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Okudan Soyal T, Aydın G. An Investigation Into the Social Profiles of Drug-Addicted Adolescents in Turkey. CURRENT ADDICTION REPORTS 2022. [DOI: 10.1007/s40429-022-00426-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Characteristics of depressed suicide attempters with remitted substance use disorders. J Psychiatr Res 2021; 137:572-578. [PMID: 33158553 PMCID: PMC8084874 DOI: 10.1016/j.jpsychires.2020.10.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/06/2020] [Accepted: 10/28/2020] [Indexed: 01/26/2023]
Abstract
Substance use disorder (SUD) comorbidity in mood disorders increases suicide risk. Suicide attempters with active SUD appear to have distinct characteristics but little is known whether these characteristics persist during remission and if they are related to different aspects of suicidal behavior. In this study, suicide attempters with a DSM mood disorder and remitted SUD (AT+SUD) (N = 135) were compared to those without lifetime SUD (AT-SUD) (N = 219) in terms of demographic, clinical and suicidal behavioral characteristics. Factor analyses were conducted to generate subjective distress and impulsivity/aggression factors - previously identified by our group to predict suicide risk in mood disorders. Associations between these traits and SUD history and suicidal behavior characteristics were then tested. Compared with AT-SUD, AT+SUD were more likely to be male, less educated and to have a Cluster B personality disorder. AT+SUD individuals had greater impulsivity/aggression factor scores, but comparable subjective distress scores. AT+SUD made a greater number of suicide attempts, with higher lethality, despite comparable suicide intent and degree of planning with AT-SUD. Impulsivity/aggression was higher in multiple versus single attempters, but did not correlate with suicide attempt lethality. Among suicide attempters with mood disorders, a history of lifetime SUD was associated with more frequent and more lethal suicide attempts. Among other correlates of lifetime SUD in this sample, impulsive/aggressive traits may explain greater frequency of suicide attempts. The results underscore that persons with mood disorders and lifetime SUD are at particularly high risk of frequent and lethal suicide attempts where more intensive prevention efforts are warranted.
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Chung CH, Chien WC, Yeh HW, Tzeng NS. Psychiatric consultations as a modifiable factor for repeated suicide attempt-related hospitalizations: A nationwide, population-based study. J Affect Disord 2021; 278:157-164. [PMID: 32961411 DOI: 10.1016/j.jad.2020.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/26/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The risk of mortality and morbidity increased in repeated suicide attempts. This study aimed to investigate how psychiatric consultations, a modifiable factor, affects the risk of repeated suicide attempts in patients. METHODS The National Health Insurance Research Database was used in this study. All inpatients aged ≧10 with suicide attempts were recruited in Taiwan from 2000 through 2015. Both the cross-sectional and cohort studies were used to evaluate the risk of repeated suicide attempts associated with psychiatric consultations. RESULTS In the cross-sectional approach, a total of 88,161 suicide attempts and 7,997 with repeated suicide attempts were found. Multivariable logistic regression found that the patients with psychiatric consultations were associated with the decreased risk of repeated suicide attempt-related hospitalization (SARD), as per the adjusted odds ratio of 0.527 (95% confidence interval [CI]=0.416-0.859, p <0.001). In the retrospective cohort approach, the Fine and Gray's survival analysis revealed that the patients with psychiatric consultations were associated with a lower risk of repeated SARD (adjusted subdistribution hazard ratio [SHR] =0.533( 95% CI, 0.332-0.850, p <0.001). CONCLUSIONS Overall, psychiatric consultations for the patients could be a modifiable factor, which were associated with the decreased risk of repeated suicide attempts. The age of clinicians and their experience could be the primary variable above and beyond the mental illness or the performed suicide attempt method.
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Affiliation(s)
- Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan; Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan.
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan; Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan; Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.
| | - Hui-Wen Yeh
- Institute of Bioinformatics and System Biology, National Chiao Tung University, Taipei, Taiwan; Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan; Student Counseling Center, National Defense Medical Center, Taipei, Taiwan.
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Sultanoğlu H, Erdem Sultanoğlu T. Evaluation of elderly patients in adult suicide cases admitted to the emergency department. J Forensic Leg Med 2020; 77:102103. [PMID: 33341021 DOI: 10.1016/j.jflm.2020.102103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/09/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
The proportion of elderly people in the general population has been increasing in our country. The suicide rate increases by a person's age, and old age appears as one of the life periods with a high suicide incidence. We aimed at investigating the causes and risk factors of suicide attempts and to analyze the sociodemographic and clinical features of the elderly individuals presenting to the emergency department after suicide attempt. Cross-sectional retrospective study was performed.1403 patients were enrolled. The patients were categorized into two age groups of 18-64 years and 65 years or older. The male gender had a greater proportion in both groups. The young group contained more subjects having an educational level of primary school while the illiterate ones in the older group had a greater suicide tendency. The married subjects had a greater suicide tendency in the younger group while widowed/divorced subjects had a greater suicide tendency in the older group. Subjects without any comorbidity or medication use had a greater suicide tendency in the younger group whereas those who had comorbidities or medication use greater suicide tendency. Mood disorders were the most common psychiatric disorder in both groups. Medication intake was the most common method of suicide in both groups; suicide attempts were more common in summer and between 16:00-24:00. Domestic problems as the cause of suicide were more common in the younger group, while communication problems were more common in the older group. Male gender, divorced/widowed, low education and sociocultural level, presence of depression, communication problems have been identified as risk factors for older group.
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Affiliation(s)
- Hasan Sultanoğlu
- Department of Emergency Medicine, School of Medicine, Düzce University, Düzce, Turkey.
| | - Tuba Erdem Sultanoğlu
- Department of Physical Medicine and Rehabilitation, School of Medicine, Düzce University, Düzce, Turkey.
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Ünübol H, Sayar GH. Substance use and its risk factors in Turkey: a nationally representative sample study. J Ethn Subst Abuse 2020; 21:476-498. [DOI: 10.1080/15332640.2020.1781731] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Im PK, Millwood IY, Chen Y, Guo Y, Du H, Kartsonaki C, Bian Z, Tan Y, Su J, Li Y, Yu C, Lv J, Li L, Yang L, Chen Z. Problem drinking, wellbeing and mortality risk in Chinese men: findings from the China Kadoorie Biobank. Addiction 2020; 115:850-862. [PMID: 31692116 PMCID: PMC7156287 DOI: 10.1111/add.14873] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 09/10/2019] [Accepted: 10/23/2019] [Indexed: 11/30/2022]
Abstract
AIMS To assess the associations of problem drinking with wellbeing and mortality in Chinese men. DESIGN Population-based prospective cohort study. SETTING Ten diverse areas across China. PARTICIPANTS A total of 210 259 men aged 30-79 years enrolled into China Kadoorie Biobank between 2004 and 2008. MEASUREMENTS Self-reported alcohol intake and indicators of problem drinking (i.e. drinking in the morning, unable to stop drinking, unable to work due to drinking, negative emotions after drinking, having shakes after stopping drinking) were assessed by questionnaire at baseline, along with stressful life events (e.g. divorce, income loss, violence) and wellbeing-related measures (e.g. life satisfaction, sleep problems, depression, anxiety). Problem drinking was defined as reporting at least one of the drinking problem indicators. Follow-up for mortality and hospitalized events was through linkage to death registries and national health insurance systems. Multivariate logistic regression models assessed cross-sectional relationships between problem drinking and stressful life events/wellbeing. Cox proportional hazards regression models estimated prospective associations of problem drinking with mortality/hospitalized events. FINDINGS A third of men were current regular drinkers (i.e. drank alcohol at least weekly), 24% of whom reported problem drinking: 8% of all men. Experience of stressful life events in the past 2 years, especially income loss [odds ratio (OR) = 1.86, 95% confidence interval (CI) = 1.45-2.39], was associated with increased problem drinking. Compared with low-risk drinkers (i.e. intake < 200 g/week, no reported problem drinking or habitual heavy drinking episodes), men with problem drinking had poorer self-reported health, poorer life satisfaction and sleep problems, and were more likely to have symptoms of depression and anxiety. Men with two or more problem drinking indicators had an approximately twofold higher risk for all-cause mortality as well as mortality and morbidity from external causes (i.e. injuries), respectively, and 15% higher risk for any hospitalization, compared with low-risk drinkers (all P < 0.01). CONCLUSION Eight per cent of men in China are problem drinkers, and this is associated with significantly increased risk of physical and mental health problems and premature death.
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Affiliation(s)
- Pek Kei Im
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Iona Y. Millwood
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Yu Guo
- Chinese Academy of Medical SciencesBeijingChina
| | - Huaidong Du
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Christiana Kartsonaki
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Zheng Bian
- Chinese Academy of Medical SciencesBeijingChina
| | - Yunlong Tan
- Chinese Academy of Medical SciencesBeijingChina
| | | | | | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public HealthPeking UniversityBeijingChina
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public HealthPeking UniversityBeijingChina
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public HealthPeking UniversityBeijingChina
| | - Ling Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population HealthUniversity of OxfordOxfordUK
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Kang D, Fairbairn CE, Ariss TA. A meta-analysis of the effect of substance use interventions on emotion outcomes. J Consult Clin Psychol 2019; 87:1106-1123. [PMID: 31724427 PMCID: PMC6859954 DOI: 10.1037/ccp0000450] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Emotional distress has been posited as a key underlying mechanism in the development and maintenance of substance use disorder (SUD), and patients seeking SUD treatment are often experiencing high levels of negative emotion and/or low levels of positive emotion. But the extent to which SUD interventions impact emotional outcomes among general SUD populations is yet unquantified. The current meta-analysis aims to fill this gap. METHOD A total of 11,754 records were screened for randomized, controlled trials examining the effect of behavioral SUD interventions on emotion outcomes. Our search yielded a total of 138 effect sizes calculated based on data from 5,146 individuals enrolled in 30 independent clinical trials. Random-effects meta-analysis was used to calculate pooled effect sizes, and metaregression analyses examined study-level moderators (e.g., intervention type). RESULTS Findings indicated a small but significant effect of SUD interventions on emotion outcomes, d = 0.157, 95% CI [0.052, 0.262] (k = 30). The effect size for negative emotion was nominally bigger, d = 0.162, 95% CI [0.056, 0.269] (k = 30), whereas the effect for positive emotion did not reach statistical significance, d = 0.062, 95% CI [-0.089, 0.213] (k = 7). Studies featuring SUD interventions designed to specifically target emotions (i.e., affect-regulation, mindfulness-based treatments) produced larger reductions in negative emotion compared with studies featuring interventions that did not contain specific emotion modules (e.g., contingency management). CONCLUSIONS Findings suggest that SUD interventions-especially mindfulness-based and affect-regulation treatments-indeed significantly reduce negative emotion, although relatively small effect sizes indicate potential room for improvement. Conclusions regarding positive emotion should be considered preliminary because of the limited numbers of samples assessing these outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Explaining socioeconomic inequalities in illicit drug use disorders in Iran. Med J Islam Repub Iran 2018; 31:108. [PMID: 29951409 PMCID: PMC6014806 DOI: 10.14196/mjiri.31.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Indexed: 11/18/2022] Open
Abstract
Background: Drug use disorders are one of the major health problems in societies, which cause physical, psychological, and social
damages to individuals. Socioeconomic status is often inversely associated with drug use disorders. The present study aimed at determining
the effect of socioeconomic inequality on the prevalence of drug use disorders and identifying its determinants in Iran.
Methods: Data of 7886 individuals aged 15 to 64 years were collected from Iran Mental Health Survey (IranMHS). Initially, the
socioeconomic status of the participants was determined by principal component analysis. Later, socioeconomic inequality was measured
using the concentration index, and the factors influencing the gap between the high and low socioeconomic groups were identified
using the Oaxaca-Blinder Decomposition.
Results: The concentration index for drug use disorders in Iran was -0.29 (standard error= 0.06). The results of decomposition technique
revealed that 1.14% and 2.7% of the participants with high and low socioeconomic status were affected by drug use disorders,
respectively. In addition, the gap between these 2 groups was found to be 1.65%. Among the studied variables, occupation, marital
status, and gender accounted for the highest contribution to inequality, respectively.
Conclusion: There is inequality in the prevalence of drug use disorders in Iran; these disorders are more common in lower socioeconomic
group. Based on the findings, it is suggested that improvement in the socioeconomic status of the households, especially for
males, the divorced or widowed individuals, and the unemployed may lead to a reduction in inequality in drug use disorders.
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Risk factors of compliance with self-harm command hallucinations in individuals with affective and non-affective psychosis. Schizophr Res 2018; 195:115-121. [PMID: 28911915 DOI: 10.1016/j.schres.2017.09.001] [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: 12/20/2016] [Revised: 08/31/2017] [Accepted: 09/02/2017] [Indexed: 02/01/2023]
Abstract
Clinicians are often left with the difficult task of assessing and managing the risk of violent behaviors in individuals having command hallucinations, which may result in substantial rates of false positive or false negative. Moreover, findings on the association between command hallucinations and suicidal behaviors are limited. In an attempt to better understand compliance to this hallucinatory phenomenon, our objective was to identify the risk factors of compliance with self-harm command hallucinations. Secondary analyses from the MacArthur Study were performed on 82 participants with psychosis reporting such commands. Univariate logistic regression was used to examine the classification value of each characteristic associated with compliance with such commands. Seriousness and frequency of childhood physical abuse, a current comorbid substance use disorder, emotional distress, general symptomatology, history of compliance, and belief about compliance in the future were found to be significant risk factors of compliance with self-harm commands in the week preceding psychiatric inpatient. Multivariate analyses revealed that severity of childhood physical abuse, belief about compliance in the future, and a current comorbid substance use disorder were independent risk factors. The final model showed excellent classification accuracy as suggest by the receiver operating characteristic curve (AUC=0.84, 95% CI: 0.75-0.92, p<0.001). Our results suggest considerable clinical implications in regard to the assessment of risk of compliance to self-harm command hallucinations in individuals with psychosis.
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Madrid Study (Spain) on the Prevalence and Characteristics of Outpatients With Dual Disorders. ADDICTIVE DISORDERS & THEIR TREATMENT 2017. [DOI: 10.1097/adt.0000000000000119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Ginley MK, Bagge CL. Psychiatric heterogeneity of recent suicide attempters: A latent class analysis. Psychiatry Res 2017; 251:1-7. [PMID: 28167395 PMCID: PMC5991076 DOI: 10.1016/j.psychres.2017.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 11/21/2016] [Accepted: 02/02/2017] [Indexed: 12/13/2022]
Abstract
Presence of, and comorbidity between, psychiatric disorders is a risk factor for suicide attempts. No study to date has used a person-centered approach to determine whether there are subgroups of attempters showing differing patterns of psychiatric disorders. This study aimed to identify psychiatric subgroups amongst recent suicide attempters (i.e., hospitalized within 24h of their attempt) and to determine whether identified classes could be differentiated in terms of important clinical correlates. Participants included 97 adult patients who were hospitalized due to a recent suicide attempt at a large Trauma 1 hospital. A structured diagnostic interview assessed a range of psychiatric disorders, and a battery of measures assessed acute and distal clinical correlates and characteristics of the current attempt. The person-centered analytic approach of latent class analysis was used to identify psychiatric diagnostic subgroups, or classes, of attempters. Three psychiatric subgroups were identified: Major Depressive Disorder, High Externalizing Disorders, and High Internalizing High Externalizing Disorders. Classes were found to significantly differ on a range of acute and distal clinical correlates, but not by demographics. Identification of psychiatric subgroups of individuals who have recently attempted suicide has important practical implications for increasing subsequent treatment utilization and tailoring treatment interventions for this population.
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Affiliation(s)
- Meredith K. Ginley
- University of Mississippi Medical Center, Department of Psychiatry and Human Behavior, 2500 North State Street, Jackson, MS, 39216
| | - Courtney L. Bagge
- University of Mississippi Medical Center, Department of Psychiatry and Human Behavior, 2500 North State Street, Jackson, MS, 39216,Correspondence to: Tel: 601-984-5824; Fax: 601-984-5867.
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12
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Investigation of a Suicide Ideation Risk Profile in People With Co-occurring Depression and Substance Use Disorder. J Nerv Ment Dis 2016; 204:820-826. [PMID: 26807880 DOI: 10.1097/nmd.0000000000000473] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Disengagement from services is common before suicide, hence identifying factors at treatment presentation that predict future suicidality is important. This article explores risk profiles for suicidal ideation among treatment seekers with depression and substance misuse. Participants completed assessments at baseline and 6 months. Baseline demographics, psychiatric history, and current symptoms were entered into a decision tree to predict suicidal ideation at follow-up. Sixty-three percent of participants at baseline and 43.5% at follow-up reported suicidal ideation. Baseline ideation most salient when psychiatric illness began before adulthood, increasing the rate of follow-up ideation by 16%. Among those without baseline ideation, dysfunctional attitudes were the most important risk factor, increasing rates of suicidal ideation by 35%. These findings provide evidence of factors beyond initial diagnoses that increase the likelihood of suicidal ideation and are worthy of clinical attention. In particular, providing suicide prevention resources to those with high dysfunctional attitudes may be beneficial.
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Rafnsson SB, Oliver JJ, Elton RA, Bateman DN. Poisons admissions in Edinburgh 1981-2001: agent trends and predictors of hospital readmissions. Hum Exp Toxicol 2016; 26:49-57. [PMID: 17334179 DOI: 10.1177/0960327107071855] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Self-poisoning is a major public health problem. This study describes patterns of admissions and readmissions from self-poisoning to the Royal Infirmary of Edinburgh from 1981 to 2001. A database on hospital discharges with a diagnosis (ICD-9/10) of poisoning between 1981 and 2001 was used. Annual admissions were described for seven main drug categories, and proportions of patients readmitted within 1-5 years from first admission, were computed for each category. Cox proportional hazards regression was used to evaluate prognostic factors for readmission risk over 1981-2001. For both sexes, admissions increased from the early to mid 1990s, and declined thereafter. The proportion readmitted varied with the drug taken at first admission, from 11.9% (95% CI: 10.8-13%) for non-opiate analgesics, to 17.6% (16.5-18.7%) for benzodiazepines. Deprivation was positively related to readmission risk after first admissions with paracetamol (P<0.001) and benzodiazepines (P<0.001). Timing of first admissions involving paracetamol (P<0.01), benzodiazepines (P<0.001), antidepressants (P<0.001), non-opiate analgesics (P<0.001), and opiates (P<0.05), was inversely associated with readmission risk. In patients admitted for drug overdose, readmission risk is influenced by type of drug taken at first admission. Information on drug type used in self-poisoning may assist in identifying patients at risk for future events, and in reducing hospital read-missions.
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Affiliation(s)
- S B Rafnsson
- Department of Public Health Sciences, University of Edinburgh Medical School, Teviot Place, EH8 9AG, Edinburgh, UK.
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Chakravorty S, Siu HYK, Lalley-Chareczko L, Brown GK, Findley JC, Perlis ML, Grandner MA. Sleep Duration and Insomnia Symptoms as Risk Factors for Suicidal Ideation in a Nationally Representative Sample. Prim Care Companion CNS Disord 2015; 17:13m01551. [PMID: 27057399 DOI: 10.4088/pcc.13m01551] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 07/16/2015] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Suicidal behavior (suicidal ideation, suicide attempts, and suicide completion) has been increasingly linked with difficulty initiating sleep, maintaining sleep, and early morning awakenings. However, the relationship between suicidal behavior and sleep duration abnormalities is unclear, especially at the population level. The present study used a nationally representative sample to examine the association of suicidal ideation with extreme sleep durations and insomnia symptoms. METHOD Cross-sectional data from adult respondents (≥ 18 years of age, N = 6,228) were extracted from the 2007-2008 wave of the National Health and Nutritional Examination Survey. Ordinal logistic regression analyses were used to evaluate the relationship of suicidal ideation with sleep duration, global insomnia, and individual insomnia symptoms in models adjusted for sociodemographic, socioeconomic, and health-related covariates. RESULTS Suicidal ideation was associated with abnormalities of sleep duration. This relationship ceased to exist once the model was adjusted for depressive symptoms. As expected, an increased level of suicidal ideation was consistently associated with insomnia. Of the insomnia symptoms, difficulty maintaining sleep was found to be the most predictive of suicidal ideation, followed by difficulty initiating sleep (P< .05). CONCLUSIONS Abnormalities of sleep duration and continuity should prompt a clinical assessment for suicide risk.
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Affiliation(s)
- Subhajit Chakravorty
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - H Y Katy Siu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Gregory K Brown
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - James C Findley
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Michael L Perlis
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Michael A Grandner
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia; University of Arizona College of Medicine, Tuscon
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15
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Chakravorty S, Siu HYK, Lalley-Chareczko L, Brown GK, Findley JC, Perlis ML, Grandner MA. Sleep Duration and Insomnia Symptoms as Risk Factors for Suicidal Ideation in a Nationally Representative Sample. Prim Care Companion CNS Disord 2015. [PMID: 27057399 DOI: 10.4088/pcc.13m01551.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022] Open
Abstract
OBJECTIVE Suicidal behavior (suicidal ideation, suicide attempts, and suicide completion) has been increasingly linked with difficulty initiating sleep, maintaining sleep, and early morning awakenings. However, the relationship between suicidal behavior and sleep duration abnormalities is unclear, especially at the population level. The present study used a nationally representative sample to examine the association of suicidal ideation with extreme sleep durations and insomnia symptoms. METHOD Cross-sectional data from adult respondents (≥ 18 years of age, N = 6,228) were extracted from the 2007-2008 wave of the National Health and Nutritional Examination Survey. Ordinal logistic regression analyses were used to evaluate the relationship of suicidal ideation with sleep duration, global insomnia, and individual insomnia symptoms in models adjusted for sociodemographic, socioeconomic, and health-related covariates. RESULTS Suicidal ideation was associated with abnormalities of sleep duration. This relationship ceased to exist once the model was adjusted for depressive symptoms. As expected, an increased level of suicidal ideation was consistently associated with insomnia. Of the insomnia symptoms, difficulty maintaining sleep was found to be the most predictive of suicidal ideation, followed by difficulty initiating sleep (P< .05). CONCLUSIONS Abnormalities of sleep duration and continuity should prompt a clinical assessment for suicide risk.
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Affiliation(s)
- Subhajit Chakravorty
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - H Y Katy Siu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Gregory K Brown
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - James C Findley
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Michael L Perlis
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Michael A Grandner
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia; University of Arizona College of Medicine, Tuscon
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Rajapakse T, Griffiths KM, Christensen H, Cotton S. A comparison of non-fatal self-poisoning among males and females, in Sri Lanka. BMC Psychiatry 2014; 14:221. [PMID: 25103532 PMCID: PMC4149235 DOI: 10.1186/s12888-014-0221-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 07/23/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In the recent past Sri Lanka has had a high rate of attempted suicide by pesticide ingestion, among both males and females. Recent evidence suggests that these trends in self-poisoning may be changing, with increasing medicinal overdoses and changing gender ratios. In the past, attempted suicide in Sri Lanka has been described as impulsive acts, but research regarding aspects such as suicidal intent is limited, and there has been no comparison between genders. The objective of this study was to describe gender differences in non-fatal self-poisoning in Sri Lanka with respect to substances ingested, triggers, stressors, suicidal intent and psychiatric morbidity. METHODS Persons admitted to Teaching Hospital Peradeniya, Sri Lanka, for medical management of non-fatal self-poisoning over a consecutive 14-month period were eligible for the study. Participants were interviewed within one week of admission, with regard to demographic details, poison type ingested, triggers, psychiatric morbidity and suicidal intent. 949 participants were included in the study, of whom 44.2% were males, with a median age of 22 years. RESULTS Males were significantly more likely to ingest agrochemicals, whereas females were more likely to overdose on pharmaceutical drugs. Interpersonal conflict was a common trigger associated with non-fatal self-poisoning for both males and females. Alcohol use disorders and high suicidal intent were significantly more likely in males. There was no difference in rates of depression between the genders. Multiple regression for both genders separately showed that the presence of depression and higher levels of hopelessness was the strongest predictor of suicidal intent, for both genders. CONCLUSIONS Patterns of non-fatal self-poisoning in Sri Lanka appear to be changing to resemble Western patterns, with females having a greater rate of self-poisoning and more medicinal overdoses than males. Alcohol use disorder is a gender specific risk factor associated with non-fatal self-poisoning among males, indicating a need for specific intervention. However there are also many common risk factors that are common to both genders, particularly associations with interpersonal conflict as an acute trigger, and psychiatric morbidity such as depression and hopelessness being related to increased suicidal intent.
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Affiliation(s)
- Thilini Rajapakse
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
| | - Kathleen Margaret Griffiths
- National Institute for Mental Health Research, The Australian National University, Building 63, Canberra, ACT 0200 Australia
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Hospital Road, Randwich, NSW 2013 Australia
| | - Sue Cotton
- Centre for Youth Mental Health, University of Melbourne, 35, Poplar Road, Parkville, VIC 3052 Australia
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Construction workers struggle with a high prevalence of mental distress, and this is associated with their pain and injuries. J Occup Environ Med 2014; 55:1197-204. [PMID: 24064778 DOI: 10.1097/jom.0b013e31829c76b3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We aimed to investigate how mental distress was associated with pain and injuries in a convenience sample of construction workers. METHODS A cross-sectional, mental health assessment was conducted in a convenience sample of construction workers (N = 172). A subsample participated in a clinical interview (n = 10). We used a cutoff (1.50 or greater) on Hopkins Symptom Checklist-25 to determine substantial mental distress and determined associations with pain and injury outcomes. RESULTS The prevalence of substantial mental distress was 16% in the workers. This was supported by follow-up clinical interviews where 9 of 10 workers fulfilled the criteria for a mental disorder. Substantial mental distress was associated with both injury rate and self-reported pain. CONCLUSION This pilot study strongly suggests the need for rigorous studies on construction worker mental health and how it affects their work and well-being.
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Understanding PTSD comorbidity and suicidal behavior: associations among histories of alcohol dependence, major depressive disorder, and suicidal ideation and attempts. J Anxiety Disord 2014; 28:318-25. [PMID: 24681282 DOI: 10.1016/j.janxdis.2014.02.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 02/18/2014] [Accepted: 02/24/2014] [Indexed: 01/09/2023]
Abstract
Individuals with posttraumatic stress disorder (PTSD) are at an elevated risk for experiencing suicidal thoughts and actions. However, a relative dearth of research has examined factors that may impact this relation, such as common co-occurring disorders. Utilizing the National Comorbidity Survey-Replication data, the current study examined comparisons between comorbid PTSD and major depressive disorder (MDD) and comorbid PTSD and alcohol dependence (AD) in relation to suicidal ideation and suicide attempts. It was hypothesized that comorbid MDD would be associated with an elevated likelihood of suicidal ideation, while comorbid AD would be associated with an elevated likelihood of suicide attempt history. Results indicated that only PTSD-AD was significantly associated with an elevated likelihood of endorsing histories of both suicidal ideation and suicide attempts. These findings suggest that AD may be a critical risk factor for acquiring the capability for suicide attempts.
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Factors That Affect Treatment Initiation Among Individuals With Serious Mental Illness and Substance Abuse Disorder. ADDICTIVE DISORDERS & THEIR TREATMENT 2014. [DOI: 10.1097/adt.0b013e31827914b3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Brierley S, Baker K, Brack J, Cunningham P. Retrospective case note review of patients brought to Ipswich emergency department under mental health emergency examination orders: does intoxication alter outcome? Emerg Med Australas 2013; 22:532-6. [PMID: 21143401 DOI: 10.1111/j.1742-6723.2010.01350.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To alter staff perceptions, and to examine alternative management processes for intoxicated patients brought to Ipswich ED under mental health emergency examination orders by comparing disposition outcomes with non-intoxicated patients. METHODS Consultation-Liaison mental health nursing staff completed surveys on all patients assessed under emergency examination orders over a 6 month period in 2008. Patients were classified as intoxicated if they recorded alcometer readings of greater than 0.05%, or self-reported drug use during the events leading to their transport to the ED. Outcomes were retrospectively collated with entries in Clinical Liaison nursing logbooks. Outcome measures recorded were rates of admission, outpatient referrals to the Integrated Mental Health Service, follow up by other community services or no follow up. Differences in outcomes for intoxicated and non-intoxicated patient groups were tested for significance using χ(2) or Fisher's exact test. RESULTS One hundred and sixty-eight cases were included in the audit. No cases were excluded. Sixty patients were identified as intoxicated. The age and sex distributions were similar between intoxicated and non-intoxicated patients. There were no significant differences in admission or referral rates. The average length of assessment time in the ED was longer in the intoxicated group. DISCUSSION This audit showed similar outcomes for both patient groups contrary to the perceptions expressed by ED staff in informal surveys. The admission and referral rate for both groups indicate they are an at-risk population. The admission rate of 16% has led to this department negotiating alternative accommodation for patients while they sober up.
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Affiliation(s)
- Stephen Brierley
- Ipswich Hospital, Chelmsford Avenue, Ipswich, Queensland 4305, Australia
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21
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Cook BL, Alegría M. Racial-ethnic disparities in substance abuse treatment: the role of criminal history and socioeconomic status. Psychiatr Serv 2011; 62:1273-81. [PMID: 22211205 PMCID: PMC3665009 DOI: 10.1176/ps.62.11.pss6211_1273] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Among persons with substance use disorders, those from racial-ethnic minority groups have been found to receive substance abuse treatment at rates equal to or higher than those of non-Latino whites. Little is known about factors underlying this apparent lack of disparities. This study examines racial-ethnic disparities in treatment receipt and mechanisms that reduce or contribute to disparities. METHODS Black-white and Latino-white disparities in any and in specialty substance abuse treatment were measured among adult respondents with substance use disorders from the 2005-2009 National Survey on Drug Use and Health (N=25,159). Three staged models were used to measure disparities concordant with the Institute of Medicine definition, assess the extent to which criminal history and socioeconomic indicators contributed to disparities, and identify correlates of treatment receipt. RESULTS Treatment was rare (about 10%) for all racial-ethnic groups. Odds ratios for black-white and Latino-white differences decreased and became significantly less than 1 after adjustment for criminal history and socioeconomic status factors. Higher rates of criminal history and enrollment in Medicaid among blacks and Latinos and lower income were specific mechanisms that influenced changes in estimates of disparities across models. CONCLUSIONS The greater likelihood of treatment receipt among persons with a criminal history and lower socioeconomic status is a pattern unlike those seen in most other areas of medical treatment and important to the understanding of substance abuse treatment disparities. Treatment programs that are mandated by the criminal justice system may provide access to individuals resistant to care, which raises concerns about perceived coercion.
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Affiliation(s)
- Benjamin Lê Cook
- Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, MA 02143, USA.
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Erfan S, Hashim AH, Shaheen M, Sabry N. Effect of Comorbid Depression on Substance Use Disorders. Subst Abus 2010; 31:162-9. [DOI: 10.1080/08897077.2010.495311] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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23
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Traylor A, Price JH, Telljohann SK, King K, Thompson A. Clinical psychologists' firearm risk management perceptions and practices. J Community Health 2010; 35:60-7. [PMID: 20094905 PMCID: PMC2816245 DOI: 10.1007/s10900-009-9200-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to investigate the current perceptions and practices of discussing firearm risk management with patients diagnosed with selected mental health problems. A three-wave survey was mailed to a national random sample of clinical psychologists and 339 responded (62%). The majority (78.5%) believed firearm safety issues were greater among those with mental health problems. However, the majority of clinical psychologists did not have a routine system for identifying patients with access to firearms (78.2%). Additionally, the majority (78.8%) reported they did not routinely chart or keep a record of whether patients owned or had access to firearms. About one-half (51.6%) of the clinical psychologists reported they would initiate firearm safety counseling if the patients were assessed as at risk for self-harm or harm to others. Almost half (46%) of clinical psychologists reported not receiving any information on firearm safety issues. Thus, the findings of this study suggest that a more formal role regarding anticipatory guidance on firearms is needed in the professional training of clinical psychologists.
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Affiliation(s)
- Andrea Traylor
- Family Studies & Social Work, Miami University, McGuffey Hall 110 H, Oxford, OH 45056 USA
| | - James H. Price
- Department of Health and Rehabilitative Services, The University of Toledo, 2801 W. Bancroft Mail Stop 119, Toledo, OH 43606 USA
| | - Susan K. Telljohann
- Department of Health and Rehabilitative Services, The University of Toledo, 2801 W. Bancroft Mail Stop 119, Toledo, OH 43606 USA
| | - Keith King
- Health Promotion & Education, University of Cincinnati, TEACHERS 526E, PO Box 210068, Cincinnati, OH 45221 USA
| | - Amy Thompson
- Department of Health and Rehabilitative Services, The University of Toledo, 2801 W. Bancroft Mail Stop 119, Toledo, OH 43606 USA
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Berg JE. Death by suicide long after electroconvulsive therapy. Is the sense of coherence test of Antonovsky a predictor of mortality from depression? Ment Illn 2010; 2:e3. [PMID: 25478086 PMCID: PMC4253349 DOI: 10.4081/mi.2010.e3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 01/25/2010] [Accepted: 01/28/2010] [Indexed: 01/02/2023] Open
Abstract
Prediction of increased risk of suicide is difficult. We had the opportunity to follow up 20 patients receiving electroconvulsive therapy (ECT) because of severe depression. They filled in the Antonovsky sense of coherence test (SOC) and Beck depression inventory (BDI) before and after a series of ECT treatments. Seventeen surviving patients had a mean observation time of 20.6 months, whereas the three deceased patients had 11.3 months. There was a lower mean age at onset of illness and a longer mean duration of disease in the deceased. Other clinical parameters did not differ. The surviving patients had a significant decrease on the BDI from 35 to 18 (P<0.001) and an increase on the SOC test after ECT from 2.45 to 3.19 (P<0.001), indicating both less depression and better functioning in life. The deceased had a larger change on the BDI from 32 to 13, not attaining significance because of the low number of deceased. The SOC test, however, did not increase to a purported normal level; that is, from 2.43 to 2.87. Although the SOC scale has been shown to predict mortality in substance abusers, the SOC test has not been part of earlier reviews of predictive power. Tentatively, a low pathological score on the SOC test may indicate low sense of coherence in life that might increase the propensity for suicide. These preliminary results need replication in larger studies.
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Affiliation(s)
- John E Berg
- Department of Acute Psychiatry, Blakstad Hospital, Vestre Viken Hospital Trust, Rud, Norway
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25
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Santos SA, Lovisi G, Legay L, Abelha L. Prevalência de transtornos mentais nas tentativas de suicídio em um hospital de emergência no Rio de Janeiro, Brasil. CAD SAUDE PUBLICA 2009; 25:2064-74. [DOI: 10.1590/s0102-311x2009000900020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Accepted: 05/26/2009] [Indexed: 11/22/2022] Open
Abstract
Há poucos estudos nacionais sobre prevalência de transtornos mentais nas tentativas de suicídio, os quais utilizararam principalmente dados secundários e instrumentos de rastreamento. O objetivo deste estudo foi estimar a prevalência de transtornos mentais em 96 casos de tentativas de suicídio atendidos em hospital de emergência, Rio de Janeiro, Brasil (2006-2007), utilizando o Composite International Development Interview. A maioria da amostra consistiu em mulheres, jovens, baixa escolaridade e ingestão de medicamentos psicoativos como principal meio. Outros fatores: histórias prévias de tentativa e uso de álcool no momento do agravo. Os transtornos mentais mais freqüentes foram: episódio depressivo (38,9%), dependência de substâncias psicoativas (21,9%), transtorno de estresse pós-traumático (20,8%), dependência de álcool (17,7%) e esquizofrenia (15,6%). A taxa total dos transtornos mentais foi de 71,9%. Tais achados são mais próximos aos estudos em países em desenvolvimento. Além do acesso ao tratamento dos transtornos mentais, são necessárias políticas públicas que enfatizem o controle de meios e respostas sociais à redução do comportamento suicida.
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YALDIZLI ÖZGÜR, KUHL HANSCHRISTIAN, GRAF MARC, WIESBECK GERHARDA, WURST FRIEDRICHM. Risk factors for suicide attempts in patients with alcohol dependence or abuse and a history of depressive symptoms: A subgroup analysis from the WHO/ISBRA study. Drug Alcohol Rev 2009; 29:64-74. [DOI: 10.1111/j.1465-3362.2009.00089.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Arria AM, O'Grady KE, Caldeira KM, Vincent KB, Wilcox HC, Wish ED. Suicide ideation among college students: a multivariate analysis. Arch Suicide Res 2009; 13:230-46. [PMID: 19590997 PMCID: PMC2709750 DOI: 10.1080/13811110903044351] [Citation(s) in RCA: 189] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The goal of this study was to develop a multi-dimensional model that might explain suicide ideation among college students. Face-to-face interviews were conducted with 1,249 first-year college students. An estimated 6%(wt) of first-year students at this university had current suicide ideation. Depressive symptoms, low social support, affective dysregulation, and father-child conflict were each independently associated with suicide ideation. Only 40%(wt) of individuals with suicide ideation were classified as depressed according to standard criteria. In the group who reported low levels of depressive symptoms, low social support and affective dysregulation were important predictors of suicide ideation. Alcohol use disorder was also independently associated with suicide ideation, while parental conflict was not. Results highlight potential targets for early intervention among college students.
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Affiliation(s)
- Amelia M Arria
- Center for Substance Abuse Research, University of Maryland, College Park, 4321 Hartwick Rd., College Park, MD 20740, USA .
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Specker S, Meller WH, Thurber S. Psychiatric consultation and substance use disorders. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2009; 3:93-8. [PMID: 24357934 PMCID: PMC3864914 DOI: 10.4137/sart.s3457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background A substantial number of patients in general hospitals will evince substance abuse problems but a majority is unlikely to be adequately identified in the referral-consultation process. This failure may preclude patients from receiving effective interventions for substance use disorders. Objectives 1. To evaluate all referred patients for possible substance use disorders. 2. To ascertain the degree of convergence between patients referred for chemical problems and the corresponding DSM diagnosis. 3. To compare demographic data for substance abusing patients and referrals not so classified. 4. To evaluate conditions concomitant with substance use disorders. Method Consecutive one-year referrals (524) to consultation-liaison psychiatric services were scrutinized for chemically-related problems by psychiatric consultants. Results Of the referrals, 176 met criteria for substance use disorders (SUD) (57% alcohol; 25% other drugs; 18% both alcohol and other drugs). Persons diagnosed with SUD tended to be younger, male, non-Caucasian, unmarried, and unemployed. They were more likely to be depressed, have liver and other gastrointestinal problems, and to have experienced traumatic events; they also tended to have current financial difficulties. Most were referred for SUD evaluation by personnel in general medicine and family practice. Following psychiatric consultation, SUD designated patients were referred mainly to substance abuse treatment programs. The only variable related to recommended inpatient versus outpatient services for individuals with SUD was the Global Assessment of Functioning Axis (GAF) with persons having lower estimated functioning more likely to be referred for inpatient interventions. Conclusions These data are similar to the results of past studies in this area. Unlike previous investigations in the domain of consultative-liaison psychiatry, financial stressors and specific consultant recommendations were included in data gathering. Although the results are encouraging in that individuals with SUD were identified and potentially sent for appropriate treatment, the likelihood is that many patients with SUD remain unrecognized and do not receive necessary consultative and treatment services.
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Affiliation(s)
- Sheila Specker
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - William H Meller
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
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Hasley JP, Ghosh B, Huggins J, Bell MR, Adler LE, Shroyer ALW. A review of "suicidal intent" within the existing suicide literature. Suicide Life Threat Behav 2008; 38:576-91. [PMID: 19014309 DOI: 10.1521/suli.2008.38.5.576] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The results of a systematic literature review that investigated suicide intent are presented. Of the 44 relevant articles identified, 17 investigated the relationships between various suicide risk factors and suicide intent and 25 publications investigated the relationships between suicide intent and various suicide outcomes. Despite recent advancements in the definition and nomological validity of suicide intent, a high degree of variability in the empirical measurement and analysis of suicide intent was found. Such variability limits future research related to measuring suicidal risk and outcomes, reporting suicide intent, or the meaningful comparison of diagnostic approaches or treatments across multiple studies.
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Affiliation(s)
- Joseph P Hasley
- Department of Veterans Affairs Medical Center, Denver, Colorado, USA.
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Suicidal Ideation Among Drug-Dependent Treatment-Seeking Inner-City Pregnant Women. ACTA ACUST UNITED AC 2008; 3:53-64. [PMID: 21796240 DOI: 10.1300/j126v03n02_07] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The current retrospective study compared the psychiatric and lifestyle characteristics of two groups of treatment-seeking pregnant, opiate and/or cocaine dependent women admitted to the Center for Addiction and Pregnancy (CAP). Women reporting past and/or current suicidal ideation (SI) (46%; n = 35) were compared to women who did not report thoughts of suicidal ideation (NSI) (54%; n = 41). SI women were more likely to be homeless (p = .020), to report histories of emotional (p = .022), physical (p < 001), sexual abuse (p = .002) and psychiatric treatment (p < .001), and less likely to be married (p = .024) than NSI women. Psychiatrically, SI women were more likely to have co-morbid current and lifetime disorders than NSI women. These findings highlight the need to identify women with histories of suicidal ideation, recognize the potential relapse risk imposed by emotional distress, and confront these issues in treatment.
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Rutter PA, Freedenthal S, Osman A. Assessing protection from suicidal risk: psychometric properties of the suicide resilience inventory. DEATH STUDIES 2008; 32:142-53. [PMID: 18693384 DOI: 10.1080/07481180701801295] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
This study investigated psychometric properties of the Suicide Resilience Inventory-25 (SRI-25) in a diverse sample of 239 college students. Participants completed the SRI-25, Beck Hopelessness Scale (BHS), Suicidal Ideation Questionnaire, and the Multidimensional Scale of Perceived Social Support (MSPSS). Confirmatory factor analysis supported the 3 dimensions described by SRI-25 authors (A. Osman et al., 2004): internal protective, emotional stability, and external protective. Correlations with the BHS (r = - .68) and SIQ (r = - .67) supported the scale's validity, although the external protective subscale and MSPSS were only moderately correlated (r = .47). Overall, the SRI-25's reliability and validity support its use in suicide research. Implications for exploring young adults' resilience in the face of suicidal thoughts via clinical interview or administration of the SRI-25 are discussed as they create an opportunity to potentially infuse hope, tap into strengths, and identify avenues for positive change.
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Affiliation(s)
- Philip A Rutter
- University of Colorado at Denver and Health Sciences Center, Counseling Psychology & Counselor Education, P.O. Box 177364, Campus Box 106, Denver, CO 80217, USA.
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Karvonen K, Sammela HL, Rahikkala H, Hakko H, Särkioja T, Meyer-Rochow VB, Räsänen P, Timonen M. Sex, timing, and depression among suicide victims with schizophrenia. Compr Psychiatry 2007; 48:319-22. [PMID: 17560951 DOI: 10.1016/j.comppsych.2007.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Revised: 08/08/2006] [Accepted: 02/23/2007] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Schizophrenia and depression by themselves and especially in combination with each other are known to be important risk factors of suicide. An increased risk of suicide has also been reported for the period immediately after a psychiatric patient's discharge from the hospital. However, to the best of our knowledge, it remains unknown whether survival times differ between suicide victims with schizophrenia concomitantly with and those without depression. OBJECTIVE This study aimed to examine survival times from the discharge of last hospital treatment (irrespective of the kind of illness) to the day of death in suicide victims with schizophrenia with or without concomitant depression. MATERIAL AND METHOD A 16-year database of all suicides (1535 males, 342 females) committed during the years 1988-2003 in the province of Oulu in northern Finland, and information available from the national hospital discharge registers formed the basis of this study. RESULTS In male suicide victims with schizophrenia, the median survival time after final hospitalization was approximately 1 day in those with a history of depression and 90 days in those without depression (P = .005). The corresponding times for females were 50 and 24 days, respectively (P = .396). Using Cox regression analysis after adjusting for confounders, we noticed a statistically significant difference in survival times from last hospitalization to suicide between depressive and nondepressive male patients with schizophrenia (hazard ratio, 1.80; 95% confidence interval, 1.04-3.11), but not females (hazard ratio, 0.72; 95% confidence interval, 0.34-1.53). CONCLUSION Concomitant depression was markedly linked with shorter survival time in male suicide victims with schizophrenia after last hospitalization. Psychiatric inpatient facilities appear to be in a key position to establish suicide prevention programs for patients with schizophrenia, especially those with depression.
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Affiliation(s)
- Kaisa Karvonen
- Department of Psychiatry, University of Oulu, 90014 Oulu, Finland.
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Jané-Llopis E, Matytsina I. Mental health and alcohol, drugs and tobacco: a review of the comorbidity between mental disorders and the use of alcohol, tobacco and illicit drugs. Drug Alcohol Rev 2007; 25:515-36. [PMID: 17132571 DOI: 10.1080/09595230600944461] [Citation(s) in RCA: 280] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This paper reviews some major epidemiological studies undertaken in high-income countries during the last 15 years which have reported the prevalence of mental disorders and substance use disorders and their relationship. Comorbidity between mental and substance use disorders is highly prevalent across countries. In general, people with a substance use disorder had higher comorbid rates of mental disorders than vice versa, and people with illicit drug disorders had the highest rates of comorbid mental disorders. There is a strong direct association between the magnitude of comorbidity and the severity of substance use disorders. While causal pathways differ across substances and disorders, there is evidence that alcohol is a casual factor for depression, in some European countries up to 10% of male depression. Policies that reduce the use of substances are likely to reduce the prevalence of mental disorders. Treatment should be available in an integrated fashion for both mental and substance use disorders. There is a need to expand the evidence base on comorbidity, particularly in low-income countries.
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Affiliation(s)
- Eva Jané-Llopis
- Mental Health Programme, World Health Organization Regional Office for Europe, Copenhagen, Denmark.
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Batt A, Campeon A, Leguay D, Lecorps P. Épidémiologie du phénomène suicidaire : complexité, pluralité des approches et prévention. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s0246-1072(07)43505-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hakko H, Koponen P, Viilo K, Särkioja T, Meyer-Rochow VB, Räsänen P, Timonen M. Alcohol-related suicides in victims with a history of hospital-treated depression. Am J Addict 2006; 14:455-63. [PMID: 16257882 DOI: 10.1080/10550490500247131] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Victims of suicides are frequently known to have suffered from depression and alcohol-related disorders, but whether these disorders exert different impacts on the period of survival following last hospitalizations have remained unknown. We surveyed 1,585 suicide victims from northern Finland and assigned them to one of three groups, based on lifetime history of depression, alcohol-related disorders, and both together. We then compared survival times in the three groups. Survival times in depressed alcoholic and non-alcoholic males were significantly shorter than those of males with alcohol-related disorders alone. Depressed but non-alcoholic suicide victims had more commonly used violent methods, had less often been under the influence of alcohol, and had had more psychotic disorders than the rest. It is apparently important in clinical practice to recognize the increased risk of suicide soon after hospital discharge not only in depressed patients, but also in those with a history of both depression and alcohol-related disorders.
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Affiliation(s)
- Helinä Hakko
- Department of Psychiatry, Oulu University Hospital, PO Box 26, FIN-90029 OYS, Finland.
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Holmstrand C, Niméus A, Träskman-Bendz L. Risk factors of future suicide in suicide attempters--a comparison between suicides and matched survivors. Nord J Psychiatry 2006; 60:162-7. [PMID: 16635937 DOI: 10.1080/08039480600583597] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The objective of this study was to find risk factors for suicide by looking for clinical and care/treatment consumption differences between 15 hospitalized suicide attempters, who later committed suicide ("completers"), and 15 suicide attempters who did not ("non-completers"), matched according to sex, age and principal diagnosis. Completers had significantly more often attempted suicide after the index admission. After index, completers had received more psychiatric care and treatment than non-completers. Comorbidity was common in both groups of patients. Personality disorders according to the DSM III-R, axis II, Cluster B, however, tended to be more common in the completer group. Increased comorbidity over time could also be seen to a larger extent in completers. In spite of the matching of principal diagnosis, completers tended to have higher Montgomery-Asberg Depression Rating Scale ratings than non-completers. They also had significantly higher Suicide Assessment Scale (SUAS) scores. From this study, it is apparent that suicide attempters at risk of future suicide have major and multiple psychiatric problems, which cause difficulties in the care and treatment.
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Landheim AS, Bakken K, Vaglum P. What characterizes substance abusers who commit suicide attempts? Factors related to Axis I disorders and patterns of substance use disorders. A study of treatment-seeking substance abusers in Norway. Eur Addict Res 2006; 12:102-8. [PMID: 16543746 DOI: 10.1159/000090430] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The frequency of suicide attempts and clinical characteristics of attempters among poly-substance abusers and alcoholics were examined. METHODS A consecutive sample (n = 260) of in- and outpatients from two Norwegian counties were assessed by Composite International Diagnostic Interview (Axis I disorders), Millon's Clinical Multiaxial Inventory (Axis II disorders) and the Norwegian National Client Assessment Form. When analysing the association between suicide attempters and the range of predictor variables, logistic regression analysis was conducted. RESULTS Almost half (47%) of the sample reported lifetime suicide attempts; significantly more frequently in poly-substance abusers (58%) than alcoholics (38%). A substance use disorder with duration of >or=15 years and an early onset (<18 years of age) were independently associated with being a suicide attempter after controlling for Axis I disorders. In addition, eating disorders, agoraphobia and major depression were strongly and independently associated with being a suicide attempter. CONCLUSION Attempts at preventing suicidal behaviour should not ignore the suicide risk among poly-substance abusers. In addition, prevention of suicidal behaviour demands a treatment programme focusing concomitantly on both addictive behaviour and comorbid psychiatric disorders.
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Affiliation(s)
- A S Landheim
- Department for Substance Abuse, Centre for Addiction Issues, Sanderud Hospital, Ottestad, Norway.
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Abstract
A large proportion of patients treated for substance dependencies have attempted suicide. Scarce empirical evidence exists regarding their prognosis. Data from the Drug Abuse Treatment Outcome Survey were analyzed to determine the course of depression and substance dependence of 416 suicide attempters one year after discharge. The likelihood of recovery from drug dependence did not differ between patients who did or did not attempt suicide. Among suicide attempters who recovered from substance dependence, the frequency of Major Depression Disorder was significantly lower compared to admission, but its prevalence was nearly three times higher than that found in the general community.
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Affiliation(s)
- Vito Agosti
- New York State Psychiatric Institute, Depression Evaluation Service, New York, New York 10032, USA.
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Shanahan CW, Lincoln A, Horton NJ, Saitz R, Winter M, Samet JH. Relationship of depressive symptoms and mental health functioning to repeat detoxification. J Subst Abuse Treat 2005; 29:117-23. [PMID: 16135340 DOI: 10.1016/j.jsat.2005.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2005] [Revised: 05/19/2005] [Accepted: 05/27/2005] [Indexed: 11/20/2022]
Abstract
To better understand residential detoxification use, we assessed the roles of depressive symptoms (DS) and mental health functioning (MHF) on repeat detoxification. A prospective cohort of residential detoxification patients (N=400) without primary medical care was followed over 2 years at 6-month intervals. Subsequent detoxification admissions were examined using a statewide administrative database and DS (Center for Epidemiologic Studies Depression Scale) and MHF (SF-36 mental component summary subscale) measurements at follow-up. Incidence rate ratios of return to detoxification were estimated using multivariable longitudinal Poisson regression. In separate analyses, greater DS and worse MHF predicted higher detoxification use rates. Clinically significant worsening (10 points) of DS and MHF on objective scales predicted a 20% increased rate of detoxification readmission. Male sex, heroin as a problem substance, and race/ethnicity each predicted detoxification use. These data suggest that identifying individuals with DS or worse MHF after detoxification may provide opportunities for clinical intervention to reduce recurrent residential detoxification.
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Affiliation(s)
- Christopher W Shanahan
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA 02118, USA.
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The Role of Coercion in the Treatment of Women With Co-occurring Disorders and Histories of Abuse. J Behav Health Serv Res 2005. [DOI: 10.1097/00075484-200504000-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Os autores se propõem a abordar os aspectos particulares da interconsulta psiquiátrica em um hospital de trauma. Para isso, revisam os aspectos gerais de uma interconsulta em um hospital geral, e, posteriormente, destacam as características que diferenciam a consultoria psiquiátrica em um hospital de trauma. Os eventos psiquiátricos mais relevantes no trauma são as tentativas de suicídio violentas, o abuso de substâncias e as reações psíquicas ao traumatismo. O ponto de destaque se refere à especificidade da relação entre trauma e doenças psiquiátricas: ambos podem ser causa ou conseqüência. A interconsulta psiquiátrica é um novo campo de atuação interdisciplinar e de produção científica para a psiquiatria.
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Affiliation(s)
- Ricardo Schmitt
- Universidade Comunitária Regional de Chapecó; Instituto de Formação em Teoria Psicanalítica
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Clark C, Becker M, Giard J, Mazelis R, Savage A, Vogel W. The role of coercion in the treatment of women with co-occurring disorders and histories of abuse. J Behav Health Serv Res 2005; 32:167-81. [PMID: 15834266 DOI: 10.1007/bf02287265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Debate continues on issues of involuntary treatment for individuals with behavioral healthcare problems. Women with co-occurring disorders and histories of abuse are an especially vulnerable population. This study seeks to increase our knowledge about the experiences of coercion for women in the behavioral healthcare system. Patterns of coercion are explored. This study did not find the predicted relationship between high levels of interpersonal violence and frequent involuntary treatment experiences. The results do offer support for the hypothesis that women are more likely to be currently mandated to treatment if they have been recently arrested, and that being mandated to treatment does not appear to be related to clinical issues such as recidivism and acute symptoms. As expected, women currently required to be in treatment report having less choice in other aspects of their care. Implications for future research in the current climate of increasingly coercive policies are presented.
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Murase S, Ochiai S, Ueyama M, Honjo S, Ohta T. Psychiatric features of seriously life-threatening suicide attempters: a clinical study from a general hospital in Japan. J Psychosom Res 2003; 55:379-83. [PMID: 14507550 DOI: 10.1016/s0022-3999(03)00024-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Although attempted suicide is one of the strongest predictors of completed suicide, few Japanese studies have described psychiatric differences between those who attempt suicide by overdose (OD) and those who use more violent methods (MV). METHODS A total of 22 consecutively admitted MVs were compared to 78 ODs. All patients were referred for psychiatric evaluation during the same 3-year period. RESULTS The MV group was predominantly male (68%), whereas the OD group was predominantly female (72%). Using DSM-IV criteria, depressive disorders were most common in both groups, followed by psychotic disorders. The OD group had significantly more borderline patients. Contrary to previous reports, prior psychiatric contact was low in the MV group. MVs were more likely to complain of financial problems and to retain a definite wish to die after the attempt. CONCLUSIONS This study identified meaningful differences between the two groups of patients who attempted suicide.
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Affiliation(s)
- Satomi Murase
- Department of Psychiatry and Department of Emergency Medicine, Chukyo Hospital, 1-1-10, Sanjo, Minami-ku, Nagoya 457-0866, Japan.
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Preuss UW, Schuckit MA, Smith TL, Danko GP, Buckman K, Bierut L, Bucholz KK, Hesselbrock MN, Hesselbrock VM, Reich T. Comparison of 3190 Alcohol-Dependent Individuals With and Without Suicide Attempts. Alcohol Clin Exp Res 2002. [DOI: 10.1111/j.1530-0277.2002.tb02563.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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