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Akinyemi O, Ogundare T, Weldeslase T, Andine T, Fasokun M, Odusanya E, Hughes K, Mallory W, Luo G, Cornwell E. The association between community-level economic deprivation and incidences of emergency department visits on account of attempted suicides in Maryland. Front Public Health 2024; 12:1353283. [PMID: 38384877 PMCID: PMC10879598 DOI: 10.3389/fpubh.2024.1353283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024] Open
Abstract
Background Suicide is a major cause of mortality in the United States, accounting for 14.5 deaths per 100,000 population. Many emergency department (ED) visits in the United States are due to attempted suicides. Suicide attempts predict subsequent completed suicides. Socioeconomic factors, such as community-level socioeconomic deprivation, significantly affect many traditional risk factors for attempted suicides and suicides. Aim To determine the association between community-level socioeconomic deprivation and ED visits for attempted suicide in Maryland. Methods A retrospective analysis of attempted suicides in the Maryland State Emergency Department Database from January 2018 to December 2020. Community-level socioeconomic deprivation was measured using the Distress Community Index (DCI). Multivariate regression analyses were conducted to identify the association between DCI and attempted suicides/self-harm. Results There were 3,564,987 ED visits reported in the study period, with DCI data available for 3,236,568 ED visits; 86.8% were younger than 45 years, 64.8% were females, and 54.6% non-Hispanic Whites. Over the study period, the proportion of ED visits due to attempted suicide was 0.3%. In the multivariate logistic regression, compared to prosperous zones, those in comfortable (OR = 0.80, 95% CI: 0.73-0.88, p < 0.01), Mid-Tier (OR = 0.76, 95%CI:0.67-0.86, p < 0.01), At-Risk (OR = 0.77; 95%CI: 0.65-0.92, p < 0.01) and Distressed zones (OR = 0.53; 95% CI:0.42-0.66, p < 0.01) were less likely to visit the ED for attempted suicide. Conclusion Prosperous communities had the highest rate of attempted suicides, with the risk of attempted suicide increasing as individuals move from the least prosperous to more prosperous areas.
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Affiliation(s)
- Oluwasegun Akinyemi
- Clive O Callender Department of Surgery, Howard University College of Medicine, Washington, DC, United States
| | - Temitope Ogundare
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Terhas Weldeslase
- Department of Surgery, Howard University College of Medicine, Washington, DC, United States
| | - Tsion Andine
- Department of Surgery, Howard University College of Medicine, Washington, DC, United States
| | - Mojisola Fasokun
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Eunice Odusanya
- Department of Surgery, Howard University College of Medicine, Washington, DC, United States
| | - Kakra Hughes
- Department of Surgery, Howard University College of Medicine, Washington, DC, United States
| | - Williams Mallory
- Department of Surgery, Howard University College of Medicine, Washington, DC, United States
| | - Guoyang Luo
- Department of Obstetrics and Gynecology, Howard University College of Medicine, Washington, DC, United States
| | - Edward Cornwell
- Department of Surgery, Howard University College of Medicine, Washington, DC, United States
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Schofield P, Das-Munshi J, Webb RT, Horsdal HT, Pedersen CB, Agerbo E. Lack of fit with the neighbourhood social environment as a risk factor for psychosis - a national cohort study. Psychol Med 2023; 53:866-874. [PMID: 34140057 PMCID: PMC9975998 DOI: 10.1017/s0033291721002233] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Many studies report an ethnic density effect whereby psychosis incidence among ethnic minority groups is higher in low co-ethnic density areas. It is unclear whether an equivalent density effect applies with other types of socioeconomic disadvantages. METHODS We followed a population cohort of 2 million native Danes comprising all those born on 1st January 1965, or later, living in Denmark on their 15th birthday. Socioeconomic disadvantage, based on parents' circumstances at age 15 (low income, manual occupation, single parent and unemployed), was measured alongside neighbourhood prevalence of these indices. RESULTS Each indicator was associated with a higher incidence of non-affective psychosis which remained the same, or was slightly reduced, if neighbourhood levels of disadvantage were lower. For example, for individuals from a low-income background there was no difference in incidence for those living in areas where a low-income was least common [incidence rate ratio (IRR) 1.01; 95% confidence interval (CI) 0.93-1.10 v. those in the quintile where a low income was most common. Typically, differences associated with area-level disadvantage were the same whether or not cohort members had a disadvantaged background; for instance, for those from a manual occupation background, incidence was lower in the quintile where this was least v. most common (IRR 0.83; 95% CI 0.71-0.97), as it was for those from a non-manual background (IRR 0.77; 95% CI 0.67-0.87). CONCLUSION We found little evidence for group density effects in contrast to previous ethnic density studies. Further research is needed with equivalent investigations in other countries to see if similar patterns are observed.
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Affiliation(s)
- Peter Schofield
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Jayati Das-Munshi
- ESRC Centre for Society and Mental Health, King's College London, London, UK
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Roger T. Webb
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- National Institute of Health Research (NIHR) Greater Manchester Patient Safety Centre, Manchester, UK
| | | | - Carsten B. Pedersen
- National Centre for Register-Based Research (NCCR), Aarhus University, Aarhus, Denmark
- CIRRAU – Centre for Integrated Register-based Research at Aarhus University, Aarhus, Denmark
| | - Esben Agerbo
- National Centre for Register-Based Research (NCCR), Aarhus University, Aarhus, Denmark
- CIRRAU – Centre for Integrated Register-based Research at Aarhus University, Aarhus, Denmark
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Midlife suicide: A systematic review and meta-analysis of socioeconomic, psychiatric and physical health risk factors. J Psychiatr Res 2022; 154:233-241. [PMID: 35961179 DOI: 10.1016/j.jpsychires.2022.07.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 07/09/2022] [Accepted: 07/20/2022] [Indexed: 10/16/2022]
Abstract
Suicide is an increasing contributing cause of mortality in middle-aged adults; however, knowledge to guide prevention is limited. This first systematic review and meta-analysis of studies on midlife suicide has provided an overview of published research on this issue and synthesized the evidence on socioeconomic and physical and mental health factors associated with this mortality. Using PRISMA guidelines MEDLINE, Embase, PsycINFO, Scopus and Web of Science were searched for English-language publications that involved persons aged 35 to 65, used individual-level data, and reported prevalence of exposure(s) or relative risks. The search identified 62 studies on midlife suicides and associated factors (28 for SES, 22 for psychiatric disorder and 23 for physical illness). All studies were from high income countries, and most (80.6%) used data from population registries. Meta-analyses showed that the pooled prevalence of exposure in suicide decedents was 57.8% for psychiatric disorder, 56.3% for low income, 43.2% for unemployment, and 27.3% for physical illness. The associated pooled risk ratio was 11.68 (95% confidence intervals: 5.82-23.47) for psychiatric illness of any type, 12.59 (8.29-19.12) for mood disorders, 3.91 (2.72-5.59) for unemployment, 3.18 (2.72-3.72) for being separated or divorced, 2.64 (2.26-3.10) for cancer, 2.50 (0.96-6.38) for central nervous system illness, and 2.26 (1.16-4.41) for low income. In conclusion, midlife suicide is strongly associated with socioeconomic difficulties and physical and psychiatric illnesses that are common in this age population. Future investigations should consider the interactions between risk factors, the intersectionality of sex and ethnicity, and include data from low- and middle-income countries.
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Jakobsen AL, Lund RL. Neighborhood social context and suicide mortality: A multilevel register-based 5-year follow-up study of 2.7 million individuals. Soc Sci Med 2022; 311:115320. [PMID: 36081301 DOI: 10.1016/j.socscimed.2022.115320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 06/10/2022] [Accepted: 08/25/2022] [Indexed: 11/20/2022]
Abstract
Previous studies have linked neighborhood social characteristics to suicide mortality. However, the effects of the operational definition of neighborhoods and the general importance of neighborhood context on suicide mortality have received little attention, with most studies using various administrative areas as neighborhood delineations. In this study, neighborhoods were delineated by micro-areas generated with an automated redistricting algorithm and divided by physical barriers, such as large roads. The geographic data were linked to register data on the Danish adult population in the age range of 20-59 years in December 2013 (N = 2,672,799 individuals nested into 7943 neighborhoods). This cohort was followed for five years to evaluate the association between suicide mortality and neighborhood socioeconomic deprivation, social fragmentation, and population density. We used the median hazard ratio (MHR) to quantify the general contextual effect (GCE) of neighborhoods on suicide mortality and hazard ratios to quantify the specific contextual effects (SCEs) using multilevel survival models stratified by age group. The results showed a larger GCE and larger SCEs of neighborhoods on suicide mortality for individuals aged 20-39 years compared with those aged 40-59 years. After controlling for individual characteristics, higher suicide mortality was observed for individuals living in the least densely populated neighborhoods and the most socially fragmented neighborhoods for both age groups. We found cross-level interactions between neighborhood population density and gender and ethnicity for those aged 40-59 years, as well as between neighborhood social fragmentation and ethnicity for those aged 20-39 years. The results indicate that beyond individual characteristics, the neighborhood social context may affect the risk of suicide, especially for people aged 20-39 years.
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Affiliation(s)
| | - Rolf Lyneborg Lund
- Department of Sociology and Social Work, Aalborg University, Fibigerstræde 13, 9220, Aalborg, Denmark
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5
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Hagedoorn P, Helbich M. Longitudinal effects of physical and social neighbourhood change on suicide mortality: A full population cohort study among movers and non-movers in the Netherlands. Soc Sci Med 2021; 294:114690. [PMID: 34979332 DOI: 10.1016/j.socscimed.2021.114690] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 01/04/2023]
Abstract
Associations between the residential neighbourhood environment and suicide mortality are well-established; however, most evidence is cross-sectional and not capable of incorporating place-based and residential moving-related neighbourhood changes. We studied how suicide mortality is associated with changes in the physical and social neighbourhood environment for movers and non-movers. Our retrospective analysis was based on longitudinal register data for the entire Dutch population aged 25-64 years enriched with annually time-varying data on the residential neighbourhood environment between 2007 and 2016. A total of 8,741,021 people were followed-up between 2007 and 2016 of which 10,019 committed suicide. Upward and downward neighbourhood change was measured by comparing neighbourhood conditions separately at two time points. Cox proportional hazard models indicated that movers had a significantly lower risk of suicide compared to non-movers. Suicide risk was lower for people experiencing improvements in social fragmentation and deprivation compared to those remaining in poor conditions. Change from rural to urban conditions also resulted in lower suicide risk, while a gain in green space put people at increased risk. For those stable neighbourhood conditions over time, suicide mortality was lower for men and women in urban vs. rural neighbourhoods as well as for women in neighbourhoods with low vs. high social fragmentation. Stable exposure to high levels of green space resulted in higher suicide risk among women. Interactions and stratification by moving type revealed associations between neighbourhood change and suicide were more pronounced in non-movers. Our findings suggest that neighbourhood improvements might contribute to a lower suicide risk, especially for long-term residents in poor neighbourhood conditions.
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Affiliation(s)
- Paulien Hagedoorn
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, the Netherlands.
| | - Marco Helbich
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, the Netherlands
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6
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Verhofstadt M, Pardon K, Audenaert K, Deliens L, Mortier F, Liégeois A, Chambaere K. Why adults with psychiatric conditions request euthanasia: A qualitative interview study of life experiences, motives and preventive factors. J Psychiatr Res 2021; 144:158-167. [PMID: 34638052 DOI: 10.1016/j.jpsychires.2021.09.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 08/24/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE As the empirical picture of adults with psychiatric conditions (further referred to as 'patients') requesting euthanasia is still incomplete, this study aims to deepen our understanding of why these patients request euthanasia, how this relates to the option of suicide, and what could have prevented these patients from considering death and requesting euthanasia. METHODS A qualitative study using in-depth, face-to-face interviews was conducted with 16 patients who had their euthanasia request under assessment in the period 2016-2020. Thematic coding was used. FINDINGS Most patients were in a state of feeling emotionally worn-out as a result of the many accumulated misfortunes and setbacks, leading to the all-pervasive sense that life is no longer worth living. Whereas some patients reported lifelong adversity, others struggled predominantly in later life. Whereas some patients longed for death strongly, others expressed ambivalence towards death ideation, and some even requested euthanasia to hear of their ineligibility for it, to restore hope and to (re)find meaning in life. patients valued euthanasia over suicide as being more dignified and acceptable, both for themselves and for their inner circle. With regard to preventive factors, patients posited the need for improved accessibility and quality of mental healthcare, as well as a profound change in society's perception of, and support for, these patients. CONCLUSIONS This study revealed the many complexities of euthanasia in the context of psychiatry, due to the many differences in patients' background characteristics, in their motives for requesting euthanasia, and the multi-layered aspects of mental suffering that go beyond the field of psychiatry.
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Affiliation(s)
- Monica Verhofstadt
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Brussels, Belgium.
| | - Koen Pardon
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Brussels, Belgium.
| | - Kurt Audenaert
- Department of Psychiatry, Ghent University Hospital, Belgium.
| | - Luc Deliens
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Brussels, Belgium
| | - Freddy Mortier
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Brussels, Belgium; Bioethics Institute Ghent, Ghent University, Ghent, Belgium.
| | - Axel Liégeois
- Faculty of Theology and Religious Studies, KU Leuven, Louvain, Belgium; Organisation Brothers of Charity, Ghent, Belgium.
| | - Kenneth Chambaere
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Brussels, Belgium.
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Fakhari A, Farahbakhsh M, Esmaeili ED, Azizi H. A longitudinal study of suicide and suicide attempt in northwest of Iran: incidence, predictors, and socioeconomic status and the role of sociocultural status. BMC Public Health 2021; 21:1486. [PMID: 34330239 PMCID: PMC8323272 DOI: 10.1186/s12889-021-11527-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/21/2021] [Indexed: 12/12/2022] Open
Abstract
Background A detailed community-level understanding of socioeconomic status (SES) and sociocultural status (SCS) of suicides and suicide attempters (SAs) in a prospective design could have significant implications for policymakers at the local prevention and treatment levels. The effect of SCS and SES on SAs is poorly understood and investigated in Iran. The present study aimed to investigate the incidence, trend, and role of SES and SCS on suicide and SAs. Methods A longitudinal study was conducted based on the registry for SAs in Malekan County, Iran, from 2015 to 2018. Demographic characteristics, SES, SCS, incidence rates, and predictors of suicidal behaviors were measured via structured instruments. Simple and multiple logistic regressions were used to estimate crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Results A total of 853 SAs (32 suicides and 821 attempts) were identified during the study. Trend analysis revealed that the suicide rate significantly decreased from 2014 (10.28) to 2018 (1.75) per 100,000. In the final multiple variable models, age (26–40), male sex, unemployment, antisocial activities, history of SA, hanging method, and season (spring) increased the suicide risk while religious commitment had protective effects on suicide. Conclusions Our findings indicated that demographic characteristics, low SES, and SCS are associated with suicide. In this county, trend of suicide and SA were decreased from 2014 to 2018. This study findings highlight the need to consider a wide range of contextual variables, socio-demographic, SES, and SCS in suicide prevention strategies. Improving inter-sectoral collaborations and policymakers’ attitudes are imperative for SA reduction.
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Affiliation(s)
- Ali Fakhari
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.,Medical Education Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mostafa Farahbakhsh
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Hosein Azizi
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran. .,Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran. .,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Longitudinal exposure assessments of neighbourhood effects in health research: What can be learned from people's residential histories? Health Place 2021; 68:102543. [PMID: 33676125 DOI: 10.1016/j.healthplace.2021.102543] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 01/10/2023]
Abstract
Health research into neighbourhood effects has generally examined neighbourhoods cross-sectionally, ignoring the fact that neighbourhood exposures might accumulate over people's lives and affect health outcomes later in life. Using longitudinal Dutch register data with complete 15-year residential address histories, we examined whether health effects of neighbourhood socioeconomic characteristics differ between cumulative and current exposures. We illustrated these differences between exposure assessments using suicide mortality among middle-aged adults. All suicides aged 40-64 years between 2012 and 2016 were matched with 10 random controls in a nested case-control design. We measured neighbourhood exposures longitudinally for circular buffers around residential addresses at the current address and through three accumulative measures, each incorporating the residential address history with increasing detail. Covariate-adjusted conditional logistic regressions were used to assess associations between suicide and neighbourhood social fragmentation, population density and unemployment rate. Our results showed that total and male suicide mortality was significantly lower in highly fragmented neighbourhoods when using accumulative exposures, but not when using the current residential address. However, we observed few differences in coefficients between exposures assessments for neighbourhood urbanicity and unemployment rate. None of the neighbourhood characteristics showed evidence that detailed cumulative exposures were a stronger predictor of suicide compared to more crude measures. Our findings provide little evidence that socioeconomic neighbourhood characteristics measured cumulatively along people's residential histories are stronger predictors of suicide mortality than cross-sectional exposures.
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Abstract
The response deals with several controversial issues: theoretical concepts of cognitive abilities, their cultural relativity in definition or level, the meaning and validity of national cognitive ability, methodological questions like the ecological fallacy, the variance of intelligence at different levels of observation, multi‐level analysis, the correctness and importance of levels of analysis in cognitive‐ability research, the aggregation and adjustment process, and the similarities of different cognitive assessment approaches. Central to this research are questions of causality (the causes and consequences of national cognitive‐ability homogeneity and level), of malleability of these levels, and of ethical and political consequences of intelligence research. Copyright © 2007 John Wiley & Sons, Ltd.
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Affiliation(s)
- Heiner Rindermann
- Institute of Psychology, Otto‐von‐Guericke‐University Magdeburg, Germany
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10
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Regional Variation of Suicide Mortality in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155433. [PMID: 32731583 PMCID: PMC7432038 DOI: 10.3390/ijerph17155433] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/21/2020] [Accepted: 07/24/2020] [Indexed: 01/22/2023]
Abstract
South Korea’s suicide rate is the highest among the members of the Organization for Economic Cooperation and Development. This study seeks to verify regional variation in suicide rates in South Korea and to identify correlating factors. We used age-adjusted suicide rates for 252 administrative districts, and a Community Health Survey, national representative data, and other national representative data such as censuses were used to obtain information on socioeconomic, health related and social integration variables according to each administrative district. Regional variation in suicide rates was analyzed by using Extremal Quotient (EQ), and multiple linear regression analyses were used to investigate associations between variation in suicide rates and regional socioeconomic, public service factors and health related factors. The average suicide rate from 252 regions was 142.7 per 100,000 people. The highest region was Hongchun-gun (217.8) and the lowest was Gwachen-si (75.5). The EQ was 2.89, meaning that there is significant regional variation in suicide rates. Financial independence (β = −0.662, p < 0.001), social welfare budget (β = −0.754, p < 0.001) and divorce rates (β = 17.743, p < 0.001) were significant, along with other adjusted variables. This study suggests considering these factors in order to reduce suicide rates in South Korea.
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11
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Tham SG, Ibrahim S, Hunt IM, Kapur N, Gooding P. Examining the mechanisms by which adverse life events affect having a history of self-harm, and the protective effect of social support. J Affect Disord 2020; 263:621-628. [PMID: 31744741 DOI: 10.1016/j.jad.2019.11.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/05/2019] [Accepted: 11/09/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Psychological models of suicide emphasize perceptions of negative stressors, hopelessness and self-harm as key antecedents to suicidal thoughts/acts. Such models also emphasize the potential protective role of social support in these pathways. However, such pathways have not been tested using population level data. Hence, this study aimed to redress this gap. METHODS Questionnaire data regarding 24,444 patient suicide deaths were analysed. All individuals died between 1996 and 2015 and were seen by secondary mental health services in England within 12 months before their death. Mediation analyses, using fitted logistic regression models, investigated direct and indirect pathways between negative stressors, hopelessness and a proxy measure of suicide, namely, self-harm history. In addition, the buffering effects of social support were examined in these pathways. RESULTS There was a direct effect of negative life events on suicidal behaviors. Supporting contemporary psychological models of suicide, a mediated effect via hopelessness and a protective effect of social support were identified. Social support buffered the pathway between stressful life events and hopelessness, with hopelessness decreasing as social support increased. LIMITATIONS Causal inferences are inappropriate as the design was cross-sectional. A proxy measure of suicidality was utilized (history of self-harm) as all individuals had died by suicide. CONCLUSIONS This is the first time that population data has been used to test psychological pathways to suicidal acts involving negative stressors, hopelessness and social support. Psychological interventions should focus on increasing social support following negative life events together with ameliorating perceptions of hopelessness.
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Affiliation(s)
- Su-Gwan Tham
- The National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, University of Manchester, UK; Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK
| | - Saied Ibrahim
- The National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, University of Manchester, UK; Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK
| | - Isabelle M Hunt
- The National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, University of Manchester, UK; Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK
| | - Nav Kapur
- The National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, University of Manchester, UK; Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK; Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, UK; NIHR Greater Manchester Patient Safety Translational Research Centre, UK
| | - Patricia Gooding
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK; Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, UK.
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12
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Demirci Ş, Konca M, Yetim B, İlgün G. Effect of economic crisis on suicide cases: An ARDL bounds testing approach. Int J Soc Psychiatry 2020; 66:34-40. [PMID: 31564187 DOI: 10.1177/0020764019879946] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Suicide events observed in various groups, community or countries, especially in the periods of economic recession. It is thought that suicide cases increase when people's income decreases dramatically and they lose their jobs. AIM/OBJECTIVE In this study, it was aimed to investigate whether the 2008 economic crisis had any effect on suicides in the United States. METHODS Autoregressive distributed lag method was used. For the purpose of the study, the number of suicide-related deaths was taken as the dependent variable, while unemployment rates and 2008 economic crisis were taken as independent variables. FINDINGS The short-term and long-term relationships obtained within the scope of the study indicated that the 2008 economic crisis had a statistically significant effect on suicide cases in the United States. RESULTS AND CONCLUSION It can be said that the results of this study are consistent with the information which emphasizes that economic crises increase suicide cases in the literature.
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Affiliation(s)
- Şenol Demirci
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Hacettepe University, Ankara, Turkey
| | - Murat Konca
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Hacettepe University, Ankara, Turkey
| | - Birol Yetim
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Hacettepe University, Ankara, Turkey
| | - Gülnur İlgün
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Hacettepe University, Ankara, Turkey
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13
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Näher AF, Rummel-Kluge C, Hegerl U. Associations of Suicide Rates With Socioeconomic Status and Social Isolation: Findings From Longitudinal Register and Census Data. Front Psychiatry 2020; 10:898. [PMID: 31992995 PMCID: PMC6971176 DOI: 10.3389/fpsyt.2019.00898] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 11/13/2019] [Indexed: 11/17/2022] Open
Abstract
Suicide represents a major challenge to public mental health. In order to provide empirical evidence for prevention strategies, we hypothesized current levels of low socioeconomic status (SES) and high social isolation (SI) to be linked to increased suicide rates in N = 390 administrative districts since SES and SI are associated with mental illness. Effects of SES on suicide rates were further expected to be especially pronounced in districts with individuals showing high SI levels as SI reduces the reception of social support and moderates the impact of low SES on poor mental health. We linked German Microcensus data to register data on all 149,033 German suicides between 1997 and 2010 and estimated Prentice and Sheppard's model for aggregate data to test the hypotheses, accounting for spatial effect correlations. The findings reveal increases in district suicide rates by 1.20% (p < 0.035) for 1% increases of district unemployment, suicide rate decreases of -0.39% (p < 0.028) for 1% increases in incomes, increases of 1.65% (p < 0.033) in suicides for 1% increases in one-person-households and increases in suicide rates of 0.54% (p < 0.036) for 1% decreases in single persons' incomes as well as suicide rate increases of 3.52% (p < 0.000) for 1% increases in CASMIN scores of individuals who moved throughout the year preceding suicide. The results represent appropriate starting points for the development of suicide prevention strategies. For the definition of more precise measures, future work should focus on the causal mechanisms resulting in suicidality incorporating individual level data.
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Affiliation(s)
- Anatol-Fiete Näher
- Department of Pneumology, Helios Klinikum Emil von Behring, Berlin, Germany
| | | | - Ulrich Hegerl
- Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe Universität Frankfurt am Main, Frankfurt am Main, Germany
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Hagedoorn P, Groenewegen PP, Roberts H, Helbich M. Is suicide mortality associated with neighbourhood social fragmentation and deprivation? A Dutch register-based case-control study using individualised neighbourhoods. J Epidemiol Community Health 2019; 74:197-202. [DOI: 10.1136/jech-2019-212699] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/12/2019] [Accepted: 10/27/2019] [Indexed: 02/03/2023]
Abstract
BackgroundNeighbourhood social fragmentation and socioeconomic deprivation seem to be associated with suicide mortality. However, results are inconclusive, which might be because dynamics in the social context are not well-represented by administratively bounded neighbourhoods at baseline. We used individualised neighbourhoods to examine associations between suicide mortality, social fragmentation, and deprivation for the total population as well as by sex and age group.MethodsUsing a nested case-control design, all suicides aged 18–64 years between 2007 and 2016 were selected from longitudinal Dutch register data and matched with 10 random controls. Indices for social fragmentation and deprivation were calculated annually for 300, 600 and 1000 metre circular buffers around each subject’s residential address.ResultsSuicide mortality was significantly higher in neighbourhoods with high deprivation and social fragmentation. Accounting for individual characteristics largely attenuated these associations. Suicide mortality remained significantly higher for women living in highly fragmented neighbourhoods in the fully adjusted model. Age-stratified analyses indicate associations with neighbourhood fragmentation among women in older age groups (40–64 years) only. Among men, suicide risk was lower in fragmented neighbourhoods for those aged 18–39 years and for short-term residents. In deprived neighbourhoods, suicide risk was lower for men aged 40–64 years and long-term residents. Associations between neighbourhood characteristics and suicide mortality were comparable across buffer sizes.ConclusionOur findings suggest that next to individual characteristics, the social and economic context within which people live may both enhance and buffer the risk of suicide.
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López-Contreras N, Rodríguez-Sanz M, Novoa A, Borrell C, Medallo Muñiz J, Gotsens M. Socioeconomic inequalities in suicide mortality in Barcelona during the economic crisis (2006-2016): a time trend study. BMJ Open 2019; 9:e028267. [PMID: 31455702 PMCID: PMC6719772 DOI: 10.1136/bmjopen-2018-028267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES This study aimed to analyse trends in socioeconomic inequalities in suicide mortality in Barcelona before and after the start of the economic crisis that started at the end of 2008, including both individual factors and contextual factors of the deceased's neighbourhood of residence. DESIGN This is a trend study of three time periods: pre-economic crisis (2006-2008), early crisis (2009-2012) and late crisis (2013-2016). SETTING Total Barcelona residents between 2006 and 2016 (≥25 years of age) and death data derived from the Judicial Mortality Registry of Barcelona. PARTICIPANTS 996 deaths by suicide between 2006 and 2016 were analysed. PRIMARY AND SECONDARY OUTCOME MEASURES The outcomes were age-standardised suicide mortality rates and the associations (relative and absolute risk) between suicide mortality and individual and contextual characteristics for the three time periods. RESULTS From 2006 to 2008, men with a lower educational level were more likely to commit suicide than better educated men (relative risk (RR)=1.46; 95% CI 1.11 to 1.91). This difference disappeared after the onset of the crisis. We found no differences among women. From 2013 to 2016, suicide risk increased among men living in neighbourhoods with higher unemployment levels (RR=1.57; 95% CI 1.09 to 2.25) and among women living in neighbourhoods with a higher proportion of elderly people living alone (RR=2.13; 95% CI 1.15 to 3.93). CONCLUSIONS We observed risks for suicide among men living in neighbourhoods of Barcelona with higher unemployment levels and among women living in neighbourhoods with a higher proportion of elderly people living alone. Inequalities in suicide mortality according to educational level tended to disappear during the crisis among men. Thus, it is important to continue to monitor suicide determinants especially in times of economic crisis.
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Affiliation(s)
- Natalia López-Contreras
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Maica Rodríguez-Sanz
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Àrea de Recerca, Docència i Comunicació, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Institut d'Investigació Biomèdica (IIB) de Sant Pau, Barcelona, Spain
| | - Ana Novoa
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Institut d'Investigació Biomèdica (IIB) de Sant Pau, Barcelona, Spain
| | - Carme Borrell
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica (IIB) de Sant Pau, Barcelona, Spain
- Gerència, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Jordi Medallo Muñiz
- Clinical Service, Catalonian Institute of Legal Medicine and Forensic Science, Barcelona, Spain
| | - Mercè Gotsens
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Assessing local chlamydia screening performance by combining survey and administrative data to account for differences in local population characteristics. Sci Rep 2019; 9:7070. [PMID: 31068656 PMCID: PMC6506589 DOI: 10.1038/s41598-019-43521-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 04/18/2019] [Indexed: 11/08/2022] Open
Abstract
Reducing health inequalities requires improved understanding of the causes of variation. Local-level variation reflects differences in local population characteristics and health system performance. Identifying low- and high-performing localities allows investigation into these differences. We used Multilevel Regression with Post-stratification (MRP) to synthesise data from multiple sources, using chlamydia testing as our example. We used national probability survey data to identify individual-level characteristics associated with chlamydia testing and combined this with local-level census data to calculate expected levels of testing in each local authority (LA) in England, allowing us to identify LAs where observed chlamydia testing rates were lower or higher than expected, given population characteristics. Taking account of multiple covariates, including age, sex, ethnicity, student and cohabiting status, 5.4% and 3.5% of LAs had testing rates higher than expected for 95% and 99% posterior credible intervals, respectively; 60.9% and 50.8% had rates lower than expected. Residual differences between observed and MRP expected values were smallest for LAs with large proportions of non-white ethnic populations. London boroughs that were markedly different from expected MRP values (≥90% posterior exceedance probability) had actively targeted risk groups. This type of synthesis allows more refined inferences to be made at small-area levels than previously feasible.
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Ransome Y, Perez A, Strayhorn S, Gilman SE, Williams DR, Krause N. Contextual religiosity and the risk of alcohol use disorders and suicidal thoughts among adults in the united states. J Affect Disord 2019; 250:439-446. [PMID: 30901581 PMCID: PMC6530790 DOI: 10.1016/j.jad.2019.03.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 12/17/2018] [Accepted: 03/04/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Suicide and alcohol use disorders (AUD) have high public health and economic costs. We investigate the relationship between religious features that are external to the individual (hereafter, contextual religiosity) and individuals' risk of AUD and suicidal thoughts. METHODS Data are from Wave 2 of the National Epidemiological Survey on Alcohol and Related Conditions (analytic N = 34,326). Regression analysis assessed whether contextual (i.e., Geographic state) religiosity and membership rates of Catholics and the three major Protestant traditions, are associated with DSM-IV AUD risk in the past 12 months and suicidal thoughts since last interview, controlling for individual and state-level covariates. In a secondary analysis, we test for interactions between individual race/ethnicity and contextual religiosity on the outcomes since prior work suggested differences by race and individual religiosity. RESULTS Some contextual religious variables were significantly associated with AUD risk but not suicidal thoughts. Individuals living in a state with higher membership rates of Evangelical Protestant had higher AUD risk (Adjusted Relative Risk [ARR]=1.27, 95%CI=1.08-1.49). Individuals living in states with higher membership rates of Historically Black Protestant had a lower risk of AUD (ARR=0.83, 95% CI=0.72-0.96). The interaction between individual race and contextual-level religious variables on the outcomes were not significant. LIMITATIONS NESARC is an observational cross-sectional so causality between religiosity and the outcomes cannot be established. CONCLUSIONS The risk of AUD among individuals varies depending on the religious membership rates among Protestant groups within their geographic state of residence. Contextual religiosity may impact AUD risk above and beyond one's individual religiosity.
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Affiliation(s)
- Yusuf Ransome
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Ashley Perez
- Department of Social and Behavioral Sciences, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Shaila Strayhorn
- Institute for Health Research and Policy, University of Illinois, Chicago, IL, USA
| | - Stephen E. Gilman
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David R. Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Neil Krause
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Erlangsen A, Qin P, Mittendorfer-Rutz E. Studies of Suicidal Behavior Using National Registers. CRISIS 2018; 39:153-158. [PMID: 29792362 DOI: 10.1027/0227-5910/a000552] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Annette Erlangsen
- 1 Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Hellerup, Denmark.,2 Department of Mental Health, John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,3 Centre for Mental Health Research, Australian National University, Canberra, Australia
| | - Ping Qin
- 4 National Center for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway
| | - Ellenor Mittendorfer-Rutz
- 5 Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
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Yildiz M, Demirhan E, Gurbuz S. Contextual Socioeconomic Disadvantage and Adolescent Suicide Attempts: A Multilevel Investigation. J Youth Adolesc 2018; 48:802-814. [PMID: 30499039 DOI: 10.1007/s10964-018-0961-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/10/2018] [Indexed: 11/26/2022]
Abstract
Multilevel research on whether and how contextual socioeconomic disadvantage affects adolescent suicidal behaviors is scarce. Using data from the first two waves (1994/95 and 1996) of the National Longitudinal Study of Adolescent to Adult Health (N = 13,335; 49.63% girls; Mage = 15.02 years), this study examined (1) the association between area-level socioeconomic disadvantage and adolescent suicide attempts over and above individual-level socioeconomic factors, (2) the moderating role of gender, and (3) the mediating roles of contextually relevant stressors and available psychosocial resources. The results revealed that area-level socioeconomic disadvantage increased the risk of attempting suicide even after adjusting for individual-level socioeconomic status, especially for boys. Consistent with the stress process perspective, reports of exposure to violence and lack of safety explain this contextual effect. National suicidal behavior prevention strategies across the U.S. should recognize the strong association with the socioeconomic context, along with individual-level risk factors.
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Affiliation(s)
- Muhammed Yildiz
- Department of Sociology, Louisiana State University, 126 Stubbs Hall, Baton Rouge, LA, 70803, USA.
| | - Emirhan Demirhan
- Department of Sociology, University of North Texas, 288 Sycamore Hall, Denton, TX, 76203, USA
| | - Suheyl Gurbuz
- Department of Sociology, Midwestern State University, 3410 Taft Blvd., Wichita Falls, TX, 76308, USA
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Robust Compositional Analysis of Physical Activity and Sedentary Behaviour Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102248. [PMID: 30322203 PMCID: PMC6210094 DOI: 10.3390/ijerph15102248] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/10/2018] [Accepted: 10/11/2018] [Indexed: 12/22/2022]
Abstract
Although there is an increasing awareness of the suitability of using compositional data methodology in public health research, classical methods of statistical analysis have been primarily used so far. The present study aims to illustrate the potential of robust statistics to model movement behaviour using Czech adolescent data. We investigated: (1) the inter-relationship between various physical activity (PA) intensities, extended to model relationships by age; and (2) the associations between adolescents’ PA and sedentary behavior (SB) structure and obesity. These research questions were addressed using three different types of compositional regression analysis—compositional covariates, compositional response, and regression between compositional parts. Robust counterparts of classical regression methods were used to lessen the influence of possible outliers. We outlined the differences in both classical and robust methods of compositional data analysis. There was a pattern in Czech adolescents’ movement/non-movement behavior—extensive SB was related to higher amounts of light-intensity PA, and vigorous PA ratios formed the main source of potential aberrant observations; aging is associated with more SB and vigorous PA at the expense of light-intensity PA and moderate-intensity PA. The robust counterparts indicated that they might provide more stable estimates in the presence of outlying observations. The findings suggested that replacing time spent in SB with vigorous PA may be a powerful tool against adolescents’ obesity.
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Berg JM, Malte CA, Reger MA, Hawkins EJ. Medical Records Flag for Suicide Risk: Predictors and Subsequent Use of Care Among Veterans With Substance Use Disorders. Psychiatr Serv 2018; 69:993-1000. [PMID: 29879873 PMCID: PMC6196077 DOI: 10.1176/appi.ps.201700545] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The U.S. Department of Veterans Affairs (VA) health care system established policies to include patient record flags (PRFs) for high suicide risk in the electronic medical record to alert providers and to increase health care contacts. This study identified predictors of new PRFs and described health care utilization before and after PRF initiation among VA patients with substance use disorders. METHODS The sample included patients ages ≥18 who received a substance use disorder diagnosis in 2012 (N=474,946). Demographic, clinical, and utilization predictors of PRFs were identified by multivariable logistic regression. Changes in short-term (three months) and longer-term (12 months) health care utilization before and after PRF initiation were compared by negative binomial regression. RESULTS A total of 8,913 patients received PRFs. Demographic predictors of PRF initiation included being younger than 35, white, and homeless. Clinical predictors were cocaine, opioid, and sedative use disorders; posttraumatic stress, psychotic, bipolar, and depressive disorders; and diagnosis of a suicide attempt. Patients with PRFs averaged 1.33 (95% confidence interval [CI]=1.29-1.38) times more primary care visits, 2.29 (CI=2.24-2.34) times more mental health visits, 4.10 (CI=3.80-4.42) times more substance use visits, and fewer (incidence rate ratio=.55, CI=.53-.58) emergency department visits in the three months following compared with the three months before PRF initiation. Modest increases in mental health- and substance use--related days hospitalized were observed. CONCLUSIONS Veterans received significantly more health care services after PRF initiation. Further research is warranted on the effects of PRFs on clinical outcomes, such as suicide behaviors.
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Affiliation(s)
- Joanna M Berg
- Dr. Berg is with the Evidence-Based Treatment Centers of Seattle. Ms. Malte and Dr. Hawkins are with the U.S. Department of Veterans Affairs (VA) Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System Seattle. Dr. Hawkins is also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Reger is affiliated. Dr. Reger is also with the Department of Mental Health Services, VA Puget Sound Health Care System
| | - Carol A Malte
- Dr. Berg is with the Evidence-Based Treatment Centers of Seattle. Ms. Malte and Dr. Hawkins are with the U.S. Department of Veterans Affairs (VA) Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System Seattle. Dr. Hawkins is also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Reger is affiliated. Dr. Reger is also with the Department of Mental Health Services, VA Puget Sound Health Care System
| | - Mark A Reger
- Dr. Berg is with the Evidence-Based Treatment Centers of Seattle. Ms. Malte and Dr. Hawkins are with the U.S. Department of Veterans Affairs (VA) Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System Seattle. Dr. Hawkins is also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Reger is affiliated. Dr. Reger is also with the Department of Mental Health Services, VA Puget Sound Health Care System
| | - Eric J Hawkins
- Dr. Berg is with the Evidence-Based Treatment Centers of Seattle. Ms. Malte and Dr. Hawkins are with the U.S. Department of Veterans Affairs (VA) Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System Seattle. Dr. Hawkins is also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Reger is affiliated. Dr. Reger is also with the Department of Mental Health Services, VA Puget Sound Health Care System
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Too LS, Law PCF, Spittal MJ, Page A, Milner A. Widening socioeconomic inequalities in Australian suicide, despite recent declines in suicide rates. Soc Psychiatry Psychiatr Epidemiol 2018; 53:969-976. [PMID: 29713729 DOI: 10.1007/s00127-018-1527-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 04/25/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE This study aims to investigate trends in socioeconomic inequalities of suicide from 1979 to 2013 for Australian males and females aged 15-34 years and 35-64 years. METHODS Data on suicides and population were obtained from national registries. An area-based measure of socioeconomic status (SES) was used, and categorized into low, middle, and high SES areas. Suicide rates for each SES groups were estimated using a negative binomial regression model, adjusted for confounders. Socioeconomic inequalities in suicide were assessed using absolute and relative risk of low-to-high SES areas. Secular changes in socioeconomic inequalities were assessed using trend tests for relative risk. RESULTS For young males, there was an increase in socioeconomic inequality driven by a significant decrease in suicide rates in high SES areas. For older males, inequality in suicide increased by 29%, which was related to a marked increase in suicide rates in low SES areas. Inequalities in both young and older female suicides also increased. These increases occurred when corresponding suicide rates in high SES areas decreased. CONCLUSIONS Recent widening socioeconomic inequalities in Australian suicide have been primarily associated with declines in suicide rates in high SES areas. However, an increasing inequality in older male suicide is linked with low SES. Efforts targeting people from poor areas, especially older males, should be considered when developing suicide prevention strategy.
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Affiliation(s)
- Lay San Too
- Melbourne School of Population and Global Health, Centre for Mental Health, The University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Phillip C F Law
- Melbourne School of Population and Global Health, Centre for Health Equity, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Matthew J Spittal
- Melbourne School of Population and Global Health, Centre for Mental Health, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Andrew Page
- Centre for Health Research, University of Western Sydney, Kingswood, NSW, 2747, Australia
| | - Allison Milner
- Melbourne School of Population and Global Health, Centre for Health Equity, The University of Melbourne, Parkville, VIC, 3010, Australia
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Knipe D, Gunnell D, Pearson M, Jayamanne S, Pieris R, Priyadarshana C, Weerasinghe M, Hawton K, Konradsen F, Eddleston M, Metcalfe C. Attempted suicide in Sri Lanka - An epidemiological study of household and community factors. J Affect Disord 2018; 232:177-184. [PMID: 29494901 PMCID: PMC6081369 DOI: 10.1016/j.jad.2018.01.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 12/18/2017] [Accepted: 01/28/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND An individual's suicide risk is determined by personal characteristics, but is also influenced by their environment. Previous studies indicate a role of contextual effects on suicidal behaviour, but there is a dearth of quantitative evidence from Asia. METHODS Individual and community level data were collected on 165,233 people from 47,919 households in 171 communities in rural Sri Lanka. Data were collected on individual (age, sex, past suicide attempts and individual socioeconomic position (SEP)) and household (household SEP, pesticide access, alcohol use and multigenerational households) level factors. We used 3-level logit models to investigate compositional (individual) and contextual (household/community) effects. RESULTS We found significant variation between households 21% (95% CI 18%, 24%) and communities 4% (95% CI 3%, 5%) in the risk of a suicide attempt. Contextual factors as measured by low household SEP (OR 2.37 95% CI 2.10, 2.67), low community SEP (OR 1.45 95% CI 1.21, 1.74), and community 'problem' alcohol use (OR 1.44 95% CI 1.19, 1.75) were associated with an increased risk of suicide attempt. Women living in households with alcohol misuse were at higher risk of attempted suicide. We observed a protective effect of living in multigenerational households (OR 0.53 95% CI 0.42, 0.65). LIMITATIONS The outcome was respondent-reported and refers to lifetime reports of attempted suicide, therefore this study might be affected by socially desirable responding. CONCLUSIONS Our study finds that contextual factors are associated with an individual's risk of attempted suicide in Sri Lanka, independent of an individual's personal characteristics.
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Affiliation(s)
- D.W. Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK,South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka,Corresponding author at: Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK.
| | - D. Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK
| | - M. Pearson
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka,Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - S. Jayamanne
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka,Faculty of Medicine, University of Kelanyia, Kelanyia, Sri Lanka
| | - R. Pieris
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - C. Priyadarshana
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - M. Weerasinghe
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka,Department of Community Medicine, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
| | - K. Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
| | - F. Konradsen
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M. Eddleston
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka,Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - C. Metcalfe
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
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Abstract
RESUMO Objetivo Identificar padrões de tendências do suicídio registrado em Portugal, tendo em conta um conjunto de variáveis socioeconômicas e demográficas entre os anos 2007 e 2014, de modo a obter uma visão geral desse flagelo em Portugal. Métodos Recorrendo a dados do Instituto Nacional de Estatística (INE) e do Sistema de Informação dos Certificados de Óbito (SICO), foi analisado o suicídio segundo a categoria do CID-10 (Classificação Internacional de Doenças), examinando-se as incidências por gênero, faixa etária e região. Resultados Os mais acometidos pelo suicídio são homens (54,8%), com idade superior a 75 anos (30,9%), e ele ocorre nas zonas economicamente mais desfavorecidas. A mortalidade por suicídio mais elevada encontra-se na região do Alentejo (12,8%). Conclusão A mortalidade por suicídio continua a crescer em Portugal e varia em função do gênero e idade, sendo mais elevada nas regiões do Centro e Sul. É necessária uma estratégia de acompanhamento e de prevenção no âmbito da ação social e dos cuidados de saúde, com importantes variações regionais, e maior vigilância sobre a comercialização ilegal de armas de fogo e de pesticidas.
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Marital status integration and suicide: A meta-analysis and meta-regression. Soc Sci Med 2018; 197:116-126. [DOI: 10.1016/j.socscimed.2017.11.053] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 11/23/2017] [Accepted: 11/28/2017] [Indexed: 11/19/2022]
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Liu K. To Compare is to Despair? A Population-Wide Study of Neighborhood Composition and Suicide in Stockholm. SOCIAL PROBLEMS 2017; 64:532-557. [PMID: 29456271 PMCID: PMC5812291 DOI: 10.1093/socpro/spw044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Neighborhood context can change the effect of a socio-demographic attribute on the risk of suicide. Eight hypotheses about the interactions between neighborhood composition, ethnicity, income, and socially disadvantaged propositions are proposed based on social support, social comparison, and social regulation mechanisms. They are tested with a population-based dataset of all adults (1.4 million) who lived in the greater Stockholm area in the 1990s. On one hand, multilevel analysis shows that suicide risk increases with the level of affluence in one's neighborhood, particularly among individuals with low income. This supports the notion that income comparison can have negative consequences. On the other hand, social welfare recipients are less likely to commit suicide when there are other social welfare recipients in the neighborhood. Suicide risk among immigrants deceases with the proportion of co-ethnics in the neighborhood, confirming previous findings on social support and suicide. However, further analyses show that the protection effect of having co-ethnic neighbors is limited to immigrants from countries with low suicide rates. This study shows that administrative data can be used to examine neighborhood effects on rare outcomes. The findings are relevant to the contemporary trends towards rising income inequality and ethnic diversity.
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Cairns JM, Graham E, Bambra C. Area-level socioeconomic disadvantage and suicidal behaviour in Europe: A systematic review. Soc Sci Med 2017; 192:102-111. [DOI: 10.1016/j.socscimed.2017.09.034] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 06/21/2017] [Accepted: 09/20/2017] [Indexed: 11/16/2022]
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Kim C, Cho Y. Does Unstable Employment Have an Association with Suicide Rates among the Young? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14050470. [PMID: 28452940 PMCID: PMC5451921 DOI: 10.3390/ijerph14050470] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 04/14/2017] [Accepted: 04/21/2017] [Indexed: 11/16/2022]
Abstract
Although a growing body of literature has indicated that unemployment has a positive association with suicide, the dynamic aspects of unstable employment have not yet been considered in suicidology. This study explored the association between employment stability and completed suicide among people aged 25–34 years in 20 OECD (Organization for Economic Cooperation and Development) countries with time-series data (1994–2010). In order to consider the different aspects of unstable employment, we tested the impacts of employment protection legislation indicators as another proxy of job insecurity (employed, but unstable) apart from unemployment rates. Covariates, including economic growth rates, GDP per capita, fertility rates, and divorce rate, were controlled for. The analysis was designed to be gender- and age-specific, where observations with ages of 25–29 were separated from those with ages of 30–34. Random effect models were applied to examine changes over time in suicide rates, and other models were presented to check robustness. The results showed that it is a low level of employment protection, rather than unemployment itself, that was associated with increased suicide rates among all of the studied populations. The magnitude of the effect differed by gender.
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Affiliation(s)
- Chungah Kim
- Department of Health Policy, McMaster University, Hamilton, ON L8S 4L8, Canada.
| | - Youngtae Cho
- Department of Public Health Science, School of Public Health, Seoul National University, Seoul 151-172, Korea.
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Thompson RG, Alonzo D, Hu MC, Hasin DS. Substance Use Disorders and Poverty as Prospective Predictors of Adult First-Time Suicide Ideation or Attempt in the United States. Community Ment Health J 2017; 53:324-333. [PMID: 27423659 PMCID: PMC5239762 DOI: 10.1007/s10597-016-0045-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
Abstract
This study examined whether substance use disorders (SUD) and poverty predicted first-time suicide ideation or attempt in United States national data. Respondents without prior histories of suicide ideation or attempt at Wave 1 of the NESARC (N = 31,568) were analyzed to determine the main and interactive effects of SUD and poverty on first-time suicide ideation or attempt by Wave 2, 3 years later. Adjusted for controls, poverty (AOR = 1.35, CI = 1.05-1.73) and drug use disorders (AOR = 2.10, CI = 1.07-4.14) independently increased risk for first-time suicide ideation or attempt at Wave 2. SUD and poverty did not interact to differentially increase risk for first-time suicide ideation or attempt, prior to or after adjustment for controls. This study reinforces the importance of SUD and poverty in the risk for first-time suicide ideation or attempt. Public health efforts should target messages to drug users and the impoverished that highlight their increased risk for first-time suicide.
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Affiliation(s)
- Ronald G Thompson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, Box 123, New York, NY, 10032, USA.
| | - Dana Alonzo
- Graduate School of Social Service, Fordham University, West Harrison, NY, 10604, USA
| | - Mei-Chen Hu
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, Box 123, New York, NY, 10032, USA
| | - Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, Box 123, New York, NY, 10032, USA
- New York State Psychiatric Institute, New York, NY, 10032, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
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Pirkis J, Currier D, Butterworth P, Milner A, Kavanagh A, Tibble H, Robinson J, Spittal MJ. Socio-Economic Position and Suicidal Ideation in Men. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14040365. [PMID: 28362354 PMCID: PMC5409566 DOI: 10.3390/ijerph14040365] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 03/28/2017] [Accepted: 03/29/2017] [Indexed: 11/24/2022]
Abstract
People in low socio-economic positions are over-represented in suicide statistics and are at heightened risk for non-fatal suicidal thoughts and behaviours. Few studies have tried to tease out the relationship between individual-level and area-level socio-economic position, however. We used data from Ten to Men (the Australian Longitudinal Study on Male Health) to investigate the relationship between individual-level and area-level socio-economic position and suicidal thinking in 12,090 men. We used a measure of unemployment/employment and occupational skill level as our individual-level indicator of socio-economic position. We used the Index of Relative Socio-Economic Disadvantage (a composite multidimensional construct created by the Australian Bureau of Statistics that combines information from a range of area-level variables, including the prevalence of unemployment and employment in low skilled occupations) as our area-level indicator. We assessed suicidal thinking using the Patient Health Questionnaire (PHQ-9). We found that even after controlling for common predictors of suicidal thinking; low individual-level and area-level socio-economic position heightened risk. Individual-level socio-economic position appeared to exert the greater influence of the two; however. There is an onus on policy makers and planners from within and outside the mental health sector to take individual- and area-level socio-economic position into account when they are developing strategic initiatives.
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Affiliation(s)
- Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia.
| | - Dianne Currier
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia.
| | - Peter Butterworth
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia.
| | - Allison Milner
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia.
| | - Anne Kavanagh
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia.
| | - Holly Tibble
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia.
| | - Jo Robinson
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia.
| | - Matthew J Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia.
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Voracek M. Regional Intelligence and Suicide Rate: New Data for Australia and a Synthesis of Research. Percept Mot Skills 2016; 105:191-6. [DOI: 10.2466/pms.105.1.191-196] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Previous research has shown for the most part positive correlations between intelligence and suicide prevalence on the national level. However, this study found proxies for regional intelligence in Australia (international average domain scores from the PISA 2000 study) to be significantly negatively correlated with the total, male, and female suicide rates of the different administrative divisions of Australia, and this finding was independent of regional wealth. A research synthesis of the current results and those from similar studies of other countries (positive correlations for Austria, Belarus, The British Isles, Denmark, and The Netherlands; inconclusive findings for France, Germany, and the USA) was conducted. This synthesis of research findings showed that positive ecological correlations of intelligence with suicide rate were more likely observed for nations with higher suicide rates and poorer general living conditions, whereas there was no relation with national IQ.
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Abstract
Previous findings pertaining to the direction (positive or negative) of the ecological correlation between intelligence and suicide rates in the USA have been conflicting. Using novel state IQ estimates, derived from the Scholastic Assessment Test, the American College Test, these tests combined, or the National Assessment of Educational Progress state scores, these estimates were not consistently associated to state suicide rates. Whereas ACT-derived state IQ was significantly positively correlated with suicide rates, the correlation with composite ACT-SAT-derived state IQ was significantly negative and with both SAT-derived and NAEP-derived state IQ also negative but not significant. Validity checks pointed to possible methodological problems with the state IQ estimates. Currently available estimates of state IQ, therefore, seem not appropriate to resolve the question of the direction of the ecological correlation of intelligence and suicide mortality across the USA.
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Voracek M. Evidence for a Positive Ecological Correlation of Regional Intelligence and Suicide Mortality in the United States during the Early 20th Century. Percept Mot Skills 2016; 105:391-402. [DOI: 10.2466/pms.105.2.391-402] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Several contemporary cross-national and intranational geographic studies have reported positive ecological (group-level) associations of intelligence and suicide mortality. These findings are consistent with facts from suicide research and with an evolutionary view of suicidal behavior. The present research extended these accounts cross-temporally. Analysis of E. L. Thorndike's state-level personal quality scores and standardized birth rates of eminent persons, taken as proxy variables for regional intelligence, along with historical state suicide rates (1913–1924 and 1928–1932) showed that intelligence and suicide mortality across the USA were already clearly positively related during the early 20th century, suggesting time stability of the effect. Within the USA, the effect is possibly due to state differences in the ethnic composition, which correspond to both suicide rates and intelligence proxies. It is argued that the most parsimonious interpretation of these ecological findings remains that they indeed reflect individual-level effects, that a positive link between intelligence and suicide is entirely compatible with positive overall links between intelligence and health and longevity, and that the ultimate explanative background for the positive link between intelligence and suicide may be provided through the framework of Rushton's differential K theory.
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Voracek M. National Differences in Intelligence and Population Rates of Suicidal Ideation, Suicide Plans, and Attempted Suicide. Percept Mot Skills 2016; 105:355-61. [DOI: 10.2466/pms.105.2.355-361] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Population rates of suicidal ideation, suicide plans or attempted suicide from three independent multinational epidemiological surveys (the WHO/EURO and WHO SUPRE-MISS studies and a third one) were not significantly associated with national IQ figures. This result conflicts with previous evidence from cross-national studies (by Lester and by Voracek) of a positive ecological correlation between level of national intelligence and rates of completed suicide. Across nations, the indicators for the prevalence of suicidal behavior also lacked close correspondence with suicide rates, which may be due to the higher unreliability of assessing covert suicidal behavior (suicide ideas, thoughts, plans, and, to a lesser extent, also suicide attempts) as compared to suicidal behavior that is indisputably overt (completed suicide). Several alternative explanations for the current nil findings are also discussed.
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Werbeloff N, Markou M, Hayes JF, Pitman AL, Osborn DPJ. Individual and area-level risk factors for suicidal ideation and attempt in people with severe depression. J Affect Disord 2016; 205:387-392. [PMID: 27585905 DOI: 10.1016/j.jad.2016.08.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/06/2016] [Accepted: 08/14/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Previous research has identified several risk factors that are strongly associated with suicidal behavior in patients with severe depression. However, the effects of area-level characteristics on suicidal ideation and attempt in this population remain unclear. METHODS The Clinical Record Interactive Search (CRIS) database was used to identify 2587 patients with severe depression who received secondary mental health services from the Camden & Islington NHS Foundation Trust. Stepwise multivariable logistic regression models were used to examine associations between socio-demographic characteristics, clinical variables, area-level measures, and suicidal ideation and attempt as separate outcomes. RESULTS Both suicidal ideation and attempts were common among this cohort of severely depressed individuals (70.5% and 37.7%, respectively). While several individual socio-demographic and clinical characteristics were associated with both outcomes, particularly past psychiatric admission (suicidal ideation: adjusted OR=2.86, 95% CI: 2.26-3.62; suicide attempt: adjusted OR=4.00, 95% CI: 3.30-4.89), neither social deprivation nor ethnic density (measured at the area-level) was associated with risk for either outcome. LIMITATIONS Data were not collected specifically for research purposes and hence information on some potential confounders was not available. Additionally, information was restricted to individuals who accessed secondary mental health services in a defined catchment area and period. The study therefore does not take into account individuals who did not access mental health services. CONCLUSIONS The variation in risk for suicidal ideation and attempt among severely depressed individuals is explained by differences in individual socio-demographic and clinical characteristics, most notably past psychiatric admission and substance misuse, and not by area-level measures.
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Affiliation(s)
- Nomi Werbeloff
- UCL Division of Psychiatry, University College London, Gower St, London WC1E 6BT, United Kingdom; Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 Saint Pancras Way, London NW1 0PE, United Kingdom.
| | - Maria Markou
- UCL Division of Psychiatry, University College London, Gower St, London WC1E 6BT, United Kingdom
| | - Joseph F Hayes
- UCL Division of Psychiatry, University College London, Gower St, London WC1E 6BT, United Kingdom; Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 Saint Pancras Way, London NW1 0PE, United Kingdom
| | - Alexandra L Pitman
- UCL Division of Psychiatry, University College London, Gower St, London WC1E 6BT, United Kingdom; Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 Saint Pancras Way, London NW1 0PE, United Kingdom
| | - David P J Osborn
- UCL Division of Psychiatry, University College London, Gower St, London WC1E 6BT, United Kingdom; Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 Saint Pancras Way, London NW1 0PE, United Kingdom
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Voracek M. National Intelligence and Suicide Rate across Europe: An Alternative Test Using Educational Attainment Data. Psychol Rep 2016; 101:512-8. [DOI: 10.2466/pr0.101.2.512-518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
National mean scores on a historical knowledge test (taken as a proxy for intelligence), stemming from representative samples of male (and female) 9th-grade school students from 26 European countries in a 1999 report by Wilberg and Lynn, were significantly positively associated with the national male (and female) suicide rates, independent of the general quality-of-living conditions in these countries. This finding replicates previous evidence from cross-national studies (by Lester and by Voracek), of a correspondence of higher national IQ to higher suicide rates, with an alternative measure of national IQ that is independent of the national IQ estimates recently published by Lynn and Vanhanen which have been used in prior studies.
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Too LS, Spittal MJ, Bugeja L, Milner A, Stevenson M, McClure R. An investigation of neighborhood-level social, economic and physical factors for railway suicide in Victoria, Australia. J Affect Disord 2015; 183:142-8. [PMID: 26005775 DOI: 10.1016/j.jad.2015.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 05/05/2015] [Accepted: 05/06/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study investigates the associations between railway suicide and neighborhood social, economic, and physical determinants using postcode-level data. It also examines whether the associations are influenced by having high concentration of high-risk individuals in a neighborhood area. METHODS Railway suicide cases from Victoria, Australia for the period of 2001-2012, their age, sex, year of death, usual residential address and suicide location were obtained from the National Coronial Information System. Univariate negative binomial regression models were used to estimate the association between railway suicide and neighborhood-level social, economic and physical factors. Variables which were significant in these univariate models were then assessed in a multivariate model, controlling for age and sex of the deceased and other known confounders. RESULTS Findings from the multivariate analysis indicate that an elevated rate of railway suicide was strongly associated with neighborhood exposure of higher number of railway stations (IRR=1.30 95% CI=1.16-1.46). Other significant neighborhood risk factors included patronage volume (IRR=1.06, 95% CI=1.02-1.11) and train frequency (IRR=1.02, 95% CI=1.01-1.04). An increased number of video surveillance systems at railway stations and carparks was significantly associated with a modest reduction in railway suicide risk (IRR=0.93, 95% CI=0.88-0.98). These associations were independent of concentration of high-risk individuals. LIMITATIONS Railway suicide may be under-reported in Australia. CONCLUSIONS Interventions to prevent railway suicide should target vulnerable individuals residing in areas characterized by high station density, patronage volume and train frequency.
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Affiliation(s)
- Lay San Too
- Monash Injury Research Institute, Monash University, Victoria, Australia.
| | - Matthew J Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Lyndal Bugeja
- Monash Injury Research Institute, Monash University, Victoria, Australia
| | - Allison Milner
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Mark Stevenson
- Melbourne School of Design, The University of Melbourne, Victoria, Australia
| | - Roderick McClure
- Harvard Injury Control Research Center, Harvard School of Public Health, Boston, MA, USA
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Santana P, Costa C, Cardoso G, Loureiro A, Ferrão J. Suicide in Portugal: Spatial determinants in a context of economic crisis. Health Place 2015; 35:85-94. [PMID: 26277771 DOI: 10.1016/j.healthplace.2015.07.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/05/2015] [Accepted: 07/09/2015] [Indexed: 11/15/2022]
Abstract
This study compares the existing statistical association between suicide mortality and the characteristics of places of residence (municipalities), before and during the current economic crisis, in Portugal. We found that (1) the traditional culture-based North/South pattern of suicidal behaviour has faded away, while the socioeconomic urban/rural divide has become more pronounced; (2) suicide is associated with higher levels of rurality and material deprivation; and (3) recent shifts in suicidal trends may result from the current period of crisis. Strategies targeting rural areas combined with public policies that address area deprivation may have important implications for tackling suicide.
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Affiliation(s)
- Paula Santana
- Centre of Studies on Geography and Spatial Planning, Department of Geography, University of Coimbra, Portugal.
| | - Cláudia Costa
- Centre of Studies on Geography and Spatial Planning, University of Coimbra, Portugal
| | - Graça Cardoso
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, NOVA Medical School, New University of Lisbon, Portugal
| | - Adriana Loureiro
- Centre of Studies on Geography and Spatial Planning, University of Coimbra, Portugal
| | - João Ferrão
- Institute of Social Sciences, University of Lisbon, Portugal
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Denney JT, Wadsworth T, Rogers RG, Pampel FC. Suicide in the City: Do Characteristics of Place Really Influence Risk? SOCIAL SCIENCE QUARTERLY 2015; 96:313-329. [PMID: 26236047 PMCID: PMC4519975 DOI: 10.1111/ssqu.12165] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE This article investigates the role of social context on individual suicide mortality with attention paid to the possibility that contextual effects are simply the sum of individual characteristics associated with suicide. METHODS We use restricted data from the 1986-2006 National Health Interview Survey-Linked Mortality Files, which include nearly one million records and 1,300 suicides, to examine the role of familial and socioeconomic context on adult suicide. RESULTS Results show that adults living in cities with more socioeconomic disadvantage and fewer families living together have higher odds of suicidal death than adults living in less disadvantaged cities and cities with more families living together, respectively, after controlling for individual-level socioeconomic status, marital status, and family size. CONCLUSION The findings support classic sociological arguments that the risk of suicide is indeed influenced by the social milieu and cannot simply be explained by the aggregation of individual characteristics.
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Erlangsen A, Fedyszyn I. Danish nationwide registers for public health and health-related research. Scand J Public Health 2015; 43:333-9. [DOI: 10.1177/1403494815575193] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2015] [Indexed: 11/15/2022]
Abstract
Aims: The Nordic countries have a strong tradition of using nationwide social and health registers for research purposes. The aim of the current paper is to provide an overview of the Danish population-based registers in public health and health-related research, and to discuss their strengths and limitations. Methods: Danish registers on somatic and psychiatric hospital contacts as well as care provided by general practitioners were reviewed. The availability of demographic, individual-level variables of relevance for health-related research was summarized. Results: Since 1968, every person living in Denmark has a unique identifier. This identifier is listed in Danish registers enabling linkage of information from a range of registers on an individual level. The nationwide coverage of all patient contacts at somatic and psychiatric hospitals, consultations with general practitioners, purchases of prescribed medications, and a complete follow-up with respect to causes of death support public health studies surveying trends of prevalence and incidence. Historical data on psychiatric and somatic hospitalizations since 1969 and 1977, respectively, allow an in-depth assessment of the burden of disease and time trends. Demographic characteristics of individuals and family units, together with information on education, employment, income, place of residence and migration, are provided by social registers. Conclusions: Register data are fully representative of the entire population with no loss to follow-up. Nationwide coverage also ensures a large sample to investigate events and conditions with low base rates. Clinical observations are limited and often only available for select patient populations. However, the opportunities available for public health research through linkage of register data with the increasing number of nationwide clinical databases, bio-banks and surveys entail promising perspectives for future research.
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Affiliation(s)
- Annette Erlangsen
- Suicide Prevention Research, Research Unit, Mental Health Centre Copenhagen, Capital Region of Denmark, Denmark
- Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Izabela Fedyszyn
- Suicide Prevention Research, Research Unit, Mental Health Centre Copenhagen, Capital Region of Denmark, Denmark
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Ngamini Ngui A, Apparicio P, Moltchanova E, Vasiliadis HM. Spatial analysis of suicide mortality in Québec: spatial clustering and area factor correlates. Psychiatry Res 2014; 220:20-30. [PMID: 25095757 DOI: 10.1016/j.psychres.2014.07.033] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 07/09/2014] [Accepted: 07/16/2014] [Indexed: 11/18/2022]
Abstract
Understanding the spatial distribution of suicide can inform the planning, implementation and evaluation of suicide prevention actions. No previous study has assessed spatial clustering of the different methods of suicide in Quebec. The aim of this study was to assess spatial clustering of suicide in Quebec between 2004 and 2007 and neighborhood level predictors of the clusters. Scan statistics was applied to detect clusters of suicides by method and by sex. Smoothed standardized mortality ratios (SMRs) for suicide for each neighborhood were also estimated and their association with neighborhood characteristics was investigated using the Bayesian hierarchical spatial model. The pattern of suicide rate was different among men and women; men showed higher standardized mortality rates. The most likely clusters of suicide were found in remote rural areas. However, some neighborhoods in urban areas also had noticeable suicide clusters. Firearms suicide was most likely found in remote rural areas while poisoning and hanging suicide methods clustered in urban areas. These findings suggest that it is important to take geographical variations into account in national policy and health services planning.
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Affiliation(s)
- André Ngamini Ngui
- Centre de réadaptation en dépendance de Montréal - Institut Universitaire, Canada; Hôpital Charles LeMoyne Research Centre Longueuil (QC), Canada.
| | - Philippe Apparicio
- Institut national de la recherche scientifique, Centre Urbanisation Culture Société, Montréal, Québec, Canada.
| | - Elena Moltchanova
- Department of Mathematics and Statistics, University of Canterbury, New Zealand.
| | - Helen-Maria Vasiliadis
- Hôpital Charles LeMoyne Research Centre Longueuil (QC), Canada; Department of Community Health Sciences, Université de Sherbrooke, Qc, Canada.
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42
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Zammit S, Gunnell D, Lewis G, Leckie G, Dalman C, Allebeck P. Individual- and area-level influence on suicide risk: a multilevel longitudinal study of Swedish schoolchildren. Psychol Med 2014; 44:267-277. [PMID: 23611138 DOI: 10.1017/s0033291713000743] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Characteristics related to the areas where people live have been associated with suicide risk, although these might reflect aggregation into these communities of individuals with mental health or social problems. No studies have examined whether area characteristics during childhood are associated with subsequent suicide, or whether risk associated with individual characteristics varies according to childhood neighbourhood context. METHOD We conducted a longitudinal study of 204,323 individuals born in Sweden in 1972 and 1977 with childhood data linked to suicide (n = 314; 0.15%) up to age 26-31 years. Multilevel modelling was used to examine: (i) whether school-, municipality- or county-level characteristics during childhood are associated with later suicide, independently of individual effects, and (ii) whether associations between individual characteristics and suicide vary according to school context (reflecting both peer group and neighbourhood effects). RESULTS Associations between suicide and most contextual measures, except for school-level gender composition, were explained by individual characteristics. There was some evidence of cross-level effects of individual- and school-level markers of ethnicity and deprivation on suicide risk, with qualitative interaction patterns. For example, having foreign-born parents increased the risk for individuals raised in areas where they were in a relative minority, but protected against suicide in areas where larger proportions of the population had foreign-born parents. CONCLUSIONS Characteristics that define individuals as being different from most people in their local environment as they grow up may increase suicide risk. If robustly replicated, these findings have potentially important implications for understanding the aetiology of suicide and informing social policy.
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Affiliation(s)
- S Zammit
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK
| | - D Gunnell
- School of Social and Community Medicine, University of Bristol, UK
| | - G Lewis
- School of Social and Community Medicine, University of Bristol, UK
| | - G Leckie
- Centre for Multilevel Modelling, University of Bristol, UK
| | - C Dalman
- Department of Public Health Sciences, Karolinska Institute, Sweden
| | - P Allebeck
- Department of Public Health Sciences, Karolinska Institute, Sweden
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Kunst AE, van Hooijdonk C, Droomers M, Mackenbach JP. Community social capital and suicide mortality in the Netherlands: a cross-sectional registry-based study. BMC Public Health 2013; 13:969. [PMID: 24139454 PMCID: PMC3856594 DOI: 10.1186/1471-2458-13-969] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 10/03/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence on the effect of community social capital on suicide mortality rates is fragmentary and inconsistent. The present study aims to determine whether geographic variations in suicide mortality across the Netherlands were associated with community social capital. METHODS We included 3507 neighbourhoods with 6207 suicide deaths in the period 1995-2000. For each neighbourhood, we measured perceived social capital using information from interview surveys, and we measured structural aspects of social capital using population registers. Associations with mortality were determined using Poisson regression analysis with control for confounders at individual level (age, sex, marital status, country of origin) and area level (area income, population density, religious orientation). RESULTS Suicide mortality rates were related to the measure of perceived social capital. Mortality rates were 8 percent higher (95% confidence interval (CI): 2 to 16 percent) in areas with low capital. In stratified analyses, this difference was found to be significantly larger among men (12 percent, CI: 2 to 22) than women (1 percent, CI: -9 to 13), larger among those age 0-50 (18 percent, CI: 8 to 29) than older residents (-2 percent, CI: -12 to 8), and larger among the unmarried (30 percent, CI: 16-45) than the married (-2 percent, CI: -12 to 9). Associations with the structural aspect of social capital were in the same direction, but weaker, and not statistically significant. CONCLUSIONS This study contributed some evidence to assume a modest effect of community social capital on suicide mortality rates. This effect may be restricted to specific population groups such as younger unmarried men.
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Affiliation(s)
- Anton E Kunst
- Department of Public Health, Academic Medical Centre (AMC), University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
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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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Cho J, Lee WJ, Moon KT, Suh M, Sohn J, Ha KH, Kim C, Shin DC, Jung SH. Medical care utilization during 1 year prior to death in suicides motivated by physical illnesses. J Prev Med Public Health 2013; 46:147-54. [PMID: 23766873 PMCID: PMC3677068 DOI: 10.3961/jpmph.2013.46.3.147] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 04/29/2013] [Indexed: 11/26/2022] Open
Abstract
Objectives Many epidemiological studies have suggested that a variety of medical illnesses are associated with suicide. Investigating the time-varying pattern of medical care utilization prior to death in suicides motivated by physical illnesses would be helpful for developing suicide prevention programs for patients with physical illnesses. Methods Suicides motivated by physical illnesses were identified by the investigator's note from the National Police Agency, which was linked to the data from the Health Insurance Review and Assessment. We investigated the time-varying patterns of medical care utilization during 1 year prior to suicide using repeated-measures data analysis after adjustment for age, gender, area of residence, and socioeconomic status. Results Among 1994 suicides for physical illness, 1893 (94.9%) suicides contacted any medical care services and 445 (22.3%) suicides contacted mental health care during 1 year prior to suicide. The number of medical care visits and individual medical expenditures increased as the date of suicide approached (p<0.001). The number of medical care visits for psychiatric disorders prior to suicide significantly increased only in 40- to 64-year-old men (p=0.002), women <40 years old (p=0.011) and women 40 to 64 years old (p=0.021) after adjustment for residence, socioeconomic status, and morbidity. Conclusions Most of the suicides motivated by physical illnesses contacted medical care during 1 year prior to suicide, but many of them did not undergo psychiatric evaluation. This underscores the need for programs to provide psychosocial support to patients with physical illnesses.
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Affiliation(s)
- Jaelim Cho
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
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46
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Pan YJ, Stewart R, Chang CK. Socioeconomic disadvantage, mental disorders and risk of 12-month suicide ideation and attempt in the National Comorbidity Survey Replication (NCS-R) in US. Soc Psychiatry Psychiatr Epidemiol 2013; 48:71-9. [PMID: 22996607 DOI: 10.1007/s00127-012-0591-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 09/08/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE We aim to explore the distinctive interrelationships between family income and mental disorders on suicidality in recent 12 months. METHODS A stratified random subsample of adults in a household survey in US, National Comorbidity Survey Replication, was used for analyses. The ratio of family income to poverty threshold (RoFIPT) per capita was the primary predictor of interest to 12-month occurrence of suicide ideation and attempt. Effect modification by mental disorders was further explored. RESULTS A total of 4,724 subjects were analyzed. Inverse associations were found with RoFIPT for both suicidal outcomes after confounding control. Furthermore, effect modification was revealed that RoFIPT was more strongly associated with suicide ideation for those with mental disorders (OR 0.87; 95 % CI 0.79, 0.95). CONCLUSIONS An inverse gradient of RoFIPT was shown with suicide ideation and attempt. Moreover, having mental disorders was found to be an effect modifier for the relationships between family income and suicidality.
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Affiliation(s)
- Yi-Ju Pan
- Department of Psychiatry, Far Eastern Memorial Hospital, Taipei, Taiwan
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Martiello MA, Giacchi MV. Ecological study of isolation and suicide in Tuscany (Italy). Psychiatry Res 2012; 198:68-73. [PMID: 22386571 DOI: 10.1016/j.psychres.2011.11.013] [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: 11/21/2010] [Revised: 10/12/2011] [Accepted: 11/17/2011] [Indexed: 10/28/2022]
Abstract
The purpose of the study was to investigate the association between suicide and demographic and socio-economic measures in Tuscany. Data on standardized rates of suicide from 1997 to 2005 in addition to census-derived variables, income and abstention were derived from the Mortality register, the 2001 Census, the Tax Agency and the Regional Electoral Office databases. Pearson's correlation and stepwise multiple regression analyses (unweighted and weighted by population) were used to analyze the association between suicide rates and demographic and socio-economic measures for the 34 health districts for both males and females. The correlation analyses showed that suicide was significantly associated with many variables in men, but only with old age in women. The multiple regression analyses showed that the best predictors in men were education, single person households and isolated houses (only education and single person households in the weighted model). For women, the best predictors were the proportion of elderly people and income (this was also true for the weighted model, but in the opposite order). An ecological correlation between suicide and measures of economic deprivation and social fragmentation was found in both men and women. Among the best predictors, isolated houses may act as a marker for remoteness and isolation on a small scale.
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Michimi A, Wimberly MC. Natural Environments, Obesity, and Physical Activity in Nonmetropolitan Areas of the United States. J Rural Health 2012; 28:398-407. [DOI: 10.1111/j.1748-0361.2012.00413.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Cheung YTD, Spittal MJ, Pirkis J, Yip PSF. Spatial analysis of suicide mortality in Australia: investigation of metropolitan-rural-remote differentials of suicide risk across states/territories. Soc Sci Med 2012; 75:1460-8. [PMID: 22771036 DOI: 10.1016/j.socscimed.2012.04.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 03/12/2012] [Accepted: 04/21/2012] [Indexed: 10/28/2022]
Abstract
Studies of suicide epidemiology in regions of Australia have been conducted, but the spatial pattern in the whole country has not been fully investigated. This study aimed at visualizing the sex-specific suicide pattern over the country from 2004 to 2008, and studying the metropolitan-rural-remote differentials of suicide across all states/territories. We applied a Poisson hierarchical model to yield smoothed sex specific, age standardized mortality ratios of suicide in all postal areas, and compiled the age-standardized suicide rates across different levels of remoteness and different jurisdictions. We identified the area variation of suicide risk across states/territories, and metropolitan-rural-remote differential with rates higher in rural and remote areas for males. Spatial clusters of some high risk postal areas were also identified. Socio-economic deprivation, compositional factors, high risks for Indigenous people and low access to mental health service are the underlying explanations of the elevation of suicide risk in some areas. These findings suggest that it is important to take geographical variations in suicide risk into account in national policy making. Particular suicide prevention interventions might be targeted at males living in remote areas, and some localized areas in metropolitan zones.
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Affiliation(s)
- Yee Tak Derek Cheung
- Centre for Health Policy, Programs and Economics, School of Population Health, The University of Melbourne, Melbourne, Australia.
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Hooghe M, Vanhoutte B. An ecological study of community-level correlates of suicide mortality rates in the Flemish region of Belgium, 1996-2005. Suicide Life Threat Behav 2011; 41:453-64. [PMID: 21707729 DOI: 10.1111/j.1943-278x.2011.00047.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
An ecological study of age-standardized suicide rates in Belgian communities (1996-2005) was conducted using spatial regression techniques. Community characteristics were significantly related to suicide rates. There was mixed support for the social integration perspective: single person households were associated with higher suicide rates, while religious participation was unrelated and both immigration and the presence of non-European inhabitants had a negative impact. Deprivation had a positive relation with suicide. Population density had a negative influence on suicide rates. Areas with older populations had higher suicide risks than expected. A spatial contagion effect of neighboring communities was present for men. In the conclusion, hypotheses are presented on why an aging population could be associated with higher suicide rates in the community.
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Affiliation(s)
- Marc Hooghe
- Department of Political Science, University of Leuven, Leuven, Belgium.
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