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Kim KV, Rehm J, Kaplan MS, Lange S. Relationship Between Alcohol Use and Firearm-Involved Suicide: Findings From the National Violent Death Reporting System, 2003-2020. Am J Prev Med 2024; 66:832-839. [PMID: 38000484 DOI: 10.1016/j.amepre.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION Acute alcohol intoxication is a contributing factor in firearm-involved suicides. However, knowledge of the relationship between alcohol intoxication and firearm-involved suicide by age and sex (defined herein as the biological sex of the decedent) is limited. The purpose of the current study was to evaluate the sex- and age group-specific relationship between alcohol intoxication and firearm-involved suicide. METHODS Data from the National Violent Death Reporting System, 2003-2020, on suicide decedents (18+ years of age) were utilized. Age-group- and sex-specific multivariate binary logistic regression analyses were conducted. Statistical analyses were performed in 2023. RESULTS Alcohol intoxication (i.e., having a blood alcohol concentration of 0.08 g/dL or more) was significantly associated with using a firearm as the method of suicide for young (18-34 years; relative risk (RR)=1.31, 95% CI: 1.22-1.40) and middle-aged (35-64 years; RR=1.34, 95% CI: 1.27-1.39) females but not among older females (65+ years; RR=1.01, 95% CI: 0.87-1.17). Among males, the association was significant for all age-groups (young: RR=1.28, 95% CI: 1.25-1.30; middle-aged: RR=1.17, 95% CI: 1.15-1.19; and older: RR=1.04, 95% CI: 1.01-1.07). CONCLUSIONS Among males of all ages and young and middle-aged females, alcohol intoxication was associated with increased risk of suicide by firearm-an extremely lethal method that accounts for a majority of suicides in the U.S.-compared to their non-intoxicated counterparts. Interventions targeting excessive alcohol consumption may be effective in reducing suicide mortality rates.
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Affiliation(s)
- Kawon V Kim
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research (ZIS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Mark S Kaplan
- Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California
| | - Shannon Lange
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
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Calixte R, Chahal K, Besson A, Kaplan MS. Access to routine health care and awareness of hypertension status among adults: Results from the National Health and Nutrition Examination Survey, 2011-2018. Prev Med 2024; 179:107843. [PMID: 38176445 DOI: 10.1016/j.ypmed.2023.107843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Hypertension is a growing pandemic affecting over 1 billion people worldwide; about 46% of people with hypertension are unaware. METHOD Data from the National Health and Nutrition Examination Survey (NHANES) 2011-2018 were analyzed to assess the relationship between access to a routine place of care and undiagnosed hypertension in adults aged 18 to 64 years old. We defined undiagnosed hypertension as those meeting the 2017 American Heart Association's guidelines for stage 1 or 2 hypertension who reported not being told by their healthcare provider that they had hypertension. We used a multivariable Poisson regression model to assess the relationship between access to a routine place of care and undiagnosed hypertension. RESULT The final analytic sample was 5345 hypertensive American adults, with 56% unaware of their status. The results indicate that lack of awareness of hypertension status was highest among those without a routine place of care [PR = 1.20, CI = (1.12-1.29), p < 0.001] compared to those with access to a routine place of care, after adjustment for sociodemographic and clinical characteristics. CONCLUSION Access to a routine place of care in a non-emergency department setting is essential to reduce the rate of undiagnosed hypertension among American adults. Policymakers should implement policies to address the shortage of primary care providers and increase access to a routine place of care.
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Affiliation(s)
- Rose Calixte
- Department of Epidemiology and Biostatistics, SUNY Downstate Health Sciences University, Brooklyn, NY, United States of America.
| | - Kunika Chahal
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, United States of America
| | - Ayanna Besson
- Department of Epidemiology and Biostatistics, SUNY Downstate Health Sciences University, Brooklyn, NY, United States of America
| | - Mark S Kaplan
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, United States of America
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Kim KV, Russell C, Kaplan MS, Rehm J, Lange S. Types of suicide pacts: a comparative analysis using the National Violent Death Reporting System. Front Psychiatry 2023; 14:1139305. [PMID: 37215672 PMCID: PMC10196347 DOI: 10.3389/fpsyt.2023.1139305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/18/2023] [Indexed: 05/24/2023] Open
Abstract
Introduction Suicide pacts are lethal acts of violence involving multiple decedents. No study has ever compared suicide pact types using a large sample, limiting our understanding of this rare but serious phenomenon. The objective of the current study was to describe suicide pacts in the United States and empirically compare suicide pacts wherein all decedents died by self-harm with those that involved assisted suicide. Methods Using restricted access incident-level data from the National Violent Death Reporting System, we identified 277 suicide pact incidents (225 suicide pacts wherein all decedents died by self-harm and 52 suicide pacts wherein one pact member died by assisted suicide). The two suicide pact types were compared for demographics, pact characteristics, and preceding circumstances. Results Compared with decedents of suicide pacts involving assisted suicide, decedents of suicide pacts wherein both members died by self-harm had significantly lower odds of being non-white, Hispanic or non-Hispanic (OR = 0.33, 95%CI: 0.18, 0.64), using an active method of suicide (i.e., ICD-10 codes X70-X83) (OR = 0.01, 95%CI: <0.01, 0.04), and experiencing interpersonal relationship problems (OR = 0.48, 95%CI: 0.27, 0.87) and a crisis within two weeks of their death (OR = 0.58, 95%CI: 0.36, 0.97), but greater odds of preceding physical health problems (OR = 3.25, 95%CI: 1.84, 6.04). Discussion Overall, our findings indicate that suicide pacts wherein all decedents died by self-harm and suicide pacts that involved an assisted suicide appear to have largely distinct profiles. While further research is required, the discrete characteristics of these two types of suicide pacts have important implications for prevention.
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Affiliation(s)
- Kawon Victoria Kim
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Cayley Russell
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Mark S. Kaplan
- Luskin School of Public Affairs, University of California, Los Angeles, CA, United States
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), Centre for Addiction and Mental Health, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Zentrum für Interdisziplinäre Suchtforschung (ZIS), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Shannon Lange
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Lange S, Jiang H, Štelemėkas M, Tran A, Cherpitel C, Giesbrecht N, Midttun NG, Jasilionis D, Kaplan MS, Manthey J, Xuan Z, Rehm J. Evaluating the Impact of Alcohol Policy on Suicide Mortality: A Sex-Specific Time-Series Analysis for Lithuania. Arch Suicide Res 2023; 27:339-352. [PMID: 34779348 PMCID: PMC9098693 DOI: 10.1080/13811118.2021.1999873] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE It is reasonable to believe that the alcohol policy environment can impact the suicide mortality rates in a given country, considering the well-known link between alcohol use and death by suicide. The current literature, albeit limited, suggests that an increase in alcohol taxation may result in a decrease in deaths by suicide and that the effect is sex-specific. Therefore, the objective of the current study was to test the impact of three alcohol control policy enactments (in 2008, 2017 and 2018) on suicide mortality among adults 25-74 years of age in Lithuania, by sex. METHODS To estimate the unique impact of three alcohol control policies, we conducted interrupted time-series analyses by employing a generalized additive mixed model on monthly sex-specific age-standardized suicide mortality rates from January 2001 to December 2018. RESULTS Analyses showed a significant impact of the 2017 (p = 0.016) alcohol control policy on suicide mortality for men only. Specifically, we estimated that in the year following the 2017 policy enactment, approximately 57 (95% CI: 9-107) deaths by suicide were prevented among men, 25-74 years of age. The three policy enactments tested were not found to significantly impact the suicide mortality rate among women. CONCLUSION Alcohol control policies involving pricing, which result in a notable decrease in alcohol affordability, could be a cost-effective indirect suicide prevention mechanism in not only countries of the former Soviet Union, but in other high-income countries with a comparable health care system to that in Lithuania. HIGHLIGHTSIncreasing excise tax on alcohol was found to have a sex-specific impact on suicide mortalityThe 2017 alcohol policy prevented 57 deaths by suicide among men, 25-74 years of age, in the following yearAlcohol pricing policies may be a cost-effective indirect suicide prevention mechanism.
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Affiliation(s)
- Shannon Lange
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto ON, Canada
| | - Huan Jiang
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto ON, Canada
| | - Mindaugas Štelemėkas
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Alexander Tran
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto ON, Canada
| | - Cheryl Cherpitel
- Public Health Institute, Alcohol Research Group, Emeryville CA, USA
| | - Norman Giesbrecht
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto ON, Canada
| | | | - Domantas Jasilionis
- Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Rostock, Germany
- Demographic Research Centre, Faculty of Social Sciences, Vytautas Magnus University, Kaunas, Lithuania
| | - Mark S. Kaplan
- Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles CA, USA
| | - Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, Boston MA, USA
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto ON, Canada
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- Department of Psychiatry, University of Toronto, Toronto ON, Canada
- Institute of Medical Science, University of Toronto, Toronto ON, Canada
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
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Lange S, Jiang H, Kaplan MS, Kim KV, Rehm J. Association Between Acute Alcohol Use and Firearm-Involved Suicide in the United States. JAMA Netw Open 2023; 6:e235248. [PMID: 36988957 PMCID: PMC10061235 DOI: 10.1001/jamanetworkopen.2023.5248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Importance Firearms are the method of suicide used most often in the US. Acute alcohol use is associated with an increased risk of suicide by firearm. However, the dose-response association between acute alcohol use and the probability of using a firearm as the method of suicide is unknown. Objective To evaluate the association between the amount of alcohol consumed and the probability of using a firearm as the method of suicide. Design, Setting, and Participants This cross-sectional study used mortality data from the US National Violent Death Reporting System on suicide decedents aged 18 years or older with a positive blood alcohol concentration (BAC; ie, ≥0.01 g/dL). Statistical analysis was performed from January 2003 to December 2020. Exposure Acute alcohol use, ascertained via postmortem toxicologic examination. Main Outcomes and Measures Probability of using a firearm as the method of suicide compared with all other methods of suicide. Results The study included 45 959 male suicide decedents (mean [SD] age, 42.6 [14.8] years) and 12 136 female suicide decedents (mean [SD] age, 44.2 [13.8] years) with a positive BAC; of those, 24 720 male decedents (53.8%) and 3599 female decedents (29.7%) used a firearm as the method of suicide. The probability of using a firearm as the method of suicide when alcohol is consumed was higher for male decedents, with the probability starting at just below 0.50 and increasing to approximately 0.75. In contrast, for female decedents, the probability began at just above 0.30 and increased to approximately 0.55. For both male and female decedents, the dose-response curves were an inverted U shape; as BAC increased, the probability of firearm-involved suicide initially increased and then decreased at very high BACs (approximately 0.40 g/dL for male decedents and approximately 0.30 g/dL for female decedents; these BACs were present among only a small percentage of alcohol-involved suicides: male decedents, 589 [1.3%]; female decedents, 754 [6.2%]). Conclusions and Relevance This cross-sectional study of suicide decedents who had consumed alcohol prior to their death suggests that, as alcohol consumption increased, the probability of a firearm-involved suicide increased until a certain BAC, at which point the probability started to decrease.
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Affiliation(s)
- Shannon Lange
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Huan Jiang
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mark S Kaplan
- Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles
| | - Kawon Victoria Kim
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Program on Substance Abuse, Public Health Agency of Catalonia, Barcelona, Spain
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
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Goldman-Mellor S, Kaplan MS, Qin P. Mortality Risk Following Nonfatal Injuries With Alcohol Use Disorder Involvement: A One-Year Follow-Up of Emergency Department Patients Using Linked Administrative Data. J Stud Alcohol Drugs 2022; 83:879-887. [PMID: 36484585 PMCID: PMC9756401 DOI: 10.15288/jsad.21-00444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/21/2022] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Patient presentations to the emergency department (ED) for alcohol-involved injury represent a growing public health burden, but their characteristics and sequelae remain understudied. This study examined mortality rates among ED patients presenting with alcohol-involved injuries and assessed how mortality varied by injury intent and other characteristics. METHOD This retrospective cohort study used statewide, longitudinally linked ED patient record and mortality data from California. Participants comprised all residents presenting to a licensed ED in 2009-2012 with a nonfatal injury that involved comorbid diagnosis of alcohol use disorder (AUD; n = 261,222; 59.3% male). Injury intent was defined using International Classification of Diseases, 9th Revision, Clinical Modification external cause-of-injury codes. Cox regression was used to investigate factors associated with 12-month all-cause mortality rates. Age-, sex-, and race/ethnicity-adjusted standardized mortality ratios (SMRs) were calculated using statewide mortality data. RESULTS Most ED injury visits involving an AUD diagnosis were coded as unintentional (75.9%). Following the index ED visit, all-cause mortality among AUD-involved injury patients was 5,205 per 100,000 person-years, five times higher than the demographically matched population (SMR = 5.3; 95% confidence interval [5.2, 5.4]). Adjusted Cox regression models indicated that patients whose index injury was unintentional, and whose AUD was for acute intoxication, had significantly higher mortality. Most deaths among unintentionally injured patients were from natural causes, whereas external-cause deaths were relatively more common in the other patient groups. CONCLUSIONS AUD-involved injury presentations to the ED in California are common and associated with high patient mortality burden, which varies by injury intent. Interventions are needed to reduce excess mortality in these patients.
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Affiliation(s)
- Sidra Goldman-Mellor
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced, California
| | - Mark S. Kaplan
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Sakai-Bizmark R, Kumamaru H, Estevez D, Bedel LEM, Marr EH, Mena LA, Kaplan MS. Association between suicide attempt and previous healthcare utilization among homeless youth. Suicide Life Threat Behav 2022; 52:994-1001. [PMID: 35765815 DOI: 10.1111/sltb.12897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/14/2022] [Accepted: 06/10/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The purpose of this study was to examine the association between prior emergency department (ED) visit or hospitalization and subsequent suicide attempt among homeless youth aged 10-17 years old. METHODS With New York statewide databases, a case-control design was conducted. Cases and controls were homeless patients with an ED visit or hospitalization due to suicide attempt (cases) or appendicitis (controls) between April and December. We examined ED and inpatient records for 90 days prior to the visit for suicide attempt or appendicitis. The primary exposure variable was prior healthcare utilization for any reason other than the following four reasons: mental health disorder, substance use, self-harm, and other injuries. Multivariable logistic regression models, with year fixed effect and hospital random effect, were used. RESULTS A total of 335 cases and 742 controls were identified. Cases had lower odds of prior healthcare utilization for any reason other than the four reasons listed above. (adjusted Odds Ratio [aOR]: 0.53, p-value = 0.03). CONCLUSIONS The association between prior healthcare utilization and decreased risk of suicide attempt among homeless youth may be due to comprehensive care provided during healthcare utilization. It may also reflect the presence of a social network that provided a protective effect.
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Affiliation(s)
- Rie Sakai-Bizmark
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA.,Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California, USA.,David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, The University of Tokyo School of Medicine, Tokyo, Japan
| | - Dennys Estevez
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Lauren E M Bedel
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA.,Network for Excellence in Health Innovation (NEHI), Boston, Massachusetts, USA
| | - Emily H Marr
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Laurie A Mena
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Mark S Kaplan
- The Luskin School of Public Affairs, University of California, Los Angeles (UCLA), Los Angeles, California, USA
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Lange S, Kaplan MS, Tran A, Rehm J. Growing alcohol use preceding death by suicide among women compared with men: age-specific temporal trends, 2003-18. Addiction 2022; 117:2530-2536. [PMID: 35491753 PMCID: PMC9357152 DOI: 10.1111/add.15905] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/07/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS In the United States, until 2018 both the prevalence of heavy alcohol use and the suicide mortality rate increased among men and women; however, women had experienced a notably higher increase in both. As heavy alcohol use may have contributed to the observed sex disparity in the suicide mortality rate increase, the aim of the current study was to estimate the temporal trend of the sex- and age-group-specific proportion of suicides that were alcohol-involved in the United States. DESIGN Using restricted-access data from the National Violent Death Reporting System, we performed joinpoint regression analyses to investigate temporal trends in the sex- and age-group (young adults = 18-34 years; middle-aged adults = 35-64 years; and older adults = 65+ years)-specific proportion of suicides that were alcohol-involved. SETTING United States. PARTICIPANTS A total of 115 202 suicide decedents 18+ years of age from 2003 to 2018. MEASUREMENTS The sex- and age-group-specific proportion of suicides that were alcohol-involved, among all suicide decedent, for which the decedent had a blood alcohol concentration (BAC) (a) ≥ 0.04 g/dl and (b) ≥ 0.08 g/dl. FINDINGS For 2003-18, the proportion of suicides that were alcohol-involved wherein the decedent had a BAC ≥ 0.08 g/day significantly increased on average annually for women of all age groups [young women: 2.80%, 95% confidence interval (CI) = 1.86%, 3.75%; middle-aged women: 2.20%, 95% CI = 1.20%, 3.21%; older women: 10.48%, 95% CI = 1.17%, 20.65%], while only middle-aged men experienced a significant average annual percentage increase (0.81%, 95% CI = 0.003%, 1.62%). CONCLUSION In the United States between 2003 and 2018, alcohol use preceding death by suicide increased among women compared with men.
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Affiliation(s)
- Shannon Lange
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto ON, Canada M5S 2S1,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto ON, Canada M5T 1R8,Department of Psychiatry, University of Toronto, 250 College St., Toronto ON, Canada M5T 1R8,Corresponding author: Shannon Lange, MPH, PhD, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, T521, Toronto ON, Canada M5S 2S1, Tel: 416-535-8501 ext. 34512,
| | - Mark S. Kaplan
- Luskin School of Public Affairs, University of California, 3250 Public Affairs Building. Los Angeles CA, USA 90095-1656
| | - Alexander Tran
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto ON, Canada M5S 2S1
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto ON, Canada M5S 2S1,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto ON, Canada M5T 1R8,Department of Psychiatry, University of Toronto, 250 College St., Toronto ON, Canada M5T 1R8,Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto ON, Canada M5T 3M7,Institute of Medical Science, University of Toronto, 1 King’s College Circle, Toronto ON, Canada M5S 1A8,Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya Street 8, b. 2, Moscow, 119991, Russian Federation
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9
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Fowler KA, Kaplan MS, Stone DM, Zhou H, Stevens MR, Simon TR. Suicide Among Males Across the Lifespan: An Analysis of Differences by Known Mental Health Status. Am J Prev Med 2022; 63:419-422. [PMID: 35987559 PMCID: PMC9437900 DOI: 10.1016/j.amepre.2022.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/12/2022] [Accepted: 02/24/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Suicide among males is a major public health challenge. In 2019, males accounted for nearly 80% of the suicide deaths in the U.S., and suicide was the eighth leading cause of death for males aged ≥10 years. Males who die by suicide are less likely to have known mental health conditions than females; therefore, it is important to identify prevention points outside of mental health systems. The purpose of this analysis was to compare suicide characteristics among males with and without known mental health conditions by age group to inform prevention. METHODS Suicides among 4 age groups of males were examined using the 3 most recent years of data at the time of the analysis (2016-2018) from the Centers for Disease Control and Prevention's National Violent Death Reporting System. Decedents with and without known mental health conditions were compared within age groups. The analysis was conducted in August 2021. RESULTS Most male suicide decedents had no known mental health conditions. More frequently, those without known mental health conditions died by firearm, and many tested positive for alcohol. Adolescents, young adults, and middle-aged males without known mental health conditions more often had relationship problems, arguments, and/or a crisis as a precipitating circumstance than those with known mental health conditions. CONCLUSIONS Acute stressors more often precipitated suicides of males without known mental health conditions, and they more often involved firearms. These findings underscore the importance of mitigating acute situational stressors that could contribute to emotionally reactive/impulsive suicides. Suicide prevention initiatives targeting males might focus on age-specific precipitating circumstances in addition to standard psychiatric markers.
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Affiliation(s)
- Katherine A Fowler
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Mark S Kaplan
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, California
| | - Deborah M Stone
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hong Zhou
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mark R Stevens
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Thomas R Simon
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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10
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Kaplan MS, C Mueller-Williams A, Goldman-Mellor S, Sakai-Bizmark R. Changing Trends in Suicide Mortality and Firearm Involvement Among Black Young Adults in the United States, 1999-2019. Arch Suicide Res 2022:1-6. [PMID: 35848370 DOI: 10.1080/13811118.2022.2098889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The suicide rate among adolescents and young adults in the United States increased 57% between 2007 and 2018, from 6.8 to 10.7 deaths per 100 000 individuals. Recent research characterized as alarming the increases in overall suicide rates among young Black and other racial/ethnic minority populations. To assess the temporal trends in overall suicide and firearm suicide mortality rates among non-Hispanic Black young adults, we conducted a sex-specific Joinpoint regression analysis to identify changing trends in these rates between 1999 and 2019. Data were obtained from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System. Results showed an 84.5% increase in the firearm suicide rate among young Black men and a 76.9% increase among young Black women between 2013 and 2019. Additional research is needed to investigate potential population-level exposures during or before 2013 that may have influenced suicide and firearm suicide risk.
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11
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Lange S, Rehm J, Tran A, L. Bagge C, Jasilionis D, Kaplan MS, Meščeriakova-Veliulienė O, Štelemėkas M, Probst C. Comparing gender-specific suicide mortality rate trends in the United States and Lithuania, 1990-2019: putting one of the "deaths of despair" into perspective. BMC Psychiatry 2022; 22:127. [PMID: 35177011 PMCID: PMC8851770 DOI: 10.1186/s12888-022-03766-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 02/07/2022] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION The increase in the suicide mortality rate among middle-aged adults in the United States (US) has been well documented. Aside from a few studies from the United Kingdom, it is unclear whether the suicide mortality rate trend in the US is also occurring in other developed countries. Accordingly, we aimed to compare the suicide mortality rate trends over the past 30 years in the US to a country in the European Union-Lithuania. METHODS Joinpoint regression analyses were performed to identify secular trends in the gender-specific age-standardized suicide mortality rate among individuals 15 + years of age, as well as middle-aged adults (45-54 years of age), and suicide mortality rate ratio for men-to-women. RESULTS Age-standardized suicide mortality rates among middle-aged adults in the US increased annually, on average, by 0.89% (95% CI: 0.66%, 1.12%) among men and 1.21% (95% CI: 0.75%, 1.66%) among women between 1990 and 2019. In contrast to the US, there was an overall downward trend in the suicide mortality rates among middle-aged adults in Lithuania across the study period. The average annual percent change in the suicide mortality rate ratio for men-to-women were not statistically significant for either country. CONCLUSION The suicide mortality rate trend in the US does not appear to be an indicator of an upcoming global trend, but rather should be regarded as a cautionary example of what other countries should strive to avoid.
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Affiliation(s)
- Shannon Lange
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada. .,Campbell Family Mental Health Research Institute, CAMH, 250 College Street, Toronto, ON, M5T 1R8, Canada. .,Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON, M5T 1R8, Canada.
| | - Jürgen Rehm
- grid.155956.b0000 0000 8793 5925 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON M5S 2S1 Canada ,grid.155956.b0000 0000 8793 5925Campbell Family Mental Health Research Institute, CAMH, 250 College Street, Toronto, ON M5T 1R8 Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON M5T 3M7 Canada ,grid.4488.00000 0001 2111 7257Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8 Canada ,grid.17063.330000 0001 2157 2938Institute of Medical Science, Medical Sciences Building, University of Toronto, King’s College Circle, Room 2374, Toronto, ON M5S 1A8 Canada ,grid.13648.380000 0001 2180 3484Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany ,grid.448878.f0000 0001 2288 8774Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya str., 8, b. 2, 119992 Moscow, Russian Federation
| | - Alexander Tran
- grid.155956.b0000 0000 8793 5925 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON M5S 2S1 Canada
| | - Courtney L. Bagge
- grid.214458.e0000000086837370Department of Psychiatry, University of Michigan Medical School, 2800 Plymouth Road, Ann Arbor, MI 48109 USA ,grid.418356.d0000 0004 0478 7015Center for Clinical Management Research, Department of Veterans Affairs, 2215 Fuller Road, Ann Arbor, MI 48105 USA
| | - Domantas Jasilionis
- grid.419511.90000 0001 2033 8007Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Konrad-Zuse-Str. 1, 18057 Rostock, Germany ,grid.19190.300000 0001 2325 0545Demographic Research Centre, Faculty of Social Sciences, Vytautas Magnus University, Jonavos g. 66, 44191 Kaunas, Lithuania
| | - Mark S. Kaplan
- grid.19006.3e0000 0000 9632 6718Luskin School of Public Affairs, University of California, Los Angeles, 337 Charles E Young Drive East, Los Angeles, CA 90095 USA
| | - Olga Meščeriakova-Veliulienė
- grid.45083.3a0000 0004 0432 6841Department of Health Management, Faculty of Public Health, Lithuanian University of Health Sciences, Tilžės 18, 47181 Kaunas, Lithuania
| | - Mindaugas Štelemėkas
- grid.45083.3a0000 0004 0432 6841Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Tilžės 18, 47181 Kaunas, Lithuania ,grid.45083.3a0000 0004 0432 6841Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Tilžės 18, 47181 Kaunas, Lithuania
| | - Charlotte Probst
- grid.155956.b0000 0000 8793 5925 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON M5S 2S1 Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8 Canada ,grid.7700.00000 0001 2190 4373 Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
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12
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Liu L, Capaldi CA, Orpana HM, Kaplan MS, Tonmyr L. Changes over time in means of suicide in Canada: an analysis of mortality data from 1981 to 2018. CMAJ 2021; 193:E331-E338. [PMID: 33685950 PMCID: PMC8034317 DOI: 10.1503/cmaj.202378] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND: Ongoing surveillance of the means of suicide is necessary for effective prevention. We examined how mortality rates owing to different means of suicide changed in Canada from 1981 to 2018. METHODS: We obtained data from 1981 to 2018 on suicide deaths of individuals aged 10 years and older, from the Canadian Vital Statistics Death Database. We used joinpoint regression analysis to examine changes over time in the suicide mortality rate for the 3 most common means of suicide. RESULTS: The age-standardized suicide mortality rate declined in earlier decades for both sexes, but did not significantly change in recent decades for either sex. The age-standardized rate of suicide by suffocation increased from 1993 for females (2.1% per year) and from 1996 for males (0.4% per year). The age-standardized rate of suicide by poisoning decreased for females (2.2% per year) and males (2.1% per year) from 1981 to 2018. The age-standardized rate of suicide by firearm decreased from 1981 to 2008 (7.4% per year) but did not significantly change there-after for females; for males, it decreased 2.1% per year from 1981 to 1993 and 5.7% per year from 1993 to 2007, but did not significantly change thereafter. INTERPRETATION: For both sexes, the rate of suicide by poisoning is decreasing, the rate of suicide by suffocation is increasing, and the rate of suicide by firearm has not significantly changed in the last decade. Given the high proportion of suicide deaths by suffocation, its increasing rate and the difficulty of restricting the means of suffocation, other approaches to suicide prevention are needed.
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Affiliation(s)
- Li Liu
- Centre for Surveillance and Applied Research (Liu, Capaldi, Orpana, Tonmyr), Public Health Agency of Canada; School of Epidemiology and Public Health (Orpana), University of Ottawa, Ottawa, Ont.; Luskin School of Public Affairs (Kaplan), University of California, Los Angeles, Calif.; Department of Sociology and Anthropology (Tonmyr), Carleton University, Ottawa, Ont
| | - Colin A Capaldi
- Centre for Surveillance and Applied Research (Liu, Capaldi, Orpana, Tonmyr), Public Health Agency of Canada; School of Epidemiology and Public Health (Orpana), University of Ottawa, Ottawa, Ont.; Luskin School of Public Affairs (Kaplan), University of California, Los Angeles, Calif.; Department of Sociology and Anthropology (Tonmyr), Carleton University, Ottawa, Ont.
| | - Heather M Orpana
- Centre for Surveillance and Applied Research (Liu, Capaldi, Orpana, Tonmyr), Public Health Agency of Canada; School of Epidemiology and Public Health (Orpana), University of Ottawa, Ottawa, Ont.; Luskin School of Public Affairs (Kaplan), University of California, Los Angeles, Calif.; Department of Sociology and Anthropology (Tonmyr), Carleton University, Ottawa, Ont
| | - Mark S Kaplan
- Centre for Surveillance and Applied Research (Liu, Capaldi, Orpana, Tonmyr), Public Health Agency of Canada; School of Epidemiology and Public Health (Orpana), University of Ottawa, Ottawa, Ont.; Luskin School of Public Affairs (Kaplan), University of California, Los Angeles, Calif.; Department of Sociology and Anthropology (Tonmyr), Carleton University, Ottawa, Ont
| | - Lil Tonmyr
- Centre for Surveillance and Applied Research (Liu, Capaldi, Orpana, Tonmyr), Public Health Agency of Canada; School of Epidemiology and Public Health (Orpana), University of Ottawa, Ottawa, Ont.; Luskin School of Public Affairs (Kaplan), University of California, Los Angeles, Calif.; Department of Sociology and Anthropology (Tonmyr), Carleton University, Ottawa, Ont
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13
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Sakai-Bizmark R, Kumamaru H, Estevez D, Marr EH, Haghnazarian E, Bedel LEM, Mena LA, Kaplan MS. Health-Care Utilization Due to Suicide Attempts Among Homeless Youth in New York State. Am J Epidemiol 2021; 190:1582-1591. [PMID: 33576370 PMCID: PMC8484771 DOI: 10.1093/aje/kwab037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 02/10/2021] [Indexed: 11/14/2022] Open
Abstract
Suicide remains the leading cause of death among homeless youth. We assessed differences in health-care utilization between homeless and nonhomeless youth presenting to the emergency department or hospital after a suicide attempt. New York Statewide Inpatient and Emergency Department Databases (2009-2014) were used to identify homeless and nonhomeless youth aged 10-17 who utilized health-care services following a suicide attempt. To evaluate associations with homelessness, we used logistic regression models for use of violent means, intensive care unit utilization, log-transformed linear regression models for hospitalization cost, and negative binomial regression models for length of stay. All models adjusted for individual characteristics with a hospital random effect and year fixed effect. We identified 18,026 suicide attempts with health-care utilization rates of 347.2 (95% confidence interval (CI): 317.5, 377.0) and 67.3 (95% CI: 66.3, 68.3) per 100,000 person-years for homeless and nonhomeless youth, respectively. Length of stay for homeless youth was statistically longer than that for nonhomeless youth (incidence rate ratio = 1.53, 95% CI: 1.32, 1.77). All homeless youth who visited the emergency department after a suicide attempt were subsequently hospitalized. This could suggest a higher acuity upon presentation among homeless youth compared with nonhomeless youth. Interventions tailored to homeless youth should be developed.
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Affiliation(s)
- Rie Sakai-Bizmark
- Correspondence to Dr. Rie Sakai-Bizmark, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W. Torrance Street, Torrance, CA 90502 (e-mail: )
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14
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Zuriaga A, Kaplan MS, Choi NG, Hodkinson A, Storman D, Brudasca NI, Hirani SP, Brini S. Association of mental disorders with firearm suicides: A systematic review with meta-analyses of observational studies in the United States. J Affect Disord 2021; 291:384-399. [PMID: 34098496 DOI: 10.1016/j.jad.2021.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 11/30/2022]
Abstract
In the United States (US), 61% of all suicide cases may involve firearms, and some evidence suggests that mental disorders may play a role in suicide by firearm. We performed the first systematic review and meta-analyses to investigate: (i) whether mental disorders are associated with suicide by firearm, and (ii) whether the risk of using a firearm compared with alternative means is associated with higher levels of suicide in individuals with a mental disorder METHODS AND FINDINGS: We searched twelve databases from inception to the 24th of May 2020. We retrieved 22 observational studies conducted in the US. Random-effects meta-analyses showed individuals who had a diagnosis of a mental disorder had lower odds (odds ratios (OR)= 0.50, 95% CI: 0.36 to 0.69; I2=100 (95% CI: 87 to 100%), of dying by suicide with a firearm than those who did not have a diagnosis of a mental disorder. Secondary analysis showed that decedents who had a mental health diagnosis resulted in lower odds of dying by suicide by using firearms than using other means LIMITATIONS: Risk of bias revealed a heterogeneous and poor definition of mental disorders as well as lack of control for potential demographic confounding factors. In the meta-analyses, studies were combined in the same analytic sample as 77% of these studies did not specify the type of mental disorder CONCLUSION: While our results seem to suggest that having a mental disorder may not be consistently associated with the odds of dying by suicide using a firearm, the presence of substantial heterogeneity and high risk of bias precludes any firm conclusions.
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Affiliation(s)
- Ana Zuriaga
- Division of Health Services Research and Management, School of Health Sciences, City, University of London, London, United Kingdom.
| | - Mark S Kaplan
- Luskin School of Public Affairs, University of California, Los Angeles, United States
| | - Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin, United States
| | - Alexander Hodkinson
- National Institute for Health Research, School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Dawid Storman
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland; Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Nicoleta I Brudasca
- Division of Health Services Research and Management, School of Health Sciences, City, University of London, London, United Kingdom
| | - Shashivadan P Hirani
- Division of Health Services Research and Management, School of Health Sciences, City, University of London, London, United Kingdom
| | - Stefano Brini
- Division of Health Services Research and Management, School of Health Sciences, City, University of London, London, United Kingdom
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15
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Ishimo MC, Sampasa-Kanyinga H, Olibris B, Chawla M, Berfeld N, Prince SA, Kaplan MS, Orpana H, Lang JJ. Universal interventions for suicide prevention in high-income Organisation for Economic Co-operation and Development (OECD) member countries: a systematic review. Inj Prev 2021; 27:184-193. [PMID: 33483327 PMCID: PMC8005806 DOI: 10.1136/injuryprev-2020-043975] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION To examine the effectiveness of universal suicide prevention interventions on reducing suicide mortality in high-income Organisation for Economic Co-operation and Development (OECD) member countries. METHODS We implemented a comprehensive search strategy across three electronic databases: MEDLINE (Ovid), PsycINFO (Ovid) and Embase (Ovid). All studies using time-series, retrospective, prospective, pre-post or cross-sectional study designs were included. Studies were required to examine suicide mortality as the outcome of interest. To help organise the results, studies were grouped into six broad categories of universal interventions consistent with the World Health Organization (WHO) Comprehensive Mental Health Action Plan. A narrative synthesis of results was used to describe the findings. RESULTS Of the 15 641 studies identified through the search strategy, 100 studies were eligible in the following categories: law and regulation reforms (n=66), physical barriers (n=13), community-based interventions (n=9), communication strategies (n=4), mental health policies and strategies (n=7), and access to healthcare (n=1). Overall, 100% (13/13) of the included physical barrier interventions resulted in a significant reduction in suicide mortality. Although only 70% (46/66) of the law and regulation reform interventions had a significant impact on reducing suicide, they hold promise due to their extended reach. Universal suicide prevention interventions seem to be more effective at reducing suicide among males than females, identifying a need to stratify results by sex in future studies. CONCLUSIONS These findings suggest that universal suicide prevention interventions hold promise in effectively reducing suicide mortality in high-income OECD countries.
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Affiliation(s)
- Marie-Claire Ishimo
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Hugues Sampasa-Kanyinga
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Brieanne Olibris
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada.,Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Mitulika Chawla
- Centre for Health Promotion, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Noami Berfeld
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Stephanie A Prince
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Mark S Kaplan
- Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California, USA
| | - Heather Orpana
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Justin J Lang
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada .,School of Mathematics and Statistics, Carleton University, Ottawa, Ontario, Canada
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16
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Kaplan MS, Kerr WC, McFarland BH, Bensley K, Caetano R, Giesbrecht N, Monnat SM, Nolte KB. A Reply to Monteiro et al.’s (2020) ‘Alcohol Policy and Coronavirus: An Open Research Agenda’. J Stud Alcohol Drugs 2020. [DOI: 10.15288/jsad.2020.81.687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Mark S. Kaplan
- Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California
| | - William C. Kerr
- Alcohol Research Group, Public Health Institute, Oakland, California
| | - Bentson H. McFarland
- Professor Emeritus of Psychiatry, Public Health & Preventive Medicine, Oregon Health & Science University, Portland, Oregon
| | - Kara Bensley
- Alcohol Research Group, Public Health Institute, Oakland, California
| | - Raul Caetano
- Prevention Research Center, Berkeley, California
| | | | - Shannon M. Monnat
- Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, New York
| | - Kurt B. Nolte
- University of New Mexico School of Medicine, Albuquerque, New Mexico
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17
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Kaplan MS, Kerr WC, McFarland BH, Bensley K, Caetano R, Giesbrecht N, Monnat SM, Nolte KB. A Reply to Monteiro et al.'s (2020) 'Alcohol Policy and Coronavirus: An Open Research Agenda'. J Stud Alcohol Drugs 2020; 81:687-688. [PMID: 33028483 PMCID: PMC8076483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024] Open
Affiliation(s)
- Mark S. Kaplan
- Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California
| | - William C. Kerr
- Alcohol Research Group, Public Health Institute, Oakland, California
| | - Bentson H. McFarland
- Professor Emeritus of Psychiatry, Public Health & Preventive Medicine, Oregon Health & Science University, Portland, Oregon
| | - Kara Bensley
- Alcohol Research Group, Public Health Institute, Oakland, California
| | - Raul Caetano
- Prevention Research Center, Berkeley, California
| | | | - Shannon M. Monnat
- Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, New York
| | - Kurt B. Nolte
- University of New Mexico School of Medicine, Albuquerque, New Mexico
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18
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Orpana H, Giesbrecht N, Hajee A, Kaplan MS. Alcohol and other drugs in suicide in Canada: opportunities to support prevention through enhanced monitoring. Inj Prev 2020; 27:194-200. [PMID: 32220934 PMCID: PMC8005800 DOI: 10.1136/injuryprev-2019-043504] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 02/06/2023]
Abstract
The use of alcohol and other drugs has been identified as a significant factor related to suicide through multiple pathways. This paper highlights current understanding of their contributions to suicide in Canada and identifies opportunities for enhancing monitoring and prevention initiatives. Publications from 1998 to 2018 about suicide in Canada and that referred to alcohol or other drugs were identified using PubMed and Google Scholar. A second literature search restricted to articles including results of toxicology testing was conducted by a librarian. We summarised the literature identified on ecological analyses, attributable fractions and deaths, and research including the results of toxicological analyses. Our literature search yielded 5230 publications, and 164 documents were identified for full-text screening. We summarised the findings from 30 articles. Ecological analyses support the association between alcohol sales, annual per capita alcohol consumption and suicide rates. Based on published estimates, approximately a quarter of suicide deaths in Canada are alcohol-attributable, while the estimated attributable fraction for illegal drugs is more variable. Finally, there is a dearth of literature examining the role of acute alcohol and/or drug consumption prior to suicide based on toxicological findings. The proportion of suicide decedents with drugs or alcohol present at the time of death varies widely. While there is evidence on the role of alcohol and drugs in suicide deaths, there is not a large body of research about the acute use of these substances at the time of death among suicide decedents in Canada. Our understanding of the role of alcohol and other drugs in suicide deaths could be enhanced through systematic documentation, which in turn could provide much needed guidance for clinical practice, prevention strategies and policy initiatives.
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Affiliation(s)
- Heather Orpana
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada .,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Norman Giesbrecht
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Aliya Hajee
- Downtown West Clinic, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Mark S Kaplan
- Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California, USA
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19
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Caetano R, Kaplan MS, Kerr W, McFarland BH, Giesbrecht N, Kaplan Z. Suicide, Alcohol Intoxication, and Age Among Whites and American Indians/Alaskan Natives. Alcohol Clin Exp Res 2020; 44:492-500. [PMID: 31782530 PMCID: PMC7018549 DOI: 10.1111/acer.14251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/18/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Among American Indians/Alaskan Natives (AI/ANs), suicides are disproportionately high among those younger than 40 years of age. This paper examines suicide and alcohol intoxication (postmortem BAC ≥ 0.08 g/dl) by age among Whites and AI/ANs to better understand the reasons for the high rate of suicide among AI/ANs for those younger than 40. METHODS Data come from the restricted 2003 to 2016 National Violent Death Reporting System (NVDRS), with postmortem information on 79,150 White and AI/AN suicide decedents of both genders who had a BAC test in 32 states of the United States. RESULTS Among Whites, 39.3% of decedents legally intoxicated are younger than 40 years of age, while among AI/ANs the proportion is 72.9% (p < 0.001). Multivariable logistic regression with data divided by age shows that in the 18 to 39 age group, AI/ANs are about 2 times more likely than Whites to have a postmortem BAC ≥ 0.08. Veteran status compared to nonveteran, and history of alcohol problems prior to suicide were also associated with BAC ≥ 0.08. Suicide methods other than by firearm and a report of the presence of 2 or more suicide precipitating circumstances were protective against BAC ≥ 0.08. Results for the age group 40 years of age and older mirror those for the younger group with 1 exception: Race/ethnicity was not associated with BAC level. CONCLUSIONS The proportion of suicide decedents with a BAC ≥ 0.08 is higher among AI/ANs than Whites, especially among those 18 to 39 years of age. However, acute alcohol intoxication does not fully explain differences in suicide age structure between AI/ANs and Whites.
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Affiliation(s)
- Raul Caetano
- Prevention Research Center, Berkeley, California
| | - Mark S Kaplan
- Luskin School of Public Affairs, University of California Los Angeles, Los Angeles, California
| | | | - Bentson H McFarland
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - Norman Giesbrecht
- Social & Epidemiological Research Department, Centre for Addiction & Mental Health, Toronto, Ontario, Canada
| | - Zoe Kaplan
- Prevention Research Center, Berkeley, California
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Kaplan MS, Mueller-Williams AC. The Hidden Epidemic of Firearm Suicide in the United States: Challenges and Opportunities. Health Soc Work 2019; 44:276-279. [PMID: 31651029 DOI: 10.1093/hsw/hlz029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 08/06/2019] [Indexed: 06/10/2023]
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Leung C, Kaplan MS, Xuan Z. The Association between Firearm Control Policies and Firearm Suicide among Men: A State-Level Age-Stratified Analysis. Health Soc Work 2019; 44:249-258. [PMID: 31665312 DOI: 10.1093/hsw/hlz028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 07/22/2019] [Accepted: 08/07/2019] [Indexed: 06/10/2023]
Abstract
This study examined the association between state-specific firearm control policies and firearm suicide rates among men after adjusting for state-level demographics. This cross-sectional study used state-level mortality data from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System and the Brady Campaign State Scorecard in 2017. An age-stratified (15-24 years, 25-44 years, 45-64 years, and ≥ 65 years) multivariable analysis was conducted to identify gun control policies that are associated with firearm suicide rates among men in each age group. Results indicate that the associations of specific firearm control policies and firearm suicide rates differ across the age span. In particular, more policies (for example, dealer regulations and waiting periods) are negatively associated with firearm suicide rate among men 15 to 24 years of age. The findings underscore the importance of designing gender- and age-specific policy advocacy programs directed at lowering the rate of firearm suicide. This study also suggests that California, known for its innovative gun safety legislation efforts, could serve as a model for other states starting preventive programs to reduce the firearm suicide rate. Implications of the findings for social work practice are discussed.
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Sperlich M, Logan-Greene P, Slovak K, Kaplan MS. Addressing Gun Violence: A Social Work Imperative. Health Soc Work 2019; 44:217-220. [PMID: 31621848 DOI: 10.1093/hsw/hlz022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Goldman-Mellor S, Allen K, Kaplan MS. Rural/Urban Disparities in Adolescent Nonfatal Suicidal Ideation and Suicide Attempt: A Population-Based Study. Suicide Life Threat Behav 2018; 48:709-719. [PMID: 28940747 DOI: 10.1111/sltb.12390] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 06/15/2017] [Indexed: 11/28/2022]
Abstract
Adolescent suicide rates exhibit stark geographic disparities, with rates highest in rural areas. The causes of this disparity remain unclear. We investigated whether adolescent nonfatal suicidal ideation and attempt-leading risk factors for suicide-demonstrate the same rural/urban disparity. Using adolescent data from the 2011-2014 waves of the population-representative California Health Interview Survey (CHIS; N = 4,616), we estimated associations between residence in a rural area and suicidal ideation and suicide attempt, as well as access to psychological care. Survey-weighted logistic regression models controlled for individual- and family-level covariates. Results showed that rural adolescents were, compared to urban adolescents, substantially less likely to report recent suicidal ideation (OR = 0.25, 95% confidence interval [CI] = 0.10, 0.61) and suicide attempt (OR = 0.17, 95% CI = 0.05, 0.66). Suicidal youths in rural and urban areas were equally likely, however, to report receiving psychological care. In this study, rural adolescents in California reported lower rates of nonfatal suicidal behavior compared to urban peers. This pattern contrasts with rates of adolescent suicide fatality, which are higher in rural areas. Results suggest that reducing geographic disparities in youth suicide may require multifaceted public health approaches, in addition to better identification and treatment for high-risk adolescents.
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Affiliation(s)
- Sidra Goldman-Mellor
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, CA, USA
| | - Kristina Allen
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, CA, USA
| | - Mark S Kaplan
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, CA, USA
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Leung CA, Kaplan MS. SUICIDE BY FIREARM AMONG WOMEN ACROSS THE AGE SPAN: FINDINGS FROM THE NATIONAL VIOLENT DEATH REPORTING SYSTEM. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C A Leung
- UCLA, Los Angeles, California, United States
| | - M S Kaplan
- University of California, Los Angeles, Los Angeles, California, USA
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Choi NG, DiNitto DM, Marti CN, Kaplan MS, Conwell Y. Suicide Means among Decedents Aged 50+ Years, 2005-2014: Trends and Associations with Sociodemographic and Precipitating Factors. Am J Geriatr Psychiatry 2017; 25:1404-1414. [PMID: 28689643 DOI: 10.1016/j.jagp.2017.06.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/19/2017] [Accepted: 06/01/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine 1) temporal trends between 2005 and 2014 in the three most frequently used suicide means (firearms, hanging/suffocation, alcohol/drug/medicine overdose) by decedents aged 50+ years and 2) associations of suicide means with sociodemographic and precipitating factors. METHODS The National Violent Death Reporting System, 2005-2014, provided data (N = 46,857). Suicide means were identified from ICD-10 codes for underlying cause of death and coroner/medical examiner (CME) reports. Precipitating factors are based on either CME or law enforcement report. Age-group (50-64 and 65+ years) and gender-separate logistic regression analyses were used to examine study questions. RESULTS In the 50-64 years age group, each advancing year (i.e., from 2005 to 2014) was associated with a 1% decrease in the odds of firearm use and a 6% increase in the odds of hanging/suffocation among men; a 9% increase in the odds of hanging/suffocation among women; and a 4% decrease in the odds of overdose among each gender. In the 65+ years age group, each advancing year was associated with a 4% increase in the odds of overdose among men. Physical health was a significant factor for firearm use among men (adjusted odds ratio: 1.47; 95% CI: 1.39-1.55) only. Regardless of gender and age, mental health and substance abuse problems and prior suicide attempts were associated with hanging/suffocation and overdose. CONCLUSIONS Firearm use decreased among men aged 50-64 years between 2005 and 2014, but its use did not change among the other gender by age groups. With rapidly growing numbers of older adults, routine suicide risk assessments, firearm safety monitoring, and interventions to improve quality of life are needed.
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Affiliation(s)
- Namkee G Choi
- School of Social Work, University of Texas at Austin, Austin, TX.
| | - Diana M DiNitto
- School of Social Work, University of Texas at Austin, Austin, TX
| | - C Nathan Marti
- School of Social Work, University of Texas at Austin, Austin, TX
| | - Mark S Kaplan
- Luskin School of Public Affairs, University of California at Los Angeles, Los Angeles, CA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
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Choi NG, DiNitto DM, Marti CN, Kaplan MS. Older Suicide Decedents: Intent Disclosure, Mental and Physical Health, and Suicide Means. Am J Prev Med 2017; 53:772-780. [PMID: 28985982 DOI: 10.1016/j.amepre.2017.07.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 06/05/2017] [Accepted: 07/24/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION This study examined: (1) associations of suicide intent disclosure with depressed mood and health problems; (2) age-group differences in those associations; and (3) relationship between disclosure and suicide means among suicide decedents aged ≥50 years (N=46,857). METHODS Data came from the National Violent Death Reporting Systems, 2005-2014. Data analysis was conducted in 2017. Chi-square tests were used to compare disclosers and nondisclosers on sociodemographic and precipitating factors and suicide means. Logistic regression analyses were used to examine the research questions. RESULTS The overall disclosure rate was 23.4%. Logistic regression results showed that both depressed mood (AOR=1.57, 95% CI=1.50, 1.65, p<0.001) and health problems (AOR=1.56, 95% CI=1.48, 1.64, p<0.001) were associated with increased odds of disclosure. Compared with decedents aged 50-59 years, those aged 70-79 years and ≥80 years had greater disclosure odds. When interaction terms of age group X health problems were entered in the model, disclosure odds increased among those with health problems in the groups aged 60-69 years (ratio of AOR=1.19, 95% CI=1.06, 1.34, p=0.003), 70-79 years (ratio of AOR=1.29, 95% CI=1.13, 1.48, p<0.001), and ≥80 years (ratio of AOR=1.41, 95% CI=1.20, 1.66, p<0.001). Compared with other suicide means, both firearm use and hanging/suffocation were associated with lower disclosure odds. CONCLUSIONS The older the decedents were, the more likely they were to have disclosed suicidal intent, and health problems largely explained their higher odds of disclosure. Healthcare providers need better preparation to screen and aid those in need to prevent suicide. Social support system members should also be assisted in identifying warning signs and linking older adults to services.
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Affiliation(s)
- Namkee G Choi
- University of Texas at Austin School of Social Work, Austin, Texas.
| | - Diana M DiNitto
- University of Texas at Austin School of Social Work, Austin, Texas
| | - C Nathan Marti
- University of Texas at Austin School of Social Work, Austin, Texas
| | - Mark S Kaplan
- University of California at Los Angeles Luskin School of Public Affairs, Los Angeles, California
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Kaplan MS, Caetano R, Giesbrecht N, Huguet N, Kerr WC, McFarland BH, Nolte KB. The National Violent Death Reporting System: Use of the Restricted Access Database and Recommendations for the System's Improvement. Am J Prev Med 2017; 53:130-133. [PMID: 28347589 PMCID: PMC5500302 DOI: 10.1016/j.amepre.2017.01.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/30/2016] [Accepted: 01/27/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Mark S Kaplan
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, California.
| | - Raul Caetano
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California
| | - Norman Giesbrecht
- Social and Epidemiological Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - William C Kerr
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Bentson H McFarland
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - Kurt B Nolte
- Office of the Medical Investigator, University of New Mexico, Albuquerque, New Mexico
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Kerr WC, Kaplan MS, Huguet N, Caetano R, Giesbrecht N, McFarland BH. Economic Recession, Alcohol, and Suicide Rates: Comparative Effects of Poverty, Foreclosure, and Job Loss. Am J Prev Med 2017; 52:469-475. [PMID: 27856114 PMCID: PMC5362282 DOI: 10.1016/j.amepre.2016.09.021] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/29/2016] [Accepted: 09/12/2016] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Suicide rates and the proportion of alcohol-involved suicides rose during the 2008-2009 recession. Associations between county-level poverty, foreclosures, and unemployment and suicide rates and proportion of alcohol-involved suicides were investigated. METHODS In 2015, National Violent Death Reporting System data from 16 states in 2005-2011 were utilized to calculate suicide rates and a measure of alcohol involvement in suicides at the county level. Panel models with year and state fixed effects included county-level measures of unemployment, foreclosure, and poverty rates. RESULTS Poverty rates were strongly associated with suicide rates for both genders and all age groups, were positively associated with alcohol involvement in suicides for men aged 45-64 years, and negatively associated for men aged 20-44 years. Foreclosure rates were negatively associated with suicide rates for women and those aged ≥65 years but positively related for those aged 45-64 years. Unemployment rate effects on suicide rates were mediated by poverty rates in all groups. CONCLUSIONS Population risk of suicide was most clearly associated with county-level poverty rates, indicating that programs addressing area poverty should be targeted for reducing suicide risk. Poverty rates were also associated with increased alcohol involvement for men aged 45-64 years, indicating a role for alcohol in suicide for this working-aged group. However, negative associations between economic indicators and alcohol involvement were found for four groups, suggesting that non-economic factors or more general economic effects not captured by these indicators may have played a larger role in alcohol-related suicide increases.
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Affiliation(s)
- William C Kerr
- Alcohol Research Group, Public Health Institute, Emeryville, California.
| | - Mark S Kaplan
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, California
| | - Nathalie Huguet
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon
| | - Raul Caetano
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California
| | - Norman Giesbrecht
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Bentson H McFarland
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
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Xuan Z, Naimi TS, Kaplan MS, Bagge CL, Few LR, Maisto S, Saitz R, Freeman R. Alcohol Policies and Suicide: A Review of the Literature. Alcohol Clin Exp Res 2016; 40:2043-2055. [PMID: 27618526 DOI: 10.1111/acer.13203] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 07/25/2016] [Indexed: 11/28/2022]
Abstract
Both intoxication and chronic heavy alcohol use are associated with suicide. There is extensive population-level evidence linking per capita alcohol consumption with suicide. While alcohol policies can reduce excessive alcohol consumption, the relationship between alcohol policies and suicide warrants a critical review of the literature. This review summarizes the associations between various types of alcohol policies and suicide, both in the United States and internationally, as presented in English-language literature published between 1999 and 2014. Study designs, methodological challenges, and limitations in ascertaining the associations are discussed. Because of the substantial between-states variation in alcohol policies, U.S.-based studies contributed substantially to the literature. Repeated cross-sectional designs at both the ecological level and decedent level were common among U.S.-based studies. Non-U.S. studies often used time series data to evaluate pre-post comparisons of a hybrid set of policy changes. Although inconsistency remained, the published literature in general supported the protective effect of restrictive alcohol policies on reducing suicide as well as the decreased level of alcohol involvement among suicide decedents. Common limitations included measurement and selection bias and a focus on effects of a limited number of alcohol policies without accounting for other alcohol policies. This review summarizes a number of studies that suggest restrictive alcohol policies may contribute to suicide prevention on a general population level and to a reduction of alcohol involvement among suicide deaths.
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Affiliation(s)
- Ziming Xuan
- Department of Community Health Sciences , Boston University School of Public Health, Boston, Massachusetts.
| | - Timothy S Naimi
- Section of General Internal Medicine , Boston Medical Center, Boston, Massachusetts
| | - Mark S Kaplan
- Department of Social Welfare, Luskin School of Public Affairs, University of California Los Angeles, Los Angeles, California
| | - Courtney L Bagge
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi
| | - Lauren R Few
- Department of Psychiatry , Washington University School of Medicine, Saint Louis, Missouri
| | - Stephen Maisto
- Department of Psychology , Syracuse University, Syracuse, New York
| | - Richard Saitz
- Department of Community Health Sciences , Boston University School of Public Health, Boston, Massachusetts
| | - Robert Freeman
- National Institute on Alcohol Abuse and Alcoholism , NIH, Bethesda, Maryland
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Denneson LM, Kovas AE, Britton PC, Kaplan MS, McFarland BH, Dobscha SK. Suicide Risk Documented During Veterans' Last Veterans Affairs Health Care Contacts Prior to Suicide. Suicide Life Threat Behav 2016; 46:363-74. [PMID: 26833711 DOI: 10.1111/sltb.12226] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 10/11/2015] [Indexed: 11/28/2022]
Abstract
A total of 295 veterans who died by suicide in 2009 across 11 states and received Veterans Affairs (VA) health care in the 6 months prior to death were identified. The suicide risk factors documented and the care received at these veterans' last VA contacts are described, and the study explores whether veterans present differently to VA care (i.e., different risk factors documented or different care settings accessed) based on the proximity of their last contact to suicide. Many veterans were seen in primary care (n = 136; 46%) for routine follow-up (n = 168; 57%). Fifty-three (18%) were assessed for suicidal thoughts; 20 (38%) of whom endorsed such thoughts. Although higher frequencies of some risk factors at last contacts more proximal to suicide compared to those more distal were observed, findings overall highlight the challenges clinicians face detecting enhanced risk prior to suicide.
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Affiliation(s)
- Lauren M Denneson
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA.,Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Anne E Kovas
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA
| | - Peter C Britton
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA.,Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Mark S Kaplan
- Department of Social Welfare, University of California - Los Angeles Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Bentson H McFarland
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Steven K Dobscha
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA.,Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
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Kaplan MS, Huguet N, Caetano R, Giesbrecht N, Kerr WC, McFarland BH. Heavy Alcohol Use Among Suicide Decedents Relative to a Nonsuicide Comparison Group: Gender-Specific Effects of Economic Contraction. Alcohol Clin Exp Res 2016; 40:1501-6. [PMID: 27187543 DOI: 10.1111/acer.13100] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 04/11/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The primary objective of this gender-stratified study was to assess the rate of heavy alcohol use among suicide decedents relative to a nonsuicide comparison group during the 2008 to 2009 economic crisis. METHODS The National Violent Death Reporting System and the Behavioral Risk Factor Surveillance System were analyzed by gender-stratified multiple logistic regression to test whether change in acute intoxication (blood alcohol content ≥0.08 g/dl) before (2005 to 2007), during (2008 to 2009), and after (2010 to 2011) the Great Recession mirrored change in heavy alcohol use in a living sample. RESULTS Among men, suicide decedents experienced a significantly greater increase (+8%) in heavy alcohol use at the onset of the recession (adjusted ratio of odds ratio = 1.15, 95% confidence interval = 1.10 to 1.20) (relative to the prerecession period) than did men in a nonsuicide comparison group (-2%). Among women, changes in rates of heavy alcohol use were similar in the suicide and nonsuicide comparison groups at the onset and after the recession. CONCLUSIONS Acute alcohol use contributed to suicide among men during the recent economic downturn. Among women who died by suicide, acute alcohol use mirrored consumption in the general population. Women may show resilience (or men, vulnerability) to deleterious interaction of alcohol with financial distress.
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Affiliation(s)
- Mark S Kaplan
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, California
| | - Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Raul Caetano
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California
| | - Norman Giesbrecht
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - William C Kerr
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Bentson H McFarland
- Department of Psychiatry, Oregon Health and Science University, Portland, Oregon
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Kaplan MS, Huguet N, McFarland BH, Caetano R, Conner KR, Nolte KB, Giesbrecht N. Heavy Alcohol Use Among Suicide Decedents: Differences in Risk Across Racial-Ethnic Groups. Psychiatr Serv 2016; 67:258. [PMID: 26725300 DOI: 10.1176/appi.ps.201500494] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Mark S Kaplan
- Dr. Kaplan is with the Luskin School of Public Affairs, University of California, Los Angeles (e-mail: ). Dr. Huguet and Dr. McFarland are with the Oregon Health and Science University, Portland. Dr. Caetano is with the Pacific Institute for Research and Evaluation, Oakland, California. Dr. Conner is with the VISN 2 Center of Excellence for Suicide Prevention, U.S. Department of Veterans Affairs, Canandaigua, New York, and the University of Rochester Medical Center, Rochester, New York. Dr. Nolte is with the University of New Mexico, Albuquerque. Dr. Giesbrecht is with the Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Amy M. Kilbourne, Ph.D., M.P.H., and Tami L. Mark, Ph.D., are editors of this column
| | - Nathalie Huguet
- Dr. Kaplan is with the Luskin School of Public Affairs, University of California, Los Angeles (e-mail: ). Dr. Huguet and Dr. McFarland are with the Oregon Health and Science University, Portland. Dr. Caetano is with the Pacific Institute for Research and Evaluation, Oakland, California. Dr. Conner is with the VISN 2 Center of Excellence for Suicide Prevention, U.S. Department of Veterans Affairs, Canandaigua, New York, and the University of Rochester Medical Center, Rochester, New York. Dr. Nolte is with the University of New Mexico, Albuquerque. Dr. Giesbrecht is with the Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Amy M. Kilbourne, Ph.D., M.P.H., and Tami L. Mark, Ph.D., are editors of this column
| | - Bentson H McFarland
- Dr. Kaplan is with the Luskin School of Public Affairs, University of California, Los Angeles (e-mail: ). Dr. Huguet and Dr. McFarland are with the Oregon Health and Science University, Portland. Dr. Caetano is with the Pacific Institute for Research and Evaluation, Oakland, California. Dr. Conner is with the VISN 2 Center of Excellence for Suicide Prevention, U.S. Department of Veterans Affairs, Canandaigua, New York, and the University of Rochester Medical Center, Rochester, New York. Dr. Nolte is with the University of New Mexico, Albuquerque. Dr. Giesbrecht is with the Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Amy M. Kilbourne, Ph.D., M.P.H., and Tami L. Mark, Ph.D., are editors of this column
| | - Raul Caetano
- Dr. Kaplan is with the Luskin School of Public Affairs, University of California, Los Angeles (e-mail: ). Dr. Huguet and Dr. McFarland are with the Oregon Health and Science University, Portland. Dr. Caetano is with the Pacific Institute for Research and Evaluation, Oakland, California. Dr. Conner is with the VISN 2 Center of Excellence for Suicide Prevention, U.S. Department of Veterans Affairs, Canandaigua, New York, and the University of Rochester Medical Center, Rochester, New York. Dr. Nolte is with the University of New Mexico, Albuquerque. Dr. Giesbrecht is with the Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Amy M. Kilbourne, Ph.D., M.P.H., and Tami L. Mark, Ph.D., are editors of this column
| | - Kenneth R Conner
- Dr. Kaplan is with the Luskin School of Public Affairs, University of California, Los Angeles (e-mail: ). Dr. Huguet and Dr. McFarland are with the Oregon Health and Science University, Portland. Dr. Caetano is with the Pacific Institute for Research and Evaluation, Oakland, California. Dr. Conner is with the VISN 2 Center of Excellence for Suicide Prevention, U.S. Department of Veterans Affairs, Canandaigua, New York, and the University of Rochester Medical Center, Rochester, New York. Dr. Nolte is with the University of New Mexico, Albuquerque. Dr. Giesbrecht is with the Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Amy M. Kilbourne, Ph.D., M.P.H., and Tami L. Mark, Ph.D., are editors of this column
| | - Kurt B Nolte
- Dr. Kaplan is with the Luskin School of Public Affairs, University of California, Los Angeles (e-mail: ). Dr. Huguet and Dr. McFarland are with the Oregon Health and Science University, Portland. Dr. Caetano is with the Pacific Institute for Research and Evaluation, Oakland, California. Dr. Conner is with the VISN 2 Center of Excellence for Suicide Prevention, U.S. Department of Veterans Affairs, Canandaigua, New York, and the University of Rochester Medical Center, Rochester, New York. Dr. Nolte is with the University of New Mexico, Albuquerque. Dr. Giesbrecht is with the Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Amy M. Kilbourne, Ph.D., M.P.H., and Tami L. Mark, Ph.D., are editors of this column
| | - Norman Giesbrecht
- Dr. Kaplan is with the Luskin School of Public Affairs, University of California, Los Angeles (e-mail: ). Dr. Huguet and Dr. McFarland are with the Oregon Health and Science University, Portland. Dr. Caetano is with the Pacific Institute for Research and Evaluation, Oakland, California. Dr. Conner is with the VISN 2 Center of Excellence for Suicide Prevention, U.S. Department of Veterans Affairs, Canandaigua, New York, and the University of Rochester Medical Center, Rochester, New York. Dr. Nolte is with the University of New Mexico, Albuquerque. Dr. Giesbrecht is with the Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Amy M. Kilbourne, Ph.D., M.P.H., and Tami L. Mark, Ph.D., are editors of this column
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Caetano R, Kaplan MS, Huguet N, Conner K, McFarland BH, Giesbrecht N, Nolte KB. Precipitating Circumstances of Suicide and Alcohol Intoxication Among U.S. Ethnic Groups. Alcohol Clin Exp Res 2015; 39:1510-7. [PMID: 26173709 DOI: 10.1111/acer.12788] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 05/19/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Our goal was to assess the prevalence of 9 different types of precipitating circumstances among suicide decedents, and examine the association between circumstances and postmortem blood alcohol concentration (BAC ≥ 0.08 g/dl) across U.S. ethnic groups. METHODS Data come from the restricted 2003 to 2011 National Violent Death Reporting System, with postmortem information on 59,384 male and female suicide decedents for 17 U.S. states. RESULTS Among men, precipitating circumstances statistically associated with a BAC ≥ 0.08 g/dl were physical health and job problems for Blacks, and experiencing a crisis, physical health problems, and intimate partner problem for Hispanics. Among women, the only precipitating circumstance associated with a BAC ≥ 0.08 g/dl was substance abuse problems other than alcohol for Blacks. The number of precipitating circumstances present before the suicide was negatively associated with a BAC ≥ 0.08 g/dl for Whites, Blacks, and Hispanics. CONCLUSIONS Selected precipitating circumstances were associated with a BAC ≥ 0.08 g/dl, and the strongest determinant of this level of alcohol intoxication prior to suicide among all ethnic groups was the presence of an alcohol problem.
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Affiliation(s)
- Raul Caetano
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California
| | - Mark S Kaplan
- Luskin School of Public Affairs, University of California Los Angeles, Los Angeles, California
| | | | - Kenneth Conner
- VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, New York.,Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Bentson H McFarland
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - Norman Giesbrecht
- Social & Epidemiological Research Department, Centre for Addiction & Mental Health, Toronto, Ontario, Canada
| | - Kurt B Nolte
- Office of the Medical Investigator, University of New Mexico School of Medicine, Albuquerque, New Mexico
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Giesbrecht N, Huguet N, Ogden L, Kaplan MS, McFarland BH, Caetano R, Conner KR, Nolte KB. Acute alcohol use among suicide decedents in 14 US states: impacts of off-premise and on-premise alcohol outlet density. Addiction 2015; 110:300-7. [PMID: 25310999 PMCID: PMC4427246 DOI: 10.1111/add.12762] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/21/2014] [Accepted: 10/03/2014] [Indexed: 11/29/2022]
Abstract
AIMS To estimate the association between per capita alcohol retail outlet density and blood alcohol concentration (BAC) from 51 547 suicide decedents and to analyse the relationship between alcohol outlet density and socio-demographic characteristics among alcohol-positive suicide decedents in the United States by racial/ethnic groups and method of suicide. DESIGN Analysis of US data, 2003-11, National Violent Death Reporting System. SETTING Suicide decedents from 14 US states. PARTICIPANTS A total of 51 347 suicide decedents tested for BAC. MEASUREMENTS BAC and levels were derived from coroner/medical examiner reports. Densities of county level on-premises and off-premises alcohol retail outlets were calculated using the 2010 Census. FINDINGS Multi-level logistic regression models suggested that higher off-premises alcohol outlet densities were associated with greater proportions of alcohol-related suicides among men-for suicides with alcohol present [BAC >0; adjusted odds ratio (AOR) = 1.08, 95% confidence interval (CI) = 1.03-1.13]. Interactions between outlet density and decedents' characteristics were also tested. There was an interaction between off-premises alcohol availability and American Indian/Alaska Native race (AOR = 1.36; 95% CI = 1.10-1.69) such that this subgroup had highest BAC positivity. On-premises density was also associated with BAC >0 (AOR = 1.07; 95% CI = 1.03-1.11) and BAC ≥0.08 (AOR = 1.05; 95% CI = 1.02-1.09) among male decedents. CONCLUSIONS In the United States, the density of both on- and off-premises alcohol outlets in a county is associated positively with alcohol-related suicide, especially among American Indians/Alaska Natives.
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Affiliation(s)
- Norman Giesbrecht
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Huguet N, McFarland BH, Kaplan MS. A Comparison of Suicides and Undetermined Deaths by Poisoning among Women: An Analysis of the National Violent Death Reporting System. Arch Suicide Res 2015; 19:190-201. [PMID: 25010383 DOI: 10.1080/13811118.2014.915275] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The study compared the prevalence of common suicide risk factors between poisoning deaths classified as injuries of undetermined intent or suicides among women. Data were derived from the 2003-10 National Violent Death Reporting System. Multiple logistic regression assessed the factors associated with 799 undetermined deaths (relative to 3,233 suicides). Female decedents with lower education, a substance use problem, and a health problem were more likely to be classified as undetermined death. Older women, those with an intimate partner problem, financial problem, depressed mood, mental health problem, attempted suicide, and disclosed intent to die were less likely to be classified as undetermined death. The present study raises the possibility that many (perhaps most) undetermined female poisoning deaths are suicides.
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Affiliation(s)
- Nathalie Huguet
- a Research Associate, Center for Public Health Studies , Portland State University , Portland , Oregon , USA
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Dobscha SK, Denneson LM, Kovas AE, Teo A, Forsberg CW, Kaplan MS, Bossarte R, McFarland BH. Correlates of suicide among veterans treated in primary care: case-control study of a nationally representative sample. J Gen Intern Med 2014; 29 Suppl 4:853-60. [PMID: 25355088 PMCID: PMC4239287 DOI: 10.1007/s11606-014-3028-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Veterans receiving Veterans Affairs (VA) healthcare have increased suicide risk compared to the general population. Many patients see primary care clinicians prior to suicide. Yet little is known about the correlates of suicide among patients who receive primary care treatment prior to death. OBJECTIVE Our aim was to describe characteristics of veterans who received VA primary care in the 6 months prior to suicide; and to compare these to characteristics of control patients who also received VA primary care. DESIGN This was a retrospective case-control study. SUBJECTS The investigators partnered with VA operations leaders to obtain death certificate data from 11 states for veterans who died by suicide in 2009. Cases were matched 1:2 to controls based on age, sex, and clinician. MAIN MEASURES Demographic, diagnosis, and utilization data were obtained from VA's Corporate Data Warehouse. Additional clinical and psychosocial context data were collected using manual medical record review. Multivariate conditional logistic regression was used to examine associations between potential predictor variables and suicide. KEY RESULTS Two hundred and sixty-nine veteran cases were matched to 538 controls. Average subject age was 63 years; 97 % were male. Rates of mental health conditions, functional decline, sleep disturbance, suicidal ideation, and psychosocial stressors were all significantly greater in cases compared to controls. In the final model describing men in the sample, non-white race (OR = 0.51; 95 % CI = 0.27-0.98) and VA service-connected disability (OR = 0.54; 95 % CI = 0.36-0.80) were associated with decreased odds of suicide, while anxiety disorder (OR = 3.52; 95 % CI = 1.79-6.92), functional decline (OR = 2.52; 95 % CI = 1.55-4.10), depression (OR = 1.82; 95 % CI = 1.07-3.10), and endorsement of suicidal ideation (OR = 2.27; 95 % CI = 1.07-4.83) were associated with greater odds of suicide. CONCLUSIONS Assessment for anxiety disorders and functional decline in addition to suicidal ideation and depression may be especially important for determining suicide risk in this population. Continued development of interventions that support identifying and addressing these conditions in primary care is indicated.
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Affiliation(s)
- Steven K Dobscha
- Center to Improve Veteran Involvement in Care, Portland Veterans Affairs Medical Center, P.O. Box 1034 (R&D 66), Portland, OR, 97207, USA,
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Feeny D, Garner R, Bernier J, Thompson A, McFarland BH, Huguet N, Kaplan MS, Ross NA, Blanchard CM. Physical activity matters: associations among body mass index, physical activity, and health-related quality of life trajectories over 10 years. J Phys Act Health 2014; 11:1265-75. [PMID: 24176861 PMCID: PMC4358805 DOI: 10.1123/jpah.2012-0268] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The objective of this study was to assess the associations among body mass index (BMI), leisure time physical activity (LTPA) and health-related quality of life (HRQL) trajectories among adults. METHODS Self-reported data were drawn from the Canadian National Population Health Survey, with respondents being interviewed every 2 years between 1996-97 and 2006-07. Using growth curve modeling, HRQL trajectories for individuals aged 18 and over were associated with measures of BMI and LTPA. Growth models were constructed separately for males and females. RESULTS Findings suggested that, for males, BMI categories had little impact on baseline HRQL, and no impact on the rate of change in HRQL. Among women, higher BMI categories were associated with significantly lower baseline HRQL. However, BMI had no impact on the rate of change of HRQL. Conversely, for both men and women and regardless of BMI category, LTPA had significant impacts on baseline HRQL, as well as the rate of change in HRQL. Individuals who were inactive or sedentary had much steeper declines in HRQL as they aged, as compared with individuals who were active in their leisure time. CONCLUSIONS The results underscore the importance of LTPA in shaping trajectories of HRQL.
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Affiliation(s)
- David Feeny
- Dept of Economics, McMaster University, Canada
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Kaplan MS, Huguet N, Caetano R, Giesbrecht N, Kerr WC, McFarland BH. Economic contraction, alcohol intoxication and suicide: analysis of the National Violent Death Reporting System. Inj Prev 2014; 21:35-41. [PMID: 25024394 DOI: 10.1136/injuryprev-2014-041215] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Although there is a large and growing body of evidence concerning the impact of contracting economies on suicide mortality risk, far less is known about the role alcohol consumption plays in the complex relationship between economic conditions and suicide. The aims were to compare the postmortem alcohol intoxication rates among male and female suicide decedents before (2005-2007), during (2008-2009) and after (2010-2011) the economic contraction in the USA. METHODS Data from the restricted National Violent Death Reporting System (2005-2011) for male and female suicide decedents aged 20 years and older were analysed by Poisson regression analysis to test whether there was significant change in the fractions of suicide decedents who were acutely intoxicated at the time of death (defined as blood alcohol content ≥0.08 g/dL) prior, during and after the downturn. RESULTS The fraction of all suicide decedents with alcohol intoxication increased by 7% after the onset of the recession from 22.2% in 2005-2007 to 23.9% in 2008-2011. Compared with the years prior to the recession, male suicide decedents showed a 1.09-fold increased risk of alcohol intoxication within the first 2 years of the recession. Surprisingly, there was evidence of a lag effect among female suicide decedents, who had a 1.14-fold (95% CI 1.02 to 1.27) increased risk of intoxication in 2010-2011 compared with 2005-2007. CONCLUSIONS These findings suggest that acute alcohol intoxication in suicide interacts with economic conditions, becoming more prevalent during contractions.
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Affiliation(s)
- M S Kaplan
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, California, USA
| | - N Huguet
- Center for Public Health Studies, Portland State University, Portland, Oregon, USA
| | - R Caetano
- School of Public Health, University of Texas, Dallas, Texas, USA
| | - N Giesbrecht
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - W C Kerr
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA
| | - B H McFarland
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
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Kaplan MS, Huguet N, McFarland BH, Caetano R, Conner KR, Giesbrecht N, Nolte KB. Use of alcohol before suicide in the United States. Ann Epidemiol 2014; 24:588-592.e1-2. [PMID: 24953567 DOI: 10.1016/j.annepidem.2014.05.008] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 04/22/2014] [Accepted: 05/16/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE Few studies have compared acute use of alcohol in suicide decedents with that in a nonsuicide group. This study provides the first national analysis of acute use of alcohol before suicide compared with an estimate of acute use of alcohol in a living sample. METHODS Pooled 2003-2011 National Violent Death Reporting System data were used to estimate the prevalence of postmortem blood alcohol content positivity (blood alcohol content >0.0 g/dL) and intoxication (blood alcohol content ≥0.08 g/dL). Population estimates of comparable use of alcohol (within the past 48 hours) were based on the National Epidemiologic Survey on Alcohol and Related Conditions. RESULTS Compared with the living sample, male and female suicide decedents showed, respectively, a 1.83-fold (95% confidence interval [CI], 1.73-1.93) and 2.40-fold (95% CI, 2.24-2.57) increased risk of alcohol ingestion before their death after age, race/ethnicity, and chronic alcohol problems were controlled. Furthermore, male and female decedents exhibited, respectively, a 6.18-fold (95% CI, 5.57-6.86) and a 10.04-fold (95% CI, 8.67-11.64) increased risk of being intoxicated before their death after confounders were considered. CONCLUSIONS The findings underscore the crucial need to include among the essential components of suicide prevention policies programs that minimize the use of alcohol, particularly drinking to intoxication.
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Affiliation(s)
- Mark S Kaplan
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA.
| | - Nathalie Huguet
- Center for Public Health Studies, School of Community Health, College of Urban & Public Affairs, Portland State University, Portland, OR
| | | | - Raul Caetano
- The University of Texas School of Public Health, Dallas Regional Campus, Dallas
| | - Kenneth R Conner
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY; VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY
| | - Norman Giesbrecht
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kurt B Nolte
- Office of the Medical Investigator, University of New Mexico School of Medicine, Albuquerque
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Huguet N, Kaplan MS, McFarland BH. Huguet et al. Respond. Am J Public Health 2014; 104:e1-2. [DOI: 10.2105/ajph.2013.301856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Nathalie Huguet
- Nathalie Huguet is with the Center for Public Health Studies, Portland State University, Portland, OR. Mark S. Kaplan is with the Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California, Los Angeles. Bentson H. McFarland is with the Department of Psychiatry, Oregon Health & Science University, Portland
| | - Mark S. Kaplan
- Nathalie Huguet is with the Center for Public Health Studies, Portland State University, Portland, OR. Mark S. Kaplan is with the Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California, Los Angeles. Bentson H. McFarland is with the Department of Psychiatry, Oregon Health & Science University, Portland
| | - Bentson H. McFarland
- Nathalie Huguet is with the Center for Public Health Studies, Portland State University, Portland, OR. Mark S. Kaplan is with the Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California, Los Angeles. Bentson H. McFarland is with the Department of Psychiatry, Oregon Health & Science University, Portland
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Kaplan MS, Huguet N, Feeny D, McFarland BH, Caetano R, Bernier J, Giesbrecht N, Oliver L, Ramage-Morin P, Ross NA. The association between alcohol use and long-term care placement among older Canadians: a 14-year population-based study. Addict Behav 2014; 39:219-24. [PMID: 24169370 DOI: 10.1016/j.addbeh.2013.09.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 08/15/2013] [Accepted: 09/09/2013] [Indexed: 11/17/2022]
Abstract
Studies have shown that moderate alcohol use confers protection against some of the dominant predictors of long-term care placement, including diminished cognitive functioning, physical disability, and injury. But little is known about the association between alcohol use and the likelihood of placement in long-term care facilities. A nationally representative sample of 5404 community-dwelling Canadians ages 50 years and older at baseline (1994/95) was obtained from the longitudinal National Population Health Survey. Alcohol use categories were developed based on the quantity and frequency of use in the 12 months before the interview. Cox proportional hazards models were used to estimate the association between alcohol use at baseline and subsequent placement in long-term care facilities after adjusting for covariates measured at baseline. During the 14-year follow-up period, 14% of lifetime abstainers, 10% of former drinkers, 7% of infrequent drinkers, 4% of moderate drinkers, and 3% of heavy drinkers were placed in long-term care facilities. Furthermore, the multivariate analysis revealed that abstainers, former drinkers, and infrequent drinkers were more than twice as likely to be placed in long-term care as moderate drinkers. Moderate drinking was protective against placement in long-term care facilities even after adjusting for an array of well-known confounders. The strong protective effect of moderate alcohol use on long-term care entry is likely due to a complex mix of physical, cognitive and psychosocial health factors.
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Abstract
OBJECTIVES We assessed the impact that possible veteran suicide misclassification biases (i.e., inaccuracy in ascertainment of veteran status on the death certificate and misclassification of suicide as other manner of death) have on veteran suicide rate estimates. METHODS We obtained suicide mortality data from the 2003-2010 National Violent Death Reporting System and the 2003-2010 Department of Defense Casualty Analysis System. We derived population estimates from the 2003-2010 American Community Survey and 2003-2010 Department of Veterans Affairs data. We computed veteran and nonveteran suicide rates. RESULTS The results showed that suicide rates were minimally affected by the adjustment for the misclassification of current military personnel suicides as veterans. Moreover, combining suicides and deaths by injury of undetermined intent did not alter the conclusions. CONCLUSIONS The National Violent Death Reporting System is a valid surveillance system for veteran suicide. However, more than half of younger (< 25 years) male and female suicides, labeled as veterans, were likely to have been current military personnel at the time of their death and misclassified on the death certificate.
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Affiliation(s)
- Nathalie Huguet
- Nathalie Huguet is with the Center for Public Health Studies, Portland State University, Portland, OR. At the time of the study, Mark S. Kaplan was with the School of Community Health, Portland State University. Bentson H. McFarland is with the Department of Psychiatry, Oregon Health and Science University, Portland
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Kaplan MS, Giesbrecht N, Caetano R, Conner KR, Huguet N, McFarland BH, Nolte KB. Acute alcohol consumption as a contributing factor to suicidal behavior. Am J Public Health 2013; 103:e2-3. [PMID: 23865652 DOI: 10.2105/ajph.2013.301422] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gutierrez PM, Brenner LA, Rings JA, Devore MD, Kelly PJ, Staves PJ, Kelly CM, Kaplan MS. A Qualitative Description of Female Veterans’ Deployment-Related Experiences and Potential Suicide Risk Factors. J Clin Psychol 2013; 69:923-35. [DOI: 10.1002/jclp.21997] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Conner KR, Huguet N, Caetano R, Giesbrecht N, McFarland BH, Nolte KB, Kaplan MS. Acute use of alcohol and methods of suicide in a US national sample. Am J Public Health 2013; 104:171-8. [PMID: 23678938 DOI: 10.2105/ajph.2013.301352] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES We explored age, gender, and racial/ethnic differences with alcohol use and firearms, hanging or asphyxiation, and poisoning methods of suicide. METHODS We analyzed data for 37,993 suicide decedents aged 18 years and older from the 2005-2010 National Violent Death Reporting System database. Multinomial logistic regressions examined associations of method with alcohol use defined by blood alcohol content. Two-way interactions tested the effects of age, gender, and race/ethnicity on the associations between alcohol use and method of suicide. RESULTS Alcohol was present among decedents who used the 3 leading methods of suicide: firearm (35.0%), hanging (36.8%), and poisoning (32.7%). Two-way interaction tests suggested that in young and middle adulthood, individuals were more likely to drink alcohol when they used a firearm or hanging (compared with poisoning), but in older adulthood, the reverse was true, with alcohol use more likely with poisoning. Interaction tests also suggested that Asians and Pacific Islanders were most likely to use alcohol in poisonings and that Blacks were least likely to use alcohol in hangings. CONCLUSIONS The results suggested that alcohol use before suicide was influenced by several factors, including age, race/ethnicity, and suicide method.
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Affiliation(s)
- Kenneth R Conner
- Kenneth R. Conner is with the Department of Psychiatry, University of Rochester Medical Center, Rochester, NY. Nathalie Huguet is with the Center for Public Health Studies, Portland State University, Portland, OR. Raul Caetano is with the University of Texas School of Public Health, Dallas Regional Campus, Dallas. Norman Giesbrecht is with the Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, ON. Bentson H. McFarland is with the Department of Psychiatry, Oregon Health & Science University, Portland. Kurt B. Nolte is with the Office of the Medical Investigator, University of New Mexico School of Medicine, Albuquerque. At the time of the study, Mark S. Kaplan was with the School of Community Health, Portland State University
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Caetano R, Kaplan MS, Huguet N, McFarland BH, Conner K, Giesbrecht N, Nolte KB. Acute alcohol intoxication and suicide among United States ethnic/racial groups: findings from the national violent death reporting system. Alcohol Clin Exp Res 2013; 37:839-46. [PMID: 23384174 DOI: 10.1111/acer.12038] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 09/18/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND To assess the prevalence and sociodemographic correlates of suicide involving acute alcohol intoxication among U.S. ethnic minorities. METHODS Data were derived from the restricted 2003 to 2009 National Violent Death Reporting System. The study focused on the sociodemographic and toxicological information of 59,384 male and female suicide decedents for 16 states of the United States. Acute alcohol intoxication was defined as having a blood alcohol content (BAC) ≥0.08 g/dl. Overall, 76% of decedents were tested for the presence of alcohol. RESULTS The proportion of suicide decedents with a positive BAC ranged from 47% among American Indians/Alaska Natives (AIs/ANs) to 23% among Asians/Pacific Islanders (PIs). Average BAC was highest among AIs/ANs. Among those who were tested for BAC, the proportion of decedents legally intoxicated prior to suicide was as follows: Blacks, 15%; AIs/ANs, 36%; Asians/PIs, 13%; and Hispanics, 28%. Bivariate associations showed that most suicide decedents who were legally intoxicated were male, younger than 30 years of age, with a high school education, not married, nonveterans, lived in metropolitan areas, and used a firearm to complete suicide. However, with the exception of Whites, most of these associations became not statistically significant in multivariate analysis. CONCLUSIONS Alcohol use and legal intoxication prior to completing suicide are common among U.S. ethnic groups, especially among men and those who are younger than 30 years of age. The AI/AN group had the highest mean BAC, the highest rate of legal intoxication and decedents who were particularly young. Suicide prevention strategies should address alcohol use as a risk factor. Alcohol problems prevention strategies should focus on suicide as a consequence of alcohol use, especially among AI/AN youth and young adults.
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Affiliation(s)
- Raul Caetano
- University of Texas School of Public Health, Dallas, TX 75390-9128, USA.
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48
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Abstract
Persistent smoking following stroke is associated with poor outcomes including development of secondary stroke and increased mortality risk. This study uses longitudinal data from the U.S. Health and Retirement Study (1992-2008) to investigate whether depression and duration of inpatient hospital care impact smoking outcomes among stroke survivors (N = 745). Longer duration of care was associated with lower likelihood of persistent smoking. Depression was associated with greater cigarette consumption. Interaction effects were also significant, indicating that for survivors who experienced longer inpatient care there was a weaker association between depression and cigarette consumption. Implications for practice and research are discussed.
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49
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Newsom JT, Huguet N, Ramage-Morin PL, McCarthy MJ, Bernier J, Kaplan MS, McFarland BH. Health behaviour changes after diagnosis of chronic illness among Canadians aged 50 or older. Health Rep 2012; 23:49-53. [PMID: 23356045 PMCID: PMC4427234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Changes in health behaviours (smoking, physical activity, alcohol consumption, and fruit and vegetable consumption) after diagnosis of chronic health conditions (heart disease, cancer, stroke, respiratory disease, and diabetes) were examined among Canadians aged 50 or older. Results from 12 years of longitudinal data from the Canadian National Population Health Survey indicated relatively modest changes in behaviour. Although significant decreases in smoking were observed among all groups except those with respiratory disease, at least 75% of smokers did not quit. No significant changes emerged in the percentage meeting physical activity recommendations, except those with diabetes, or in excessive alcohol consumption, except those with diabetes and respiratory disease. The percentage reporting the recommended minimum fruit and vegetable intake did not increase significantly among any group.
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Affiliation(s)
- Jason T. Newsom
- Portland State University, Portland, Oregon., 1-503-725-8588
| | | | - Pamela L. Ramage-Morin
- Health Analysis Division at Statistics Canada, Ottawa, Ontario, K1A 0T6., 1-613-951-1760
| | | | - Julie Bernier
- Health Analysis Division at Statistics Canada, Ottawa, Ontario, K1A 0T6., 1-613-951-4556
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50
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Kaplan MS, McFarland BH. Veterans who have served in the conflicts of Iraq and Afghanistan are at increased risk of suicide compared to other veterans if they have a psychiatric diagnosis. Evid Based Ment Health 2012; 15:99. [PMID: 22942335 DOI: 10.1136/eb-2012-100914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Mark S Kaplan
- School of Community Health, Portland State University, Portland, OR, USA
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