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Woolverton GA, Rastogi R, Brieger KK, Wong SHM, Keum BT, Hahm HC, Liu CH. Barriers and risk factors associated with non-treatment-seeking for suicidality onset during the COVID-19 pandemic among young adults. Psychiatry Res 2024; 340:116095. [PMID: 39111234 PMCID: PMC11371488 DOI: 10.1016/j.psychres.2024.116095] [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: 11/22/2023] [Revised: 04/15/2024] [Accepted: 07/20/2024] [Indexed: 08/15/2024]
Abstract
INTRODUCTION Researchers predict long-term increases in suicide deaths following the COVID-19 pandemic. Little is known about risk factors for suicidal ideation (SI) and suicidal attempts (SA) or treatment barriers and promoters during the pandemic. We examine these factors in a young adult sample. METHODS Analyses used a 2022 cross-sectional survey dataset (N = 1,956). Logistic regression identified factors associated with pandemic suicidality (i.e., SI, SA). Non-treatment seekers reported barriers to seeking treatment. Logistic regression identified promotive factors associated with treatment-seeking. RESULTS 28.6 % of our sample developed suicidality during the pandemic, of whom 49.6 % did not seek treatment. Asian race and sexual minority status were strongly associated with increased odds of pandemic suicidality. Among SI non-treatment-seekers, barriers were primarily attitudinal (e.g., "symptoms are not serious enough for treatment"); among non-treatment-seekers with SA, barriers were mostly structural (e.g., insufficient funds). Previous depression treatment was strongly associated with increased odds of treatment-seeking. CONCLUSION Asian American individuals were at increased risk for pandemic suicidality, which may reflect interpersonal risks related to COVID-19-related anti-Asian racism. Our findings point to a "foot-in-the-door" effect: past treatment-seeking was positively associated with future treatment-seeking. To promote this effect and decrease barriers, we suggest integrated mental health screening and referrals in primary care.
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Affiliation(s)
| | - Ritika Rastogi
- Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA
| | - Katharine K Brieger
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Sylvia H M Wong
- Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Brian TaeHyuk Keum
- Carolyn A. and Peter S. Lynch School of Education and Human Development, Boston College, Chestnut Hill, MA, USA
| | | | - Cindy H Liu
- Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA; Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Vidal-Ribas P, Govender T, Yu J, Livinski AA, Haynie DL, Gilman SE. The developmental origins of suicide mortality: a systematic review of longitudinal studies. Eur Child Adolesc Psychiatry 2024; 33:2083-2110. [PMID: 36205791 PMCID: PMC10207387 DOI: 10.1007/s00787-022-02092-6] [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: 02/08/2022] [Accepted: 09/23/2022] [Indexed: 11/30/2022]
Abstract
Suicide prevention efforts generally target acute precipitants of suicide, though accumulating evidence suggests that vulnerability to suicide is partly established early in life before acute precipitants can be identified. The aim of this systematic review was to synthesize evidence on early life vulnerability to suicide beginning in the prenatal period and extending through age 12. We searched PubMed, Embase, PsycNet, Web of Science, Scopus, Social Services Abstracts, and Sociological Abstracts for prospective studies published through January 2021 that investigated early life risk factors for suicide mortality. The search yielded 13,237 studies; 54 of these studies met our inclusion criteria. Evidence consistently supported the link between sociodemographic (e.g., young maternal age at birth, low parental education, and higher birth order), obstetric (e.g., low birth weight), parental (e.g., exposure to parental death by external causes), and child developmental factors (e.g., exposure to emotional adversity) and higher risk of suicide death. Among studies that also examined suicide attempt, there was a similar profile of risk factors. We discuss a range of potential pathways implicated in these associations and suggest that additional research be conducted to better understand how early life factors could interact with acute precipitants and increase vulnerability to suicide.
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Affiliation(s)
- Pablo Vidal-Ribas
- Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
| | - Theemeshni Govender
- Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Jing Yu
- Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Alicia A Livinski
- Office of Research Services, National Institutes of Health Library, OD, NIH, Bethesda, MD, USA
| | - Denise L Haynie
- Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Stephen E Gilman
- Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Mehanović E, Rosso G, Cuomo GL, Diecidue R, Maina G, Costa G, Vigna-Taglianti F. Risk factors for mortality after hospitalization for suicide attempt: results of 11-year follow-up study in Piedmont Region, Italy. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1039-1051. [PMID: 37552335 PMCID: PMC11116226 DOI: 10.1007/s00127-023-02544-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/30/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE Suicide attempters are at high risk of premature death, both for suicide and for non-suicidal causes. The aim of this study is to investigate risk factors and temporal span for mortality in a cohort of cases admitted to hospital for suicide attempt. METHODS The cohort included 1489 patients resident in Piedmont Region, North West of Italy, who had been admitted to hospital or emergency department for suicide attempt between 2010 and 2020. Cox regression models were used to identify risk factors for death. The final multivariate model included gender, age, area deprivation index, family composition, psychiatric disorders, malignant neoplasms, neurological disorders, diabetes mellitus, cardiovascular diseases, chronic obstructive pulmonary disease, and intracranial injury or skull fracture. RESULTS During the observation period, 7.3% of patients died. The highest mortality was observed within the first 12 months after suicide attempt, and remained elevated for many years afterwards. Male gender, older age, high deprivation index of the census area, single-parent family, mood disorders, malignant neoplasms, diabetes mellitus and intracranial injuries or skull fracture were independent predictors of death. Risk factors for natural and unnatural causes of death were also identified. CONCLUSIONS The mortality risk of suicide attempters is very high, both in the months immediately following the attempt and afterwards. The identification of high-risk groups can help to plan outpatient care following the hospital discharge. Our findings urge the need to design strategies for the assistance and care of these patients at long term in order to reduce the unfavourable outcomes.
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Affiliation(s)
- Emina Mehanović
- Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy.
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Turin, Italy.
| | - Gianluca Rosso
- Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Gian Luca Cuomo
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Turin, Italy
| | - Roberto Diecidue
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Turin, Italy
| | - Giuseppe Maina
- Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Giuseppe Costa
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Turin, Italy
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Kim C, Jin H, Kang G, Dusing GJ, Chum A. Patterns of follow-up mental health care after hospitalization for suicide-related behaviors among older adults in South Korea. J Affect Disord 2024; 350:313-318. [PMID: 38237869 DOI: 10.1016/j.jad.2024.01.089] [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: 07/06/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/21/2024]
Abstract
OBJECTIVE This study aimed to investigate the sociodemographic and clinical factors associated with receiving follow-up mental healthcare within 7 days and 30 days after hospitalization for suicide-related behaviors (SRB) among older adults in South Korea. METHODS Data from the Korean National Health Information Database were used, including information on sociodemographic variables and healthcare utilization. The study cohort consisted of individuals born in 1950 or before with a prior hospitalization record for suicide attempts or probable suicide attempts. Logistic regression analysis was conducted to predict the odds of receiving follow-up care within 7 days and 30 days, adjusting for covariates. RESULTS Among the 37,595 older adults discharged from hospitalization for SRB, 29.13 % and 37.86 % received follow-up care within 7 days and 30 days, respectively. Follow-up care was more common among younger individuals, women, those with higher socio-economic status (SES), urban residents, and individuals with comorbidities. CONCLUSION The provision of mental health follow-up care for older adults after hospitalization for suicide attempts is inadequate in South Korea. Increasing access to follow-up care among those with lower income, residing in rural areas, and older age is crucial. Public awareness campaigns, stigma reduction training for healthcare providers, and system-level changes, such as telemedicine and integrated care pathways, can help bridge the healthcare gap and reduce suicide mortality among older adults.
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Affiliation(s)
- Chungah Kim
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Hyunju Jin
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China; Seoul National University Institute of Sport Science, Seoul, South Korea
| | - Goneui Kang
- Department of Economics, Korea University, Seoul, South Korea
| | | | - Antony Chum
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
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Cailhol L, Marcoux M, Mathur A, Yrondi A, Birmes P. Predictors of prospective suicide attempts in a group at risk of personality disorder following self-poisoning. Front Psychiatry 2023; 14:1084730. [PMID: 37363177 PMCID: PMC10289019 DOI: 10.3389/fpsyt.2023.1084730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 05/16/2023] [Indexed: 06/28/2023] Open
Abstract
Background Patients with personality disorder (PD) are at risk for suicidal behavior and are frequently admitted for this reason to emergency departments. In this context, researchers have tried to identify predictors of their suicidal acts, however, the studies have been mostly retrospective, and uncertainty remains. To prospectively explore factors associated with suicide attempts (SA) in individuals screened for PD from the ecological context of emergencies. Methods Patients were recruited from two emergency departments after a self-poisoning episode (n = 310). PDQ-4+ (risk of PD), TAS-20 (alexithymia), SIS (suicidal intent), H (hopelessness), BDI-13 (depression), AUDIT (alcohol consumption), and MINI (comorbidity) questionnaires were completed. SA over the subsequent two years were identified by mailed questionnaires and hospitals' active files. Logistic regression analyses were performed. Results Having a previous suicidal attempt was linked to a 2.7 times higher chance of recurrence after 6 months, whereas the TAS-20 showed a 1.1 times higher risk at 18 months (OR = 1.1) and the BDI at 24 months (OR = 1.2). Each one-unit increment in TAS-20 and BDI-13 scores increased the risk of SA by 9.8 and 20.4% at 18 and 24 months, respectively. Conclusion Some clinical features, such as alcohol dependence, suicide intent, and hopelessness, may not be reliable predictors of SA among PD patients. However, in the short term, previous SA and, in the long term, depression and alexithymia may be the most robust clinical predictors to consider in our sample of patients with self-poisoning SA.Clinical trial registration: [ClinicalTrials.gov], NCT00641498 24/03/2008 [#2006-A00450-51].
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Affiliation(s)
- Lionel Cailhol
- Department of Psychiatry, Institut Universitaire de Santé Mentale de Montréal, CIUSSS of East Montreal, University of Montreal, Montreal, QC, Canada
| | - Mariève Marcoux
- Department of Psychology, University of Montreal, Montreal, QC, Canada
| | - Anjali Mathur
- Department of Brief therapy, University Hospital Center of Toulouse (CHU Toulouse), Toulouse, Occitanie, France
| | - Antoine Yrondi
- Department of Psychiatry and Medical Psychology, University Hospital Center of Toulouse (CHU Toulouse), Expert Centre for Treatment-Resistant Depression FondaMental, ToNIC Toulouse NeuroImaging Centre, Toulouse University, Toulouse, Occitanie, France
| | - Philippe Birmes
- Department of Psychiatry, Psychotherapies and Art Therapy, University Hospital Center of Toulouse (CHU Toulouse), ToNIC Toulouse NeuroImaging Centre, Toulouse University, Toulouse, Occitanie, France
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Cause-specific mortality after hospital discharge for suicide attempt or suicidal ideation: A cohort study in Piedmont Region, Italy. J Psychiatr Res 2023; 161:19-26. [PMID: 36893667 DOI: 10.1016/j.jpsychires.2023.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Suicide attempters are at higher risk of death than the general population. The present study aims to investigate the excess of all-cause mortality and cause-specific mortality in a cohort of patients who have attempted suicide or had suicidal ideation compared with the general population. METHOD The cohort included 826 patients residing in the Piedmont Region of Northwest Italy who were admitted to a hospital or emergency department for suicide attempts or suicidal ideation between 2010 and 2016. Mortality excesses of the study population compared to the general population were estimated by applying indirect standardization. Standardized Mortality Ratios and 95% Confidence Intervals were calculated for all-cause, and cause-specific, natural, and unnatural causes of death by gender and age. RESULTS During the 7 years of follow-up, 8.2% of the study sample died. The mortality of suicide attempters and ideators was significantly higher than that of the general population. Mortality was about twice than expected from natural causes, and 30 times than expected from unnatural causes. The mortality due to suicide was 85 times higher than that of the general population, with an excess of 126 times for females. The SMRs for all-cause mortality decreased with increasing age. CONCLUSIONS Patients who access hospitals or emergency departments for suicide attempts or suicidal ideation are a frail group at high risk of dying from natural or unnatural causes. Clinicians should pay special attention to the care of these patients, and public health and prevention professionals should develop and implement appropriate interventions to timely identify individuals at higher risk for suicide attempts and suicidal ideation and provide standardized care and support services.
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Simon GE, Shortreed SM, Boggs JM, Clarke GN, Rossom RC, Richards JE, Beck A, Ahmedani BK, Coleman KJ, Bhakta B, Stewart CC, Sterling S, Schoenbaum M, Coley RY, Stone M, Mosholder AD, Yaseen ZS. Accuracy of ICD-10-CM encounter diagnoses from health records for identifying self-harm events. J Am Med Inform Assoc 2022; 29:2023-2031. [PMID: 36018725 PMCID: PMC9667165 DOI: 10.1093/jamia/ocac144] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/02/2022] [Accepted: 08/20/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Assess the accuracy of ICD-10-CM coding of self-harm injuries and poisonings to identify self-harm events. MATERIALS AND METHODS In 7 integrated health systems, records data identified patients reporting frequent suicidal ideation. Records then identified subsequent ICD-10-CM injury and poisoning codes indicating self-harm as well as selected codes in 3 categories where uncoded self-harm events might be found: injuries and poisonings coded as undetermined intent, those coded accidental, and injuries with no coding of intent. For injury and poisoning encounters with diagnoses in those 4 groups, relevant clinical text was extracted from records and assessed by a blinded panel regarding documentation of self-harm intent. RESULTS Diagnostic codes selected for review include all codes for self-harm, 43 codes for undetermined intent, 26 codes for accidental intent, and 46 codes for injuries without coding of intent. Clinical text was available for review for 285 events originally coded as self-harm, 85 coded as undetermined intent, 302 coded as accidents, and 438 injury events with no coding of intent. Blinded review of full-text clinical records found documentation of self-harm intent in 254 (89.1%) of those originally coded as self-harm, 24 (28.2%) of those coded as undetermined, 24 (7.9%) of those coded as accidental, and 48 (11.0%) of those without coding of intent. CONCLUSIONS Among patients at high risk, nearly 90% of injuries and poisonings with ICD-10-CM coding of self-harm have documentation of self-harm intent. Reliance on ICD-10-CM coding of intent to identify self-harm would fail to include a small proportion of true self-harm events.
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Affiliation(s)
- Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Susan M Shortreed
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Jennifer M Boggs
- Kaiser Permanente Colorado Institute for Health Research, Denver, Colorado, USA
| | - Gregory N Clarke
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA
| | | | - Julie E Richards
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Arne Beck
- Kaiser Permanente Colorado Institute for Health Research, Denver, Colorado, USA
| | - Brian K Ahmedani
- Center for Health Policy and Services Research, Henry Ford Health, Detroit, Michigan, USA
| | - Karen J Coleman
- Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena, California, USA
| | - Bhumi Bhakta
- Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena, California, USA
| | - Christine C Stewart
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Stacy Sterling
- Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | | | - R Yates Coley
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Marc Stone
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Zimri S Yaseen
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
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Troya M, Spittal MJ, Pendrous R, Crowley G, Gorton HC, Russell K, Byrne S, Musgrove R, Hannah-Swain S, Kapur N, Knipe D. Suicide rates amongst individuals from ethnic minority backgrounds: A systematic review and meta-analysis. EClinicalMedicine 2022; 47:101399. [PMID: 35518122 PMCID: PMC9065636 DOI: 10.1016/j.eclinm.2022.101399] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Existing evidence suggests that some individuals from ethnic minority backgrounds are at increased risk of suicide compared to their majority ethnic counterparts, whereas others are at decreased risk. We aimed to estimate the absolute and relative risk of suicide in individuals from ethnic minority backgrounds globally. METHODS Databases (Medline, Embase, and PsycInfo) were searched for epidemiological studies between 01/01/2000 and 3/07/2020, which provided data on absolute and relative rates of suicide amongst ethnic minority groups. Studies reporting on clinical or specific populations were excluded. Pairs of reviewers independently screened titles, abstracts, and full texts. We used random effects meta-analysis to estimate overall, sex, location, migrant status, and ancestral origin, stratified pooled estimates for absolute and rate ratios. PROSPERO registration: CRD42020197940. FINDINGS A total of 128 studies were included with 6,026,103 suicide deaths in individuals from an ethnic minority background across 31 countries. Using data from 42 moderate-high quality studies, we estimated a pooled suicide rate of 12·1 per 100,000 (95% CIs 8·4-17·6) in people from ethnic minority backgrounds with a broad range of estimates (1·2-139·7 per 100,000). There was weak statistical evidence from 51 moderate-high quality studies that individuals from ethnic minority groups were more likely to die by suicide (RR 1·3 95% CIs 0·9-1·7) with again a broad range amongst studies (RR 0·2-18·5). In our sub-group analysis we only found evidence of elevated risk for indigenous populations (RR: 2·8 95% CIs 1·9-4·0; pooled rate: 23·2 per 100,000 95% CIs 14·7-36·6). There was very substantial heterogeneity (I2 > 98%) between studies for all pooled estimates. INTERPRETATION The homogeneous grouping of individuals from ethnic minority backgrounds is inappropriate. To support suicide prevention in marginalised groups, further exploration of important contextual differences in risk is required. It is possible that some ethnic minority groups (for example those from indigenous backgrounds) have higher rates of suicide than majority populations. FUNDING No specific funding was provided to conduct this research. DK is funded by Wellcome Trust and Elizabeth Blackwell Institute Bristol. Matthew Spittal is a recipient of an Australian Research Council Future Fellowship (project number FT180100075) funded by the Australian Government. Rebecca Musgrove is funded by the NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC-2016-003).
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Affiliation(s)
- M.Isabela Troya
- School of Public Health, College of Medicine and Health, University College Cork, 4.07 Western Gateway Building, Cork, Ireland
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, Ireland
| | - Matthew J. Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Grace Crowley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hayley C Gorton
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK
| | - Kirsten Russell
- School of Psychological Sciences and Health, Graham Hills Building, 40 George Street, Glasgow, UK
| | - Sadhbh Byrne
- Trinity Centre for Global Health, Trinity College Dublin, Dublin, Ireland
| | - Rebecca Musgrove
- Centre for Mental Health and Safety, National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | - Navneet Kapur
- Division of Psychology and Mental Health, Centre for Mental Health and Safety, The University of Manchester, Manchester, UK
| | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Corresponding author.
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Luk JW, Bond AE, Gabrielli J, LaCroix JM, Perera KU, Lee-Tauler SY, Goldston DB, Soumoff A, Ghahramanlou-Holloway M. A latent class analysis of physical, emotional, and sexual abuse history among suicidal inpatients. J Psychiatr Res 2021; 142:9-16. [PMID: 34311282 DOI: 10.1016/j.jpsychires.2021.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/23/2021] [Accepted: 07/05/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Physical, emotional, and sexual abuse are subtypes of childhood abuse that may persist into adulthood. This study applied latent class analysis to describe the pattern of co-occurrence of these three abuse subtypes during childhood and adulthood and examined latent class differences in psychosocial characteristics and three types of suicide attempt history (aborted, interrupted, and actual). METHODS Data were drawn from a high-risk sample of 115 military service members and adult beneficiaries who were psychiatrically hospitalized following a suicide-related crisis. RESULTS Three latent classes were identified: Multiple and Persistent Abuse (Class One: 29.6%), Childhood Physical and Persistent Emotional Abuse (Class Two: 27.0%), and Minimal Abuse (Class Three: 43.5%). Females were more likely than males to report a history of Multiple and Persistent Abuse. After controlling for gender, the Multiple and Persistent Abuse Class had higher scores of depressive symptoms and hazardous drinking, poorer sleep quality, and increased social stress than the Minimal Abuse Class. Moreover, the Multiple and Persistent Abuse Class was associated with increased likelihood of lifetime interrupted suicide attempt (Odds Ratio [OR] = 3.81, 95% CI = 1.20, 12.07) and actual suicide attempt (OR = 3.65, 95% CI = 1.23, 10.85), and had the greatest number of total actual suicide attempt (1.82 times on average). CONCLUSION Co-occurrence of multiple subtypes of abuse across development is associated with higher psychosocial risk and history of suicide attempt. The assessment of specific subtypes of abuse and their timing may inform case conceptualization and the management of suicide risk among psychiatric inpatients.
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Affiliation(s)
- Jeremy W Luk
- National Institute on Alcohol Abuse and Alcoholism, Office of the Clinical Director, Building 10 - CRC, Room 1-5340, Bethesda, MD, 20892, USA
| | - Allison E Bond
- The University of Southern Mississippi, Department of Psychology, 118 College Dr., Hattiesburg, MS, 39406, USA
| | - Joy Gabrielli
- University of Florida, Department of Clinical and Health Psychology, 1225 Center Dr., Rm. 3130, Gainesville, FL, 32610-0165, USA
| | - Jessica M LaCroix
- Uniformed Services University of the Health Sciences, Department of Medical and Clinical Psychology, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Kanchana U Perera
- Uniformed Services University of the Health Sciences, Department of Medical and Clinical Psychology, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Su Yeon Lee-Tauler
- Uniformed Services University of the Health Sciences, Department of Medical and Clinical Psychology, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - David B Goldston
- Duke University School of Medicine, Box 3527 Med Ctr, Durham, NC, 27710, USA
| | - Alyssa Soumoff
- Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD, 20889, USA
| | - Marjan Ghahramanlou-Holloway
- Uniformed Services University of the Health Sciences, Department of Medical and Clinical Psychology, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
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Berardelli I, Rogante E, Sarubbi S, Erbuto D, Lester D, Pompili M. The Importance of Suicide Risk Formulation in Schizophrenia. Front Psychiatry 2021; 12:779684. [PMID: 34975579 PMCID: PMC8716825 DOI: 10.3389/fpsyt.2021.779684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/02/2021] [Indexed: 12/31/2022] Open
Abstract
Suicide is a cause of early mortality in nearly 5% of patients with schizophrenia, and 25-50% of patients with schizophrenia attempt suicide in their lifetime. Evidence points to numerous individual, clinical, social, and psychological risk factors for suicide in patients with schizophrenia. Although recognizing suicidal risk factors in schizophrenia is extremely important in suicidal risk assessment, we have recently witnessed a change in suicide risk management that shifts the focus from suicide risk assessment to suicide risk formulation. Suicide risk formulation is dependent on the data gathered in the suicide risk assessment and assigns a level of suicide risk that is indispensable for the choice of treatment and the management of patients with a high suicidal risk. In this article, we extend the suicide risk formulation model to patients with schizophrenia. Suicide risk formulation results from four different areas that help clinicians collect as much information as possible for the management of suicidal risk. The four distinct judgments comprise risk status (the risk relating to the specific group to which the patient belongs), risk state (the risk for the person compared with his baseline or another reference point in the course of his life), available resources (on whom the person can count during a crisis) and foreseeable events (which can exacerbate the crisis). In schizophrenia, the suicide risk formulation model allows the clinician to evaluate in depth the clinical context of the patient, the patient's own history and patient-specific opportunities for better choosing and applying suicide prevention strategies.
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Affiliation(s)
- Isabella Berardelli
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Elena Rogante
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Salvatore Sarubbi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Denise Erbuto
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - David Lester
- Psychology Program, Stockton University, Galloway, NJ, United States
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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11
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A study of job stress, suicidal ideation and suicide attempts in display manufacturing workers: a cross-sectional study. Ann Occup Environ Med 2020; 32:e16. [PMID: 32676194 PMCID: PMC7332350 DOI: 10.35371/aoem.2020.32.e16] [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] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/20/2020] [Indexed: 11/28/2022] Open
Abstract
Background This study aimed to investigate the association between job stress and suicide ideation/attempts among display manufacturing workers. Methods Data were collected from 836 workers in a display manufacturing company who participated in health screenings from May 22 to June 16, 2017. The data included general characteristics, night work, job tenure, previous physician-diagnosed chronic diseases, suicidal ideation/suicide attempts, and job stress. We investigated suicidal ideation/suicide attempts that covered the past year by using a self-reported questionnaire. Job stress was measured using the 43-item Korean Occupational Stress Scale. Multiple logistic regression analysis was used to investigate the association between job stress and suicidal ideation/suicide attempts. The mediator effect of depression on suicidal ideation/suicide attempts was tested using a series of logistic regression by applying Baron and Kenny's mediation method. Results In the model adjusting for variables (e.g., age, body mass index, smoking, alcohol consumption, regular exercise, shift work, job tenure, chronic disease and depression), physical environment (OR: 3.60, 95% CI: 1.08–12.02), lack of reward (OR: 5.31, 95% CI: 1.54–18.34), and occupation climate (OR: 7.36, 95% CI: 2.28–23.72) were correlated with suicidal ideation/suicide attempts in women. However, all subscales of job stress were not significantly correlated with suicidal ideation/suicide attempts in men. In mediation analysis, job instability and occupational climate were correlated with suicidal ideation/suicide attempts and were mediated by depression in men workers. Conclusions In women workers, the experiences of suicidal ideation/suicide attempts were significantly correlated with the physical environment, lack of reward, and occupational climate that were subscales of job stress. In men workers, depression rather than job stress was correlated with experiences of suicidal ideation/suicide attempts.
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12
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Swain RS, Taylor LG, Braver ER, Liu W, Pinheiro SP, Mosholder AD. A systematic review of validated suicide outcome classification in observational studies. Int J Epidemiol 2020; 48:1636-1649. [PMID: 30907424 DOI: 10.1093/ije/dyz038] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Suicidal outcomes, including ideation, attempt, and completed suicide, are an important drug safety issue, though few epidemiological studies address the accuracy of suicidal outcome ascertainment. Our primary objective was to evaluate validated methods for suicidal outcome classification in electronic health care database studies. METHODS We performed a systematic review of PubMed and EMBASE to identify studies that validated methods for suicidal outcome classification published 1 January 1990 to 15 March 2016. Abstracts and full texts were screened by two reviewers using prespecified criteria. Sensitivity, specificity, and predictive value for suicidal outcomes were extracted by two reviewers. Methods followed PRISMA-P guidelines, PROSPERO Protocol: 2016: CRD42016042794. RESULTS We identified 2202 citations, of which 34 validated the accuracy of measuring suicidal outcomes using International Classification of Diseases (ICD) codes or algorithms, chart review or vital records. ICD E-codes (E950-9) for suicide attempt had 2-19% sensitivity, and 83-100% positive predictive value (PPV). ICD algorithms that included events with 'uncertain' intent had 4-70% PPV. The three best-performing algorithms had 74-92% PPV, with improved sensitivity compared with E-codes. Read code algorithms had 14-68% sensitivity and 0-56% PPV. Studies estimated 19-80% sensitivity for chart review, and 41-97% sensitivity and 100% PPV for vital records. CONCLUSIONS Pharmacoepidemiological studies measuring suicidal outcomes often use methodologies with poor sensitivity or predictive value or both, which may result in underestimation of associations between drugs and suicidal behaviour. Studies should validate outcomes or use a previously validated algorithm with high PPV and acceptable sensitivity in an appropriate population and data source.
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Affiliation(s)
- Richard S Swain
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology, Divisions of Epidemiology I and II, Silver Spring, MD, USA
| | - Lockwood G Taylor
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology, Divisions of Epidemiology I and II, Silver Spring, MD, USA
| | - Elisa R Braver
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology, Divisions of Epidemiology I and II, Silver Spring, MD, USA
| | - Wei Liu
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology, Divisions of Epidemiology I and II, Silver Spring, MD, USA
| | - Simone P Pinheiro
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology, Divisions of Epidemiology I and II, Silver Spring, MD, USA
| | - Andrew D Mosholder
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology, Divisions of Epidemiology I and II, Silver Spring, MD, USA
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13
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Cho CH, Jee HJ, Nam YJ, An H, Kim L, Lee HJ. Temporal association between zolpidem medication and the risk of suicide: A 12-year population-based, retrospective cohort study. Sci Rep 2020; 10:4875. [PMID: 32184423 PMCID: PMC7078307 DOI: 10.1038/s41598-020-61694-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 03/02/2020] [Indexed: 01/25/2023] Open
Abstract
There have been concerns about abuse and unnecessary chronic administration of zolpidem, and zolpidem's relation to suicide risk. To investigate the temporal association of zolpidem with the risk of suicide, we conducted a 12-year, population-based, retrospective cohort study on the National Health Insurance Service-National Sample Cohort (NHIS-NSC), South Korea. Data were collected from 2002 to 2013 from the NHIS-NSC, and data cleaning was performed for 1,125,691 subjects. Cox proportional hazards regression analysis was used to investigate the correlation over time between zolpidem medication and suicide. Over intervals commencing after 80 months of observation, the adjusted hazard ratio of suicides associated with the use of the zolpidem was 2.01 (95% CI: 1.58-2.56; p < 0.001). The mean cumulative number of days of zolpidem prescription was significantly longer in the suicide group than in the non-suicide group after log-transformation (p = 0.005). Cases of chronic use of zolpidem (over six months or one year) were significantly more common in the suicide group compared to the non-suicide group (p = 0.002 and 0.005, respectively). Subjects who received zolpidem medication had a significantly higher risk of suicide after at least 80 months of observation, suggesting a long-term increased suicide risk associated with insomnia exposed to zolpidem medication.
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Affiliation(s)
- Chul-Hyun Cho
- Department of Psychiatry, School of Medicine, Chungnam National University, Daejeon, South Korea
- Department of Psychiatry, Sejong Chungnam National University Hospital, Sejong, South Korea
- Korea University Chronobiology Institute, Seoul, South Korea
| | - Hee-Jung Jee
- Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea
| | - Yoon-Ju Nam
- Department of Psychiatry, Korea University College of Medicine, Seoul, South Korea
| | - Hyonggin An
- Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea
| | - Leen Kim
- Korea University Chronobiology Institute, Seoul, South Korea
- Department of Psychiatry, Korea University College of Medicine, Seoul, South Korea
| | - Heon-Jeong Lee
- Korea University Chronobiology Institute, Seoul, South Korea.
- Department of Psychiatry, Korea University College of Medicine, Seoul, South Korea.
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14
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Singleton MD, Frey LM, Webb A, Cerel J. Public Health Surveillance of Youth Suicide Attempts: Challenges and Opportunities. Suicide Life Threat Behav 2020; 50:42-55. [PMID: 31318087 DOI: 10.1111/sltb.12572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/25/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surveillance of youth suicide attempts presents many challenges. To assess common data sources that capture information about youth suicidal behavior, we compared counts of high school students who reported (a) a suicide attempt and (b) an injurious suicide attempt, requiring medical treatment in the previous twelve months, with counts of suicide deaths and intentional self-injuries obtained from administrative data sources. METHOD Youth Risk Behavior Surveillance System (YRBSS), high school enrollments, and vital statistics were used to estimate the ratio of suicide attempts to suicide deaths among Kentucky high school students. YRBSS and enrollment data were used to estimate the number of Kentucky high school students who received medical treatment following a suicide attempt, which was compared with hospital and emergency department (ED) discharges for intentional self-injury from administrative claim records. RESULTS We estimated 943 students reporting a suicide attempt for every suicide death, a result that is higher than previous estimates for youth. Self-reported suicide attempts resulting in medical treatment were 7.5 times higher than self-injuries reported in claims records. CONCLUSION Future research should address concerns about undocumented cases of intentional self-injury in administrative claims systems; patient encounters in nonhospital settings for injuries resulting from a suicide attempt; and validity of Youth Risk Behavior Survey questions on suicidal behavior.
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Affiliation(s)
| | - Laura M Frey
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
| | - Ashley Webb
- Kentucky Poison Control Center, Norton Children's Hospital, Louisville, KY, USA
| | - Julie Cerel
- College of Social Work, University of Kentucky, Lexington, KY, USA
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15
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George BJ, Ribeiro S, Lee-Tauler SY, Bond AE, Perera KU, Grammer G, Weaver J, Ghahramanlou-Holloway M. Demographic and Clinical Characteristics of Military Service Members Hospitalized Following a Suicide Attempt versus Suicide Ideation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3274. [PMID: 31489903 PMCID: PMC6765803 DOI: 10.3390/ijerph16183274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/22/2019] [Accepted: 09/04/2019] [Indexed: 11/16/2022]
Abstract
Psychiatric hospitalization for a suicide attempt (SA), rather than suicide ideation (SI) alone, is a stronger risk indicator for eventual suicide death. Yet, little is known about demographic and clinical characteristics differentiating those admitted for SA versus SI. Understanding these differences has implications for assessment and treatment. A retrospective review of electronic medical records (EMRs) was performed on service members (n = 955) admitted for SA or SI at the Walter Reed Army Medical Center between 2001-2006. Service members hospitalized for SA were younger compared to those hospitalized for SI. The proportion of women admitted for SA was significantly higher than those admitted for SI whereas their male counterparts showed the opposite pattern. Patients admitted for SA, versus SI, had significantly higher prevalence of adjustment disorder with mixed disturbance of emotion and conduct (MDEC), personality disorder not otherwise specified (PDNOS), and borderline personality disorder (BPD). Patients admitted for SI had significantly higher prevalence of adjustment disorder with depressed mood and deferred Axis II diagnosis, compared to those admitted for SA. There were no significant between-group differences in the average or median number of documented prior suicide attempts. Findings highlight the need for more standardized assessment, diagnostic decision-making, and documentation practices for all patients.
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Affiliation(s)
| | - Sissi Ribeiro
- The Department of Psychology, George Mason University, Fairfax, VA 22030, USA.
| | - Su Yeon Lee-Tauler
- The Department of Medical & Clinical Psychology, Suicide Care, Prevention, and Research Initiative; The Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
| | - Allison E Bond
- The Department of Psychology, The University of Southern Mississippi, Hattiesburg, MS 39406, USA.
| | - Kanchana U Perera
- The Department of Medical & Clinical Psychology, Suicide Care, Prevention, and Research Initiative; The Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
| | | | - Jennifer Weaver
- Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA.
| | - Marjan Ghahramanlou-Holloway
- The Department of Medical & Clinical Psychology, Suicide Care, Prevention, and Research Initiative; The Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
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16
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Risk of readmission for suicide attempt after epilepsy hospitalization. Epilepsy Behav 2018; 83:124-130. [PMID: 29702413 DOI: 10.1016/j.yebeh.2018.03.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/29/2018] [Accepted: 03/29/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective of this study was to examine if epilepsy admissions are associated with a higher readmission risk for suicide attempt, independent of psychiatric comorbidity, compared with index admissions for other medical causes. METHODS The Nationwide Readmissions Database is a nationally representative dataset containing data from roughly 15 million hospital discharges. Analysis of International Classification of Disease Clinical Modification 9 (ICD-9-CM) codes in the year 2013 revealed 58,278 index admissions for epilepsy; this group was compared with admissions for stroke (N=215,821) and common medical causes (N=973,078). Ninety-day readmission rates for suicide attempts were calculated. Cox regression tested for associations between admission type and suicide attempt readmissions up to 1year following index admission. RESULTS There were 402/100,000 readmissions for suicide attempt within 90days from index admission in the group with epilepsy; 43/100,000 in the stroke group; and between 37 and 89/100,000 in the medical group. Unadjusted hazard ratios (HR) for suicide readmissions within 1year in the group with epilepsy compared with the stroke group were 9.61 (95% confidence interval (CI): 7.69-11.90, p<2.0×10-16) and 5.02 compared with the medical group (95% CI: 4.40-5.73, p<2.0×10-16). The HR for readmission in the group with epilepsy, after adjustment for sociodemographic and psychiatric variables, were elevated at 4.91 compared with the stroke group (95% CI: 3.83-6.27, p<2.0×10-16), and 2.66 compared with the medical group (95% CI: 2.32-3.05, p<2.0×10-16). CONCLUSION Independent of psychiatric comorbidities, epilepsy admissions may be independently associated with more than a threefold increased risk of hospital readmission for suicide in the year following index admission in comparison with patients recently hospitalized because of stroke or other common medical disorders.
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17
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Zhong QY, Gelaye B, Smoller JW, Avillach P, Cai T, Williams MA. Adverse obstetric outcomes during delivery hospitalizations complicated by suicidal behavior among US pregnant women. PLoS One 2018; 13:e0192943. [PMID: 29447245 PMCID: PMC5814027 DOI: 10.1371/journal.pone.0192943] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 01/16/2018] [Indexed: 11/19/2022] Open
Abstract
Objective The effects of suicidal behavior on obstetric outcomes remain dangerously unquantified. We sought to report on the risk of adverse obstetric outcomes for US women with suicidal behavior at the time of delivery. Methods We performed a cross-sectional analysis of delivery hospitalizations from 2007–2012 National (Nationwide) Inpatient Sample. From the same hospitalization record, International Classification of Diseases codes were used to identify suicidal behavior and adverse obstetric outcomes. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were obtained using logistic regression. Results Of the 23,507,597 delivery hospitalizations, 2,180 were complicated by suicidal behavior. Women with suicidal behavior were at a heightened risk for outcomes including antepartum hemorrhage (aOR = 2.34; 95% CI: 1.47–3.74), placental abruption (aOR = 2.07; 95% CI: 1.17–3.66), postpartum hemorrhage (aOR = 2.33; 95% CI: 1.61–3.37), premature delivery (aOR = 3.08; 95% CI: 2.43–3.90), stillbirth (aOR = 10.73; 95% CI: 7.41–15.56), poor fetal growth (aOR = 1.70; 95% CI: 1.10–2.62), and fetal anomalies (aOR = 3.72; 95% CI: 2.57–5.40). No significant association was observed for maternal suicidal behavior with cesarean delivery, induction of labor, premature rupture of membranes, excessive fetal growth, and fetal distress. The mean length of stay was longer for women with suicidal behavior. Conclusion During delivery hospitalization, women with suicidal behavior are at increased risk for many adverse obstetric outcomes, highlighting the importance of screening for and providing appropriate clinical care for women with suicidal behavior during pregnancy.
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Affiliation(s)
- Qiu-Yue Zhong
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Jordan W. Smoller
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Paul Avillach
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States of America
- Children’s Hospital Informatics Program, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Tianxi Cai
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Michelle A. Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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18
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Kim SY, Shin DW, Oh KS, Kim EJ, Park YR, Shin YC, Lim SW. Gender Differences of Occupational Stress Associated with Suicidal Ideation among South Korean Employees: The Kangbuk Samsung Health Study. Psychiatry Investig 2018; 15:156-163. [PMID: 29475218 PMCID: PMC5900399 DOI: 10.30773/pi.2017.05.31.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/09/2017] [Accepted: 05/31/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE In this study, the relationship between occupational stress and suicidal ideation was investigated, focusing on gender differences among Korean employees. METHODS Cross-sectional data for 53,969 workers were collected at Kangbuk Samsung Hospital health screening centers. Risk of suicidal ideation was assessed using a self-reported questionnaire examining suicidal ideation during the past year. Occupational stress was measured using 24 items of the Korean Occupational Stress Scale-Short Form (KOSS-SF). Logistic regression analysis was employed to estimate the odds ratios and 95% confidence intervals of the relationships between suicidal ideation and components of occupational stress. RESULTS In multivariable-adjusted models, all job stress contributed to increased risk of suicidal ideation in males. Most subscales, except insufficient job control and organizational system, were risk factors of suicidal ideation in females. Further adjustments for depression markedly attenuated this relationship. However, the effects of insufficient job control and lack of reward on suicidal ideation remained significant in males, and interpersonal conflict remained significant in females. CONCLUSION The results suggest that occupational stress plays a significant role in increasing risk of suicidal ideation through elevation of depressive symptoms. Gender differences in components of occupational stress associated with suicidal ideation were also observed.
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Affiliation(s)
- Sun-Young Kim
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong-Won Shin
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kang-Seob Oh
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun-Jin Kim
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Workplace Mental Health Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yang-Ri Park
- Workplace Mental Health Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young-Chul Shin
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Workplace Mental Health Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Se-Won Lim
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Workplace Mental Health Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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19
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Rosellini AJ, Stein MB, Benedek DM, Bliese PD, Chiu WT, Hwang I, Monahan J, Nock MK, Petukhova MV, Sampson NA, Street AE, Zaslavsky AM, Ursano RJ, Kessler RC. Using self-report surveys at the beginning of service to develop multi-outcome risk models for new soldiers in the U.S. Army. Psychol Med 2017; 47:2275-2287. [PMID: 28374665 PMCID: PMC5679702 DOI: 10.1017/s003329171700071x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The U.S. Army uses universal preventives interventions for several negative outcomes (e.g. suicide, violence, sexual assault) with especially high risks in the early years of service. More intensive interventions exist, but would be cost-effective only if targeted at high-risk soldiers. We report results of efforts to develop models for such targeting from self-report surveys administered at the beginning of Army service. METHODS 21 832 new soldiers completed a self-administered questionnaire (SAQ) in 2011-2012 and consented to link administrative data to SAQ responses. Penalized regression models were developed for 12 administratively-recorded outcomes occurring by December 2013: suicide attempt, mental hospitalization, positive drug test, traumatic brain injury (TBI), other severe injury, several types of violence perpetration and victimization, demotion, and attrition. RESULTS The best-performing models were for TBI (AUC = 0.80), major physical violence perpetration (AUC = 0.78), sexual assault perpetration (AUC = 0.78), and suicide attempt (AUC = 0.74). Although predicted risk scores were significantly correlated across outcomes, prediction was not improved by including risk scores for other outcomes in models. Of particular note: 40.5% of suicide attempts occurred among the 10% of new soldiers with highest predicted risk, 57.2% of male sexual assault perpetrations among the 15% with highest predicted risk, and 35.5% of female sexual assault victimizations among the 10% with highest predicted risk. CONCLUSIONS Data collected at the beginning of service in self-report surveys could be used to develop risk models that define small proportions of new soldiers accounting for high proportions of negative outcomes over the first few years of service.
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Affiliation(s)
- Anthony J. Rosellini
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Murray B. Stein
- Departments of Psychiatry and Family Medicine & Public Health, University of California San Diego, La Jolla, California, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | - David M. Benedek
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
| | - Paul D. Bliese
- Darla Moore School of Business, University of South Carolina, Columbia, South Carolina, USA
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - John Monahan
- School of Law, University of Virginia, Charlottesville, VA, USA
| | - Matthew K. Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
| | - Maria V. Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy E. Street
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Alan M. Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
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20
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Randall JR, Roos LL, Lix LM, Katz LY, Bolton JM. Emergency department and inpatient coding for self-harm and suicide attempts: Validation using clinician assessment data. Int J Methods Psychiatr Res 2017; 26:e1559. [PMID: 28233360 PMCID: PMC6877200 DOI: 10.1002/mpr.1559] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 12/01/2016] [Accepted: 01/13/2017] [Indexed: 11/06/2022] Open
Abstract
Administrative data have been used to determine the occurrence of suicide attempts and deliberate self-harm, but research about the accuracy of these sources is limited. This study used a clinical sample (n = 5719) containing psychiatry consultations from the emergency departments and inpatient units of the two major tertiary hospitals in Winnipeg, Canada to validate the accuracy of inpatient hospital diagnosis codes at identifying presentations for self-harm and suicide attempts. The Columbia Classification Algorithm of Suicide Assessment (C-CASA) was used as the gold standard. International Classification of Diseases version 10 Canadian Enhancement codes for intentional self-harm, undetermined intent self-harm, and accidental poisoning were assessed. Measures of validity included Kappa (κ), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Sensitivity of hospitalized attempts was low using intentional intent codes (36.9%, 95% confidence interval [CI]: 32.4-41.4%) but improved using unknown intent and accidental poisoning codes (44.8%, 95% CI: 40.2-49.4%). Agreement for suicide attempts did not increase with the addition of unknown intent and accidental poisoning codes (κ = 0.465-0.481), but were better for any self-harm (κ = 0.395-0.478). Hospital diagnosis codes undercount attempts and self-harm admissions. Including more data sources might improve the detection of events.
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Affiliation(s)
- Jason R Randall
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Center for Health Policy, Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leslie L Roos
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Center for Health Policy, Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laurence Y Katz
- Manitoba Center for Health Policy, Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James M Bolton
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Center for Health Policy, Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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21
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Kalesan B, Adhikarla C, Pressley JC, Fagan JA, Xuan Z, Siegel MB, Galea S. The Hidden Epidemic of Firearm Injury: Increasing Firearm Injury Rates During 2001-2013. Am J Epidemiol 2017; 185:546-553. [PMID: 28338922 DOI: 10.1093/aje/kww147] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 03/11/2016] [Indexed: 11/12/2022] Open
Abstract
Investigating firearm injury trends over the past decade, we examined temporal trends overall and according to race/ethnicity and intent in fatal and nonfatal firearm injuries (FFIs and NFIs) in United States during 2001-2013. Counts of FFIs and estimated counts of NFIs were obtained from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System. Poisson regression was used to analyze overall and subgroup temporal trends and to estimate annual change per 100,000 persons (change). Total firearm injuries (n = 1,328,109) increased annually by 0.36 (Ptrend < 0.0001). FFIs remained constant (change = 0.02; Ptrend = 0.22) while NFIs increased (change = 0.35; Ptrend < 0.0001). Homicide FFIs declined (change = -0.05; Ptrend < 0.0001) while homicide NFIs increased (change = 0.43; Ptrend < 0.0001). Suicide FFIs increased (change = 0.07; Ptrend < 0.0001) while unintentional FFIs and NFIs declined (changes = -0.01 and -0.09, respectively; Ptrend < 0.0001 and 0.005). Among whites, FFIs (change = 0.15; Ptrend < 0.0001) and NFIs (change = 0.13; Ptrend < 0.0001) increased; among blacks, FFIs declined (change = -0.20; Ptrend < 0.0001). Among Hispanics, FFIs declined (change = -0.28; Ptrend < 0.0001) while NFIs increased (change = 0.55; Ptrend = 0.014). The endemic firearm-related injury rates during the first decade of the 21st century mask a shift from firearm deaths towards a rapid rise in nonfatal injuries.
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Lim M, Lee S, Park JI. Differences between Impulsive and Non-Impulsive Suicide Attempts among Individuals Treated in Emergency Rooms of South Korea. Psychiatry Investig 2016; 13:389-96. [PMID: 27482239 PMCID: PMC4965648 DOI: 10.4306/pi.2016.13.4.389] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 10/19/2015] [Accepted: 11/08/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE A considerable proportion of suicide attempts are the result of sudden desires. Understanding such impulsive suicide attempts is necessary for effective interventions. We evaluated the impulsivity of suicide attempters treated in emergency rooms. The aim of the study was to identify the characteristics of impulsive suicide attempts by comparing these individuals to those who attempted to commit suicide in a non-impulsive manner. METHODS This study analyzed suicide attempters who visited the emergency departments of seven selected university hospitals. A total of 269 medical records in which impulsivity of suicide attempt were confirmed were subject to be analyzed. The impulsivity of the suicide attempt was examined using a summative score of items 6 and 15 on the Suicide Intent Scale. RESULTS A total of 48.0% of the participants were impelled by sudden inclinations to attempt suicide. Impulsive attempters were younger, unmarried and less physical illness than non-impulsive attempters, whereas no significant differences were found on psychiatric history and previous suicide history. Impulsive suicide attempters had suicide ideations that were not as severe (χ(2)=55.33, p<0.001) or intense (t=-8.38, p<0.001) as their counterparts'. Furthermore, medical results of impulsive suicide attempts were better than non-impulsive suicide attempts (t=-3.77, p<0.001). CONCLUSION The results suggested that a considerable proportion of suicide attempts were the result of sudden inclinations. Impulsive attempts were made in relatively earlier stages of suicide ideation; consequently, they have less intent than non-impulsive attempts.
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Affiliation(s)
- Meerae Lim
- St. Andrea Neuropsychiatric Hospital, Icheon, Republic of Korea
| | - Soojung Lee
- Korea Suicide Prevention Center, Seoul, Republic of Korea
| | - Jong-Ik Park
- Korea Suicide Prevention Center, Seoul, Republic of Korea
- Department of Psychiatry, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
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Coimbra DG, Pereira E Silva AC, de Sousa-Rodrigues CF, Barbosa FT, de Siqueira Figueredo D, Araújo Santos JL, Barbosa MR, de Medeiros Alves V, Nardi AE, de Andrade TG. Do suicide attempts occur more frequently in the spring too? A systematic review and rhythmic analysis. J Affect Disord 2016; 196:125-37. [PMID: 26921865 DOI: 10.1016/j.jad.2016.02.036] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 01/25/2016] [Accepted: 02/06/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Seasonal variations in suicides have been reported worldwide, however, there may be a different seasonal pattern in suicide attempts. The aim of this study was to perform a systematic review on seasonality of suicide attempts considering potential interfering variables, and a statistical analysis for seasonality with the collected data. METHOD Observational epidemiological studies about seasonality in suicide attempts were searched in PubMed, Web of Science, LILACS and Cochrane Library databases with terms attempted suicide, attempt and season. Monthly or seasonal data available were evaluated by rhythmic analysis softwares. RESULTS Twenty-nine articles from 16 different countries were included in the final review. It was observed different patterns of seasonality, however, suicide attempts in spring and summer were the most frequent seasons reported. Eight studies indicated differences in sex and three in the method used for suicide attempts. Three articles did not find a seasonal pattern in suicide attempts. Cosinor analysis identified an overall pattern of seasonal variation with a suggested peak in spring, considering articles individually or grouped and independent of sex and method used. A restricted analysis with self-poisoning in hospital samples demonstrated the same profile. LIMITATIONS Grouping diverse populations and potential analytical bias due to lack of information are the main limitations. CONCLUSIONS The identification of a seasonal profile suggests the influence of an important environmental modulator that can reverberate to suicide prevention strategies. Further studies controlling interfering variables and investigating the biological substrate for this phenomenon would be helpful to confirm our conclusion.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Antonio Egidio Nardi
- Panic & Respiration Laboratory, Institute of Psychiatry, Federal University of Rio de Janeiro, National Institute for Translational Medicine (INCT-TM), Rio de Janeiro, Brazil
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Linden S, Bussing R, Kubilis P, Gerhard T, Segal R, Shuster JJ, Winterstein AG. Risk of Suicidal Events With Atomoxetine Compared to Stimulant Treatment: A Cohort Study. Pediatrics 2016; 137:peds.2015-3199. [PMID: 27244795 PMCID: PMC4845870 DOI: 10.1542/peds.2015-3199] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Antidepressant effects on increased suicidality in children have raised public concern in recent years. Approved in 2002 for attention-deficit/hyperactivity disorder treatment, the selective noradrenalin-reuptake-inhibitor atomoxetine was initially investigated for the treatment of depression. In post-hoc analyses of clinical trial data, atomoxetine has been associated with an increased risk of suicidal ideation in children and adolescents. We analyzed whether the observed increased risk of suicidal ideation in clinical trials translates into an increased risk of suicidal events in pediatric patients treated with atomoxetine compared with stimulants in 26 Medicaid programs. METHODS Employing a retrospective cohort design, we used propensity score-adjusted Cox proportional hazard models to evaluate the risk of suicide and suicide attempt in pediatric patients initiating treatment with atomoxetine compared with stimulants from 2002 to 2006. RESULTS The first-line treatment cohort included 279 315 patients. During the first year of follow-up, the adjusted hazard ratio for current atomoxetine use compared with current stimulant use was 0.95 (95% CI 0.47-1.92, P = .88). The second-line treatment cohort included 220 215 patients. During the first year of follow-up, the adjusted hazard ratio for current atomoxetine use compared with current stimulant use was 0.71 (95% CI 0.30-1.67, P = .43). CONCLUSIONS First- and second-line treatment of youths age 5 to 18 with atomoxetine compared with stimulants was not significantly associated with an increased risk of suicidal events. The low incidence of suicide and suicide attempt resulted in wide confidence intervals and did not allow stratified analysis of high-risk groups or assessment of suicidal risk associated with long-term use of atomoxetine.
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Affiliation(s)
- Stephan Linden
- Pharmaceutical Outcomes and Policy, College of Pharmacy,
| | - Regina Bussing
- Departments of Psychiatry and Pediatrics, College of Medicine, Clinical and Health Psychology, College of Public Health and Health Professions
| | - Paul Kubilis
- Pharmaceutical Outcomes and Policy, College of Pharmacy
| | - Tobias Gerhard
- Ernest Mario School of Pharmacy and Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Richard Segal
- Pharmaceutical Outcomes and Policy, College of Pharmacy
| | - Jonathan J Shuster
- Health Outcomes and Policy, UF Clinical Research Center, College of Medicine, and
| | - Almut G Winterstein
- Pharmaceutical Outcomes and Policy, College of Pharmacy,,Epidemiology, College of Public Health and Health Professions and College of Medicine. University of Florida, Gainesville, Florida; and
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Nkhoma ET, Coumbis J, Farr AM, Johnston SS, Chu BC, Rosenblatt LC, Seekins D, Villasis-Keever A. No Evidence of an Association Between Efavirenz Exposure and Suicidality Among HIV Patients Initiating Antiretroviral Therapy in a Retrospective Cohort Study of Real World Data. Medicine (Baltimore) 2016; 95:e2480. [PMID: 26817882 PMCID: PMC4998256 DOI: 10.1097/md.0000000000002480] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Recently, published studies have reported conflicting results regarding the association between efavirenz exposure and the risk of suicidality among patients with human immunodeficiency virus. The objective of this analysis was to compare the rate of suicidality among patients initiating efavirenz-containing versus efavirenz-free antiretroviral (ARV) regimens.This retrospective cohort study used US administrative claims data for commercially and Medicaid-insured individuals for the years 2006 to 2013. ARV-naive patients aged ≥12 years initiating an efavirenz-containing or efavirenz-free ARV regimen with ≥6 months of continuous insurance enrollment prior to ARV initiation were selected. The primary outcome was suicidality, defined as the occurrence of any medical claim with a diagnosis code for suicidal ideation or an inpatient or emergency department medical claim for suicide attempt. Unadjusted incidence rates were calculated and propensity score-adjusted hazard ratios were estimated to account for differences in patient characteristics.There were 19,983 patients (efavirenz-containing, n = 11,187; efavirenz-free, n = 8796) in the commercial database and 5154 patients (efavirenz-containing, n = 2224; efavirenz-free, n = 2930) in the Medicaid database. Unadjusted incidence rates (95% confidence interval [CI]) of suicidality per 1000 person-years were: commercial, efavirenz-containing (3.3 [2.4-4.4]), efavirenz-free (4.0 [2.7-5.8]); Medicaid, efavirenz-containing (25.7 [18.8-34.4]), efavirenz-free (40.6 [31.9-50.9]). In propensity score-adjusted analyses, efavirenz use was not associated with suicidality: adjusted hazard ratio (95% CI) of suicidality compared with efavirenz-free regimen, commercial, 1.029 (0.636-1.665); Medicaid, 0.902 (0.617-1.319).This analysis found no conclusive evidence of an increased risk of suicidality among patients initiating an efavirenz-containing ARV regimen. However, channeling bias may exist even after adjusting for measured patient characteristics.
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Affiliation(s)
- Ella T Nkhoma
- From the Bristol-Myers Squibb, Global Pharmacovigilance and Epidemiology, Wallingford, Connecticut (ETN); Bristol-Myers Squibb, Global Pharmacovigilance and Epidemiology, Hopewell, New Jersey (JC, DS); Truven Health Analytics, Bethesda, Maryland (AMF, SSJ, BCC); Bristol-Myers Squibb, Health Economics and Outcomes Research (LCR); and Bristol-Myers Squibb, US Medical, Plainsboro, New Jersey (AV-K)
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Ivoneide MIVO, Gomes Bezerra Filho J, Gonçalves-Feitosa RF. Tentativas de suicídio atendidas em unidades públicas de saúde de Fortaleza-Ceará, Brasil. Rev Salud Publica (Bogota) 2015. [DOI: 10.15446/rsap.v16n5.40138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
<p> </p><p><strong>Objetivos</strong> Descrever as principais características de vítimas de tentativas de suicídio atendidas em instituições públicas de saúde de Fortaleza-Ceará, Brasil.</p><p><strong>Método</strong> Estudo quantitativo, utilizaram-se um questionário com perguntas estruturadas e Inventário de Depressão de Beck. Trabalhou-se com amostra por conveniência com 360 vítimas nos Centros de Atenção Psicossocial Geral, Atenção ao usuário de álcool/ drogas, Assistência à criança/adolescente, Hospital Doutor José Frota e Projeto de Apoio à Vida.</p><p><strong>Resultados </strong>Na análise estatística, usouse como variável dependente mais de uma tentativa de suicídio,<strong> </strong>associada às variáveis independentes. Na análise multivariada com mais de uma tentativa, e com significância (p<0,05), mantiveram associação: sexo masculino, OR=2,1 (IC95 %:1,2-3,6), p=0,005; sentimento de rejeição, RC=2,4 (IC95 %:1,4-3,9), p=0,001; internamento em hospital psiquiátrico, RC=3,4 (IC95 % :2,0-5,7), p=0,000; acreditar decepcionar alguém, RC=2,4 (IC95 %:1,3-4,4), p=0,005; depressão, RC=1,0 (IC95 %:1,0-1,0), p=0,001.</p><p><strong>Conclusão</strong> Os dados apontam a necessidade de maior atenção a essa população, no sentido de promover diferenciados serviços de apoio, quer psicológico, quer psiquiátrico para melhoria de vida das pessoas. </p>
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Sbarra DA, Law RW, Portley RM. Divorce and Death: A Meta-Analysis and Research Agenda for Clinical, Social, and Health Psychology. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2015; 6:454-74. [PMID: 26168197 DOI: 10.1177/1745691611414724] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Divorce is a relatively common stressful life event that is purported to increase risk for all-cause mortality. One problem in the literature on divorce and health is that it is fragmented and spread across many disciplines; most prospective studies of mortality are based in epidemiology and sociology, whereas most mechanistic studies are based in psychology. This review integrates research on divorce and death via meta-analysis and outlines a research agenda for better understanding the potential mechanisms linking marital dissolution and risk for all-cause mortality. Random effects meta-analysis with a sample of 32 prospective studies (involving more than 6.5 million people, 160,000 deaths, and over 755,000 divorces in 11 different countries) revealed a significant increase in risk for early death among separated/divorced adults in comparison to their married counterparts. Men and younger adults evidenced significantly greater risk for early death following marital separation/divorce than did women and older adults. Quantification of the overall effect size linking marital separation/divorce to risk for early death reveals a number of important research questions, and this article discusses what remains to be learned about four plausible mechanisms of action: social selection, resource disruptions, changes in health behaviors, and chronic psychological distress.
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Myers RP, Li B, Shaheen AAM. Emergency department visits for acetaminophen overdose: a Canadian population-based epidemiologic study (1997–2002). CAN J EMERG MED 2015; 9:267-74. [PMID: 17626691 DOI: 10.1017/s1481803500015153] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
ABSTRACTObjective:We describe the epidemiology of emergency department (ED) visits for acetaminophen overdose in a large Canadian health region, with a focus on sociodemographic risk factors and temporal trends.Methods:Patients presenting to an ED in the Calgary Health Region (population ~ 1.1 million) for acetaminophen overdose between 1997 and 2002 were identified using regional administrative data.Results:A total of 2699 patients made 3015 ED visits for acetaminophen overdose between 1997 and 2002, corresponding to an age- and sex-adjusted incidence of 45.7 per 100 000 population. Alcohol-related disorders were common (19%) and overdose rates were higher in females, younger patients, Aboriginals and social assistance recipients. The incidence decreased from 52.6 per 100 000 in 1997 to 35.1 per 100 000 in 2002 (34% relative reduction;p< 0.0005). When classified according to suicidal intent, the rates of intentional and unintentional overdose (69% and 25% of all overdoses, respectively) showed similar temporal trends. A marked seasonality was observed, with a peak in spring and early summer.Conclusions:ED visit rates for acetaminophen overdose fell between 1997 and 2002. High-risk groups, including young females and marginalized populations, may benefit from preventive and educational initiatives.
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Affiliation(s)
- Robert P Myers
- Liver Unit, Division of Gastroenterology, Department of Medicine, University of Calgary, Alberta.
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Ali MM, O'Brien CE, Cleves MA, Martin BC. Exploring the possible association between montelukast and neuropsychiatric events among children with asthma: a matched nested case-control study. Pharmacoepidemiol Drug Saf 2015; 24:435-45. [DOI: 10.1002/pds.3758] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 12/19/2014] [Accepted: 12/23/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Mir M. Ali
- Division of Pharmaceutical Evaluation and Policy; University of Arkansas for Medical Sciences; Little Rock AR USA
| | - Catherine E. O'Brien
- College of Pharmacy; University of Arkansas for Medical Sciences; Little Rock AR USA
| | - Mario A. Cleves
- College of Medicine; University of Arkansas for Medical Sciences; Little Rock AR USA
| | - Bradley C. Martin
- Division of Pharmaceutical Evaluation and Policy; University of Arkansas for Medical Sciences; Little Rock AR USA
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Sun J, Guo X, Zhang J, Wang M, Jia C, Xu A. Incidence and fatality of serious suicide attempts in a predominantly rural population in Shandong, China: a public health surveillance study. BMJ Open 2015; 5:e006762. [PMID: 25673439 PMCID: PMC4325129 DOI: 10.1136/bmjopen-2014-006762] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To estimate the incidence of serious suicide attempts (SSAs, defined as suicide attempts resulting in either death or hospitalisation) and to examine factors associated with fatality among these attempters. DESIGN A surveillance study of incidence and mortality. Linked data from two public health surveillance systems were analysed. SETTING Three selected counties in Shandong, China. PARTICIPANTS All residents in the three selected counties. OUTCOME MEASURES Incidence rate (per 100 000 person-years) and case fatality rate (%). METHODS Records of suicide deaths and hospitalisations that occurred among residents in selected counties during 2009-2011 (5 623 323 person-years) were extracted from electronic databases of the Disease Surveillance Points (DSP) system and the Injury Surveillance System (ISS) and were linked by name, sex, residence and time of suicide attempt. A multiple logistic regression model was developed to examine the factors associated with a higher or lower fatality rate. RESULTS The incidence of SSAs was estimated to be 46 (95% CI 44 to 48) per 100 000 person-years, which was 1.5 times higher in rural versus urban areas, slightly higher among females, and increased with age. Among all SSAs, 51% were hospitalised and survived, 9% were hospitalised but later died and 40% died with no hospitalisation. Most suicide deaths (81%) were not hospitalised and most hospitalised SSAs (85%) survived. The fatality rate was 49% overall, but was significantly higher among attempters living in rural areas, who were male, older, with lower education or with a farming occupation. With regard to the method of suicide, fatality was lowest for non-pesticide poisons (7%) and highest for hanging (97%). CONCLUSIONS The incidence of serious suicide attempts is substantially higher in rural areas than in urban areas of China. The risk of death is influenced by the attempter's sex, age, education level, occupation, method used and season of year.
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Affiliation(s)
- Jiandong Sun
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Xiaolei Guo
- Shandong Provincial Centre for Disease Control and Prevention, Jinan, Shandong, China
| | - Jiyu Zhang
- Shandong Provincial Centre for Disease Control and Prevention, Jinan, Shandong, China
| | - Mei Wang
- Shandong Provincial Centre for Disease Control and Prevention, Jinan, Shandong, China
| | | | - Aiqiang Xu
- Shandong Provincial Centre for Disease Control and Prevention, Jinan, Shandong, China
- Shandong University, Jinan, Shandong, China
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Lim M, Lee SU, Park JI. Difference in suicide methods used between suicide attempters and suicide completers. Int J Ment Health Syst 2014; 8:54. [PMID: 25584067 PMCID: PMC4290454 DOI: 10.1186/1752-4458-8-54] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/11/2014] [Indexed: 11/10/2022] Open
Abstract
Background In light of the increased suicide rate in Korea, it has become important for researchers to examine the various factors associated with it. The purpose of this study is to compare and analyze the difference between suicide attempters and completers in terms of the suicide methods used and the lethality of these methods. In addition, we investigated certain demographic factors that are associated with the choice of suicide method by evaluating their lethality. Finding The most frequently used methods of suicide were different in the two groups of attempters and completers. Drug poisoning was the most frequent method in suicide attempters, whereas hanging was the most common method among suicide completers. Drug poisoning, stabbing, and other chemical poisoning were evaluated as relatively non-lethal compared to other suicide methods. While about 70.0% of the suicide attempters used relatively non-lethal methods, almost all suicide completers used lethal methods, based on our classification of the lethality of the method. In terms of gender, males used more lethal methods of suicide. Conclusions Suicide completers’ choice of suicide methods are different from those of suicide attempters and tend to be more lethal. Interventions to restrict access to more lethal suicidal methods could be a useful strategy to reduce the suicide rates in South Korea.
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Affiliation(s)
- Meerae Lim
- St. Andrea Neuropsychiatric Hospital, Icheon, Republic of Korea
| | - Sang Uk Lee
- Korea Suicide Prevention Center, Seoul, Republic of Korea
| | - Jong-Ik Park
- Department of Psychiatry, Kangwon National University School of Medicine, 17-1 Hyoja-3-Dong, Chuncheon-Si, Kangwon-Do 200-947 Korea
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Lorenzo-Luaces L, Phillips JA. Racial and ethnic differences in risk factors associated with suicidal behavior among young adults in the USA. ETHNICITY & HEALTH 2014; 19:458-477. [PMID: 24134205 DOI: 10.1080/13557858.2013.846299] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The objectives of this study are to examine racial and ethnic differences in suicidal behaviour, its main risk factors, and the effect of the risk factors on suicidal behaviour in young adults in the United States. DESIGN Using nationally representative data (n=10,585) from Add Health, we calculate the prevalence of suicidal behavior and associated risk factors for non-Hispanic White, non-Hispanic Black, and Hispanic youth (aged 18-26) using logistic regression models of suicidal ideation stratified by race. RESULTS Non-Hispanic White and Hispanic young adults have higher rates of suicidal ideation than their non-Hispanic Black counterparts, but racial/ethnic differences in attempts are not statistically significant. Non-Hispanic Whites and Hispanic young adults are more likely to possess key risk factors for suicide. With the exception of substance use variables (i.e. alcohol and marijuana use) which appear to be more conducive to suicidal ideation in non-Hispanic Black than in non-Hispanic White young adults, the effects of risk factors appear to be similar across race/ethnicity. CONCLUSION The higher prevalence of suicidal ideation in non-Hispanic White and Hispanic young adults may be driven by their greater exposure to risk factors, as opposed to differences in the effects of these risk factors. More research is needed to uncover why non-Hispanic White and Hispanic young adults have higher rates of suicidal ideation than their non-Hispanic Black counterparts; yet, rates of suicide attempts are comparable and non-Hispanic White young adults have the highest rate of completed suicides.
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Takahama CH, Turini CA, Girotto E. Perfil das exposições a medicamentos por mulheres em idade reprodutiva atendidas por um Centro de Informações Toxicológicas. CIENCIA & SAUDE COLETIVA 2014; 19:1191-9. [DOI: 10.1590/1413-81232014194.00512013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Accepted: 04/27/2013] [Indexed: 11/21/2022] Open
Abstract
O objetivo deste artigo é descrever os dados epidemiológicos referentes às exposições a medicamentos por mulheres em idade fértil atendidas por um Centro de Informações Toxicológicas. Realizou-se um estudo com mulheres em idade fértil, expostas a medicamentos entre 2007 e 2011. Foram estudadas variáveis relacionadas às pacientes, à ocorrência e ao medicamento envolvido, totalizando 777 notificações. Os dados foram obtidos do Sistema de Informação de Agravos de Notificação e processadas com o uso do programa Epi Info. A maioria das ocorrências (90,5%) foi intencional, em 33,7% dos casos foram utilizados de dois a três medicamentos e a frequência de hospitalização foi de 35,6%. Os medicamentos com atuação no Sistema Nervoso Central foram responsáveis por 59,9% das ocorrências, destacando-se os antiepilépticos (21,2%) e os antidepressivos (20,7%). Os principais fatores associados à hospitalização das pacientes foram: demora no atendimento após a ocorrência da exposição, pacientes com nível superior, contato com dois ou mais medicamentos e exposições a antiepilépticos e antidepressivos. Os resultados obtidos mostraram que as exposições a medicamentos representam um grave problema à saúde de mulheres em idade fértil e contribuem para o aumento das internações hospitalares.
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Lee HY, Hahm MI, Park EC. Differential association of socio-economic status with gender- and age-defined suicidal ideation among adult and elderly individuals in South Korea. Psychiatry Res 2013; 210:323-8. [PMID: 23769392 DOI: 10.1016/j.psychres.2013.05.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 01/18/2013] [Accepted: 05/08/2013] [Indexed: 10/26/2022]
Abstract
South Korea has the highest suicide rate among countries in the Organisation for Economic Co-operation and Development (OECD), with a rising trend that contrasts with the trend in most other OECD countries. This study assessed differential associations of socio-demographic factors with suicidal ideation in South Korea. We used five waves of data from the 2010 Korea National Health and Nutrition Examination Survey. Study subjects included 5803 men and women aged >25 years. We analysed weighted percentages with consideration of the complex survey sample design and unequal weights. Surveylogistic regressions were applied. Protective effects against suicidal ideation were found for higher household income, higher educational attainment, and being married. Functional limitations and depressive symptoms were risk factors for suicidal ideation. However, these significant factors may exert different effects on vulnerability for suicidal ideation among different genders and age groups. Thus, household income was mainly protective for women and subjects aged 25-44 years, and educational attainment was protective for individuals aged >65 years. Our findings suggest the need for extended social protection policies for the less privileged population and special strategies for different groups.
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Affiliation(s)
- Hoo-Yeon Lee
- Department of Social Medicine, College of Medicine, Dankook University, 201, Manghyang-ro, Dongnam-gu, Cheonan-si, Choongnam 330-714, South Korea
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Giner L, Blasco-Fontecilla H, Mercedes Perez-Rodriguez M, Garcia-Nieto R, Giner J, Guija JA, Rico A, Barrero E, Luna MA, de Leon J, Oquendo MA, Baca-Garcia E. Personality disorders and health problems distinguish suicide attempters from completers in a direct comparison. J Affect Disord 2013; 151:474-483. [PMID: 23859005 DOI: 10.1016/j.jad.2013.06.029] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 06/19/2013] [Accepted: 06/19/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Whether suicide attempters and completers represent the same population evaluated at different points along a progression towards suicide death, overlapping populations, or completely different populations is a problem still unresolved. METHODS 446 Adult suicide attempters and knowledgeable collateral informants for 190 adult suicide probands were interviewed. Sociodemographic and clinical data was collected for both groups using semi-structured interviews and structured assessments. Univariate analyses and logistic regression models were conducted to explore the similarities and differences between suicide attempters and completers. RESULTS Univariate analyses yielded significant differences in sociodemographics, recent life events, impulsivity, suicide intent, and distribution of Axis I and II disorders. A logistic regression model aimed at distinguishing suicide completers from attempters properly classified 90% of subjects. The most significant variables that distinguished suicide from attempted suicide were the presence of narcissistic personality disorder (OR=21.4; 95% CI=6.8-67.7), health problems (OR=20.6; 95% CI=5.6-75.9), male sex (OR=9.6; 95% CI=4.42-20.9), and alcohol abuse (OR=5.5; 95% CI=2.3-14.2). LIMITATIONS Our study shares the limitations of studies comparing suicide attempters and completers, namely that information from attempters can be obtained from the subject himself, whereas the assessment of completers depends on information from close family or friends. Furthermore, different semi-structured instruments assessed Axis I and Axis II disorders in suicide attempters and completers. Finally, we have no data on inter-rater reliability data. CONCLUSIONS Suicide completers are more likely to be male and suffer from alcohol abuse, health problems (e.g. somatic illness), and narcissistic personality disorder. The findings emphasize the importance of implementing suicide prevention programs tailored to suicide attempters and completers.
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Affiliation(s)
- Lucas Giner
- Department of Psychiatry, University of Seville, Seville, Spain
| | | | - M Mercedes Perez-Rodriguez
- Department of Psychiatry, Mount Sinai School of Medicine, and the Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center New York, NY, USA
| | - Rebeca Garcia-Nieto
- Department of Psychiatry, Jimenez Diaz Foundation, Autonoma University, IIS, CIBERSAM, Madrid, Spain
| | - Jose Giner
- Department of Psychiatry, University of Seville, Seville, Spain
| | - Julio A Guija
- Department of Psychiatry, University of Seville, Seville, Spain; Department of Psychiatry, Institute of Legal Medicine, Seville, Spain
| | - Antonio Rico
- Department of Pathology, Institute of Legal Medicine, Seville, Spain
| | - Enrique Barrero
- Department of Pathology, Institute of Legal Medicine, Seville, Spain
| | - Maria Angeles Luna
- Department of Pathology, Institute of Legal Medicine, Ciudad Real and Toledo, Toledo, Spain
| | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, Kentucky, USA
| | - Maria A Oquendo
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Enrique Baca-Garcia
- Department of Psychiatry, Jimenez Diaz Foundation, Autonoma University, IIS, CIBERSAM, Madrid, Spain; Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
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Deliberate self-harm before psychiatric admission and risk of suicide: survival in a Danish national cohort. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1481-9. [PMID: 23609375 DOI: 10.1007/s00127-013-0690-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 04/09/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Psychiatric illness and deliberate self-harm (DSH) are major risk factors of suicide. In largely 15% of psychiatric admissions in Denmark, the patient had an episode of DSH within the last year before admission. This study examined the survival and predictors of suicide in a suicidal high-risk cohort consisting of hospitalized psychiatric patients with recent DSH. METHODS This national prospective register-based study examined all hospitalized psychiatric patients who self-harmed within a year before admission. All admitted patients, in the time period 1998-2006, were followed and survival analyses techniques were used to identify predictors of suicide. RESULTS The study population consisted of 17,257 patients; 520 (3%) died by suicide during follow-up; 50% of the suicides occurred within a year from the index admission. A rate of 1,645 suicides per 100,000 person-years in the first year after psychiatric admission was found. Adjusted analyses showed that a higher degree of education, having DSH within a month before psychiatric admission and contact with a private psychiatrist increased the risk of suicide. CONCLUSIONS Psychiatric hospitalized patients with recent DSH revealed high suicide rates, even during hospitalization. When discharging psychiatric patients with recent DSH careful arrangement of follow-up treatment in the outpatient setting is recommendable.
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Suicide mortality gap between Francophones and Anglophones of Quebec, Canada. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1125-32. [PMID: 23262814 DOI: 10.1007/s00127-012-0637-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Accepted: 11/30/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Few studies evaluate language-group differences in suicide mortality. This study assessed the suicide mortality gap between Francophones and Anglophones of Quebec, Canada according to age, sex, method, region and socioeconomic deprivation. METHODS Suicide decedents were extracted from the Quebec death file for 1989-2007 (N = 24,465). Age- and sex-specific suicide mortality rates were calculated for four periods (1989-1993, 1994-1998, 1999-2003, 2004-2007) for Francophones and Anglophones aged ≥10 years. Age-standardized rates of suicide by method, region, and level of social and material deprivation were calculated for each sex. Rate ratios and rate differences were estimated. RESULTS Suicide rates for Francophones were two to three times higher than rates for Anglophones, and differences were greatest for adults aged 25-64 years. Francophone males had more than two times the rate of suicide by hanging or firearms than Anglophone males. Francophone females had twice the rate of hanging, poisoning or firearm suicide as Anglophone females, although precision was low. Francophone-Anglophone suicide mortality gaps were higher in urban areas despite lower suicide rates, and varied little across levels of social and material deprivation. CONCLUSIONS There was a large suicide mortality gap between Francophones and Anglophones of Quebec; especially, among adults aged 25-64 years.
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Schumock GT, Stayner LT, Valuck RJ, Joo MJ, Gibbons RD, Lee TA. Risk of suicide attempt in asthmatic children and young adults prescribed leukotriene-modifying agents: A nested case-control study. J Allergy Clin Immunol 2012; 130:368-75. [DOI: 10.1016/j.jaci.2012.04.035] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 04/24/2012] [Accepted: 04/25/2012] [Indexed: 11/15/2022]
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Marcus SC, Bridge JA, Olfson M. Payment source and emergency management of deliberate self-harm. Am J Public Health 2012; 102:1145-53. [PMID: 22515853 PMCID: PMC3483957 DOI: 10.2105/ajph.2011.300598] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2011] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated whether health insurance type (private vs Medicaid) influences the delivery of acute mental health care to patients with deliberate self-harm. METHODS Using National Medicaid Analytic Extract Files (2006) and MarketScan Research Databases (2005-2007), we analyzed claims focusing on emergency episodes of deliberate self-harm of Medicaid- (n=8,228) and privately (n=2,352) insured adults. We analyzed emergency department mental health assessments and outpatient mental health visits in the 30 days following the emergency visit for discharged patients. RESULTS Medicaid-insured patients were more likely to be discharged (62.7%), and among discharged patients they were less likely to receive a mental health assessment in the emergency department (47.8%) and more likely to receive follow-up outpatient mental health care (52.9%) than were privately insured patients (46.9%, 57.3%, and 41.2%, respectively). CONCLUSIONS Acute emergency management of deliberate self-harm is less intensive for Medicaid- than for privately insured patients, although discharged Medicaid-insured patients are more likely to receive follow-up care. Programmatic reforms are needed to improve access to emergency mental health services, especially in hospitals that serve substantial numbers of Medicaid-insured patients.
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Affiliation(s)
- Steven C Marcus
- Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, School of Social Policy and Practice of the University of Pennsylvania, Philadelphia, USA
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Walkup JT, Townsend L, Crystal S, Olfson M. A systematic review of validated methods for identifying suicide or suicidal ideation using administrative or claims data. Pharmacoepidemiol Drug Saf 2012; 21 Suppl 1:174-82. [PMID: 22262604 DOI: 10.1002/pds.2335] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE As part of the Mini-Sentinel pilot program, under contract with the Food and Drug Administration, an effort has been made to evaluate the validity of algorithms useful for identifying health outcomes of interest, including suicide and suicide attempt. METHOD Literature was reviewed to evaluate how well medical episodes associated with these events could be identified in administrative or claims data sets from the USA or Canada. RESULTS Six studies were found to include sufficient detail to assess performance characteristics of an algorithm on the basis of International Classification of Diseases, Ninth Revision, E-codes (950-959) for intentional self-injury. Medical records and death registry information were used to validate classification. Sensitivity ranged from 13.8% to 65%, and positive predictive value range from 4.0% to 100%. Study comparisons are difficult to interpret, however, as the studies differed substantially in many important elements, including design, sample, setting, and methods. Although algorithm performance varied widely, two studies located in prepaid medical plans reported that comparisons of database codes to medical charts could achieve good agreement. CONCLUSIONS Insufficient data exist to support specific recommendations regarding a preferred algorithm, and caution should be exercised in interpreting clinical and pharmacological epidemiological surveillance and research that rely on these codes as measures of suicide-related outcomes.
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Affiliation(s)
- James T Walkup
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ 08901-1293, USA.
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Study of ethnic differences in suicide attempts in Kuwait. MIDDLE EAST CURRENT PSYCHIATRY 2012. [DOI: 10.1097/01.xme.0000413051.76274.d2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Cheong KS, Choi MH, Cho BM, Yoon TH, Kim CH, Kim YM, Hwang IK. Suicide rate differences by sex, age, and urbanicity, and related regional factors in Korea. J Prev Med Public Health 2012; 45:70-7. [PMID: 22509447 PMCID: PMC3324718 DOI: 10.3961/jpmph.2012.45.2.70] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 10/26/2011] [Indexed: 01/25/2023] Open
Abstract
Objectives Identify the characteristics related to the suicide rates in rural and urban areas of Korea and discover the factors that influence the suicide rate of the rural and urban areas. Methods Using the data on causes of death from 2006 to 2008, the suicide rates were calculated and compared after age-standardization based on gender, age group and urbanicity. And, in order to understand the factors that influence suicide rate, total 10 local characteristics in four domains - public service, social integration, residential environment, and economic status - were selected for multiple regression analysis. Results The suicide rates were higher in men than women, in rural areas than urban, and in older people than the younger. Generally, although there were variations according to age group and urbanicity, suicide rates were significantly related to residential environment and regional economic status but not related to regional welfare spending and social integration. In addition, the population over the age of 65 years, only regional economic status has significantly influence on their suicide rates. Conclusions The influence of characteristics of regions on suicide rate is various by age-group, gender, and urbanicity. Therefore, in order to lower suicide rate and reduce the gap between regions, various approaches must be adopted by taking into account the socioeconomic characteristics of the regions.
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Affiliation(s)
- Kyu-Seok Cheong
- Department of Preventive and Occupational Medicine, Pusan National University College of Medicine, Yangsan, Korea
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Kidger J, Gunnell D, Jarvik JG, Overstreet KA, Hollingworth W. The association between bankruptcy and hospital-presenting attempted suicide: a record linkage study. Suicide Life Threat Behav 2011; 41:676-84. [PMID: 22145826 DOI: 10.1111/j.1943-278x.2011.00063.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The associations between admissions to an emergency department following attempted suicide and personal bankruptcy in the preceding and subsequent 2 years were evaluated. Records from a level 1 trauma center (June 1993-December 2002) in Seattle, WA, were linked with case files from the local U.S. District Bankruptcy Court (June 1991 onward). Univariable and multivariable logistic regression models were used to examine the risk of bankruptcy in (i) the 2 years after and (ii) the 2 years before a suicide attempt using a violent method, compared to patients admitted for any other reason. After adjusting for several confounders, patients who had attempted suicide were more likely than other patients to experience bankruptcy in the following 2 years (OR = 2.10, 95% CIs: 1.29, 3.42). A somewhat weaker association was seen with bankruptcy in the preceding 2 years (OR = 1.68, 95% CIs 1.06; 2.67). Attempted suicide is therefore associated with bankruptcy in the preceding and following 2 years. Changes to legislation, improved mental health counselling for those in financial difficulty, and provision of financial advice to those admitted to hospital following a suicide attempt may reduce future cases of serious self-harm and completed suicide.
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Affiliation(s)
- Judi Kidger
- School of Social and Community Medicine, University of Bristol, Bristol, UK.
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Burrows S, Auger N, Gamache P, St-Laurent D, Hamel D. Influence of social and material individual and area deprivation on suicide mortality among 2.7 million Canadians: a prospective study. BMC Public Health 2011; 11:577. [PMID: 21771330 PMCID: PMC3154174 DOI: 10.1186/1471-2458-11-577] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 07/19/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have investigated how area-level deprivation influences the relationship between individual disadvantage and suicide mortality. The aim of this study was to examine individual measures of material and social disadvantage in relation to suicide mortality in Canada and to determine whether these relationships were modified by area deprivation. METHODS Using the 1991-2001 Canadian Census Mortality Follow-up Study cohort (N = 2,685,400), measures of individual social (civil status, family structure, living alone) and material (education, income, employment) disadvantage were entered into Cox proportional hazard models to calculate hazard ratios (HR) and 95% confidence intervals (CI) for male and female suicide mortality. Two indices of area deprivation were computed - one capturing social, and the other material, dimensions - and models were run separately for high versus low deprivation. RESULTS After accounting for individual and area characteristics, individual social and material disadvantage were associated with higher suicide mortality, especially for individuals not employed, not married, with low education and low income. Associations between social and material area deprivation and suicide mortality largely disappeared upon adjustment for individual-level disadvantage. In stratified analyses, suicide risk was greater for low income females in socially deprived areas and males living alone in materially deprived areas, and there was no evidence of other modifying effects of area deprivation. CONCLUSIONS Individual disadvantage was associated with suicide mortality, particularly for males. With some exceptions, there was little evidence that area deprivation modified the influence of individual disadvantage on suicide risk. Prevention strategies should primarily focus on individuals who are unemployed or out of the labour force, and have low education or income. Individuals with low income or who are living alone in deprived areas should also be targeted.
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Affiliation(s)
- Stephanie Burrows
- Centre de recherche du Centre hospitalier de l'Université de Montréal, 1301 rue Sherbrooke Est Montréal, Québec, H2L 1M3, Canada.
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Jo SJ, Lee MS, Yim HW, Kim HJ, Lee K, Chung HS, Cho J, Choi SP, Seo YM. Factors associated with referral to mental health services among suicide attempters visiting emergency centers of general hospitals in Korea: does history of suicide attempts predict referral? Gen Hosp Psychiatry 2011; 33:294-9. [PMID: 21601727 DOI: 10.1016/j.genhosppsych.2011.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 01/15/2011] [Accepted: 01/19/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study examined whether a history of past suicide attempts was a critical factor for referral to mental health services among suicide attempters visiting emergency centers of general hospitals in Korea. METHOD In this cross-sectional study, a resident of emergency medicine at each emergency center interviewed 310 suicide attempters visiting five tertiary general hospitals located in Seoul, using standardized questionnaires, during 7 months in 2007. We examined associations between suicide attempt history and referral to mental health services via multiple logistic regressions. RESULTS Subjects' rate of referral to mental health services was 47.3%. When we controlled for participant age, time of arrival at the emergency center, psychiatric treatment history, use of alcohol, suicide attempt lethality and subjective expectation to suicide attempts, past suicide attempts did not predict referral to mental health services (odds ratio=1.74; 95% confidence interval .88-3.43). CONCLUSION Psychiatric interventions for suicide reattempters visiting emergency centers are important for preventing suicide, but providers have not considered suicide attempt history as a critical factor for referral to mental health services. Therefore, we suggest that more effort is needed to systemize psychiatric interventions for suicide reattempters at emergency centers in Korea.
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Affiliation(s)
- Sun-Jin Jo
- Department of Preventive Medicine, College of Medicine, Catholic University of Korea, and Clinical Research Center for Depression of Korea, South Korea
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Fung YL, Chan ZCY. A systematic review of suicidal behaviour in old age: a gender perspective. J Clin Nurs 2011; 20:2109-24. [DOI: 10.1111/j.1365-2702.2010.03649.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Chin YR, Lee HY, So ES. Suicidal ideation and associated factors by sex in Korean adults: a population-based cross-sectional survey. Int J Public Health 2011; 56:429-39. [DOI: 10.1007/s00038-011-0245-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Revised: 02/14/2011] [Accepted: 02/28/2011] [Indexed: 11/30/2022] Open
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Patrick AR, Miller M, Barber CW, Wang PS, Canning CF, Schneeweiss S. Identification of hospitalizations for intentional self-harm when E-codes are incompletely recorded. Pharmacoepidemiol Drug Saf 2010; 19:1263-75. [PMID: 20922709 DOI: 10.1002/pds.2037] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 05/26/2010] [Accepted: 07/19/2010] [Indexed: 11/09/2022]
Abstract
CONTEXT Suicidal behavior has gained attention as an adverse outcome of prescription drug use. Hospitalizations for intentional self-harm, including suicide, can be identified in administrative claims databases using external cause of injury codes (E-codes). However, rates of E-code completeness in US government and commercial claims databases are low due to issues with hospital billing software. OBJECTIVE To develop an algorithm to identify intentional self-harm hospitalizations using recorded injury and psychiatric diagnosis codes in the absence of E-code reporting. METHODS We sampled hospitalizations with an injury diagnosis (ICD-9 800-995) from two databases with high rates of E-coding completeness: 1999-2001 British Columbia, Canada data and the 2004 US Nationwide Inpatient Sample. Our gold standard for intentional self-harm was a diagnosis of E950-E958. We constructed algorithms to identify these hospitalizations using information on type of injury and presence of specific psychiatric diagnoses. RESULTS The algorithm that identified intentional self-harm hospitalizations with high sensitivity and specificity was a diagnosis of poisoning, toxic effects, open wound to elbow, wrist, or forearm, or asphyxiation; plus a diagnosis of depression, mania, personality disorder, psychotic disorder, or adjustment reaction. This had a sensitivity of 63%, specificity of 99% and positive predictive value (PPV) of 86% in the Canadian database. Values in the US data were 74, 98, and 73%. PPV was highest (80%) in patients under 25 and lowest those over 65 (44%). CONCLUSIONS The proposed algorithm may be useful for researchers attempting to study intentional self-harm in claims databases with incomplete E-code reporting, especially among younger populations.
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Affiliation(s)
- Amanda R Patrick
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02120, USA.
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Bernardes SS, Turini CA, Matsuo T. Perfil das tentativas de suicídio por sobredose intencional de medicamentos atendidas por um Centro de Controle de Intoxicações do Paraná, Brasil. CAD SAUDE PUBLICA 2010; 26:1366-72. [DOI: 10.1590/s0102-311x2010000700015] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 04/01/2010] [Indexed: 11/21/2022] Open
Abstract
Este trabalho apresenta o perfil das tentativas de suicídio atendidas pelo Centro de Controle de Intoxicações da cidade de Londrina, Paraná, Brasil. Foi realizado um estudo retrospectivo dos casos atendidos entre 1997-2007. As tentativas de suicídio foram significativas entre homens desempregados e mulheres donas-de-casa/aposentadas, e houve associação com outras substâncias em 51,5% dos casos, sendo a freqüência maior entre os homens. 51,1% dos homens associaram o medicamento com bebida alcoólica, e entre as mulheres, 84,8% das associações se referiram a medicamentos. Os grupos farmacológicos de maior freqüência foram os tranqüilizantes (25,5%), antidepressivos (17%), anticonvulsivos (15%) e AINES (11,9%), respectivamente. Os prescritores devem avaliar corretamente o paciente antes de receitar psicofármacos, uma vez que esse é o grupo farmacológico mais freqüente nas tentativas de suicídio. Campanhas de conscientização para o uso racional de medicamentos, juntamente com programas sociais de atendimento ao paciente suicida, também poderiam contribuir na diminuição da freqüência desses casos.
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Colman I, Yiannakoulias N, Schopflocher D, Svenson LW, Rosychuk RJ, Rowe BH. Population-based study of medically treated self-inflicted injuries. CAN J EMERG MED 2010; 6:313-20. [PMID: 17381987 DOI: 10.1017/s148180350000957x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Self-inflicted injury is commonly seen in emergency departments (EDs). It may be a pre-cursor to death by suicide. The objective of this study was to examine the epidemiology of self-inflicted injury presentations to EDs in the province of Alberta. METHODS Self-inflicted injury records for the 3 fiscal years 1998/99 to 2000/01 were accessed from the Ambulatory Care Classification System, a database that captures all ED encounters in the province of Alberta. Available data for each case included demographic details, location and time of visit, diagnoses and procedures. RESULTS There were 22 396 self-inflicted injury presentations to Alberta EDs during the study period. Self-inflicted injury rates were higher in females, younger patients, those on social services and those with Aboriginal treaty status. There were higher rates of return visits in the year following the self-inflicted injury than in other patient groups. Data showed regional variation. Trends could be seen in the timing of self-inflicted injury presentations by hour of day, day of week, and month of year. CONCLUSIONS Self-inflicted injury is common, with particularly high rates demonstrated among marginalized populations. This study provides comprehensive data on those who present with self-inflicted injuries, and can be used to guide further treatment, research and evaluation for this population.
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Affiliation(s)
- Ian Colman
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
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