Pesticide exposure and suicidal ideation in rural communities in Zhejiang province, China

OBJECTIVE

To investigate the association between pesticide exposure and suicidal ideation in rural areas of China.

METHODS

The analysis involved data from a survey of a representative sample of 9811 rural residents in Zhejiang province who had been asked about the storage of pesticides at home and about whether or not they had considered suicide within the 2 years before the interview. The Chinese version of the 12-item General Health Questionnaire (GHQ) was administered to screen for mental disorder.

FINDINGS

The unadjusted odds ratio (OR) for the association between pesticide storage at home and suicidal ideation over the prior 2 years was 2.12 (95% confidence interval, CI: 1.54-2.93). After adjusting for gender, age, education, socioeconomic status, marital status, physical health, family history of suicidal behaviour, GHQ caseness and study design effects, the OR was 1.63 (95% CI: 1.13-2.35).

CONCLUSION

A potential marker of chronic pesticide exposure was found to be associated with suicidal ideation, which supports findings from previous studies. Given the high level of pesticide exposure and the high suicide risk in rural China, clarification of the causal mechanisms underlying this association and the development of appropriate interventions are priorities for public health and health policy.

The impact of quality and quantity of social support on help-seeking behavior prior to deliberate self-harm

OBJECTIVE

Little is known about use of formal or informal help-seeking resources prior to deliberate self-harm (DSH) outside Western settings. The aim of the study was to investigate help-seeking behavior and correlates of this prior to self-harm in an East Asian setting.

METHODS

Over a year period, consecutive attendees at a general hospital emergency room in Taiwan with DSH were asked about prior medical contact and informal help-seeking in the month prior to DSH. Self-reported social support/network was measured using the Close Persons Questionnaire.

RESULTS

The mean age of the 209 participants was 35.2 years (S.D.=13.3), with three times more women (75.6%) than men. Nearly half had made medical contact (47.1%) or sought informal help (54.1%) within the month prior to DSH. After adjustment, higher level of confiding and practical support were associated with seeking informal help (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.06-1.23; OR 1.17, 95% CI 1.04-1.32, respectively). Prior medical contact was negatively associated with higher social network outside the home (OR 0.91, 95% CI 0.85-0.98).

CONCLUSION

Social support/network potentially modifies help-seeking behavior prior to DSH. Quality rather than quantity of social support was associated with seeking informal support, with the reverse pattern associated with prior medical contact.

Mortality and suicide after self-harm: community cohort study in Taiwan

BACKGROUND

Little is known about outcomes after self-harm in East Asia.

AIMS

To investigate mortality after self-harm in a Taiwanese population.

METHOD

Between 2000 and 2003, 1083 individuals who self-harmed were identified through a population self-harm register in Nantou County, Taiwan, and followed until 2007 for date and cause of death on a national mortality database.

RESULTS

In total, 145 individuals died, 48 through suicide. The risks of all-cause and suicide mortality in the first year were 4.7% and 2.1% respectively, representing 8- and 131-fold age- and gender-standardised increases. Male gender and older age were independent risk factors for both suicide and non-suicide mortality. Use of more lethal methods in the index episode was associated with higher mortality but this was accounted for by gender.

CONCLUSIONS

Results in this sample support the recommendation that people with a history of recent self-harm should be a major target for suicide prevention programmes.

Sociocultural practices in Ethiopia: association with onset and persistence of postnatal common mental disorders

BACKGROUND

Traditional perinatal practices may protect against postnatal common mental disorders (CMD) in non-Western societies.

AIMS

To evaluate the association between perinatal practices and postnatal CMD in rural Ethiopia.

METHOD

A population-based sample of 1065 women was followed up from pregnancy until 2 months postpartum. Qualitative investigation informed the development of scales measuring attitudes towards and adherence to perinatal practices. Postnatal CMD was measured using the Self-Reporting Questionnaire.

RESULTS

Endorsement of sociocultural perinatal practices was associated with lower odds of antenatal CMD persisting into the postnatal period (adjusted odds ratio (OR) = 0.66, 95% CI 0.45-0.95). Women who endorsed protective and celebratory perinatal practices but were unable to complete them had increased odds of incident (adjusted OR = 7.26, 95% CI 1.38-38.04) and persistent postnatal CMD (adjusted OR = 2.16, 95% CI 1.11-4.23) respectively.

CONCLUSIONS

There is evidence for an independent role of sociocultural practices in maintaining perinatal mental health in this Ethiopian community.

Maternal common mental disorders and infant development in Ethiopia: the P-MaMiE Birth Cohort

Background

Chronicity and severity of early exposure to maternal common mental disorders (CMD) has been associated with poorer infant development in high-income countries. In low- and middle-income countries (LAMICs), perinatal CMD is inconsistently associated with infant development, but the impact of severity and persistence has not been examined.

Methods

A nested population-based cohort of 258 pregnant women was identified from the Perinatal Maternal Mental Disorder in Ethiopia (P-MaMiE) study, and 194 (75.2%) were successfully followed up until the infants were 12 months of age. Maternal CMD was measured in pregnancy and at two and 12 months postnatal using the WHO Self-Reporting Questionnaire, validated for use in this setting. Infant outcomes were evaluated using the Bayley Scales of Infant Development.

Results

Antenatal maternal CMD symptoms were associated with poorer infant motor development (β^ -0.20; 95% CI: -0.37 to -0.03), but this became non-significant after adjusting for confounders. Postnatal CMD symptoms were not associated with any domain of infant development. There was evidence of a dose-response relationship between the number of time-points at which the mother had high levels of CMD symptoms (SRQ ≥ 6) and impaired infant motor development (β^ = -0.80; 95%CI -2.24, 0.65 for ante- or postnatal CMD only, β^ = -4.19; 95%CI -8.60, 0.21 for ante- and postnatal CMD, compared to no CMD; test-for-trend χ²13.08(1), p < 0.001). Although this association became non-significant in the fully adjusted model, the β^ coefficients were unchanged indicating that the relationship was not confounded. In multivariable analyses, lower socio-economic status and lower infant weight-for-age were associated with significantly lower scores on both motor and cognitive developmental scales. Maternal experience of physical violence was significantly associated with impaired cognitive development.

Conclusions

The study supports the hypothesis that it is the accumulation of risk exposures across time rather than early exposure to maternal CMD per se that is more likely to affect child development. Further investigation of the impact of chronicity of maternal CMD upon child development in LAMICs is indicated. In the Ethiopian setting, poverty, interpersonal violence and infant undernutrition should be targets for interventions to reduce the loss of child developmental potential.

[Exposure to violence and mental health problems in low and middle-income countries: a literature review]

OBJECTIVE

To study the epidemiological evidence on the prevalence of exposure to violence and its relationship with mental health problems in low and middle-income countries.

METHOD

The search was based on cross-sectional and cohort studies available in electronic databases (Medline, Psycinfo, Embase, SciELO and Lilacs), through July 2009, using the key words: 'violence' and 'mental disorders'.

RESULTS

The frequency of exposure to violence was shown to be very high and was significantly associated with mental health problems. Among children, the highest correlation was found to be of domestic violence with externalizing problems (OR = 9.5; 95% CI = 3.4-26.2), and suicidal ideation with sexual abuse (OR = 8.3; p < 0.05); among women, depression/anxiety symptoms correlated with intimate-partner psychological (OR = 3.2; 95% CI = 1.8-5.8) and sexual (OR = 9.7; 95% CI = 1.9-51.2) violence. In the general population, the highest prevalence rates of post-traumatic stress disorder were associated with sexual and domestic violence, kidnapping, and cumulative trauma exposure. Violence also correlated with common mental disorders.

CONCLUSION

A substantial part of the mental health problems in low and middle-income countries can be attributed to violence. Thus, interventions directed to decrease violence in low and middle-income countries might have a major positive impact on the mental health of those living in these settings.

Reducing the treatment gap for mental disorders: a WPA survey

The treatment gap for people with mental disorders exceeds 50% in all countries of the world, approaching astonishingly high rates of 90% in the least resourced countries. We report the findings of the first systematic survey of leaders of psychiatry in nearly 60 countries on the strategies for reducing the treatment gap. We sought to elicit the views of these representatives on the roles of different human resources and health care settings in delivering care and on the importance of a range of strategies to increase the coverage of evidence-based treatments for priority mental disorders for each demographic stage (childhood, adolescence, adulthood and old age). Our findings clearly indicate three strategies for reducing the treatment gap: increasing the numbers of psychiatrists and other mental health professionals; increasing the involvement of a range of appropriately trained non-specialist providers; and the active involvement of people affected by mental disorders. This is true for both high income and low/middle income countries, though relatively of more importance in the latter. We view this survey as a critically important first step in ascertaining the position of psychiatrists, one of the most influential stakeholder communities in global mental health, in addressing the global challenge of scaling up mental health services to reduce the treatment gap.

Impairment, disability, social support and depression among older parents in rural Thailand

BACKGROUND

It is not known whether social support modifies the association between depression and impairment or disability in older people from developing countries in Asia.

METHOD

We used a Thai version of the EURO-D scale to measure depression in 1104 Thai rural community-dwelling parents aged 60 years. These were all those providing data on depression who were recruited as part of a study of older adults with at least one living child (biological, stepchild or adopted child). Logistic regression modelling was used to determine: (a) whether impairment, disability and social support deficits were associated with depression; (b) whether social support modified this association.

RESULTS

There were strong graded relationships between impairment, disability, social support deficits and EURO-D caseness. Level of impairment, but not disability, interacted with poor social support in that depression was especially likely in those who had more physical impairments as well as one or more social support deficits (p value for interaction=0.018), even after full adjustment.

CONCLUSIONS

Social support is important in reducing the association between physical impairment and depression in Thai older adults, especially for those with a large number of impairments. Enhancing social support as well as improving healthcare and disability facilities should be emphasized in interventions to prevent depression in older adults.

The contribution of chronic diseases to the prevalence of dependence among older people in Latin America, China and India: a 10/66 Dementia Research Group population-based survey

BACKGROUND

The number of older people is set to increase dramatically worldwide. Demographic changes are likely to result in the rise of age-related chronic diseases which largely contribute to years lived with a disability and future dependence. However dependence is much less studied although intrinsically linked to disability. We investigated the prevalence and correlates of dependence among older people from middle income countries.

METHODS

A one-phase cross-sectional survey was carried out at 11 sites in seven countries (urban sites in Cuba, Venezuela, and Dominican Republic, urban and rural sites in Peru, Mexico, China and India). All those aged 65 years and over living in geographically defined catchment areas were eligible. In all, 15,022 interviews were completed with an informant interview for each participant. The full 10/66 Dementia Research Group survey protocol was applied, including ascertainment of depression, dementia, physical impairments and self-reported diagnoses. Dependence was interviewer-rated based on a key informant's responses to a set of open-ended questions on the participant's needs for care. We estimated the prevalence of dependence and the independent contribution of underlying health conditions. Site-specific prevalence ratios were meta-analysed, and population attributable prevalence fractions (PAPF) calculated.

RESULTS

The prevalence of dependence increased with age at all sites, with a tendency for the prevalence to be lower in men than in women. Age-standardised prevalence was lower in all sites than in the USA. Other than in rural China, dementia made the largest independent contribution to dependence, with a median PAPF of 34% (range 23%-59%). Other substantial contributors were limb impairment (9%, 1%-46%), stroke (8%, 2%-17%), and depression (8%, 1%-27%).

CONCLUSION

The demographic and health transitions will lead to large and rapid increases in the numbers of dependent older people particularly in middle income countries (MIC). The prevention and control of chronic neurological and neuropsychiatric diseases and the development of long-term care policies and plans should be urgent priorities.

Unambiguous identification of superparamagnetic iron oxide particles through quantitative susceptibility mapping of the nonlinear response to magnetic fields

Superparamagnetic iron oxide (SPIO) particles generate signal void regions on gradient echo images due to their strong magnetization. In practice, the signal void region might be indistinguishable from that generated by air. However, the response of SPIO to an externally applied magnetic field is nonlinear. Magnetization of SPIO saturates at around 1 T while magnetization of water and air increase linearly with field strength. Phantom experiment and mice experiments demonstrated the feasibility of a nonambiguous identification of superparamagnetic contrast agents.

Perinatal mental distress and infant morbidity in Ethiopia: a cohort study

OBJECTIVES

(1) To investigate the impact of perinatal common mental disorders (CMD) in Ethiopia on the risk of key illnesses of early infancy: diarrhoea, fever and acute respiratory illnesses (ARI) and (2) to explore the potential mediating role of maternal health behaviours.

DESIGN

Population-based cohort study.

SETTING

Demographic surveillance site in a predominantly rural area of Ethiopia.

PARTICIPANTS

1065 women (86.3% of eligible) in the third trimester of pregnancy were recruited and 954 (98.6%) of surviving, singleton mother-infant pairs were followed up until 2 months after birth.

MAIN EXPOSURE MEASURE

High levels of CMD symptoms, as measured by the locally validated Self-Reporting Questionnaire (SRQ-20 ≥6), in pregnancy only, postnatally only and at both time-points ('persistent').

MAIN OUTCOME MEASURES

Maternal report of infant illness episodes in first 2 months of life.

RESULTS

The percentages of infants reported to have experienced diarrhoea, ARI and fever were 26.0%, 25.0% and 35.1%, respectively. Persistent perinatal CMD symptoms were associated with 2.15 times (95% CI 1.39 to 3.34) increased risk of infant diarrhoea in a fully adjusted model. The strength of association was not affected by including potential mediators: breast feeding practices, hygiene, the infant's vaccination status or impaired maternal functioning. Persistent perinatal CMD was not associated with infant ARI or fever after adjusting for confounders.

CONCLUSIONS

Persistent perinatal CMD was associated with infant diarrhoea in this low-income country setting. The observed relationship was independent of maternal health-promoting practices. Future research should further explore the mechanisms underlying the observed association to inform intervention strategies.

Helping carers to care: the 10/66 dementia research group's randomized control trial of a caregiver intervention in Peru

OBJECTIVE: There is a need, in the absence of formal services, to design interventions aimed at improving the lives of people with dementia and their families. This study tested the effectiveness of the 10/66 caregiver intervention among people with dementia and their caregivers in Lima, Peru. METHOD: Design/participants: a randomized controlled trial was performed involving 58 caregivers of people with dementia that received the intervention in the beginning of the trial (n = 29) or six months later (n = 29). The intervention consisted of three modules: 1) assessment (one session); 2) basic education about dementia (two sessions); and 3) training regarding specific problem behaviors (two sessions). Main outcome measures: Caregivers and patients with dementia were assessed at baseline and after six months. For caregivers, the measures included strain (Zarit Burden Interview), psychological distress (SRQ-20), and quality of life (WHOQOL-BREF). Dementia patients completed scales assessing behavioral and psychological symptoms (NPI-Q) and quality of life (DEMQOL). RESULTS: Caregivers in the intervention group reported significantly decreased strain measures six months after the intervention compared to controls. No group differences were found in respect to the caregivers' psychological distress and to quality of life in both caregivers and patients. CONCLUSION: The 10/66 intervention seems to be as effective as similar interventions used in more developed countries.

Outcome of first-episode schizophrenia in India: longitudinal study of effect of insight and psychopathology

BACKGROUND

Transcultural studies have found lack of insight to be an almost invariable feature of acute and chronic schizophrenia, but its influence on prognosis is unclear.

AIMS

To investigate the relationship between insight, psychopathology and outcome of first-episode schizophrenia in Vellore, India.

METHOD

Patients with a DSM-IV diagnosis of schizophrenia (n = 131) were assessed prospectively at baseline and at 6-month and 12-month follow-up. Demographic and clinical measures included insight, psychopathology, duration of untreated psychosis (DUP) and social functioning. Linear and logistic regression was used to measure predictors of outcome.

RESULTS

Follow-up data were available for 115 patients at 1 year. All achieved remission, half of them with and half without residual symptoms. Changes in psychopathology and insight during the first 6 months and DUP strongly predicted outcome (relapse or functional impairment), controlling for baseline measures.

CONCLUSIONS

Outcome of schizophrenia in this setting is driven by early symptomatic improvement and is relatively favourable, in line with other studies from low- and middle-income countries. Early improvement in insight might be a useful clinical guide to future outcome. Reduction of DUP should be a target for intervention.

The effect of maternal common mental disorders on infant undernutrition in Butajira, Ethiopia: the P-MaMiE study

BACKGROUND

Although maternal common mental disorder (CMD) appears to be a risk factor for infant undernutrition in South Asian countries, the position in sub-Saharan Africa (SSA) is unclear

METHODS

A population-based cohort of 1065 women, in the third trimester of pregnancy, was identified from the demographic surveillance site (DSS) in Butajira, to investigate the effect of maternal CMD on infant undernutrition in a predominantly rural Ethiopian population. Participants were interviewed at recruitment and at two months post-partum. Maternal CMD was measured using the locally validated Self-Reported Questionnaire (score of > or = six indicating high levels of CMD). Infant anthropometry was recorded at six and twelve months of age.

RESULT

The prevalence of CMD was 12% during pregnancy and 5% at the two month postnatal time-point. In bivariate analysis antenatal CMD which had resolved after delivery predicted underweight at twelve months (OR = 1.71; 95% CI: 1.05, 2.50). There were no other statistically significant differences in the prevalence of underweight or stunted infants in mothers with high levels of CMD compared to those with low levels. The associations between CMD and infant nutritional status were not significant after adjusting for pre-specified potential confounders.

CONCLUSION

Our negative finding adds to the inconsistent picture emerging from SSA. The association between CMD and infant undernutrition might be modified by study methodology as well as degree of shared parenting among family members, making it difficult to extrapolate across low- and middle-income countries.

Understanding of research: a Sri Lankan perspective

Background

Lack of proper understanding on the part of researchers about public understanding of research and informed consent will increase the potential for malpractice. As a part of a larger study on ethics and informed consent in Sri Lanka, this study aimed to ascertain the level of understanding of 'research' by exploring the views of the public and professionals.

Methods

Convenience sampling and snow ball technique were used for recruitment with an emphasis on balanced age and gender representation, diverse educational, socio-cultural and professional backgrounds, and previous research experience, either as researchers or participants. Content analysis of the data was carried out.

Results

66 persons (37 males, 29 females) participated. Although fundamentally a qualitative study, themes were also quantitatively analysed for informative results. Most participants thought that the word 'research' meant searching, looking, inquiring while some others thought it meant gathering information, gaining knowledge and learning.

A third of participants did not offer an alternative word for research. Others suggested the words survey, exploration, search, experiment, discovery, invention and study as being synonymous. Doctors, health professionals, health institutions, scientists, professionals, businessmen, pharmaceutical companies, students, teachers were identified as people who conduct research.

Participants indicated that crucial information on deciding to participate in research included objectives of the research, project importance and relevance, potential benefits to individuals and society, credibility & legitimacy of researchers, what is expected of participant, reason for selection, expected outcome, confidentiality and ability to withdraw at any time. A majority (89%) expressed their willingness to participate in future research.

Conclusions

The results show that with or without prior experience in research, participants in this study had a reasonable understanding of research. The findings show that a decision about taking part in research is dependent on knowledge, education and also on social networks.

The results demonstrate that the majority were supportive of health research and believe that research is beneficial to the welfare of society.

Appraising the mitogenicity of insulin analogues relative to human insulin-response to: Weinstein D, Simon M, Yehezkel E, Laron Z, Werner H. Insulin analogues display IGF-I-like mitogenic and anti-apoptotic activity in cultured cancer cells. Diabetes Metab Res Rev 2009; 25(1): 41-9

Interest in mitogenic and potentially carcinogenic effects of insulin and insulin analogues has been renewed by several recent publications that have examined the relationship between cancer and insulin analogues. Actions mediated through the insulin-like growth factor-I receptor in a hyperinsulinaemic state have been implicated mechanistically. Both type 2 diabetes and endogenously elevated insulin-like growth factor-I have been epidemiologically linked to malignancies. Therefore, in vitro mitogenic effects and binding affinities of the various analogues have been analysed. A recent publication by Weinstein et al. studied the in vitro mitogenic and anti-apoptotic activities of insulin analogues, and their conclusion asserts that insulins glargine, detemir, and lispro displayed proliferative and anti-apoptotic effects in a number of malignant cell lines. However, their conclusions are not supported by the data which are not complete and lack clear statistical significance. This data should be interpreted cautiously in light of all other presently available scientific evidence. Prospective, randomized clinical trials will best address any direct relationship between insulin analogues and cancer. Until those studies are designed and completed, clinicians should consider the demonstrated strong benefit of glycaemic control in balance with any alleged risk.

Mental health in the tropics

Although problems in mental health constitute 14% of the global burden of disease, mental health has been largely missing from the international health agenda. The burden from mental illness is largely attributable to the chronically disabling nature of depression and other common mental disorders, alcohol-use and substance-use disorders, and psychoses. The last decade has seen some progress in addressing this gap. In 2001, the World Health Report, Mental Health: New Understanding, New Hope, drew attention to the situation, with an appeal from the World Health Organization's Director General that 'mental health - neglected for far too long - is crucial to the overall well-being of individuals, societies and countries and must be universally regarded in a new light.' In September 2007, the journal Lancet launched the global mental health series, which highlighted the public-health dimension of mental health, identified barriers to receiving treatment, and gave a call for action to the nations of the world, to make a major commitment to upgrade the quality of mental-health services, to develop evidence-based treatment and preventive measures, to provide support for research in mental health, and to develop indicators to monitor progress. In October 2008, the World Health Organization launched the Mental Health Gap Action Programme, with the aim of scaling up the services for mental, neurological and substance-use disorders in all countries but especially those with low and middle incomes. The programme aims to develop evidence-based packages of care, psycho-social interventions and pharmacotherapy for tens of millions who could be treated for depression, schizophrenia and epilepsy, prevented from suicide, and begin to lead normal lives - even in very poor countries. While there is cause for optimism, much remains to be done. Most of all, there needs to be awareness amongst health providers and planners that mental health is an integral part of general health concerns, and that there can be no health without mental health.

Prevalence and predictors of undernutrition among infants aged six and twelve months in Butajira, Ethiopia: the P-MaMiE Birth Cohort

Background

Child undernutrition is a major public health problem in low income countries. Prospective studies of predictors of infant growth in rural low-income country settings are relatively scarce but vital to guide intervention efforts.

Methods

A population-based sample of 1065 women in the third trimester of pregnancy was recruited from the demographic surveillance site (DSS) in Butajira, south-central Ethiopia, and followed up until the infants were one year of age. After standardising infant weight and length using the 2006 WHO child growth standard, a cut-off of two standard deviations below the mean defined the prevalence of stunting (length-for-age <-2), underweight (weight-for-age <-2) and wasting (weight-for-length <-2).

Results

The prevalence of infant undernutrition was high at 6 months (21.7% underweight, 26.7% stunted and 16.7% wasted) and at 12 months of age (21.2% underweight, 48.1% stunted, and 8.4% wasted). Significant and consistent predictors of infant undernutrition in both logistic and linear multiple regression models were male gender, low birth weight, poor maternal nutritional status, poor household sanitary facilities and living in a rural residence. Compared to girls, boys had twice the odds of being underweight (OR = 2.00; 95%CI: 1.39, 2.86) at 6 months, and being stunted at 6 months (OR = 2.38, 95%CI: 1.69, 3.33) and at 12 months of age (OR = 2.08, 95%CI: 1.59, 2.89). Infant undernutrition at 6 and 12 months of age was not associated with infant feeding practices in the first two months of life.

Conclusion

There was a high prevalence of undernutrition in the first year of infancy in this rural Ethiopia population, with significant gender imbalance. Our prospective study highlighted the importance of prenatal maternal nutritional status and household sanitary facilities as potential targets for intervention.

Between life and death: exploring the sociocultural context of antenatal mental distress in rural Ethiopia

The high prevalence of antenatal common mental disorders in sub-Saharan Africa compared to high-income countries is poorly understood. This qualitative study explored the sociocultural context of antenatal mental distress in a rural Ethiopian community. Five focus group discussions and 25 in-depth interviews were conducted with purposively sampled community stakeholders. Inductive analysis was used to develop final themes. Worry about forthcoming delivery and fears for the woman's survival were prominent concerns of all participants, but only rarely perceived to be pathological in intensity. Sociocultural practices such as continuing physical labour, dietary restriction, prayer and rituals to protect against supernatural attack were geared towards safe delivery and managing vulnerability. Despite strong cultural norms to celebrate pregnancy, participants emphasised that many pregnancies were unwanted and an additional burden on top of pre-existing economic and marital difficulties. Short birth interval and pregnancy out of wedlock were both seen as shameful and potent sources of mental distress. The notion that pregnancy in traditional societies is uniformly a time of joy and happiness is misplaced. Although antenatal mental distress may be self-limiting for many women, in those with enduring life difficulties, including poverty and abusive relationships, poor maternal mental health may persist.

Non-fatal repetition of self-harm: population-based prospective cohort study in Taiwan

BACKGROUND

Repeated self-harm is relatively common and is linked with an elevated risk of eventual suicide. There has been no study of this involving a large sample from the Far East.

AIMS

To estimate the risk over the medium term of non-fatal repetition of self-harm and identify predictive factors in those carrying out self-harm.

METHOD

A total of 970 individuals who had self-harmed were recruited from a community-based suicide behaviour register system in Nantou, Taiwan from July 2000 to February 2003. Information regarding demography and suicide methods was collected. Individuals were followed-up until December 2005 to examine the risk of repeated self-harm and independent predictive factors.

RESULTS

Ninety cohort members had repeated self-harm during the follow-up period (accounting for 131 repeated self-harm episodes in all). The cumulative risks were 5.7% for the first year, 7.8% for the second year and 9.5% for the fourth year. The risk was highest within the first year after the self-harm event. Independent risk factors included female gender and self-cutting as well as self-poisoning with drugs. Effect of younger age was mediated through the choice of methods.

CONCLUSIONS

Individuals with self-harm have a high risk of repetition, especially within the first year. Suicide prevention strategies need to focus on intervening with this population to reduce their repetition.

Incidence and persistence of sleep complaints in a community older population

OBJECTIVES

To investigate factors associated with incidence and persistence of sleep complaints in an older population, with particular focus on the role of depression, subclinical depression and physical health status as predictors.

METHOD

An analysis was carried out of data from the Gospel Oak Study: a community survey of 656 residents within a geographic catchment area in north London, aged 65 and over who were followed up after 1 year. Subjective sleep complaint was ascertained using a single question at baseline and follow-up. Independent variables included age, sex, marital status, social class, number of physical illnesses, disability, social support deficit and depression (according to SHORT-CARE: both a categorical measure and a scale based score).

RESULTS

Baseline prevalence of sleep complaint was 44.7%. Incidence after 1 year was 21.4%, and persistence was 66.3%. After adjustment, female sex and depression predicted incidence of sleep complaint whereas only depression caseness predicted persistence of complaint. The population attributable fractions of depression caseness for incidence and persistence of sleep complaint were 37.4 and 23.4%, respectively. Positive but weaker associations were found between sub-case depressive symptoms and these outcomes.

CONCLUSIONS

Depression was the strongest predictor of incidence and persistence of sleep complaints in this older sample. However, overall it accounted only for a minority of instances of incident/persistent symptoms.

Late-life depression in Peru, Mexico and Venezuela: the 10/66 population-based study

BACKGROUND

The proportion of the global population aged 60 and over is increasing, more so in Latin America than any other region. Depression is common among elderly people and an important cause of disability worldwide.

AIMS

To estimate the prevalence and correlates of late-life depression, associated disability and access to treatment in five locations in Latin America.

METHOD

A one-phase cross-sectional survey of 5886 people aged 65 and over from urban and rural locations in Peru and Mexico and an urban site in Venezuela. Depression was identified according to DSM-IV and ICD-10 criteria, Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) algorithm and EURO-D cut-off point. Poisson regression was used to estimate the independent associations of sociodemographic characteristics, economic circumstances and health status with ICD-10 depression.

RESULTS

For DSM-IV major depression overall prevalence varied between 1.3% and 2.8% by site, for ICD-10 depressive episode between 4.5% and 5.1%, for GMS-AGECAT depression between 30.0% and 35.9% and for EURO-D depression between 26.1% and 31.2%; therefore, there was a considerable prevalence of clinically significant depression beyond that identified by ICD-10 and DSM-IV diagnostic criteria. Most older people with depression had never received treatment. Limiting physical impairments and a past history of depression were the two most consistent correlates of the ICD-10 depressive episode.

CONCLUSIONS

The treatment gap poses a significant challenge for Latin American health systems, with their relatively weak primary care services and reliance on private specialists; local treatment trials could establish the cost-effectiveness of mental health investment in the government sector.