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Zhang R, Liu A, Luo Y, Peng C, Wang H. The mediating role of depressive symptoms in the relationship between health literacy and suicide-related behaviors in middle school students. Sci Rep 2025; 15:17914. [PMID: 40410258 PMCID: PMC12102286 DOI: 10.1038/s41598-025-02868-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Accepted: 05/16/2025] [Indexed: 05/25/2025] Open
Abstract
Suicide-related behaviors among adolescents have garnered increasing social attention, while few studies have revealed the association between health literacy and suicide-related behaviors, and the underlying mechanism. Thus, this study aims to explore the effect of health literacy on suicide-related behaviors in Chinese adolescents, as well as the potential mediating role of depressive symptoms. A cross-sectional, questionnaire-based study was conducted among 7182 students who were selected by using stratified cluster sampling in May 2023. The Adolescent Health Literacy Scale, Center for Epidemiologic Studies Depression Scale, and three questions about the suicide-related behaviors were used to collect data. Chi-square tests were performed to compare the differences in the distribution of suicide-related behaviors across health literacy levels as well as sociodemographic characteristics. Spearman correlation analysis was performed to assess the correlations between variables. Bootstrap methods were performed to test the mediating role of depressive symptoms. The results showed that the prevalence of suicidal ideation, planning, and attempts in the past 12 months among Chinese middle school students was 26.62%, 9.27%, and 4.55%, respectively. Inadequate health literacy levels exhibited significant and positive correlation with depressive symptoms, suicidal ideation, planning, and attempts. Additionally, depressive symptoms were correlated significantly and positively with three suicide-related behaviors. Mediation analysis showed that the relationship between health literacy and suicide attempts was fully mediated by depressive symptoms and the mediation proportion was 64.9%, while depressive symptoms partially mediated the relationship between health literacy and suicidal ideation and planning, with the mediation proportion was 78.4% and 70.0%, respectively. By shedding light on these mechanisms, comprehensive health literacy improvement programs may be promising in preventing depression and suicide-related behaviors among adolescents.
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Affiliation(s)
- Ronghuinan Zhang
- College of Public Health, Chongqing Medical University, No. 61, University Town Middle Road, Huxi Street, Shapingba District, Chongqing, 401331, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, 401331, China
| | - Aini Liu
- College of Public Health, Chongqing Medical University, No. 61, University Town Middle Road, Huxi Street, Shapingba District, Chongqing, 401331, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, 401331, China
| | - Yu Luo
- College of Public Health, Chongqing Medical University, No. 61, University Town Middle Road, Huxi Street, Shapingba District, Chongqing, 401331, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, 401331, China
| | - Chang Peng
- College of Public Health, Chongqing Medical University, No. 61, University Town Middle Road, Huxi Street, Shapingba District, Chongqing, 401331, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, 401331, China.
| | - Hong Wang
- College of Public Health, Chongqing Medical University, No. 61, University Town Middle Road, Huxi Street, Shapingba District, Chongqing, 401331, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, 401331, China.
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Yang R, Zhou J, Bigambo FM, Yan W, Wang X, Yang H. The trend of suicide and self-harm in the Chinese population from 2018 to 2022 based on ambulance medical emergency cases: a retrospective study. Front Public Health 2025; 13:1494841. [PMID: 39911217 PMCID: PMC11794094 DOI: 10.3389/fpubh.2025.1494841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Accepted: 01/02/2025] [Indexed: 02/07/2025] Open
Abstract
Objective This study investigates the trends of suicide and self-harm in Nanjing, China, through 4 years of data collection, aiming to provide valuable information for developing effective suicide prevention strategies. Methods This descriptive study analyzed Nanjing Emergency Medical Center (NEMC) ambulance records from Nanjing (2018-2022) to investigate suicide and self-harm events. Out of 689,305 records, 4,261 cases were included after exclusions. The study categorized incidents into 4,103 suicide events and 158 self-harm cases. Descriptive statistics and content analysis were conducted to identify characteristics and themes related to these events, with age groups defined according to American Medical Association standards. Results The study highlights drug poisoning as the leading method, accounting for 63.56% of the 4,103 suicide events. It notes significant trends by age, gender, and season, with males showing higher rates of self-harm. The study emphasizes the need for targeted prevention strategies, particularly focusing on drug-related suicides among adults and adolescents, as well as the prevalence of various self-harming behaviors. Conclusion To reduce self-harm and suicide, interventions must be strengthened for women, who experience higher rates. Key strategies include regulating pesticides and psychotropic drugs, increasing access to mental health resources, and launching community awareness campaigns. Additionally, training healthcare providers and promoting family education can enhance support for women facing mental health challenges.
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Affiliation(s)
- Ruizhe Yang
- Department of Public Health, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jinsu Zhou
- Pediatric Intensive Care Unit, Department of Emergency, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Francis Manyori Bigambo
- Pediatric Clinical Medical Research Center, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Wu Yan
- Pediatric Clinical Medical Research Center, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xu Wang
- Pediatric Clinical Medical Research Center, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Haibo Yang
- Pediatric Intensive Care Unit, Department of Emergency, Children's Hospital of Nanjing Medical University, Nanjing, China
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Yan N, Zhang C, Wang Y, Wang Y, Luo Y, Wang Y, Shiferaw BD, Mackay LE, Wang J, Tang J, Wang Q, Gao X, Wang W. Chinese burden of depressive disorders from 1990 to 2021 and prediction for 2030: analysis of data from the global burden of disease study 2021. BMC Psychol 2025; 13:30. [PMID: 39794816 PMCID: PMC11720356 DOI: 10.1186/s40359-025-02349-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 01/02/2025] [Indexed: 01/13/2025] Open
Abstract
BACKGROUND This study aims to examine the temporal changes in the incidence, prevalence, and disability-adjusted life years (DALYs) of depressive disorders as well as its association with age, period, and birth cohort among Chinese from 1990 to 2021, and forecast the future trends of incidence rates and numbers from 2022 to 2030. METHODS Data for analysis were obtained from the Global Burden of Disease (GBD) 2021. Joinpoint analysis was used to calculate the annual percentage change (APC) and average annual percent change (AAPC) to describe the rates of depressive disorders. Age, period, and cohort model was utilized to disentangle age, period, and birth cohort effects on rates of depressive disorders. Bayesian age-period-cohort (BAPC) analysis was capitalized to forecast the incidence rates and numbers for different sexes and age groups from 2022 to 2030. RESULTS The age-standardized incidence (ASIR, AAPC: -0.35 [95%CI: -0.65, -0.04]), prevalence (ASPR, AAPC: -0.20 [95%CI: -0.24, -0.16]), and DAYLs (AAPC: -0.28 [95%CI: -0.51, -0.05]) rates of both sexes showed a downward trend from 1990 to 2021, despite a volatility growth in recent years (APC in 2019-2021 of ASPR: 0.96 [95%CI: 0.70, 1.23]). Females exhibited a higher burden of depressive disorders compared to males but experienced a more rapid rate of reduction changes. The burden of depressive disorders was most owing to the age effect and period effect in recent years. The ASIR was predicted to decrease in the whole population (males in 2030: 1,546.3 per 100,000 people; females in 2030: 2,465.8 per 100,000 people), but in children, adolescents, and the elderly demonstrate unfavorable trends in the future. CONCLUSION The burden of depressive disorders decreased in China from 1990 to 2021 in terms of age-standardized rates, but increased in recent years. Children, adolescents, and the elderly are the risk groups for future depressive disorders. Considering the large population, the increasing fewer children, and the aging trend, as well as the possible long-term effects of COVID-19 on human psychological burden, more sex-age-sensitive social healthcare programs should be considered in the future to minimize the burden of depressive disorders in China.
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Affiliation(s)
- Na Yan
- School of Public Health, Xuzhou Medical University, 209 Tong Shan Road, Xuzhou, Jiangsu, 221004, China
| | - Caochen Zhang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, 211166, China
| | - Yihan Wang
- School of Public Health, Xuzhou Medical University, 209 Tong Shan Road, Xuzhou, Jiangsu, 221004, China
| | - Yuhao Wang
- School of Public Health, Xuzhou Medical University, 209 Tong Shan Road, Xuzhou, Jiangsu, 221004, China
| | - Yunjiao Luo
- School of Public Health, Xuzhou Medical University, 209 Tong Shan Road, Xuzhou, Jiangsu, 221004, China
| | - Yingxue Wang
- School of Public Health, Xuzhou Medical University, 209 Tong Shan Road, Xuzhou, Jiangsu, 221004, China
| | - Blen Dereje Shiferaw
- School of Public Health, Xuzhou Medical University, 209 Tong Shan Road, Xuzhou, Jiangsu, 221004, China
| | - Louisa Esi Mackay
- School of Public Health, Xuzhou Medical University, 209 Tong Shan Road, Xuzhou, Jiangsu, 221004, China
| | - Jingjing Wang
- School of Public Health, Xuzhou Medical University, 209 Tong Shan Road, Xuzhou, Jiangsu, 221004, China
| | - Jie Tang
- School of Public Health, Xuzhou Medical University, 209 Tong Shan Road, Xuzhou, Jiangsu, 221004, China
| | - Qingzhi Wang
- School of Public Health, Xuzhou Medical University, 209 Tong Shan Road, Xuzhou, Jiangsu, 221004, China
| | - Xiuyin Gao
- School of Public Health, Xuzhou Medical University, 209 Tong Shan Road, Xuzhou, Jiangsu, 221004, China.
| | - Wei Wang
- School of Public Health, Xuzhou Medical University, 209 Tong Shan Road, Xuzhou, Jiangsu, 221004, China.
- Research Center for psychological Crisis Prevention and Intervention of College Students in Jiangsu Province, Xuzhou, Jiangsu, 221000, China.
- Engineering Research Innovation Center of Biological Data Mining and Healthcare Transformation, Xuzhou, Jiangsu, 221000, China.
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Wang Z, Li X, Xu H, Zhang T. Risk and protective factors of suicidal tendencies among freshmen in China revealed by a hierarchical regression model. Eur Child Adolesc Psychiatry 2024; 33:3043-3053. [PMID: 38324038 DOI: 10.1007/s00787-024-02370-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 01/08/2024] [Indexed: 02/08/2024]
Abstract
This study aimed to identify risk and protective factors for suicidal tendencies among college students by exploring current mental health, personal experiences, family environment, and school adaptation. A total of 11,504 freshmen in China were recruited. Suicidal tendencies were assessed using the Adolescents Suicidal Tendencies Scale (ASTS), while explored risk and protective factors included mental health assessed by the Symptom Checklist-90 (SCL-90), campus adaptation using the College Student School Adaptation Scale, and Personal Situation Survey. Single-factor Logistic regression analysis, correlation analysis, and hierarchical regression analysis were used to analyze the risk and protective factors affecting suicidal tendencies. The results showed that in terms of personal experience, self-injury behavior (OR = 3.522, 95% CI [3.256, 3.811]), sexual assault experience (OR = 2.603, 95% CI [2.374, 2.855]) and lack of friendship relationship (OR = 2.249, 95% CI [2.076, 2.436]) were the most significant risk factors. Regarding family environment, parenting style (OR = 2.455, 95% CI [2.272, 2.652]), parent-child relationship (OR = 2.255, 95% CI [2.092, 2.429]) and violent conflict (OR = 2.164, 95% CI [2.015, 2.324]) were the most prominent risk factors. For protective factors, life satisfaction (OR = 0.330, 95% CI [0.304, 0.359]) and rest quality (OR = 0.415, 95% CI [0.386, 0.447]) were the most significant protective factors. In addition, Symptom Checklist-90 was positively correlated with suicidal tendencies (r = 0.541, 95% CI [0.522, 0.560], p < 0.001), while school adaptation was negatively correlated with suicidal tendencies (r = - 0.590, 95% CI [- 0.579, - 0.601], p < 0.001). After considering demographic variables, psychological symptoms, school adaptation and other risk and protective factors, the hierarchical regression model could explain 48.9% of the variance of suicidal tendencies. The study emphasizes a range of multidimensional risk and protective factors for suicidal tendencies. This enhanced understanding is crucial in aiding the design of future intervention studies targeted at improving the mental health of college students.
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Affiliation(s)
| | - Xiyu Li
- Xihua University, Chengdu, China
| | - Haiyu Xu
- Xihua University, Chengdu, China
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Lu J, Jin Y, Liang S, Wang Q, Li X, Li T. Risk factors and their association network for young adults' suicidality: a cross-sectional study. BMC Public Health 2024; 24:1378. [PMID: 38778312 PMCID: PMC11112863 DOI: 10.1186/s12889-024-18860-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Understanding the intricate influences of risk factors contributing to suicide among young individuals remains a challenge. The current study employed interpretable machine learning and network analysis to unravel critical suicide-associated factors in Chinese university students. METHODS A total of 68,071 students were recruited between Sep 2016 and Sep 2020 in China. Students reported their lifetime experiences with suicidal thoughts and behaviors, categorized as suicide ideation (SI), suicide plan (SP), and suicide attempt (SA). We assessed 36 suicide-associated factors including psychopathology, family environment, life events, and stigma. Local interpretations were provided using Shapley additive explanation (SHAP) interaction values, while a mixed graphical model facilitated a global understanding of their interplay. RESULTS Local explanations based on SHAP interaction values suggested that psychoticism and depression severity emerged as pivotal factors for SI, while paranoid ideation strongly correlated with SP and SA. In addition, childhood neglect significantly predicted SA. Regarding the mixed graphical model, a hierarchical structure emerged, suggesting that family factors preceded proximal psychopathological factors, with abuse and neglect retaining unique effects. Centrality indices derived from the network highlighted the importance of subjective socioeconomic status and education in connecting various risk factors. CONCLUSIONS The proximity of psychopathological factors to suicidality underscores their significance. The global structures of the network suggested that co-occurring factors influence suicidal behavior in a hierarchical manner. Therefore, prospective prevention strategies should take into account the hierarchical structure and unique trajectories of factors.
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Affiliation(s)
- Junsong Lu
- Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310013, China
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, 518712, China
| | - Yan Jin
- Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310013, China
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, 518712, China
| | - Sugai Liang
- Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310013, China
| | - Qiang Wang
- Mental Health Centre & Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Xiaojing Li
- Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310013, China.
- Liangzhu Laboratory, MOE Frontier Science Center for Brain Science and Brain-machine Integration, State Key Laboratory of Brain-machine Intelligence, Zhejiang University, 1369 West Wenyi Road, Hangzhou, 311121, China.
- NHC and CAMS Key Laboratory of Medical Neurobiology, Zhejiang University, Hangzhou, 310058, China.
| | - Tao Li
- Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310013, China.
- Liangzhu Laboratory, MOE Frontier Science Center for Brain Science and Brain-machine Integration, State Key Laboratory of Brain-machine Intelligence, Zhejiang University, 1369 West Wenyi Road, Hangzhou, 311121, China.
- NHC and CAMS Key Laboratory of Medical Neurobiology, Zhejiang University, Hangzhou, 310058, China.
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Wu Y, Su B, Zhong P, Wang Y, Huang Y, Zheng X. The long-term changing patterns of suicide mortality in China from 1987 to 2020: continuing urban-rural disparity. BMC Public Health 2024; 24:1269. [PMID: 38725017 PMCID: PMC11083847 DOI: 10.1186/s12889-024-18743-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 04/30/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Over the past three decades, China has experienced significant changes in urban-rural, gender, and age-specific suicide mortality patterns. This study aimed to investigate the long-term trends in suicide mortality in China from 1987 to 2020. METHODS Suicide mortality data were obtained from China's National Health Commission. Joinpoint regression analysis was used to examine changes in trends and age-period-cohort modeling to estimate age, period, and cohort effects on suicide mortality from 1987 to 2020. Net drift, local drift, longitudinal age curves, and period relative risks were also calculated. RESULTS Crude and age-standardized suicide mortality in China showed continuing downward trends from 1987 to 2020, with a more pronounced decrease in rural areas (net drift = -7.07%, p<0.01) compared to urban areas (net drift = -3.41%, p<0.01). The decline curve of urban areas could be divided into three substages. Period and cohort effects were more prominent in rural areas. Suicide risk was highest among individuals aged 20-24 and gradually increased after age 60. Females, particularly those of childbearing age, had higher suicide risk than males, with a reversal observed after age 50. This gender reversal showed distinct patterns in urban and rural areas, with a widening gap in urban areas and a relatively stable gap in rural areas. CONCLUSIONS Suicide mortality in China has consistently declined over the past three decades. However, disparities in age, gender, and urban-rural settings persist, with new patterns emerging. Targeted suicide prevention programs are urgently needed for high-risk groups, including females of childbearing age and the elderly, and to address the slower decrease and reversing urban-rural gender trends.
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Affiliation(s)
- Yu Wu
- Department of Population Health and Aging Science, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 31, Road 3rd, Bei-Ji-Ge, Dongcheng District, Beijing, 100730, China
| | - Binbin Su
- Department of Population Health and Aging Science, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 31, Road 3rd, Bei-Ji-Ge, Dongcheng District, Beijing, 100730, China
| | - Panliang Zhong
- Department of Population Health and Aging Science, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 31, Road 3rd, Bei-Ji-Ge, Dongcheng District, Beijing, 100730, China
| | - Yiran Wang
- APEC Health Science Academy (HeSAY), Peking University, Beijing, China
| | - Yueqin Huang
- NHC Key Laboratory of Mental Health (Peking University), Peking University Sixth Hospital, Peking University Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China.
| | - Xiaoying Zheng
- Department of Population Health and Aging Science, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 31, Road 3rd, Bei-Ji-Ge, Dongcheng District, Beijing, 100730, China.
- APEC Health Science Academy (HeSAY), Peking University, Beijing, China.
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Lyu J, Zhang J, Wang L. Declining suicide rates in China (1990-2017): Gender and age specific analyses. J Affect Disord 2024; 352:19-25. [PMID: 38336166 DOI: 10.1016/j.jad.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 01/25/2024] [Accepted: 02/05/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND In China suicide rates have been declining for about three decades. Patterns of suicide for women and men across the lifespan over time however have not been systematically documented. METHODS Official suicide mortality data (from 1990 to 2017) available via China CDC were used to examine suicide patterns by gender and age in each of the 33 provincial-level regions. Suicide data were aggregated by five years, except for the year of 2017. The bar graphs were used to descriptive the change tread of the suicide rate. RESULTS In the past three decades, the decline in female suicide rates was greater than that in the male rates, with the overall male to female (M/F) ratio changing from 0.88 in 1996 to 1.56 in 2017. The overall suicide rate of male was 8.82 and female was 5.65 per 100,000 persons in 2017. However the decline of suicide rates for people aged 70 and older was the greatest declination (33.73/per 100,000 persons) among all the age groups in China. CONCLUSION Overall suicide rates have declined over the three decades in China, particularly among females and individuals age 70+ years. Suicide rates continue to be higher among individuals aged 50 and older (particularly among men), and this population should continue to the focus for prevention.
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Affiliation(s)
- Juncheng Lyu
- Shandong Second Medical University, Shandong, China
| | - Jie Zhang
- Central University of Finance and Economics Department of Sociology, Beijing, China; State University of New York Buffalo State University Department of Sociology, New York, USA.
| | - Lijun Wang
- China Centers for Disease Control and Prevention (CDC), Beijing, China
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Zhi Z, Yan S, Yijuan H, Jiahuan Z, Xiaohan J, Dandan C. Trends in the disease burden of anxiety disorders in middle-aged and older adults in China. BMC Psychol 2024; 12:83. [PMID: 38373999 PMCID: PMC10877872 DOI: 10.1186/s40359-024-01575-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 02/05/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Anxiety disorders in middle-aged and older adults are an important public health concern in China. Based on the data in the global disease burden (GDB) research database, this study evaluated and analyzed the trend of the disease burden of middle-aged and older patients living with anxiety in China in the past 30 years. METHODS The incidence and disability-adjusted life years (DALYs) data of anxiety disorders in China for individuals aged 45-89 years were collected from the Global Burden of Disease Study 2019, and the effects of age, period, and cohort on the incidence of and DALY rate for anxiety disorders were analysed using an age-period-cohort model. Because of the COVID-19 pandemic, the global disease burden research database has not been updated since 2019. However, this did not affect the analysis of future trends in this study, which combined data in the past three decades from 1990 to 2019. RESULTS (1) The overall age-standardised incidence rate (ASIR) and age-standardised DALY rate (ASDR) for anxiety disorders in middle-aged and older adults in China decreased by 4.0 and 7.7% from 1990 to 2019, respectively, and the ASIR and ASDR were always higher in women than in men. (2)Age-period-cohort analysis showed that the net drifts for incidence and DALY rate were - 0.27% and - 0.55% per year, respectively. For both genders, the local drifts for incidence were lower than zero in those aged 45-79 years and higher than zero in those aged 80-89 years; the local drifts for the DALY rate were lower than zero in all groups. (3) From the 1990-1994 to 2015-2019, the relative risks of anxiety disorder incidence and DALY decreased by 5.6 and 7.3% in men and 4.3 and 11.7% in women, respectively. CONCLUSION The disease burden of anxiety disorders in middle-aged and older adults in China has been relieved over the past 30 years; however, recent ASDR, ASDR, period, and cohort effects have shown adverse trends. The incidence and DALY rate decreased with age in women, while men showed a trend of increasing first and decreasing afterwards.
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Affiliation(s)
- Zeng Zhi
- School of Health and Economics Management, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
| | - Shi Yan
- Pukou Hospital of Traditional Chinese Medicine in Nanjing, Nanjing, 211899, China.
| | - He Yijuan
- School of Health and Economics Management, Nanjing University of Chinese Medicine, Nanjing, 210023, China
- Science and Education Department, Taicang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215400, Jiangsu Province, China
| | - Zheng Jiahuan
- School of Health and Economics Management, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Jiang Xiaohan
- School of Health and Economics Management, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Chen Dandan
- School of Health and Economics Management, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
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Li M, Gao W, Zhang Y, Luo Q, Xiang Y, Bao K, Zaki N. Secular trends in the incidence of major depressive disorder and dysthymia in China from 1990 to 2019. BMC Public Health 2023; 23:2162. [PMID: 37926849 PMCID: PMC10626640 DOI: 10.1186/s12889-023-17025-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Depression is increasingly recognized as a worldwide serious, public health concern. A better understanding of depression is important for advancing its management and learning the difference between major depressive disorder (MDD) and dysthymia. Our aim is to conduct a concurrent analysis of the trends of both MDD and dysthymia in China. METHODS The data on depression from 1990 to 2019 were collected from the Global Burden of Disease Study 2019 (GBD 2019). To determine the average annual percent changes (AAPC) and relative risks (RRs), joinpoint regression and the age-period-cohort models were employed, respectively. RESULTS The incidence number of MDD and dysthymia continuously increased in China from 1990 to 2019, however, the age-standardized rates (ASR) had a decreasing trend in both men and women. The results from joinpoint regression showed that a declining trend was presented in young people (< 50 years) but an increased trend in the elderly (≥ 50 years) both in men and women, during 1990-2019. Age is the most influential factor for MDD and dysthymia. Age RRs for MDD incidence had an overall increasing trend with age. Period RR in MDD presented a U-shaped pattern, while Cohort RRs presented an inverted U-shaped pattern. On the other hand, RRs in dysthymia for period and cohort effects had no statistical significance, only the age effect presented an inverted U-shaped pattern. CONCLUSIONS The disparities in trends observed between MDD and dysthymia during the period of 1990-2019 indicated the significance of distinguishing between these two disorders. The age, period and cohort effects all had a greater impact on MDD than on dysthymia, and age effects presented different influential patterns in these two. To alleviate the burden of depressive disorders in China, proactive measures need to be implemented, with particular attention to the elderly population.
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Affiliation(s)
- Ming Li
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Tianshui Southern Road 222, Lanzhou, Gansu, P. R. China
| | - Wenlong Gao
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Tianshui Southern Road 222, Lanzhou, Gansu, P. R. China.
| | - Yuqi Zhang
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Tianshui Southern Road 222, Lanzhou, Gansu, P. R. China
| | - Qiuxia Luo
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Tianshui Southern Road 222, Lanzhou, Gansu, P. R. China
| | - Yuanyuan Xiang
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Tianshui Southern Road 222, Lanzhou, Gansu, P. R. China
| | - Kai Bao
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Tianshui Southern Road 222, Lanzhou, Gansu, P. R. China
| | - Noha Zaki
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Tianshui Southern Road 222, Lanzhou, Gansu, P. R. China
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Zhao M, Li L, Rao Z, Schwebel DC, Ning P, Hu G. Suicide Mortality by Place, Gender, and Age Group - China, 2010-2021. China CDC Wkly 2023; 5:559-564. [PMID: 37415793 PMCID: PMC10319904 DOI: 10.46234/ccdcw2023.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/08/2023] [Indexed: 07/08/2023] Open
Abstract
Introduction Suicide is an important public health concern in China. We examined suicide mortality by place, sex, and age group from 2010 to 2021 to identify and quantify significant suicide mortality changes in China. Methods We retrieved age-standardized and age-specific suicide mortality rates by place (urban vs. rural) and sex from the Chinese Health Statistical Yearbook and population data from the 2010 and 2020 Chinese National Population Census. Line graphs were used to demonstrate trends in suicide mortality. Joinpoint regression models were fitted to detect the time periods experiencing significant suicide mortality changes, and average annual percent change (AAPC) and annual percent change were reported to quantify changes in suicide mortality from 2010 to 2021. Results The overall age-standardized suicide mortality rate decreased from 10.88 to 5.25 per 100,000 population between 2010 and 2021 (AAPC=-5.3%, 95% confidence interval: -6.5%, -4.0%). Similar reductions in suicide mortality were observed for both males and females, as well as in urban and rural settings during this period. From 2010 to 2021, significant declines in suicide mortality were observed among the three older age groups (25-44 years, 45-64 years, and 65 years or above), while a substantial increase was noted in the youngest age group (5-14 years). No significant change was found in suicide mortality rates for the 15-24 year age group. Subgroup analyses based on location and sex revealed consistent findings. Conclusion The findings of this study suggest a probable overall success of suicide prevention efforts in China over the past decade. However, the recent increase in suicide mortality among children aged 5-14 years calls for the attention of injury researchers, policymakers, and public health practitioners.
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Affiliation(s)
- Min Zhao
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha City, Hunan Province, China
| | - Li Li
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha City, Hunan Province, China
| | - Zhenzhen Rao
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha City, Hunan Province, China
| | - David C. Schwebel
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peishan Ning
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha City, Hunan Province, China
| | - Guoqing Hu
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha City, Hunan Province, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha City, Hunan Province, China
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Hou H, Yu B, He C, Li G, Pei Y, Wang J, Tang J, Chen X, Gao X, Wang W. Secular trends of suicide risk for residents in mainland China (2004 to 2019): An updated age-period-cohort analysis. J Affect Disord 2023; 329:235-242. [PMID: 36849004 DOI: 10.1016/j.jad.2023.02.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 02/18/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND The overall suicide rate in China has dropped substantially since the 1990s, but a slowdown in the decrease and even a reversing trend was observed in specific groups in recent years. This study aims to investigate the latest suicide risk in mainland China by using the age-period-cohort (APC) analysis. METHOD This population-based multiyear cross-sectional study included Chinese ages 10 to 84 years using data from the China Health Statistical Yearbook (2005-2020). Data were analyzed by the APC analysis and intrinsic estimator (IE) technique. RESULTS The data satisfactorily fit the constructed APC models. The cohort effect indicated a high risk of suicide among people birth in 1920-1944 and a sharp decline in the 1945-1979 cohort. The lowest risk occurred in the 1980-1994 cohort before a sharp increase in generation Z (birth years in 1995-2009). The period effect showed a declining trend since 2004. The age effect indicated that the suicide risk increased over time, except for a gradual decline from age 35 to 49. The suicide risk increased greatly in adolescents and reached the highest among the elderly. LIMITATIONS The aggregated population-level data and the non-identifiability of the APC model could result in bias in the accuracy of results in this study. CONCLUSIONS This study successfully updated the Chinese suicide risk from the age, period and cohort perspective using the latest available data (2004-2019). The findings enhance the understanding of suicide epidemiology and provide evidence supporting policies and strategies at the macro-level for suicide prevention and management. Immediate action is needed to focus on a national suicide prevention strategy that targets generation Z, adolescents and the elderly which will require a collaborative effort by government officials, public/community health planners and health care agencies.
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Affiliation(s)
- Hao Hou
- School of Public Health, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China; School of Public Health, Wuhan University, Wuhan 430064, Hubei, China
| | - Bin Yu
- School of Public Health, Wuhan University, Wuhan 430064, Hubei, China
| | - Chenlu He
- School of Public Health, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Guiyuan Li
- School of Public Health, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Yifei Pei
- School of Public Health, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Jingjing Wang
- School of Public Health, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Jie Tang
- School of Public Health, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Xinguang Chen
- Department of Epidemiology, University of Florida, 2004 Mowry Road, Gainesville, USA
| | - Xiuyin Gao
- School of Public Health, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Wei Wang
- School of Public Health, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China; Center for Medical Statistics and Data Analysis, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China; Key Laboratory of Human Genetics and Environmental Medicine, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China.
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12
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Trends of suicide rates by gender and residence in China from 2002 to 2019. SSM Popul Health 2023; 21:101342. [PMID: 36684397 PMCID: PMC9853348 DOI: 10.1016/j.ssmph.2023.101342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
Objective China has undergone tremendous social changes in the last few decades. This study aimed to research the trends of the suicide rates from 2002 to 2019, and to differentiate effects attributable to age, period, and cohort by gender and residence in China. Methods Suicide mortality data were obtained from China's Ministry of Health Vital Registration System. Joinpoint regression model was used to estimate the average annual percentage change (AAPC) of the suicide rates and ratios by gender and residence. The age-period-cohort framework was performed to analyze the underlying mechanisms for suicide mortality trends. Results Over the observation period, the significant decrease in suicide mortality rates in China for the economic development and urbanization was observed but to different degrees across gender and regional subgroups. The male-to-female ratio of suicide rates increased year by year (AAPC: 1.9%, 95% CI: 0.2% to 3.7%) while the urban-rural ratio changed little (AAPC: 0.9%, 95% CI: -1.8% to 3.7%). The age-period-cohort analysis revealed a marked increased effect of age and overall decreased effect of both period and cohort on suicide mortality rates. However, the recent cohort has presented an inversely increasing effect. Conclusion The suicide rate has fallen sharply in China which has undergone tremendous socioeconomic changes. The varied changes in the suicide rate of different residence-, gender-, and age-groups as well as the age, period, and cohort effect on suicide risk further indicate the relationship of development and the suicide rates may be neither static nor identical on different subgroups in a rapidly changing society.
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13
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Yu B, Chen X, Lu D, Yan H, Wang P. Investigating the paradox of increasing obesity and declining heart disease mortality in the United States: Age-period-cohort model. Front Cardiovasc Med 2022; 9:948561. [PMID: 36061556 PMCID: PMC9429831 DOI: 10.3389/fcvm.2022.948561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Obesity as a risk factor of heart disease (HD) is confirmed through observational, laboratory, and intervention studies. However, it cannot explain why HD declines, but obesity increases in the United States in recent decades. This study attempted to understand this paradox. Methods Annual data of national HD mortality (1999–2018) were derived from Wide-Ranging Online Data for Epidemiologic Research, biannual obesity data (1999–2016) from the National Health and Nutrition Examination Survey, and smoking data (1965–1990) were from the National Health Interview Survey. Age-period-cohort method was used to decompose HD mortality into age, period, and cohort effects, and to estimate age-cohort adjusted mortality rates. To explain the paradox, age-cohort adjusted rates were associated with obesity rates to verify the positive obesity-HD relationship, while smoking rates were associated with cohort effects to explain the current declines in HD mortality. Results During 1999–2018, the prevalence of obesity increased while the crude HD mortality rate declined for both sex and all races. After controlling for the curvilinear age effect and consistent declining cohort effect, the age-cohort adjusted HD mortality sustained stable in 1999–2007 and increased thereafter. The age-cohort adjusted rate in 1999–2018 (per 100,000) increased from 189.31 to 238.56 for males, 67.23 to 90.28 for females, 115.54 to 157.39 for White, 246.40 to 292.59 for Black, 79.79 to 101.40 for Hispanics, and 49.95 to 62.86 for Asian. The age-cohort adjusted HD mortality rates were positively associated with obesity rates (r = 0.68 for males, 0.91 for females, 0.89 for White, and 0.69 for Hispanic, p < 0.05), but not significant for Black and Asian. Further, during 1965–1990, the estimated cohort effect showed a decline in HD risk and was positively associated with smoking rates (r = 0.98 for both sex, 0.99 for White, and 0.98 for Black, p < 0.01). Conclusion Study findings reveal potential increase of HD risk and support the positive relationship between obesity and HD risk. Declines in HD mortality in the past two decades are primarily due to tobacco use reduction and this protective effect was entangled in the mortality rates as cohort effect.
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Affiliation(s)
- Bin Yu
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, China
- Population and Health Research Center, Wuhan University, Wuhan, China
- Department of Surgery, Duke University School of Medicine, Durham, NC, United States
- Deprtment of Epidemiology, University of Florida, Gainesville, FL, United States
- *Correspondence: Bin Yu,
| | - Xinguang Chen
- Global Health Institute, Xi’an Jiaotong University, Xi’an, China
| | - Dandan Lu
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, China
| | - Hong Yan
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, China
| | - Peigang Wang
- Population and Health Research Center, Wuhan University, Wuhan, China
- Department of Social Medicine and Health Management, School of Public Health, Wuhan University, Wuhan, China
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Lyu J, Shi H, Zhang J, Norvilitis J. Prediction model for suicide based on back propagation neural network and multilayer perceptron. Front Neuroinform 2022; 16:961588. [PMID: 36059864 PMCID: PMC9435582 DOI: 10.3389/fninf.2022.961588] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 07/15/2022] [Indexed: 12/18/2022] Open
Abstract
Introduction The aim was to explore the neural network prediction model for suicide based on back propagation (BP) and multilayer perceptron, in order to establish the popular, non-invasive, brief and more precise prediction model of suicide. Materials and method Data were collected by psychological autopsy (PA) in 16 rural counties from three provinces in China. The questionnaire was designed to investigate factors for suicide. Univariate statistical methods were used to preliminary filter factors, and BP neural network and multilayer perceptron were employed to establish the prediction model of suicide. Results The overall percentage correct of samples was 80.9% in logistic regression model. The total coincidence rate for all samples was 82.9% and the area under ROC curve was about 82.0% in the Back Propagation Neural Network (BPNN) prediction model. The AUC of the optimal multilayer perceptron prediction model was above 90% in multilayer perceptron model. The discrimination efficiency of the multilayer perceptron model was superior to BPNN model. Conclusions The neural network prediction models have greater accuracy than traditional methods. The multilayer perceptron is the best prediction model of suicide. The neural network prediction model has significance for clinical diagnosis and developing an artificial intelligence (AI) auxiliary clinical system.
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Affiliation(s)
- Juncheng Lyu
- School of Public Health, Weifang Medical University, Weifang, China
| | - Hong Shi
- Shandong Ikang Group, Weifang Ikang Guobin Medical Examination Center, Weifang, China
| | - Jie Zhang
- Department of Sociology, Central University of Finance Economics, Beijing, China
- Department of Sociology, State University of New York Buffalo State, Buffalo, NY, United States
| | - Jill Norvilitis
- Department of Sociology, State University of New York Buffalo State, Buffalo, NY, United States
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15
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Martínez-Alés G, Gimbrone C, Rutherford C, Keyes K, López-Cuadrado T. Role of Foreign-Born Status on Suicide Mortality in Spain Between 2000 and 2019: An Age-Period-Cohort Analysis. Int J Public Health 2022; 67:1604538. [PMID: 35664647 PMCID: PMC9156625 DOI: 10.3389/ijph.2022.1604538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: To examine recent age-period-cohort effects on suicide among foreign-born individuals, a particularly vulnerable sociodemographic group in Spain. Methods: Using 2000-2019 mortality data from Spain's National Institute of Statistics, we estimated age-period-cohort effects on suicide mortality, stratified by foreign-born status (native- vs. foreign-born) and, among the foreign-born, by Spanish citizenship status, a proxy for greater socioeconomic stability. Results: Annual suicide mortality rates were lower among foreign- than native-born individuals. There was heterogeneity in age-period-cohort effects between study groups. After 2010, suicide mortality increased markedly among the foreign-born-especially for female cohorts born around 1950, and slightly among native-born women-especially among female cohorts born after the 1960s. Among native-born men, suicide increased linearly with age and remained stable over time. Increases in suicide among the foreign-born were driven by increases among individuals without Spanish citizenship-especially among cohorts born after 1975. Conclusion: After 2010, suicide in Spain increased markedly among foreign-born individuals and slightly among native-born women, suggesting an association between the downstream effects of the 2008 economic recession and increases in suicide mortality among socioeconomically vulnerable populations.
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Affiliation(s)
- Gonzalo Martínez-Alés
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Instituto de Investigacion Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Catherine Gimbrone
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Caroline Rutherford
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Katherine Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Teresa López-Cuadrado
- National Centre of Epidemiology, Carlos III Health Institute (ISCIII), Madrid, Spain
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16
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Changes and explanations of suicide rates in China by province and gender over the past three decades. J Affect Disord 2022; 299:470-474. [PMID: 34942219 DOI: 10.1016/j.jad.2021.12.053] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 09/26/2021] [Accepted: 12/18/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study is aimed to summarize the declining trends of suicide rates by gender in China and in each of its provinces, and to explain the changes from a public health perspective. STUDY DESIGN This is a study with existing data. METHODS Data of suicide mortality were provided by China CDC (1990 to 2017). Data of suicide in each of the 33 provinces were aggregated every five years, except for the year of 2017. A statistical model was performed with the provincial region as the unit of analysis. RESULTS The overall suicide rate in China decreased from 20.9/100,000 in 1990 to 7.2 in 2017, marking a decrease of suicide rate in China by 65%. The gender ratio has increase from 0.88 in 1990 to 1.56 in 2017. Suicide rates have been going down in each of the 33 provinces. The national suicide rates are negatively correlated with GDP per capita, population density, and life expectancy, but positively related to rural population density. CONCLUSIONS The reduction of suicide rates in China is explained by the reduction of psychological strains which is a consequence of the fast-growing economy in the country. Given its large population and rapid decrease of the suicide deaths, China contributed to the global reduction of suicide mortalities.
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17
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Yu B. Suicide in China: The power of social and economic change. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 19:100356. [PMID: 35024671 PMCID: PMC8733181 DOI: 10.1016/j.lanwpc.2021.100356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Bin Yu
- Department of Preventive Medicine, School of Public Health, Wuhan University, Wuhan, China
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18
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Martínez-Alés G, Pamplin JR, Rutherford C, Gimbrone C, Kandula S, Olfson M, Gould MS, Shaman J, Keyes KM. Age, period, and cohort effects on suicide death in the United States from 1999 to 2018: moderation by sex, race, and firearm involvement. Mol Psychiatry 2021; 26:3374-3382. [PMID: 33828236 PMCID: PMC8670065 DOI: 10.1038/s41380-021-01078-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/09/2021] [Accepted: 03/24/2021] [Indexed: 12/31/2022]
Abstract
The role of sex, race, and suicide method on recent increases in suicide mortality in the United States remains unclear. Estimating the age, period, and cohort effects underlying suicide mortality trends can provide important insights for the causal hypothesis generating process. We generated updated age-period-cohort effect estimates of recent suicide mortality rates in the US, examining the putative roles of sex, race, and method for suicide, using data from all death certificates in the US between 1999 and 2018. After designating deaths as attributable to suicide according to ICD-10 underlying cause of death codes X60-X84, Y87.0, and U03, we (i) used hexagonal grids to describe rates of suicide by age, period, and cohort visually and (ii) modeled sex-, race-, and suicide method-specific age, period, and cohort effects. We found that, while suicide mortality increased in the US between 1999 and 2018 across age, sex, race, and suicide method, there was substantial heterogeneity in age and cohort effects by method, sex, and race, with a first peak of suicide risk in youth, a second peak in older ages-specific to male firearm suicide, and increased rates among younger cohorts of non-White individuals. Our findings should prompt discussion regarding age-specific clinical firearm safety interventions, drivers of minoritized populations' adverse early-life experiences, and racial differences in access to and quality of mental healthcare.
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Affiliation(s)
| | - John R Pamplin
- Center for Urban Science and Progress, New York University, New York, NY, USA
| | | | | | - Sasikiran Kandula
- Department of Environmental Health Sciences, Columbia University, New York, NY, USA
| | - Mark Olfson
- Department of Epidemiology, Columbia University, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Madelyn S Gould
- Department of Epidemiology, Columbia University, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Jeffrey Shaman
- Department of Environmental Health Sciences, Columbia University, New York, NY, USA
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He J, Ouyang F, Li L, Qiu D, Li Y, Xiao S. Incidence trends of major depressive disorder in China: an age-period-cohort modeling study. J Affect Disord 2021; 288:10-16. [PMID: 33839553 DOI: 10.1016/j.jad.2021.03.075] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is a common public health problem in China. However, few studies have focused on its incidence and separated age, period, and cohort effects. This study aimed to assess the age, period, and cohort effects on the incidence trends of MDD in China between 1993 and 2017. METHODS The incidence data of MDD were obtained from the Global Burden of Diseases Study 2017. Age-period-cohort modeling method was used to separate the age, period, and cohort effects on MDD incidence rate. RESULTS The incidence number of MDD increased by 22.8% while the age-standardized incidence rate decreased by 15.6% over 25 years. Age-period-cohort analysis indicated that the net drift was -0.433% per year, with -0.486% for females and -0.385% for males. For both sexes, the local drifts were all <0 in 10 to 54 years age groups but >0 in 55 to 94 years age groups. The longitudinal age curves of MDD incidence basically showed an increasing trend, except for a subpeak at 20-24 years age group. The period rate ratio largely declined over time, except for an uptick after 2003-2007. The cohort rate ratio followed an inverted U-shaped pattern and was highest in 1951-1955 birth cohort. LIMITATIONS The MDD data were estimated and wide social factors were not included in the analyses. CONCLUSION The changes of MDD incidence rate in China are likely to be related to rapid social and economic development, and major historical events. However, the associations need to be interpreted with caution.
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Affiliation(s)
- Jun He
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University; and Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan, China
| | - Feiyun Ouyang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University; and Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan, China
| | - Ling Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University; and Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan, China
| | - Dan Qiu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University; and Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan, China
| | - Yilu Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University; and Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan, China
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University; and Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan, China.
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20
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Trends in suicide rates and the case-fatality of pesticide self-poisoning in an agricultural county in china, 2009 to 2014. J Affect Disord 2021; 283:52-59. [PMID: 33517228 DOI: 10.1016/j.jad.2021.01.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/30/2020] [Accepted: 01/10/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Suicide rates in China have declined substantially in the last two decades, however, the correlates of the decreases are still unclear. METHODS Using hospital-based suicidal acts registry system in Meixian county, we reviewed all episodes of suicidal behaviors presented at hospitals from 2009 to 2014. The data was combined with the suicides reported in the same period by the county's Center for Disease Prevention and Control. Stratified by gender and method, age-standardized incidences of suicide death, suicide attempts, suicidal acts, as well as the case-fatalities of suicidal acts, were calculated. Joinpoint regression analysis was applied to test the time trends changes of the annual incidences and case-fatalities. Correlation coefficients between suicide rates and case-fatality were estimated. RESULTS Age-standardized suicide rates among females declined by 20.4% per year, meanwhile, overall suicide rates were characterized by downward trend without statistical significance. The annual proportions of suicide deaths by pesticide self-poisoning ranged from 57.1% to 82.6%. There were positive or marginally positive correlations between suicide rates and case-fatalities of suicidal acts in gender- and method-specific groups (r values range from 0.77 to 0.89). LIMITATIONS Underreporting in the hospital-based registry system and misclassification in the death reporting system. Changes in other related factors are not yet accessible. CONCLUSION Suicide rates in females declined prominently in Meixian from 2009 to 2014, even though overall suicide rates remained steady. Pesticide ingestion were most common suicide method. Restriction of pesticide and reduction in the case-fatality are critical targets of suicide prevention in rural China.
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He J, Ouyang F, Qiu D, Li L, Li Y, Xiao S. Time Trends and Predictions of Suicide Mortality for People Aged 70 Years and Over From 1990 to 2030 Based on the Global Burden of Disease Study 2017. Front Psychiatry 2021; 12:721343. [PMID: 34646174 PMCID: PMC8502866 DOI: 10.3389/fpsyt.2021.721343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022] Open
Abstract
Background: High suicide rate in the elderly is an important global public health problem but has not received the attention it deserves. This study aimed to examine time trends of suicide mortality for people aged 70 years and over by sex, age, and location from 1990 to 2017, and to provide predictions up to 2030. Methods: Using data from the Global Burden of Disease study 2017, we presented elderly suicide mortality changes and compared the patterns for the elderly with that for all ages. We estimated associations between socio-demographic index (SDI) and suicide mortality rates using a restricted cubic spline smoother, and predicted suicide mortality rates up to 2030. Results: In 2017, 118,813 people aged 70 years and over died from suicide, indicating a mortality rate of 27.5 per 100,000, with the highest rates in Eastern Sub-Saharan Africa, Western Sub-Saharan Africa, and Central Sub-Saharan Africa, and for countries and territories, the highest were in South Korea, Zimbabwe, Lesotho, Mozambique, and Senegal. Between 1990 and 2017, suicide mortality rate for the elderly aged 70 years and over decreased globally (percentage change -29.1%), and the largest decreases occurred in East Asia, Southern Latin America, and Western Europe. Nationally, the largest decrease was found in Chile, followed by Czech Republic, Hungary, Turkey, and Philippines. For most countries, the elderly mortality rate was higher than the age-standardized rate, with the largest percentage differences in China and countries in Sub-Saharan Africa. The elderly suicide mortality rate decreased as SDI increased, except for a slight rebound at mid to high SDI. According to projections, 10 out of 195 countries were expected to meet the SDGs indicator of a third reduction by 2030. Conclusions: Variability in suicide mortality rates for the elderly aged 70 years and over by sex, age, region, country, and SDI can guide preventive policies, but causes of the variability need further study. Comprehensive strategies should be adopted to reduce suicide rates and close the gap to the 2030 SDGs.
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Affiliation(s)
- Jun He
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.,Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China
| | - Feiyun Ouyang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.,Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China
| | - Dan Qiu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.,Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China
| | - Ling Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.,Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China
| | - Yilu Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.,Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.,Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China
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22
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Age patterns of suicide with different methods for US Whites: APC modelling analysis of the 1999-2017 national data. Epidemiol Psychiatr Sci 2020; 29:e180. [PMID: 33183394 PMCID: PMC7681140 DOI: 10.1017/s204579602000092x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
AIMS Suicide emerges as a threat to national health of USA with Whites being at extra risk. More information is needed regarding the increased suicide among Whites to improve national suicide prevention strategies. This study aims to characterise the age pattern of suicide among Whites by suicide methods adjusting for time period and birth cohort. METHODS Suicide mortality data by age of 15-84 years during 1999-2017 were derived from the Wide-Ranging Online Data for Epidemiological Research, prepared by US Center for Disease Control and Prevention. Mortality data for three common suicide methods, firearms, suffocation and poisoning were analysed using the age-period-cohort (APC) model. Period-cohort adjusted mortality rates by age were estimated based on results from APC modelling. RESULTS Period-cohort adjusted rates indicated that the overall age pattern for males contained five phases, including three increasing phases (ages 15-20, 30-50 and 65+), connected by two declining phases (ages 20-30 and 50-65); and the age pattern for females was a parabolic with an increasing phase from 15 years of age up to 50, followed by a declining phase after age 50. Furthermore, the age pattern for different suicide methods differed substantially for males, but did not for females. Among males, suicide by firearms contained two rapid increasing phases, one during adolescence and another in older ages; suicide by suffocation showed a high plateau across an age span from 20 to 55 years; and suicide by poisoning followed a parabolic, increasing by age up to 45 before it declined. Age patterns revealed by the unadjusted crude rates were biased because of significant linear period effect and W-shaped cohort effect. CONCLUSIONS This study is the first to quantify the age patterns of suicide by different methods for US Whites using period-cohort adjusted rates. Study findings provide valid evidence supporting precision interventions to reduce the extra suicide mortality among Whites by targeting specific age ranges with different suicide methods.
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Xue C, Yang Y, Xu K, Shi X, Liu H. Health personnel-targeted education interventions on inpatient suicide prevention in general hospitals: A scoping review. Int J Nurs Sci 2020; 7:477-483. [PMID: 33195761 PMCID: PMC7644556 DOI: 10.1016/j.ijnss.2020.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 08/03/2020] [Accepted: 09/15/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Inpatient suicide is an important part of patient safety management in general hospitals. Incidence of inpatient suicide can be decreased by health personnel mastering inpatient suicide prevention strategy. To enhance health personnel's inpatient suicide prevention strategy, education intervention is a common method. Educational interventions in the researches varied in contents, duration and outcome measurements. However, there has been not synthesis of education interventions targeting health personnel on inpatient suicide prevention. OBJECTIVE Prevention of inpatient suicide is a critical priority in patient safety management in general hospitals. Incidence of inpatient suicide can be decreased by effective strategies mastered by health personnel through education interventions. Educational interventions in researches varied in contents, duration and outcome measurements. We aimed to review education interventions targeting health personnel on inpatient suicide prevention. METHODS A scoping review was used to analyze existing researches on education interventions targeting health personnel focusing on inpatient suicide prevention in general hospitals. Cochrane Library, PubMed, Embase, CINAHL, China National Knowledge Infrastructure, WanFang, and Chinese Scientific Journal Database were searched in Oct 2019. According to the inclusion and exclusion criteria, the searched studies were screened by two reviewers. And then, two researchers conducted the data extraction independently by using a table format, including the first author, year of publication, study design, participants, education intervention, etc. RESULTS Twelve studies were included in this scoping review. The contents of education interventions on inpatient suicide prevention included three aspects: suicide knowledge, suicide assessment, and skills for coping with suicide. The duration of education interventions ranged from 1.5-h to 32.0-h. The effects of education interventions were mainly focused on participants' knowledge, attitudes and skills of suicide prevention. CONCLUSION The evidence showed that education interventions on inpatient suicide prevention had positive impact on health personnel's knowledge, attitude and skills about inpatient suicide prevention in general hospitals. However, the best health personnel-targeted education intervention on inpatient suicide prevention in general hospitals was yet to be determined. In the future, it is necessary to combine evidence in this review and the actual condition in clinical practice.
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Affiliation(s)
- Cuicui Xue
- School of Nursing, Peking Union Medical College, Beijing, China
- School of Nursing, Chengde Medical University, Chengde, China
| | - Yujie Yang
- School of Nursing, Peking Union Medical College, Beijing, China
| | - Kepei Xu
- School of Nursing, Peking Union Medical College, Beijing, China
| | - Xiuxiu Shi
- School of Nursing, Peking Union Medical College, Beijing, China
| | - Huaping Liu
- School of Nursing, Peking Union Medical College, Beijing, China
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24
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Ding Y, Chen X, Zhang Q, Liu Q. Historical trends in breast Cancer among women in China from age-period-cohort modeling of the 1990-2015 breast Cancer mortality data. BMC Public Health 2020; 20:1280. [PMID: 32843006 PMCID: PMC7445908 DOI: 10.1186/s12889-020-09375-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 08/11/2020] [Indexed: 11/10/2022] Open
Abstract
Background Evidence on historical trends extracted embedded in recent data can advance our understanding of the epidemiology of breast cancer for Chinese women. China is a country with significant political, socioeconomic, and cultural events since the 1900s; however, no such studies are reported in the literature. Methods Age-specific mortality rates of breast cancer during 1990–2015 in China were analyzed using APC modeling (age-period-cohort modeling) method. Net effect from birth cohort was derived to measure cancer mortality risk during 1906–1990 when no mortality data were collected, and net effect from time period was derived to measure cancer mortality risk during 1990–2015 when data were collected. Model parameters were estimated using intrinsic estimator, a novel method to handle collinearity. The estimated effects were numerical differentiated to enhance presentations of time/age trend. Results Breast cancer mortality rate per 100,000 women increased from 6.83 in 1990 to 12.07 in 2015. After controlling for age and period, the risk of breast cancer mortality declined from 0.626 in 1906–10 to − 1.752 in 1991–95 (RR = 0.09). The decline consisted of 3 phases, a gradual phase during 1906–1940, a moderate phase with some fluctuations during 1941–1970, and a rapid phase with large fluctuations during 1971–1995. After controlling for age and cohort, the risk of breast cancer mortality increased from − 0.141 in 1990 to 0.258 in 2015 (RR = 1.49) with an acceleration after 2005. The time trends revealed by both the cohort effect and the period effect were in consistency with the significant political and socioeconomic events in China since the 1900s. Conclusions With recent mortality data in 1990–2015, we detected the risk of breast cancer mortality for Chinese women over a long period from 1906 to 2015. The risk declined more than 90% from the highest level in 1906–10 to the lowest in 1990–95, followed by an increase of 49% from 1990 to 2015. Findings of this study connected historical evidence with recent data, supporting further research to exam the relationship between development and risk of breast cancer for medical and health decision-making at the population level and prevention and treatment at the individual level.
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Affiliation(s)
- Yani Ding
- Department of epidemiology and health statistics, School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan, 430071, China
| | - Xinguang Chen
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Qingjun Zhang
- Hubei Center for Disease Control and Prevention, Wuhan, China
| | - Qing Liu
- Department of epidemiology and health statistics, School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan, 430071, China.
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25
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Cayuela L, Sánchez Gayango A, Sánchez-Trincado PA, Rodríguez-Domínguez S, Velasco Quiles AA, Cayuela A. Suicide mortality in Spain (1984-2018): age-period-cohort analysis. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2020:S1888-9891(20)30068-9. [PMID: 32674993 DOI: 10.1016/j.rpsm.2020.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/17/2020] [Accepted: 05/24/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the effects of age, period and cohort suicide mortality trend in Spain (1984-2018). METHODS Mortality and population data were obtained from the National Institute of Statistics. The analysis of the effect of age, period of death and birth cohort on the evolution of suicide mortality in the period 1984-2018 was performed using a web tool for age-period-cohort analysis provided by the Division of Cancer Epidemiology and Genetics of the National Cancer Institute of the USA. RESULTS Rates increase with age (age effect) in both sexes. The period effect shows, in males, an increase over the period 1984-1998 followed by a significant decrease until 2018. In females, rates remain stable over the period 1987-2002, decrease during 2007-2012 (p < 0.05) and eventually stabilise. In both males and females, the risk decreases in each successive birth cohort between 1904 and 1939. Subsequently, the risks increase until the birth cohort of the period 1964-1974 after which the risk decreases for males and remains stable for females. CONCLUSION A better understanding of the effects of the birth cohort could open new doors in suicide prevention.
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Affiliation(s)
- Lucia Cayuela
- Servicio de Medicina Interna, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
| | - Agustín Sánchez Gayango
- Unidad de Gestión Clínica de Salud Mental, Área de Gestión Sanitaria Sur de Sevilla, Hospital de Valme, España
| | | | | | | | - Aurelio Cayuela
- Unidad de Gestión Clínica de Salud Pública, Prevención y Promoción de la Salud, Área de Gestión Sanitaria Sur de Sevilla, Hospital de Valme, España
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Yu B, Chen X, Chen X, Yan H. Marijuana legalization and historical trends in marijuana use among US residents aged 12-25: results from the 1979-2016 National Survey on drug use and health. BMC Public Health 2020; 20:156. [PMID: 32013937 PMCID: PMC6998313 DOI: 10.1186/s12889-020-8253-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 01/21/2020] [Indexed: 12/19/2022] Open
Abstract
Background Marijuana is the most commonly used illicit drug in the United States. More and more states legalized medical and recreational marijuana use. Adolescents and emerging adults are at high risk for marijuana use. This ecological study aims to examine historical trends in marijuana use among youth along with marijuana legalization. Method Data (n = 749,152) were from the 31-wave National Survey on Drug Use and Health (NSDUH), 1979–2016. Current marijuana use, if use marijuana in the past 30 days, was used as outcome variable. Age was measured as the chronological age self-reported by the participants, period was the year when the survey was conducted, and cohort was estimated as period subtracted age. Rate of current marijuana use was decomposed into independent age, period and cohort effects using the hierarchical age-period-cohort (HAPC) model. Results After controlling for age, cohort and other covariates, the estimated period effect indicated declines in marijuana use in 1979–1992 and 2001–2006, and increases in 1992–2001 and 2006–2016. The period effect was positively and significantly associated with the proportion of people covered by Medical Marijuana Laws (MML) (correlation coefficients: 0.89 for total sample, 0.81 for males and 0.93 for females, all three p values < 0.01), but was not significantly associated with the Recreational Marijuana Laws (RML). The estimated cohort effect showed a historical decline in marijuana use in those who were born in 1954–1972, a sudden increase in 1972–1984, followed by a decline in 1984–2003. Conclusion The model derived trends in marijuana use were coincident with the laws and regulations on marijuana and other drugs in the United States since the 1950s. With more states legalizing marijuana use in the United States, emphasizing responsible use would be essential to protect youth from using marijuana.
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Affiliation(s)
- Bin Yu
- Department of Epidemiology, University of Florida, Gainesville, FL, 32608, USA
| | - Xinguang Chen
- Department of Epidemiology, University of Florida, Gainesville, FL, 32608, USA
| | - Xiangfan Chen
- Department of Epidemiology and Health Statistics School of Health Sciences, Wuhan University, Wuhan, 430071, China
| | - Hong Yan
- Department of Epidemiology and Health Statistics School of Health Sciences, Wuhan University, Wuhan, 430071, China.
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Yu B, Chen X. Age and Birth Cohort-Adjusted Rates of Suicide Mortality Among US Male and Female Youths Aged 10 to 19 Years From 1999 to 2017. JAMA Netw Open 2019; 2:e1911383. [PMID: 31517968 PMCID: PMC6745055 DOI: 10.1001/jamanetworkopen.2019.11383] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
IMPORTANCE Strategic planning to curb increasing suicide rate among US youths requires unbiased measures of suicide mortality, as the unadjusted suicide mortality rates conventionally used in describing time trends and sex patterns are confounded by the differences in chronological age and year of birth. OBJECTIVE To measure time trends and sex differences in suicide mortality among US youths using age and birth cohort (age-cohort)-adjusted rates. DESIGN, SETTING, AND PARTICIPANTS This population-based multiyear cross-sectional study of US youths aged 10 to 19 years was a secondary analysis of the suicide data for January 1, 1999, to December 31, 2017, derived from the Wide-Ranging Online Data for Epidemiologic Research, a database prepared by the US Centers for Disease Control and Prevention to promote research. Data analysis was conducted from May 24 to May 27, 2019. MAIN OUTCOMES AND MEASURES Age-cohort-adjusted suicide mortality rates by year and sex were used as the main outcomes. These adjusted rates were calculated based on the period effect estimated with the age-period-cohort (APC) modeling method. Participants' age, year of birth, and the year when suicide occurred were used as time-related risk factors. RESULTS Age-cohort-adjusted suicide mortality rates were estimated successfully by year and by sex. The adjusted rates were obtained after controlling for a V-shaped cohort effect and a curved age effect that also differed by sex. The unadjusted suicide mortality rate for male youths increased from 7.4 per 100 000 in 1999 to 10.7 per 100 000 in 2017, while the adjusted rate increased from 4.9 per 100 000 in 1999 to 8.7 per 100 000 in 2017. The unadjusted suicide mortality rates for female youths were 1.6 per 100 000 in 1999 and 3.5 per 100 000 in 2017, while the adjusted rates were 1.7 per 100 000 in 1999 and 4.2 per 100 000 in 2017. CONCLUSIONS AND RELEVANCE Findings of this study indicate a more rapid increase and smaller male-female difference in suicide rates among US youths since 1999 than those shown by the unadjusted suicide mortality rates. The adjusted rates provide unbiased data that are needed for evidence-based decision-making and strategies to curb the increasing suicide rates among US youths.
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Affiliation(s)
- Bin Yu
- Department of Epidemiology, University of Florida, Gainesville
| | - Xinguang Chen
- Department of Epidemiology, University of Florida, Gainesville
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