority and immigrant populations. The rates are especially low among young males, and measures should be made to lower their threshold for consulting PHC for young males in general and young male immigrants in particular. The difference in contact due to immigrant status appears to be of equal importance as the difference due to sex, although, with few significant results, a conclusion is hard to draw.
Collapse
Affiliation(s)
- Carine Øien-Ødegaard
- Division of mental and physical health, Norwegian Institute of Public Health, PO Box 222, Skøyen, N-0213, Oslo, Norway.
| | - Anne Reneflot
- Division of mental and physical health, Norwegian Institute of Public Health, PO Box 222, Skøyen, N-0213, Oslo, Norway
| | - Lars Johan Hauge
- Division of mental and physical health, Norwegian Institute of Public Health, PO Box 222, Skøyen, N-0213, Oslo, Norway
| |
Collapse
|
12
|
Reneflot A, Kaspersen SL, Hauge LJ, Kalseth J. Use of prescription medication prior to suicide in Norway. BMC Health Serv Res 2019; 19:215. [PMID: 30947722 PMCID: PMC6449972 DOI: 10.1186/s12913-019-4009-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 03/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of psychotropic medications in relation to mental disorders is considered central to preventing suicide. However, few studies have addressed prescription patterns at different time points within the last year prior to suicide and compared these with those of the general population. METHODS We use data covering the period from 2010 to 2011 from the Norwegian Cause of Death Registry and the Norwegian Prescription Database to examine dispensing patterns of prescription medication within 12 months and within 30 days of suicide. Our data includes all registered suicides in Norway among individuals aged 15 years and older in 2011 (n = 594), 434 men and 160 women. Dispensing of prescription medication in the general population (n ≈ 4 million) are used for comparison. RESULTS Dispensing of any prescription medication were high and varied from 95.6% for females and 83.2% for males within 12 months of suicide, to 64.4% for females and 47.2% for males within 30 days of suicide, respectively. The percentages with dispensed prescription medication increased with age. A similar sex and age pattern was observed for the dispensing of psychotropic medications. Within the last 30 days, close to one in two were dispensed psychotropic medications. The dispensing of antidepressants, hypnotics and sedatives was more common than the dispensing of other categories of psychotropics. The percentages with dispensed prescription medication among the population controls were considerably lower, in particular the dispensing of psychotropics. CONCLUSION Dispensing of prescription medications, including psychotropic medications, is common prior to suicide. The percentage with dispensed prescription medication increases with age and are higher for females than for males.
Collapse
Affiliation(s)
- Anne Reneflot
- Mental and Physical Health, Norwegian Institute of Public Health, PO Box 222, 0213 Skøyen, Oslo Norway
| | - Silje L. Kaspersen
- SINTEF Digital, Department of Health, The Norwegian University of Science and Technology, Trondheim, Norway
- Department of Public Health and Nursing, The Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Johan Hauge
- Mental and Physical Health, Norwegian Institute of Public Health, PO Box 222, 0213 Skøyen, Oslo Norway
| | - Jorid Kalseth
- SINTEF Digital, Department of Health, The Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
13
|
Areas of uncertainties and unmet needs in bipolar disorders: clinical and research perspectives. Lancet Psychiatry 2018; 5:930-939. [PMID: 30146246 DOI: 10.1016/s2215-0366(18)30253-0] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/14/2018] [Accepted: 06/14/2018] [Indexed: 12/11/2022]
Abstract
This Review discusses crucial areas related to the identification, clinical presentation, course, and therapeutic management of bipolar disorder, a major psychiatric illness. Bipolar disorder is often misdiagnosed, leading to inappropriate, inadequate, or delayed treatment. Even when bipolar disorder is successfully diagnosed, its clinical management presents several major challenges, including how best to optimise treatment for an individual patient, and how to balance the benefits and risks of polypharmacy. We discuss the major unmet needs in the diagnosis and management of bipolar disorder in this Review, including improvement of adequate recognition and intervention in at-risk and early-disease stages, identification of reliable warning signs and prevention of relapses in unstable and rapid cycling patients, treatment of refractory depression, and prevention of suicide. Taken together, there are several promising opportunities for improving treatment of bipolar disorder to deliver medical care that is more personalised.
Collapse
|
14
|
Lee H, Myung W, Lee C, Choi J, Kim H, Carroll BJ, Kim DK. Clinical epidemiology of long-term suicide risk in a nationwide population-based cohort study in South Korea. J Psychiatr Res 2018; 100:47-55. [PMID: 29486402 DOI: 10.1016/j.jpsychires.2018.01.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/24/2018] [Accepted: 01/26/2018] [Indexed: 11/25/2022]
Abstract
We investigated the effects of a large range of clinical factors on the long-term risk of suicide in the general population of South Korea. We analyzed the National Health Insurance Service-National Sample Cohort (NHIS-NSC) database in South Korea. A total of 300,232 individuals were followed for up to 12 years. We obtained information on demographic variables (age and sex), lifestyle variables (cigarette smoking, alcohol drinking and exercise), psychiatric and physical disorders, laboratory examination results and physical examination findings. We conducted a competing risk survival analysis to estimate the risk of completed suicide. 725 individuals (241/100,000) died by suicide in the follow-up period. After Bonferroni correction, we found a significant suicide risk associated with 6 variables: Parkinson's disease, depressive disorder, obsessive-compulsive disorder (inverted association), elevated serum aspartate aminotransferase levels, male gender and age. Before Bonferroni correction, variables such as cigarette smoking, heavy alcohol drinking, psychotic disorder, other psychiatric disorder, benzodiazepine use and higher fasting glucose showed some significant association. In addition, body mass index and height were inversely related to completed suicide before Bonferroni correction. However, only the 6 variables listed above were robust predictors of suicide in the fully adjusted analyses with multiple test correction. Common medical conditions had no clear influence on suicide. Diverse clinical factors influenced the long-term risk of completed suicide in this general population sample. Comprehensive assessment of these risk factors will facilitate more focused suicide surveillance measures.
Collapse
Affiliation(s)
- Hyewon Lee
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, Seoul National University, South Korea
| | - Woojae Myung
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Chunsoo Lee
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Junbae Choi
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ho Kim
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, Seoul National University, South Korea.
| | - Bernard J Carroll
- Department of Psychiatry, Emeritus, Duke University Medical Center, Durham, NC, USA
| | - Doh Kwan Kim
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| |
Collapse
|
15
|
Stene-Larsen K, Reneflot A. Contact with primary and mental health care prior to suicide: A systematic review of the literature from 2000 to 2017. Scand J Public Health 2017; 47:9-17. [DOI: 10.1177/1403494817746274] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: To examine rates of contact with primary and mental health care prior to suicide in men and women and across a range of age categories. Method: The authors performed a systematic review of 44 studies from 2000 to 2017 of which 36 reported rates on contact with primary health care and 14 reported on contact with mental health care prior to suicide. Results: Contact with primary health care was highest in the year prior to suicide with an average contact rate of 80%. At one month, the average rate was 44%. The lifetime contact rate for mental health care was 57%, and 31% in the final 12 months. In general, women and those over 50 years of age had the highest rates of contact with health care prior to suicide. Conclusions: Contact with primary health care prior to suicide is common even in the final month before death. The findings presented in this study highlight the importance of placing suicide prevention strategies and interventions within the primary health care setting.
Collapse
Affiliation(s)
- Kim Stene-Larsen
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, Norway
| | - Anne Reneflot
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, Norway
| |
Collapse
|
16
|
Kim JA, Yoon S, Kim LY, Kim DS. Towards Actualizing the Value Potential of Korea Health Insurance Review and Assessment (HIRA) Data as a Resource for Health Research: Strengths, Limitations, Applications, and Strategies for Optimal Use of HIRA Data. J Korean Med Sci 2017; 32:718-728. [PMID: 28378543 PMCID: PMC5383602 DOI: 10.3346/jkms.2017.32.5.718] [Citation(s) in RCA: 455] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 01/28/2017] [Indexed: 11/20/2022] Open
Abstract
Health Insurance and Review Assessment (HIRA) in South Korea, also called National Health Insurance (NHI) data, is a repository of claims data collected in the process of reimbursing healthcare providers. Under the universal coverage system, having fee-for-services covering all citizens in South Korea, HIRA contains comprehensive and rich information pertaining to healthcare services such as treatments, pharmaceuticals, procedures, and diagnoses for almost 50 million beneficiaries. This corpus of HIRA data, which constitutes a large repository of data in the healthcare sector, has enormous potential to create value in several ways: enhancing the efficiency of the healthcare delivery system without compromising quality of care; adding supporting evidence for a given intervention; and providing the information needed to prevent (or monitor) adverse events. In order to actualize this potential, HIRA data need to actively be utilized for research. Thus understanding this data would greatly enhance this potential. We introduce HIRA data as an important source for health research and provide guidelines for researchers who are currently utilizing HIRA, or interested in doing so, to answer their research questions. We present the characteristics and structure of HIRA data. We discuss strengths and limitations that should be considered in conducting research with HIRA data and suggest strategies for optimal utilization of HIRA data by reviewing published research using HIRA data.
Collapse
Affiliation(s)
- Jee Ae Kim
- Pharmaceutical Policy Research Team, Health Insurance Review & Assessment Service, Wonju, Korea
| | - Seokjun Yoon
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Log Young Kim
- Pharmaceutical Policy Research Team, Health Insurance Review & Assessment Service, Wonju, Korea
| | - Dong Sook Kim
- Pharmaceutical Policy Research Team, Health Insurance Review & Assessment Service, Wonju, Korea.
| |
Collapse
|
17
|
Ghanbari B, Malakouti SK, Nojomi M, Alavi K, Khaleghparast S. Suicide Prevention and Follow-Up Services: A Narrative Review. Glob J Health Sci 2015; 8:145-53. [PMID: 26652085 PMCID: PMC4877223 DOI: 10.5539/gjhs.v8n5p145] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 08/21/2015] [Accepted: 09/28/2015] [Indexed: 01/03/2023] Open
Abstract
Previous suicide attempt is the most important predictor of death by suicide. Thus preventive interventions after attempting to suicide is essential to prevent reattempts. This paper attempts to determine whether phone preventive interventions or other vehicles (postal cards, email and case management) are effective in reattempt prevention and health promotion after discharge by providing an overview of studies on suicide reattempts. The research investigated in this review conducted from 1995 to 2014. A total of 26 cases related to the aim of this research were derived from 36 English articles with the aforementioned keywords Research shows that providing comprehensive aids, social support, and follow-up after discharge can significantly prevent suicide reattempts. Several studies showed that follow-up support (phone calls, crisis cards, mails, postal cards.) after discharge can significantly decrease the risk of suicide. More randomized controlled trials (RCT) are required to determine what factors of follow-up are more effective than other methods.
Collapse
Affiliation(s)
- Behrooz Ghanbari
- Mental Health Research Center (MHRC), Tehran Institute of Psychiatry, Faculty of behavioral sciences and mental health, Iran University of Medical Sciences (IUMS), Tehran, Iran..
| | | | | | | | | |
Collapse
|
18
|
Sohn J, Cho J, Moon KT, Suh M, Ha KH, Kim C, Shin DC, Jung SH. Medical care expenditure in suicides from non-illness-related causes. J Prev Med Public Health 2014; 47:327-35. [PMID: 25475200 PMCID: PMC4263001 DOI: 10.3961/jpmph.14.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 10/29/2014] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Several epidemiological studies on medical care utilization prior to suicide have considered the motivation of suicide, but focused on the influence of physical illnesses. Medical care expenditure in suicide completers with non-illness-related causes has not been investigated. METHODS Suicides motivated by non-illness-related factors were identified using the investigator's note from the National Police Agency, which was then linked to the Health Insurance Review and Assessment data. We investigated the medical care expenditures of cases one year prior to committing suicide and conducted a case-control study using conditional logistic regression analysis after adjusting for age, gender, area of residence, and socioeconomic status. RESULTS Among the 4515 suicides motivated by non-illness-related causes, medical care expenditures increased in only the last 3 months prior to suicide in the adolescent group. In the younger group, the proportion of total medical expenditure for external injuries was higher than that in the older groups. Conditional logistic regression analysis showed significant associations with being a suicide completer and having a rural residence, low socioeconomic status, and high medical care expenditure. After stratification into the four age groups, a significant positive association with medical care expenditures and being a suicide completer was found in the adolescent and young adult groups, but no significant results were found in the elderly groups for both men and women. CONCLUSIONS Younger adults who committed suicide motivated by non-illness-related causes had a higher proportion of external injuries and more medical care expenditures than their controls did. This reinforces the notion that suicide prevention strategies for young people with suicidal risk factors are needed.
Collapse
Affiliation(s)
- Jungwoo Sohn
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jaelim Cho
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | | | - Mina Suh
- National Cancer Center, Goyang, Korea
| | - Kyoung Hwa Ha
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Changsoo Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Chun Shin
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hyuk Jung
- Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| |
Collapse
|