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Ahuja M, Jain M, Mamudu H, Al Ksir K, Sathiyaseelan T, Zare S, Went N, Fernandopulle P, Schuver T, Pons A, Dooley M, Nwanecki C, Dahal K. Substance Use Disorder and Suicidal Ideation in Rural Maryland. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2024; 8:24705470241268483. [PMID: 39113832 PMCID: PMC11304480 DOI: 10.1177/24705470241268483] [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] [Indexed: 08/10/2024]
Abstract
Background Rural areas in the United States have been disproportionately burdened with high rates of substance use, mental health challenges, chronic stress, and suicide behaviors. Factors such as a lack of mental health services, decreased accessibility to public health resources, and social isolation contribute to these disparities. The current study explores risk factors to suicidal ideation, using emergency room discharge data from Maryland. Methods The current study used data from the Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) from the State of Maryland. Logistic regression was used to assess the association between ICD-10 coded opioid use disorder, alcohol use disorder, cannabis use disorder, major depressive disorder, and the outcome variable of suicidal ideation discharge. We controlled for income, race, age, and gender. Results Lifetime major depressive disorder diagnosis (odds ration [OR] = 79.30; 95% confidence interval [CI] 51.91-121.15), alcohol use disorder (OR = 6.87; 95% CI 4.97-9.51), opioid use disorder (OR = 5.39; 95% CI 3.63-7.99), and cannabis use disorder (OR = 2.67; 95% CI 1.37-5.18) were all positively associated with suicidal ideation. Conclusions The study highlights the strong link between prior substance use disorder, depression, and suicidal ideation visit to the emergency room, indicating the need for prevention and intervention, particularly among those in rural areas where the burden of suicidal ideation and chronic stress are high. As health disparities between rural and urban areas further widened during the COVID-19 pandemic, there is an urgent need to address these issues.
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Affiliation(s)
- Manik Ahuja
- College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Monika Jain
- Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Hadii Mamudu
- College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Kawther Al Ksir
- College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | | | - Shahin Zare
- College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Nils Went
- Department of Psychiatry, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | - Praveen Fernandopulle
- Psychiatry and Behavioral Sciences Department, East Tennessee State University, Johnson City, TN, USA
| | - Trisha Schuver
- College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Amanda Pons
- College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - McKenzie Dooley
- College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Chisom Nwanecki
- College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Kajol Dahal
- College of Public Health, East Tennessee State University, Johnson City, TN, USA
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Arafat SMY, Menon V, Khan MAS, Htay MNN, Singh R, Biyyala D, Krishnamoorthy Y, Mynampally K. Marital status and suicidal behavior in South Asia: A systematic review and meta-analysis. Health Sci Rep 2023; 6:e1781. [PMID: 38130329 PMCID: PMC10733573 DOI: 10.1002/hsr2.1781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/18/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
Background and Aims The connection between marital status and suicidal behavior has been poorly assessed in South Asia. We aimed to see the proportion of marital status in individuals with suicidal behavior in South Asian countries. Methods We followed PRISMA guidelines and registered the protocol in advance (PROSPERO 2023 CRD42023399906). A systematic search was conducted in Medline, Embase, and PsycINFO. Meta-analyses were performed to pool the proportion of married individuals with suicidal behavior (total [suicide + suicide attempts], suicide, and suicide attempt) in South Asian countries. We considered suicidal behavior consist of suicide and suicide attempts (nonfatal). Results Our search identified 47 studies for this review from 6 countries published from 1999 to 2022 with a sample size ranging from 27 to 89,178. The proportion of married individuals was 55.4% (95% CI: 50.1-60.5) for suicidal behavior, 52.7% (95% CI: 44.5-60.7) for suicides, and 43.1 (95% CI: 32.9-53.9) for suicide attempts. The proportion of married persons among suicide attempts varied significantly across countries (p = 0.016) which was highest (61.8%; 95% CI: 57.2-66.2) in India, followed by Bangladesh (52.5%; 95% CI: 41.8%-62.9%) and Pakistan (45.1%; 95% CI: 30.9-59.9). The pooled proportions did not differ significantly in relation to the quality of the studies (p = 0.633). Conclusion This review identified married persons died more than others by suicide in South Asian countries while single persons attempted suicide than married. As the current study did not assess any cause-and-effect association, a cautious interpretation is warranted while considering married marital status as a risk factor.
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Affiliation(s)
- S. M. Yasir Arafat
- Department of PsychiatryEnam Medical College and HospitalDhakaBangladesh
| | - Vikas Menon
- Department of PsychiatryJawaharlal Institute of Postgraduate Medical Education and ResearchPuducherryIndia
| | - Md Abdullah Saeed Khan
- Department of Community MedicineNational Institute of Preventive and Social Medicine (NIPSOM)DhakaBangladesh
| | - Mila Nu Nu Htay
- Department of Community MedicineManipal University College Malaysia, Faculty of MedicineMelakaMalaysia
| | - Rakesh Singh
- Department of Research – Transcultural Psychosocial Organization NepalKathmanduNepal
| | | | | | - Keerthana Mynampally
- Department of PsychiatryJawaharlal Institute of Postgraduate Medical Education and ResearchPuducherryIndia
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Luberenga I, Kasujja R, Vasanthan LT, Nyende A, Tumwebaze E, Henry Joseph LJ. Mental health awareness programmes to promote mental well-being at the workplace among workforce in the low-income and middle-income countries: a scoping review protocol. BMJ Open 2023; 13:e073012. [PMID: 37407035 DOI: 10.1136/bmjopen-2023-073012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION An understanding of the mental health awareness programmes among workforces in low/middle-income countries (LMICs) is lacking significantly in literature. Such understanding is crucial for the employers, government agencies and other stakeholders to initiate strategies to promote mental health and well-being at the workplace. OBJECTIVE The main aim of this study is to conduct a scoping review to systematically map the research on the mental health awareness programmes among workforces in LMICs. METHODS A comprehensive search strategy for the articles published between 2000 and 2022 will be conducted in MEDLINE, PubMed, EBSCOhost, Wiley Online Library, Cochrane and JSTOR. Various study designs such as randomised control trials, non-randomised control trials, systematic reviews, scoping reviews and observational studies that report evidence on mental health awareness programmes among workforce in LMICs will be identified through specific strategy. Search outcomes will be exported to Endnote and duplication of studies will be removed. From the list of included studies, data such as characteristics of mental health programmes, common outcome measures and domains, and motivations underlying the establishment of existing mental health awareness programmes will be extracted and analysed. ANALYSIS The search outcomes will be presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart. The characteristics of the research studies on mental health programmes will be outlined using tables. The various outcome domains and outcome measures reported in the studies will be presented in a bubble chart showing different outcome measures categorised and collated under a specific outcome domain. The findings on the motivations and justifications underlying the establishment of mental health awareness programmes will be summarised using a thematic analysis. TRIAL REGISTRATION NUMBER https://doi.org/10.17605/OSF.IO/WPURK.
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Affiliation(s)
- Ibrahim Luberenga
- Mental Health and Community Psychology, Makerere University, Kampala, Uganda
| | | | - Lenny Thinagaran Vasanthan
- Department of Physiotherapy, Physical Medicine and Rehabilitation, Christian Medical College Vellore, Vellore, India
| | - Adam Nyende
- Rehabilitation and Sports Sciences, Bournemouth University, Poole, UK
| | - Eunice Tumwebaze
- Directorate of Gender, Labor and Social Development, Kampala Capital City Authority, Kampala, Uganda
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Farmani A, Rahimianbougar M, Mohammadi Y, Faramarzi H, Khodarahimi S, Nahaboo S. Psychological, Structural, Social and Economic Determinants of Suicide Attempt: Risk Assessment and Decision Making Strategies. OMEGA-JOURNAL OF DEATH AND DYING 2023; 86:1144-1166. [PMID: 33736538 DOI: 10.1177/00302228211003462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The aim of this research was to conduct a risk assessment and management of psychological, structural, social and economic determinants (PSSED) in a suicide attempt. The sample consisted of 353 individuals who had a recorded history of suicidal attempt; and 20 professional individuals by purposive sampling method within a descriptive cross-sectional design. Worksheets for RAM and AHP were used for data collection in this study. The rate of suicide attempt was 7.21 per 100,000 population in this study. Analysis showed that depression and mental disorders; personality disorders; family problems; socio-cultural and economic problems; lack of awareness; and low level of education have a high level of risk for suicide attempts. Psychiatric and psychological services; awareness and knowledge of life skills; medical services to dysfunctional families; development of community-based planning for PSSED of suicide; and employment and entrepreneurship services may lower suicide attempt risk.
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Affiliation(s)
- Azam Farmani
- Social Emergency Center, Welfare General Bureau of Fars Province, Shiraz, Iran
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Esposti MD, Kaufman EJ. Can suicide risk be predicted to plan for prevention? Lancet Public Health 2023; 8:e162-e163. [PMID: 36702143 DOI: 10.1016/s2468-2667(22)00339-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/05/2022] [Indexed: 01/25/2023]
Affiliation(s)
| | - Elinore J Kaufman
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Yeung CY, Men YV, Caine ED, Yip PSF. The differential impacts of social deprivation and social fragmentation on suicides: A lesson from Hong Kong. Soc Sci Med 2022; 315:115524. [PMID: 36413859 DOI: 10.1016/j.socscimed.2022.115524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/02/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Little research has conducted to examine the association between social deprivation and social fragmentation, overall and method-specific suicide risk, and how these associations may change over time. This study investigated the association between social deprivation and social fragmentation with overall and method-specific suicide in Hong Kong from 1999 to 2018. METHODS Suicide death data of each small tertiary planning unit (STPU) was obtained from the Census and Statistics Department of Hong Kong. Socio-economic characteristics in STPU level were obtained from Census and Bi-census. Exploratory principal component analysis was used to construct the social deprivation (SDI) and social fragmentation indices (SFI) based on the socio-economic characteristics. Bayesian hierarchical modelling was conducted to explore the association between SDI and SFI with overall and method-specific suicide over time, controlling for population density and male-to-female ratio. RESULTS Higher risk of suicide was generally observed around Kowloon Peninsula and some parts in the Northern, Northwestern and Southwestern areas depending on methods. The effect of SDI and SFI on suicide risk varied by years and methods. In 2014-2018, for every 10% increase in SDI, the suicide risk for overall, jumping, hanging, and charcoal burning elevated by 22% (95%Crl = 10%-37%), 26% (95%Crl = 12%-41%), 31% (95%Crl = 14%-51%), and 21% (95%Crl = 4%-42%) respectively. CONCLUSION Spatial variations and effects of SDI and SFI on overall and method-specific suicide risks varied by different periods. SDI was observed to be a stronger factor in the recent years. Situations should be monitored, and interventions should be implemented and adjusted accordingly to the changes.
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Affiliation(s)
- Cheuk Yui Yeung
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
| | - Yu Vera Men
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Eric D Caine
- University of Rochester Medical Center, 300 Crittenden Blvd., Rochester, NY 14642, USA
| | - Paul Siu Fai Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China; Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, 2/F, the Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong SAR, China.
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Mukherjee S, Wei Z. Suicide disparities across metropolitan areas in the US: A comparative assessment of socio-environmental factors using a data-driven predictive approach. PLoS One 2021; 16:e0258824. [PMID: 34818324 PMCID: PMC8612572 DOI: 10.1371/journal.pone.0258824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 10/06/2021] [Indexed: 11/19/2022] Open
Abstract
Disparity in suicide rates across various metropolitan areas in the US is growing. Besides personal genomics and pre-existing mental health conditions affecting individual-level suicidal behaviors, contextual factors are also instrumental in determining region-/community-level suicide risk. However, there is a lack of quantitative approach to model the complex associations and interplays of the socio-environmental factors with the regional suicide rates. In this paper, we propose a holistic data-driven framework to model the associations of socio-environmental factors (demographic, socio-economic, and climate) with the suicide rates, and compare the key socio-environmental determinants of suicides across the large and medium/small metros of the vulnerable US states, leveraging a suite of advanced statistical learning algorithms. We found that random forest outperforms all the other models in terms of both in-sample goodness-of-fit and out-of-sample predictive accuracy, which is then used for statistical inferencing. Overall, our findings show that there is a significant difference in the relationships of socio-environmental factors with the suicide rates across the large and medium/small metropolitan areas of the vulnerable US states. Particularly, suicides in medium/small metros are more sensitive to socio-economic and demographic factors, while that in large metros are more sensitive to climatic factors. Our results also indicate that non-Hispanics, native Hawaiian or Pacific islanders, and adolescents aged 15-29 years, residing in the large metropolitan areas, are more vulnerable to suicides compared to those living in the medium/small metropolitan areas. We also observe that higher temperatures are positively associated with higher suicide rates, with large metros being more sensitive to such association compared to that of the medium/small metros. Our proposed data-driven framework underscores the future opportunities of using big data analytics in analyzing the complex associations of socio-environmental factors and inform policy actions accordingly.
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Affiliation(s)
- Sayanti Mukherjee
- Department of Industrial and Systems Engineering, University at Buffalo - The State University of New York, Buffalo, NY, United States of America
| | - Zhiyuan Wei
- Department of Industrial and Systems Engineering, University at Buffalo - The State University of New York, Buffalo, NY, United States of America
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Pollock NJ, Liu L, Wilson MM, Reccord C, Power ND, Mulay S, Karaivanov Y, Tonmyr L. Suicide in Newfoundland and Labrador, Canada: a time trend analysis from 1981 to 2018. BMC Public Health 2021; 21:1291. [PMID: 34215242 PMCID: PMC8252247 DOI: 10.1186/s12889-021-11293-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The suicide rate in Canada decreased by 24% during the past four decades. However, rates vary between provinces and territories, and not all jurisdictions experienced the same changes. This study examined suicide rates over time in the province of Newfoundland and Labrador. METHODS We used cross-sectional surveillance data from the Canadian Vital Statistics Death Database to examine suicide rates in Newfoundland and Labrador from 1981 to 2018. We calculated annual age-standardized suicide mortality rates and used joinpoint regression to estimate the average annual percent change (AAPC) in suicide rates overall and by sex, age group, and means of suicide. RESULTS From 1981 to 2018, 1759 deaths by suicide were recorded among people in Newfoundland and Labrador. The age-standardized suicide mortality rate increased more than threefold over the study period, from 4.6 to 15.4 deaths per 100,000. The suicide rate was higher among males than females, and accounted for 83.1% of suicide deaths (n = 1462); the male-to-female ratio of suicide deaths was 4.9 to 1. The average annual percent change in suicide rates was higher among females than males (6.3% versus 2.0%). Age-specific suicide rates increased significantly for all age groups, except seniors (aged 65 or older); the largest increase was among youth aged 10 to 24 years old (AAPC 3.5; 95% CI, 1.6 to 5.5). The predominant means of suicide was hanging/strangulation/suffocation, which accounted for 43.8% of all deaths by suicide. CONCLUSIONS The suicide rate in Newfoundland and Labrador increased steadily between 1981 and 2018, which was in contrast to the national rate decline. The disparity between the provincial and national suicide rates and the variations by sex and age underscore the need for a public health approach to prevention that accounts for geographic and demographic differences in the epidemiology of suicide.
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Affiliation(s)
- Nathaniel J Pollock
- School of Arctic and Subarctic Studies, Labrador Institute, Memorial University, Happy Valley-Goose Bay, Newfoundland and Labrador, Canada. .,Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada. .,Discipline of Emergency Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.
| | - Li Liu
- Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Margo M Wilson
- Discipline of Emergency Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Charlene Reccord
- Department of Research and Innovation, Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Nicole D Power
- Department of Research and Innovation, Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Shree Mulay
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Yordan Karaivanov
- Medical Services, Labrador Health Centre, Labrador-Grenfell Health, Happy Valley-Goose Bay, Newfoundland and Labrador, Canada.,Northern Family Medicine, Discipline of Family Medicine, Faculty of Medicine, Memorial University, Happy Valley-Goose Bay, Newfoundland and Labrador, Canada
| | - Lil Tonmyr
- Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
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Paterson C, Leduc C, Maxwell M, Aust B, Amann BL, Cerga-Pashoja A, Coppens E, Couwenbergh C, O’Connor C, Arensman E, Greiner BA. Evidence for implementation of interventions to promote mental health in the workplace: a systematic scoping review protocol. Syst Rev 2021; 10:41. [PMID: 33509258 PMCID: PMC7844910 DOI: 10.1186/s13643-020-01570-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/21/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Mental health problems are common in the working population and represent a growing concern internationally, with potential impacts on workers, organisations, workplace health and compensation authorities, labour markets and social policies. Workplace interventions that create workplaces supportive of mental health, promote mental health awareness, destigmatise mental illness and support those with mental disorders are likely to improve health and economical outcomes for employees and organisations. Identifying factors associated with successful implementation of these interventions can improve intervention quality and evaluation, and facilitate the uptake and expansion. Therefore, we aim to review research reporting on the implementation of mental health promotion interventions delivered in workplace settings, in order to increase understanding of factors influencing successful delivery. METHODS AND ANALYSIS A scoping review will be conducted incorporating a stepwise methodology to identify relevant literature reviews, primary research and grey literature. This review is registered with Research Registry (reviewregistry897). One reviewer will conduct the search to identify English language studies in the following electronic databases from 2008 through to July 1, 2020: Scopus, PROSPERO, Health Technology Assessments, PubMed, Campbell Collaboration, Joanna Briggs Library, PsycINFO, Web of Science Core Collection, CINAHL and Institute of Occupational Safety and Health (IOSH). Reference searching, Google Scholar, Grey Matters, IOSH and expert contacts will be used to identify grey literature. Two reviewers will screen title and abstracts, aiming for 95% agreement, and then independently screen full texts for inclusion. Two reviewers will assess methodological quality of included studies using the Mixed Methods Appraisal Tool and extract and synthesize data in line with the RE-AIM framework, Nielson and Randall's model of organisational-level interventions and Moore's sustainability criteria, if the data allows. We will recruit and consult with international experts in the field to ensure engagement, reach and relevance of the main findings. DISCUSSION This will be the first systematic scoping review to identify and synthesise evidence of barriers and facilitators to implementing mental health promotion interventions in workplace settings. Our results will inform future evaluation studies and randomised controlled trials and highlight gaps in the evidence base. SYSTEMATIC REVIEW REGISTRATION Research Registry ( reviewregistry897 ).
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Affiliation(s)
| | - Caleb Leduc
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
| | | | - Birgit Aust
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Benedikt L. Amann
- Centro Forum Research Unit, Institut de Neuropsiquiatria i Addicions (INAD), Parc de Salut Mar, Hospital del Mar Medical Research Institute (IMIM), Autonomous University Barcelona, CIBERSAM, Barcelona, Spain
| | | | - Evelien Coppens
- Centre for Health Research and Consultancy, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - Cliodhna O’Connor
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
| | - Ella Arensman
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
- Australian Institute for Research, Griffith University, Mount Gravatt, Australia
- International Association for Suicide Prevention (IASP), Washington, DC USA
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Suicidal Ideation Risk and Socio-Cultural Factors in China: A Longitudinal Study on Social Media from 2010 to 2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031098. [PMID: 33530647 PMCID: PMC7908182 DOI: 10.3390/ijerph18031098] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/23/2020] [Accepted: 01/21/2021] [Indexed: 11/16/2022]
Abstract
Many studies cited the importance of social factors as protective and risk factors for suicide. However, there is a lack of evidence on the influences of cultural and moral values. This study aims to examine the association between cultural values and suicidal ideation risks detected on an online social media platform. We collected a total of 5.1 billion pieces of Weibo posts from 2010 to 2018 to calculate their suicidal ideation risks as measured by psychache in the Chinese Suicide Dictionary. We calculated the word frequencies of cultural and moral values based on Cultural Value Dictionary and Moral Foundation Dictionary. We collected economic and population data from the China National Bureau of Statistics. Two-way fixed-effect models were performed to analyze the association between culture, economy, and population factors and suicidal ideation risks. The results confirm the relations between high suicidal ideation risk and public concerns of vice under the Chinese context such as harm (β = 0.193, p < 0.01), betrayal (β = 0.096, p < 0.01), and dirty (β = 0.624, p < 0.001). In addition, extremely individualistic or collectivistic values of the public were associated with high suicidal ideation risks. The finding indicated the significant impact of social culture on suicide risk apart from the influence of the social economy and population characteristics. Our evidence informs population-based suicide prevention policymakers that incorporating cultural and moral values can help prevent suicidal ideation in China.
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Pons-Baños J, Ballester-Ferrando D, Riesco-Miranda L, Escoté-Llobet S, Jiménez-Nuño J, Fuentes-Pumarola C, Serra-Millàs M. Sociodemographic and Clinical Characteristics Associated with Suicidal Behaviour and Relationship with a Nurse-Led Suicide Prevention Programme. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238765. [PMID: 33255772 PMCID: PMC7728328 DOI: 10.3390/ijerph17238765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/13/2020] [Accepted: 11/24/2020] [Indexed: 11/16/2022]
Abstract
Suicidal behaviour is a major public health problem that needs to be tackled by all health agents including mental health nurses. Aims: The purpose of this study was to analyse the relationship between demographic and clinical characteristics and different kinds of suicidal behaviour with a nurse-led suicide prevention programme. Methods: The design was a cross-sectional study, performed in the region of Osona (Catalonia) in the five-year period 2013–2017. Suicidal behaviour was classified as suicidal ideation, interrupted self-directed violence, suicide attempt or completed suicide. Results: The sample included 753 patients (of whom 53 completed suicide) who experienced 931 suicidal behaviour episodes. Men represented only 38.4% of the sample but 81.1% of completed suicides. Mental disorders were associated with suicidal behaviour in 75.4% of the sample. Two thirds (66.4%) of the individuals (0.8% (n = 4) of whom completed suicide) were participants in a nurse-led suicidal behaviour case management programme. Conclusion: The main risk factors were being a woman for suicidal behaviour and being a man and being older for completed suicide. Mental disorders, widowhood and retirement were also associated with completed suicide. The completed suicide rate was lower among participants in the nurse-led programme.
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Affiliation(s)
- Judit Pons-Baños
- Department of Psychiatry and Mental Health, Consorci Hospitalari de Vic, 08500 Vic, Spain; (J.P.-B.); (L.R.-M.); (S.E.-L.); (M.S.-M.)
- Faculty of Health Sciences and Wellbeing, University of Vic—Central University of Catalonia, 08500 Vic, Spain
- Interinstitutional Research Group, Department of Mental Health and Social Innovation, 08500 Vic, Spain
| | - David Ballester-Ferrando
- Health and Healthcare Research Group, Department of Nursing, University of Girona, 17003 Girona, Spain;
- Correspondence: ; Tel.: +34-972-418771
| | - Lola Riesco-Miranda
- Department of Psychiatry and Mental Health, Consorci Hospitalari de Vic, 08500 Vic, Spain; (J.P.-B.); (L.R.-M.); (S.E.-L.); (M.S.-M.)
- Faculty of Health Sciences and Wellbeing, University of Vic—Central University of Catalonia, 08500 Vic, Spain
| | - Santiago Escoté-Llobet
- Department of Psychiatry and Mental Health, Consorci Hospitalari de Vic, 08500 Vic, Spain; (J.P.-B.); (L.R.-M.); (S.E.-L.); (M.S.-M.)
- Interinstitutional Research Group, Department of Mental Health and Social Innovation, 08500 Vic, Spain
| | - Jordi Jiménez-Nuño
- Vic Forensic Medicine Department, Institute of Legal Medicine and Forensic Sciences of Catalonia, 08500 Vic, Spain;
| | | | - Montserrat Serra-Millàs
- Department of Psychiatry and Mental Health, Consorci Hospitalari de Vic, 08500 Vic, Spain; (J.P.-B.); (L.R.-M.); (S.E.-L.); (M.S.-M.)
- Faculty of Health Sciences and Wellbeing, University of Vic—Central University of Catalonia, 08500 Vic, Spain
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Zhao G, Ronda E, Barrio G, Moen BE, Regidor E. Suicide in Spanish Farmers in Two Geographical Areas with Differing Rates of Pesticide Use. J Agromedicine 2020; 26:278-283. [PMID: 33040710 DOI: 10.1080/1059924x.2020.1834480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study assesses whether farmers' suicides were associated with the pesticide use in Spain. The cohort study followed 9.5 million men aged 20-64 years who were employed in 2001. The mortality among farmers and non-farmers during the period 2001-2011 was estimated in a geographical area with high pesticide use and in an area with low pesticide use. For three major causes of death (suicide, unintentional accidents, and rest of causes of death), we estimated the age-standardized mortality rates with 95% confidence intervals (CI) between farmers and non-farmers in both areas. Farmers in the high pesticide use area showed a lower mortality rate of suicide and unintentional accidents than farmers in the rest of Spain, with mortality rate ratios of 0.74 (95% CI 0.65-0.85) and 0.57 (95% CI 0.52-0.62), respectively. Our findings on pesticide use and farmers' suicide are different from those observed in several previous investigations.
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Affiliation(s)
- Guanlan Zhao
- Preventive Medicine and Public Health Area, Universidad de Alicante, Alicante, Spain
| | - Elena Ronda
- Preventive Medicine and Public Health Area, Universidad de Alicante, Alicante, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Gregorio Barrio
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Enrique Regidor
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Public Health and Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdiSSC), Madrid, Spain
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du Toit E, Niehaus D, Jordaan E, Koen L, Jones R, Leppanen J. Perinatal suicidality: Risk factors in South African women with mental illness. S Afr J Psychiatr 2020. [DOI: 10.4102/sajpsychiatry.v26i0.1412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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14
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Goodfellow B, Kõlves K, Selefen AC, Massain T, Amadéo S, De Leo D. The WHO/START study in New Caledonia: A psychological autopsy case series. J Affect Disord 2020; 262:366-372. [PMID: 31740112 DOI: 10.1016/j.jad.2019.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 09/04/2019] [Accepted: 11/08/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Limited information is available about suicidal behavior in the Pacific Islands. Forty percent of the New Caledonian population is indigenous Kanak; insights into the characteristics of suicide deaths in this population compared to other ethnic groups would be valuable. The aim of this paper is to deepen our understanding of the cultural underpinnings of suicide in New Caledonia by presenting the results of the WHO/START psychological autopsy study. METHOD A case-series psychological autopsy study was conducted based on medical, police files, and interviews with relatives of 52 individuals who died by suicide in 2014 and 2015 in New Caledonia. RESULTS Kanak indigenous individuals represented more than half of suicides. Prevalence of mental disorders was identified in 62% of suicide decedents; a previous suicide attempt was frequent (37% of cases). A serious argument with a partner was the most prevalent life event (60%). Few warning signs were present among young people and Kanak in general. CONCLUSION Comparison with information on the general population suggests indigenous Kanak are more vulnerable and that having a mental health disorder plays an important role in suicide. Violent arguments with a partner could also be a major risk factor. Traditional protective factors (being employed, living with their family or partner, religion) appeared to have limited effect on suicide. Mental health promotion, prevention, and care should be prioritized. Prevention strategies, including domestic violence prevention are recommended in New Caledonia. Further research is needed to better identify young and Kanak subjects at risk of suicide.
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Affiliation(s)
- Benjamin Goodfellow
- Australian Institute of Suicide Research and Prevention, World Health Organization Collaborating Centre for Research in Suicide Prevention and Training, Griffith University, Mt Gravatt, Australia; Centre Hospitalier Albert Bousquet, Nouméa, New Caledonia.
| | - Kairi Kõlves
- Australian Institute of Suicide Research and Prevention, World Health Organization Collaborating Centre for Research in Suicide Prevention and Training, Griffith University, Mt Gravatt, Australia
| | - Anne-Cécile Selefen
- Direction de la Sécurité Publique de la Nouvelle-Calédonie, Nouméa, New Caledonia
| | | | - Stéphane Amadéo
- Departement of Psychiatry, Centre Hospitalier de Polynésie Française, Association SOS Suicide, French Polynesia
| | - Diego De Leo
- Australian Institute of Suicide Research and Prevention, World Health Organization Collaborating Centre for Research in Suicide Prevention and Training, Griffith University, Mt Gravatt, Australia
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The trend in mortality due to suicide in urban and rural areas of Colombia, 1979-2014. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2019; 39:339-353. [PMID: 31529821 DOI: 10.7705/biomedica.v39i3.4427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Indexed: 11/21/2022]
Abstract
Introduction: Suicide is a serious social and public health problem that affects the population in most countries in the world. Differences in suicide rates in rural and urban areas have been previously described.
Objective: To study the trend of mortality rates by suicide in Colombia, in rural and urban areas by gender, age group, and suicide method during the years 1979-2014.
Materials and methods: We conducted a temporal trend ecologic study using death certificates from the Departamento Administrativo Nacional de Estadística, DANE. Specific and adjusted by age and gender mortality rates were calculated. We estimated negative binomial and inflection point regression models to study the trends in mortality rates stratified by gender, age group, and suicide method.
Results: A total of 56,448 suicides was reported in Colombia between 1979 and 2014. The risk of suicide was higher in urban areas for men, individuals between 25 and 44 years, and 65 and over; and for those who used hanging as the suicide method. Also, the risk of suicide was higher in the rural area for men between 45 and 64 years old, and those who used firearms, sharp weapons, hanging, and others as suicide methods. The trend of suicide rates in urban areas showed its maximum peak in 1999 and in the rural ones in 2000. Then, in the two areas, there was a gradual decrease. Hanging in both areas presented a tendency to rise in men.
Conclusions: Suicide has shown a tendency toward reduction after the year 2000, with differences between urban and rural areas.
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Risk factors for suicide in rural Italy: a case-control study. Soc Psychiatry Psychiatr Epidemiol 2019; 54:607-616. [PMID: 30460378 DOI: 10.1007/s00127-018-1632-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 11/13/2018] [Indexed: 01/16/2023]
Abstract
PURPOSE Increased frequency of suicide in rural areas of Tuscany has been described since the 1970s. A case-control study was conducted in 2014 and 2015. The objective of this study was to identify major individual risk factors related to suicides in six rural districts of Tuscany. METHODS Cases were identified as all 128 suicides occurred in six rural districts between 2009 and 2013. Controls (three for each case) were matched for age, sex, and general practice. Information was collected from GPs using a structured questionnaire. Univariate and multivariate analyses were carried out to investigate the association between individual risk factors and suicide. RESULTS Informants for 91 cases of the 128 identified cases were successfully interviewed (response rate 71.1%). About 40.5-65.9% suicide cases and 11.4-20.0% of controls had some psychiatric pathology, accordingly to different definitions. Univariate conditional regression analysis showed that living in isolated houses (OR 2.48), living alone (OR 2.97), not being married (OR 2.63), low income (OR 2.73), psychiatric pathology (OR 9.70), psychotropic medication (OR 5.58), problems with relatives (OR 14.78), psychiatric family history (OR 5.67), and suicidal ideation (OR 15.61) were all risk factors. Practising religion (OR 0.27) was the only protective factor identified. Multivariate regression identified two independently and significantly associated variables namely, psychiatric pathology (OR 8.87) and living alone (OR 2.30). CONCLUSIONS Results of this study showed, similarly to recent research, that not all suicide events are the results of psychiatric pathology. Prevention strategies should, therefore, target both socio-economic and clinical risk factors.
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Chen X, Sun Y, Li Z, Yu B, Gao G, Wang P. Historical trends in suicide risk for the residents of mainland China: APC modeling of the archived national suicide mortality rates during 1987-2012. Soc Psychiatry Psychiatr Epidemiol 2019; 54:99-110. [PMID: 30171272 DOI: 10.1007/s00127-018-1593-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 08/24/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE Distinctive and dramatic changes in the history of China with a rapid suicide decline in recent years present an opportunity to investigate the risk of suicide. In this study, we investigated suicide risk with a historical perspective with archived data to inform suicide research and prevention policies and strategies. METHOD Documented age-specific suicide mortality rates in 1987-2012 were decomposed into age, period, and cohort effect using APC-modeling method and intrinsic estimator (IE) technique. The estimated effects were further analyzed by numerical differentiation. RESULTS The data satisfactorily fit the constructed APC models. Cohort effect indicated that suicide risk in China fluctuated at very high levels during 1903-1967, followed by a sharp decline during 1968-1977, and reached the lowest level in 1983-1987 before increased again. Period effect confirmed the declining trend since 1987. Three sunny cohorts with reduced suicide risk and four cloudy cohorts with increased risk were, respectively, associated with significant cultural, social, political, and economic events in China since the 1900s. CONCLUSIONS The mega trends in the suicide risk at the population level are closely related to significant historical events in China. Suicide is anticipated to increase because of the growing risk for the young cohorts (particularly young females) as the country further develops. Study findings suggest the significance of national strategies for suicide prevention and control, including maintenance of social harmony and stability, provision of more opportunities for development, enhancement of social integration, and restriction of suicide facilitating factors.
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Affiliation(s)
- Xinguang Chen
- Global Health Institute, Wuhan University, 299 Bayi Road, Wuchang District, Wuhan, 430072, Hubei, China.,Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Yang Sun
- Global Health Institute, Wuhan University, 299 Bayi Road, Wuchang District, Wuhan, 430072, Hubei, China. .,Department of Public Affairs and Management, School of Political Science and Public Administration, Wuhan University, Wuhan, China.
| | - Zhi Li
- Department of Sociology and Criminology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Bin Yu
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Ge Gao
- Department of Sociology, University of Maryland, College Park, Maryland, USA
| | - Peigang Wang
- Global Health Institute, Wuhan University, 299 Bayi Road, Wuchang District, Wuhan, 430072, Hubei, China
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Perceval M, Ross V, Kõlves K, Reddy P, De Leo D. Social factors and Australian farmer suicide: a qualitative study. BMC Public Health 2018; 18:1367. [PMID: 30541526 PMCID: PMC6292011 DOI: 10.1186/s12889-018-6287-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 11/30/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Farmers and farm workers have been recognised as a group at high risk of suicide in Australia; however this risk is not without geographic and demographic variation. This study aims to identify and better understand the complex interplay of risk and protective factors surrounding farmer suicide, with an emphasis on social influences, so as to inform tailored and effective suicide prevention initiatives. METHODS Focus groups were conducted in three diverse sites across two states in Australia with men and women separately to gain perceptions about suicide risk and protective factors and attitudes towards suicide and help seeking. The three communities in each state represented areas with a suicide rate similar to, above, and below the state average. The communities were also diverse in their population, types of farming, geographic location, distance from and access to services. There were a total of 33 female and 30 male participants. RESULTS Qualitative analysis indicated three major interrelated social factors: (1) changing rural communities, (2) community attitudes and stigma and (3) relationship issues. CONCLUSIONS The biopsycho-ecological model is considered useful to better understand and address social, as well as individual and environmental factors, pertaining to farmer suicide.
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Affiliation(s)
- Meg Perceval
- National Centre of Excellence in Suicide Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Australian Institute for Suicide Research and Prevention, Mt Gravatt campus, Griffith University, 176 Messines Ridge Road, Mt Gravatt, Brisbane, QLD 4122 Australia
| | - Victoria Ross
- National Centre of Excellence in Suicide Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Australian Institute for Suicide Research and Prevention, Mt Gravatt campus, Griffith University, 176 Messines Ridge Road, Mt Gravatt, Brisbane, QLD 4122 Australia
| | - Kairi Kõlves
- National Centre of Excellence in Suicide Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Australian Institute for Suicide Research and Prevention, Mt Gravatt campus, Griffith University, 176 Messines Ridge Road, Mt Gravatt, Brisbane, QLD 4122 Australia
| | - Prasuna Reddy
- Faculty of Science, Engineering & Technology, Swinburne University of Technology, Melbourne, Australia
- Psychology and Neuroscience, Institute of Psychiatry, King’s College London, London, UK
| | - Diego De Leo
- National Centre of Excellence in Suicide Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Australian Institute for Suicide Research and Prevention, Mt Gravatt campus, Griffith University, 176 Messines Ridge Road, Mt Gravatt, Brisbane, QLD 4122 Australia
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Knipe D, Gunnell D, Pearson M, Jayamanne S, Pieris R, Priyadarshana C, Weerasinghe M, Hawton K, Konradsen F, Eddleston M, Metcalfe C. Attempted suicide in Sri Lanka - An epidemiological study of household and community factors. J Affect Disord 2018; 232:177-184. [PMID: 29494901 PMCID: PMC6081369 DOI: 10.1016/j.jad.2018.01.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 12/18/2017] [Accepted: 01/28/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND An individual's suicide risk is determined by personal characteristics, but is also influenced by their environment. Previous studies indicate a role of contextual effects on suicidal behaviour, but there is a dearth of quantitative evidence from Asia. METHODS Individual and community level data were collected on 165,233 people from 47,919 households in 171 communities in rural Sri Lanka. Data were collected on individual (age, sex, past suicide attempts and individual socioeconomic position (SEP)) and household (household SEP, pesticide access, alcohol use and multigenerational households) level factors. We used 3-level logit models to investigate compositional (individual) and contextual (household/community) effects. RESULTS We found significant variation between households 21% (95% CI 18%, 24%) and communities 4% (95% CI 3%, 5%) in the risk of a suicide attempt. Contextual factors as measured by low household SEP (OR 2.37 95% CI 2.10, 2.67), low community SEP (OR 1.45 95% CI 1.21, 1.74), and community 'problem' alcohol use (OR 1.44 95% CI 1.19, 1.75) were associated with an increased risk of suicide attempt. Women living in households with alcohol misuse were at higher risk of attempted suicide. We observed a protective effect of living in multigenerational households (OR 0.53 95% CI 0.42, 0.65). LIMITATIONS The outcome was respondent-reported and refers to lifetime reports of attempted suicide, therefore this study might be affected by socially desirable responding. CONCLUSIONS Our study finds that contextual factors are associated with an individual's risk of attempted suicide in Sri Lanka, independent of an individual's personal characteristics.
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Affiliation(s)
- D.W. Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK,South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka,Corresponding author at: Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK.
| | - D. Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK
| | - M. Pearson
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka,Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - S. Jayamanne
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka,Faculty of Medicine, University of Kelanyia, Kelanyia, Sri Lanka
| | - R. Pieris
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - C. Priyadarshana
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - M. Weerasinghe
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka,Department of Community Medicine, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
| | - K. Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
| | - F. Konradsen
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M. Eddleston
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka,Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - C. Metcalfe
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
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Levav I, Klomek AB. A review of epidemiologic studies on suicide before, during, and after the Holocaust. Psychiatry Res 2018; 261:35-39. [PMID: 29276992 DOI: 10.1016/j.psychres.2017.12.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 11/10/2017] [Accepted: 12/15/2017] [Indexed: 12/27/2022]
Abstract
The available literature on the risk of suicides related to the Holocaust (1939-1945) and its aftermath differs in its time periods, in the countries investigated, and in the robustness of its sources. Reliable information seems to indicate that the risk of suicide for Jews in Nazi Germany and Austria during the pre-war period (1933-1939) was elevated, while information on suicide during the internment in the concentration camps is fraught with problems. The latter derives from the Nazis' decision to hide the statistics on the inmates' causes of death, and from the prevailing life conditions that impeded separation between self-inflicted death and murder. Reliable studies conducted in Israel among refugees who entered pre-state Israel, 1939-1945, and post-World War II survivors reaching Israel (1948 on), show a mixed picture: suicide rates among the former were higher than comparison groups, while the latter group shows evidence of resilience.
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Affiliation(s)
- Itzhak Levav
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, Haifa University, Haifa, Israel
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Arya V, Page A, River J, Armstrong G, Mayer P. Trends and socio-economic determinants of suicide in India: 2001-2013. Soc Psychiatry Psychiatr Epidemiol 2018; 53:269-278. [PMID: 29209745 DOI: 10.1007/s00127-017-1466-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/27/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate trends and socio-economic determinants of suicide in India over the period of 2001-2013. METHOD Suicide rates between 2001 and 2013 were calculated using suicide statistics provided by National Crime Records Bureau (NCRB) and census data provided by Census of India, stratified by sex, age group, and geographical region, to investigate trends in suicide over the study period. Multilevel negative binomial regression models were specified to investigate associations between state-level indicators of economic development, education, employment and religious factors and sex-specific suicide rates. RESULTS Male suicide rates remained relatively steady (~ 14 per 100,000) while female suicide rates decreased over the study period (9 to 7 per 100,000). The age group of 45-59 years had the highest suicide rate among males while the age group of 15-29 years had the highest suicide rate among females. On average, higher male and female suicide rates were observed in states with: higher levels of development, higher levels of agricultural employment, higher levels of literacy, and higher proportions of people identifying with Hinduism. Higher male suicide rates were also observed in states with higher levels of unemployment. CONCLUSION The process of modernization might be contributing towards higher suicide risk in more developed parts of India. Also, increase in farmer suicides since economic liberalization might be contributing towards higher suicide rates among more agricultural regions. Furthermore, ancient sanctions towards religious suicide are possibly still influencing modern Hindu suicides.
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Affiliation(s)
- Vikas Arya
- Translational Health Research Institute, Western Sydney University, Sydney, Australia.
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | - Jo River
- Sydney Nursing School, The University of Sydney, Camperdown, Australia
| | - Gregory Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Peter Mayer
- Politics and International Studies, The University of Adelaide, Adelaide, Australia
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Marital status integration and suicide: A meta-analysis and meta-regression. Soc Sci Med 2018; 197:116-126. [DOI: 10.1016/j.socscimed.2017.11.053] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 11/23/2017] [Accepted: 11/28/2017] [Indexed: 11/19/2022]
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Hagaman AK, Khadka S, Lohani S, Kohrt B. Suicide in Nepal: a modified psychological autopsy investigation from randomly selected police cases between 2013 and 2015. Soc Psychiatry Psychiatr Epidemiol 2017; 52:1483-1494. [PMID: 28856382 PMCID: PMC5705471 DOI: 10.1007/s00127-017-1433-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/16/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Yearly, 600,000 people complete suicide in low- and middle-income countries, accounting for 75% of the world's burden of suicide mortality. The highest regional rates are in South and East Asia. Nepal has one of the highest suicide rates in the world; however, few investigations exploring patterns surrounding both male and female suicides exist. This study used psychological autopsies to identify common factors, precipitating events, and warning signs in a diverse sample. METHODS Randomly sampled from 302 police case reports over 24 months, psychological autopsies were conducted for 39 completed suicide cases in one urban and one rural region of Nepal. RESULTS In the total police sample (n = 302), 57.0% of deaths were male. Over 40% of deaths were 25 years or younger, including 65% of rural and 50.8% of female suicide deaths. We estimate the crude urban and rural suicide rates to be 16.1 and 22.8 per 100,000, respectively. Within our psychological autopsy sample, 38.5% met criteria for depression and only 23.1% informants believed that the deceased had thoughts of self-harm or suicide before death. Important warning signs include recent geographic migration, alcohol abuse, and family history of suicide. CONCLUSIONS Suicide prevention strategies in Nepal should account for the lack of awareness about suicide risk among family members and early age of suicide completion, especially in rural and female populations. Given the low rates of ideation disclosure to friends and family, educating the general public about other signs of suicide may help prevention efforts in Nepal.
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Affiliation(s)
- Ashley K Hagaman
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - S Khadka
- Research Department, Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - S Lohani
- Nobel College, Pokhara University, Kathmandu, Nepal
| | - B Kohrt
- Department of Psychiatry, George Washington University, Washington, DC, USA
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Carcach C. A spatio-temporal analysis of suicide in El Salvador. BMC Public Health 2017; 17:339. [PMID: 28427363 PMCID: PMC5397781 DOI: 10.1186/s12889-017-4251-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 04/08/2017] [Indexed: 11/26/2022] Open
Abstract
Background In 2012, international statistics showed El Salvador’s suicide rate as 40th in the world and the highest in Latin America. Over the last 15 years, national statistics show the suicide death rate declining as opposed to an increasing rate of homicide. Though completed suicide is an important social and health issue, little is known about its prevalence, incidence, etiology and spatio-temporal behavior. The primary objective of this study was to examine completed suicide and homicide using the stream analogy to lethal violence within a spatio-temporal framework. Methods A Bayesian model was applied to examine the spatio-temporal evolution of the tendency of completed suicide over homicide in El Salvador. Data on numbers of suicides and homicides at the municipal level were obtained from the Instituto de Medicina Legal (IML) and population counts, from the Dirección General de Estadística y Censos (DIGESTYC), for the period of 2002 to 2012. Data on migration were derived from the 2007 Population Census, and inequality data were obtained from a study by Damianović, Valenzuela and Vera. Results The data reveal a stable standardized rate of total lethal violence (completed suicide plus homicide) across municipalities over time; a decline in suicide; and a standardized suicide rate decreasing with income inequality but increasing with social isolation. Municipalities clustered in terms of both total lethal violence and suicide standardized rates. Conclusions Spatial effects for suicide were stronger among municipalities located in the north-east and center-south sides of the country. New clusters of municipalities with large suicide standardized rates were detected in the north-west, south-west and center-south regions, all of which are part of time-stable clusters of homicide. Prevention efforts to reduce income inequality and mitigate the negative effects of weak relational systems should focus upon municipalities forming time-persistent clusters with a large rate of death by suicide. In municipalities that are part of newly-formed suicide clusters and also are located in areas with a large rate of homicide, interrupting the expansion of spatial concentrations of suicide over time may require the implementation of both public health and public safety interventions.
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Affiliation(s)
- Carlos Carcach
- Center for Public Policy, Escuela Superior de Economía y Negocios, Santa Tecla, El Salvador.
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Merzagora I, Mugellini G, Amadasi A, Travaini G. Suicide Risk and the Economic Crisis: An Exploratory Analysis of the Case of Milan. PLoS One 2016; 11:e0166244. [PMID: 28033341 PMCID: PMC5199046 DOI: 10.1371/journal.pone.0166244] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 10/25/2016] [Indexed: 02/07/2023] Open
Abstract
In the past five years, several scientific articles have claimed that the increase some countries have registered in suicide rates since 2008 is somehow related to the economic crisis. Other research has suggested that the impact of specific economic problems on the probability of suicidal behavior is often mediated by other individual-level factors, mainly psychological and physical, whose negative influence is exacerbated by reductions in the availability of health and social care during an economic crisis. On the basis of almost 1,000 cases of suicide collected by the Institute of Forensic Medicine in the province of Milan, this article aims at testing whether suicidal probability during an economic crisis is influenced by the interaction between an individual's employment status and the presence of psychological or physical disease. Using a binary logistic regression model, this article demonstrates that the likelihood of suicide during an economic crisis is three times higher for persons affected by a severe disease, either physical or psychological, than for people who are not affected (OR = 3.156; 95% CI = 1.066-9.339; p = 0.38). Neither employment status nor the interaction between employment status and health status contributed to the difference between the suicide rate before and during the economic crisis.
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Affiliation(s)
- Isabella Merzagora
- Sezione di Medicina Legale e delle Assicurazioni – Dipartimento di Scienze Biomediche per la Salute – Università degli Studi di Milano, Milano, Italy
| | - Giulia Mugellini
- Università della Svizzera Italiana, Institute for Public Communication, Lugano, Switzerland
| | - Alberto Amadasi
- Sezione di Medicina Legale e delle Assicurazioni – Dipartimento di Scienze Biomediche per la Salute – Università degli Studi di Milano, Milano, Italy
| | - Guido Travaini
- Sezione di Medicina Legale e delle Assicurazioni – Dipartimento di Scienze Biomediche per la Salute – Università degli Studi di Milano, Milano, Italy
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Cuadrado C, Zitko P, Covarrubias T, Hernandez D, Sade C, Klein C, Gomez A. Association between adolescent suicide and sociodemographic factors in Chile: cross-sectional ecological study. CRISIS 2016; 36:281-90. [PMID: 26440625 DOI: 10.1027/0227-5910/a000324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Adolescent suicide rates (ASR) are a matter of concern worldwide. Causes of this trend are not understood and could correspond to socioeconomic factors such as inequality. AIM To investigate sociodemographic variables related to ASR, particularly the potential association with indicators of socioeconomic inequality. METHOD Cross-sectional ecological study analyzing data from 29 health districts with univariate and multivariable multilevel Poisson models. RESULTS ASR were higher in male adolescents and at increasing age. No association was found between ASR and inequality (Gini coefficient and 20/20 ratio). Analysis revealed that living in a single-parent family is associated with ASR. CONCLUSIONS The usual demographic patterns of adolescent suicide apply in Chile. An emerging variable of interest is single-parent family. No cross-sectional association between social inequality and ASR was found based on conflicting evidence. These results should be explored in future prospective population studies to further understand associated social factors.
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Affiliation(s)
- Cristóbal Cuadrado
- 1 Programa de Políticas, Sistemas y Gestión en Salud, Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile
| | - Pedro Zitko
- 2 Unidad de Estudios Asistenciales, Complejo Asistencial Barros Luco, Santiago de Chile, Chile
| | - Trinidad Covarrubias
- 3 Department of Philosophy, Politics and Economics, University College of London, UK
| | - Dunia Hernandez
- 4 Departamento de Psiquiatria, Campus Sur. Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile
| | - Cristina Sade
- 4 Departamento de Psiquiatria, Campus Sur. Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile
| | - Carolina Klein
- 5 Departamento de Medicina Familiar, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Alejandro Gomez
- 4 Departamento de Psiquiatria, Campus Sur. Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile
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Townsend E, Wadman R, Sayal K, Armstrong M, Harroe C, Majumder P, Vostanis P, Clarke D. Uncovering key patterns in self-harm in adolescents: Sequence analysis using the Card Sort Task for Self-harm (CaTS). J Affect Disord 2016; 206:161-168. [PMID: 27475886 PMCID: PMC5082440 DOI: 10.1016/j.jad.2016.07.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 07/03/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Self-harm is a significant clinical issue in adolescence. There is little research on the interplay of key factors in the months, weeks, days and hours leading to self-harm. We developed the Card Sort Task for Self-harm (CaTS) to investigate the pattern of thoughts, feelings, events and behaviours leading to self-harm. METHODS Forty-five young people (aged 13-21 years) with recent repeated self-harm completed the CaTS to describe their first ever/most recent self-harm episode. Lag sequential analysis determined significant transitions in factors leading to self-harm (presented in state transition diagrams). RESULTS A significant sequential structure to the card sequences produced was observed demonstrating similarities and important differences in antecedents to first and most recent self-harm. Life-events were distal in the self-harm pathway and more heterogeneous. Of significant clinical concern was that the wish to die and hopelessness emerged as important antecedents in the most recent episode. First ever self-harm was associated with feeling better afterward, but this disappeared for the most recent episode. LIMITATIONS Larger sample sizes are necessary to examine longer chains of sequences and differences in genders, age and type of self-harm. The sample was self-selected with 53% having experience of living in care. CONCLUSIONS The CaTs offers a systematic approach to understanding the dynamic interplay of factors that lead to self-harm in young people. It offers a method to target key points for intervention in the self-harm pathway. Crucially the factors most proximal to self-harm (negative emotions, impulsivity and access to means) are modifiable with existing clinical interventions.
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Affiliation(s)
- E. Townsend
- Self-Harm Research Group, School of Psychology, University Park, The University of Nottingham, Nottingham NG7 2RD, UK,Corresponding author.
| | - R. Wadman
- Self-Harm Research Group, School of Psychology, University Park, The University of Nottingham, Nottingham NG7 2RD, UK
| | - K. Sayal
- Division of Psychiatry & Applied Psychology, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - M. Armstrong
- Child and Adolescent Mental Health Service, Nottinghamshire Healthcare NHS Foundation Trust, Thorneywood CAMHS, Porchester Rd, Nottingham NG3 6LF, UK
| | - C. Harroe
- Harmless, 7 Mansfield Road, Nottingham NG1 3FB, UK
| | - P. Majumder
- Child and Adolescent Mental Health Service, Nottinghamshire Healthcare NHS Foundation Trust, Thorneywood CAMHS, Porchester Rd, Nottingham NG3 6LF, UK
| | - P. Vostanis
- School of Neurosciences, Psychology and Behaviour, University of Leicester, Westcotes Drive, Leicester LE3 0QU, UK
| | - D. Clarke
- Self-Harm Research Group, School of Psychology, University Park, The University of Nottingham, Nottingham NG7 2RD, UK
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Yi SW, Jung M, Kimm H, Sull JW, Lee E, Lee KO, Ohrr H. Usual alcohol consumption and suicide mortality among the Korean elderly in rural communities: Kangwha Cohort Study. J Epidemiol Community Health 2016; 70:778-83. [PMID: 26888918 PMCID: PMC4975804 DOI: 10.1136/jech-2015-206849] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/28/2016] [Indexed: 11/25/2022]
Abstract
Background The evidence from prospective studies on whether greater usual alcohol consumption is associated with a higher risk of death by suicide in the general population is inconclusive. Methods 6163 participants (2635 men; 3528 women) in a 1985 survey among rural residents in Korea aged 55 years and above were followed until 2008. A Cox model was used to calculate HRs of suicide death after adjustment for demographic, socioeconomic and health-related confounders. Results 37 men and 24 women died by suicide. Elderly persons who consumed alcohol daily, 70 g alcohol (5 drinks) or more per drinking day, or 210 g alcohol (15 drinks) or more per week had higher suicide mortality (p<0.05), compared with non-drinkers. An increase of one drinking day per week (HR=1.17, 95% CI 1.05 to 1.31), 70 g (5 drinks) additional alcohol intake per drinking day (HR=1.38, 95% CI 1.13 to 1.70), and 140 g (10 drinks) additional alcohol intake per week was associated with a 17%, 38% and 12% higher risk of suicide death, respectively. Women had a higher relative risk of suicide death associated with alcohol consumption, compared with men. Conclusions A greater frequency and amount of usual alcohol consumption was linearly associated with higher suicide death. Given the same amount of alcohol consumption, women might have a higher relative risk of suicide than men. Our findings support ‘the lower the better’ for alcohol intake, no protective effect of moderate alcohol consumption, and a sex-specific guideline (lower alcohol threshold for women) as actions to prevent suicide death.
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Affiliation(s)
- Sang-Wook Yi
- Department of Preventive Medicine and Public Health, Catholic Kwandong University College of Medicine, Gangneung, Republic of Korea Institute for Clinical and Translational Research, Catholic Kwandong University College of Medicine, Gangneung, Republic of Korea
| | - Myoungjee Jung
- Department of Public Health, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Heejin Kimm
- Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Jae-Woong Sull
- Department of Biomedical Laboratory Science, Eulji University College of Health Science, Sungnam, Republic of Korea
| | - Eunsook Lee
- Department of Nursing, Sangmyung University, Cheonan, Republic of Korea
| | - Kwang Ok Lee
- Department of Nursing, Sangmyung University, Cheonan, Republic of Korea
| | - Heechoul Ohrr
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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29
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Associations between marital and educational status and risk of completed suicide in Hungary. J Affect Disord 2016; 190:777-783. [PMID: 26625089 DOI: 10.1016/j.jad.2015.11.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/13/2015] [Accepted: 11/09/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Suicide rates in Hungary are notoriously high. According to the literature, marital and educational status are associated with suicidal behaviour and these associations are somewhat influenced by gender. Since in Hungary these associations have not yet been investigated by means of large-scale multivariate epidemiological studies we aimed to investigate these in the current paper. METHOD Census data on marital and educational status, age and gender from 1980, 1990, 2001 and 2011 were used for the general population. Corresponding data from the same years for suicide victims derived from the Hungarian Demographic Register. Suicide victims younger than 20 years were excluded. Negative binomial regression analyses were used to reveal the effects of the above variables on suicide. All statistical procedures were conducted using Stata 12 software (StataCorp. 2011). RESULTS Female gender, young age, higher educational attainment and marriage were significantly associated with decreased risks of suicide. Intriguingly, effects of educational and marital status on suicide were stronger in males. LIMITATIONS Data on the length of the periods between changes in marital status and suicides were unavailable. Our four categories are not suitable to cover the whole gamut of marital statuses in a modern society (e.g. we did not have a specific category for people living in cohabitation). Ecological study design. CONCLUSION We found that in Hungary between 1980 and 2011 the effects of some frequently investigated societal factors (e.g. educational and marital status) on suicide risk were very similar to those found in the majority of other countries. The effects of studied determinants of suicide have not changed dramatically over the past three decades in Hungary.
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Breuer C. Unemployment and Suicide Mortality: Evidence from Regional Panel Data in Europe. HEALTH ECONOMICS 2015; 24:936-950. [PMID: 24934277 DOI: 10.1002/hec.3073] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 03/31/2014] [Accepted: 05/13/2014] [Indexed: 06/03/2023]
Abstract
This paper addresses the influence of economic activity on suicide mortality in Europe. To this end, it employs a new panel data set of 275 regions in 29 countries over the period 1999-2010. The results suggest that unemployment does have a significantly positive influence on suicides. In line with economic theory, this influence varies among gender and age groups. Men of working age are particularly sensitive, while old-age suicide mortality (older than 65 years old) hardly responds to unemployment. Moreover, real economic growth negatively affects the suicide rates of working-age men. The results withstand several robustness checks, such as sample variations, and after controlling for serial and spatial autocorrelation.
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Affiliation(s)
- Christian Breuer
- Ifo Institute for Economic Research at the University of Munich, Munich, Germany
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31
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Yi SW, Hong JS. Depressive symptoms and other risk factors predicting suicide in middle-aged men: a prospective cohort study among Korean Vietnam War veterans. PeerJ 2015; 3:e1071. [PMID: 26157634 PMCID: PMC4493683 DOI: 10.7717/peerj.1071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/12/2015] [Indexed: 12/17/2022] Open
Abstract
Background. Few studies have prospectively examined whether depressive symptoms and other risk factors are associated with a higher risk of suicide death in individuals other than high-risk populations such as psychiatric patients and individuals with self-harm histories. The purpose of the study is to prospectively examine whether depressive symptoms assessed by the Beck Depression Inventory (BDI) are associated with greater risk of suicide death and whether depressive symptoms and other risk factors are independent predictors of suicide in general-risk populations. Another aim is to evaluate the sensitivity of the BDI for predicting suicide death. Methods. 10,238 Korean Vietnam War veterans (mean age: 56.3 years) who participated in two surveys in 2001 were followed up for suicide mortality over 7.5 years. Results. 41 men died by suicide. Severely depressed participants had a higher adjusted hazard ratio (aHR = 3.4; 95% CI [1.5–7.7]) of suicide than non-to-moderately depressed ones. Higher suicide risk was associated with more severe depressive symptoms (p for trend = 0.009). After adjustment for depressive symptoms and other factors, very poor health, low education, and past drinking were associated with higher suicide risk, while good health, body mass index, and marital status were not associated with suicide. The sensitivity at the cut-off score of 31 for detecting suicide was higher during the earlier 3.5 years of the follow-up (75%; 95% CI [50–90]) than during the latter 4 years (60%; 95% CI [41–76]). Conclusions. Depressive symptoms are a strong independent predictor and very poor health, low education, and drinking status may be independent predictors of future suicide. The BDI may have acceptable diagnostic properties as a risk assessment tool for identifying people with depression and suicidal potential among middle-aged men.
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Affiliation(s)
- Sang-Wook Yi
- Department of Preventive Medicine and Public Health, Catholic Kwandong University College of Medicine , Gangneung , Republic of Korea ; Institute for Clinical and Translational Research, Catholic Kwandong University , Gangneung , Republic of Korea
| | - Jae-Seok Hong
- Department of Healthcare Management, Cheongju University College of Health Sciences , Cheongju , Republic of Korea
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Milner A, Page A, LaMontagne AD. Cause and effect in studies on unemployment, mental health and suicide: a meta-analytic and conceptual review. Psychol Med 2014; 44:909-917. [PMID: 23834819 DOI: 10.1017/s0033291713001621] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There are ongoing questions about whether unemployment has causal effects on suicide as this relationship may be confounded by past experiences of mental illness. The present review quantified the effects of adjustment for mental health on the relationship between unemployment and suicide. Findings were used to develop and interpret likely causal models of unemployment, mental health and suicide. METHOD A random-effects meta-analysis was conducted on five population-based cohort studies where temporal relationships could be clearly ascertained. RESULTS Results of the meta-analysis showed that unemployment was associated with a significantly higher relative risk (RR) of suicide before adjustment for prior mental health [RR 1.58, 95% confidence interval (CI) 1.33-1.83]. After controlling for mental health, the RR of suicide following unemployment was reduced by approximately 37% (RR 1.15, 95% CI 1.00-1.30). Greater exposure to unemployment was associated with higher RR of suicide, and the pooled RR was higher for males than for females. CONCLUSIONS Plausible interpretations of likely pathways between unemployment and suicide are complex and difficult to validate given the poor delineation of associations over time and analytic rationale for confounder adjustment evident in the revised literature. Future research would be strengthened by explicit articulation of temporal relationships and causal assumptions. This would be complemented by longitudinal study designs suitable to assess potential confounders, mediators and effect modifiers influencing the relationship between unemployment and suicide.
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Affiliation(s)
- A Milner
- McCaughey VicHealth Centre for Community Wellbeing, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - A Page
- School of Science and Health, University of Western Sydney, Penrith, NSW, Australia
| | - A D LaMontagne
- McCaughey VicHealth Centre for Community Wellbeing, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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