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Luo G, Wang S, Gou L, Li C, Yao C, Jing Y, Xuekelaiti Z, Li J, Zhang XY. Sex differences and risk factors of self-reported suicide attempts in middle-aged Chinese Han patients with first-episode drug-naïve anxious depression: a large-scale cross-sectional study. J Neural Transm (Vienna) 2024:10.1007/s00702-024-02779-x. [PMID: 38743092 DOI: 10.1007/s00702-024-02779-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 04/08/2024] [Indexed: 05/16/2024]
Abstract
This study aims to investigate sex differences and risk factors for self-reported suicide attempts among Chinese Han middle-aged patients with first-episode drug-naïve (FEDN) anxious depression (AD). A total of 1796 patients with FEDN major depressive disorder were enrolled in this study, including 341 middle-aged patients with AD. We compared the prevalence, demographics, and clinical characteristics of suicide attempts between male and female patients with FEDN middle-aged AD. We also explored the risk factors for self-reported suicide attempts in this population using binary logistic regression analysis. The male/female ratio was 91/250 and the age of onset was 51.50 ± 4.13. Our results showed that there were no significant sex differences in the prevalence of self-reported suicide attempts in middle-aged patients with FEDN AD. However, we did find significant differences in several demographic and clinical characteristics between self-reported suicide attempters and non-suicide attempters. Moreover, severe anxiety, measured by the Hamilton Anxiety Rating Scale score, was identified as a risk factor for self-reported suicide attempts in female middle-aged AD patients. Additionally, elevated thyroid peroxidase antibody (TPOAb) levels were linked to self-reported suicide attempts in male AD patients. Our findings suggest that there are no significant sex differences in the prevalence of self-reported suicide attempts in this population, but there may be sex-specific risk factors for self-reported suicide attempts in middle-aged AD. Clinical psychiatrists need to pay attention to thyroid hormone levels in middle-aged anxious depression.
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Affiliation(s)
- Guoshuai Luo
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, 300222, China
| | - Shuo Wang
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, 300222, China
| | - Lei Gou
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, 300222, China
| | - Cui Li
- Department of Civil Engineering, Nanjing Technical Vocational College, 58 Huangshan Rd, Nanjing, 210019, China
| | - Cong Yao
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, 300222, China
| | - Yifan Jing
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, 300222, China
| | - Zaimina Xuekelaiti
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, 300222, China
| | - Jie Li
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, 300222, China.
| | - Xiang-Yang Zhang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Beijing, 100101, China.
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Marco M, López-Quílez A, Sánchez-Sáez F, Escobar-Hernández P, Montagud-Andrés M, Lila M, Gracia E. The Spatio-Temporal Distribution of Suicide-related Emergency Calls in a European City: Age and Gender Patterns, and Neighborhood Influences. PSYCHOSOCIAL INTERVENTION 2024; 33:103-115. [PMID: 38706710 PMCID: PMC11066811 DOI: 10.5093/pi2024a8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/14/2024] [Indexed: 05/07/2024]
Abstract
Objective: The aim of this study was to conduct a comprehensive spatio-temporal analysis of suicide-related emergency calls in the city of Valencia (Spain) over a six-year period. To this end we first examined age and gender patterns and, second, the influence of neighborhood characteristics on general and gender-specific spatio-temporal patterns of suicide-related emergency calls. Method: Geocoded data on suicide-related emergency calls between 2017 and 2022 (N = 10,030) were collected from the 112 emergency service in Valencia. Data were aggregated at the census block group level, used as a proxy for neighborhoods, and trimesters were considered as the temporal unit. Two set of analyses were performed: (1) demographic (age and gender) and temporal descriptive analyses and (2) general and gender-specific Bayesian spatio-temporal autoregressive models. Results: Descriptive analyses revealed a higher incidence of suicide-related emergency calls among females and an increase in calls among the 18-23 age group from 2020 onwards. The general spatio-temporal model showed higher levels of suicide-related emergency calls in neighborhoods characterized by lower education levels and population density, and higher residential mobility, aging population, and immigrant concentration. Relevant gender differences were also observed. A seasonal effect was noted, with a peak in calls during spring for females and summer for males. Conclusions: These findings highlight the need for comprehensive mental health targeted interventions and preventive strategies that account for gender-specific disparities, age-related vulnerabilities, and the specific characteristics of neighborhoods.
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Affiliation(s)
- Miriam Marco
- University of ValenciaDepartment of Social PsychologyValenciaSpainDepartment of Social Psychology, University of Valencia, Spain;
| | - Antonio López-Quílez
- University of ValenciaDepartment of Statistics and Operational ResearchValenciaSpainDepartment of Statistics and Operational Research, University of Valencia, Spain;
| | - Francisco Sánchez-Sáez
- Universidad Internacional de La RiojaSchool of Engineering and TechnologySpainSchool of Engineering and Technology (ESIT), Universidad Internacional de La Rioja, Spain
| | - Pablo Escobar-Hernández
- University of ValenciaDepartment of Statistics and Operational ResearchValenciaSpainDepartment of Statistics and Operational Research, University of Valencia, Spain;
| | - María Montagud-Andrés
- University of ValenciaDepartment of Social PsychologyValenciaSpainDepartment of Social Psychology, University of Valencia, Spain;
| | - Marisol Lila
- University of ValenciaDepartment of Social PsychologyValenciaSpainDepartment of Social Psychology, University of Valencia, Spain;
| | - Enrique Gracia
- University of ValenciaDepartment of Social PsychologyValenciaSpainDepartment of Social Psychology, University of Valencia, Spain;
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Guo J, Wang L, Zhao X, Wang D, Zhang X. Sex difference in association between suicide attempts and lipid profile in first-episode and drug naive patients with major depressive disorder. J Psychiatr Res 2024; 172:24-33. [PMID: 38354544 DOI: 10.1016/j.jpsychires.2024.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND The relationship between suicide attempts and lipid profiles in patients with major depressive disorder (MDD) remains uncertain. The purpose of this study was to investigate sex differences in the relationship between suicide attempts and plasma lipid profiles in a large sample of first-episode and drug naive (FEDN) MDD patients. METHODS We recruited 1718 FEDN MDD patients and gathered demographic, clinical, and blood lipid data. The Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale and the Positive and Negative Syndrome Scale were used to assess the symptoms of patients. RESULTS There was no significant difference in the prevalence of suicide attempts between male and female MDD patients. The suicide attempt group had higher levels of depression, anxiety, psychotic symptoms, total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C), but lower levels of high-density lipoprotein cholesterol (HDL-C) levels than the non-suicide attempt group. Binary logistic regression showed that TC levels were significantly correlated with suicidal attempts in both male and female patients. Correlation analysis revealed that the levels of TC, HDL-C and LDL-C were significantly associated with the number of suicide attempts in both male and female patients. Further multiple linear regression revealed that TC levels were significantly associated with the number of suicide attempts in male patients only. CONCLUSIONS Lipid biomarkers, particularly high TC levels, are associated with suicide attempts in both male and female MDD patients. However, there is gender difference in association between lipid biomarkers, especially TC levels, and the number of suicide attempts in MDD patients.
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Affiliation(s)
- Junru Guo
- School of Psychology, Guizhou Normal University, Guiyang, 550025, China; Department of Psychology, Guizhou Minzu University, Guiyang, 550025, China
| | - Li Wang
- School of Psychology, Guizhou Normal University, Guiyang, 550025, China; CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100101, China
| | - Xiaoqing Zhao
- Student Affairs Office, Guizhou University, Guiyang, 550025, China
| | - Dongmei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100101, China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100101, China.
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Luo G, Ma H, Wang S, Yao C, Li Y, Sun D, Zhang X. Sex differences in prevalence and clinical correlates of suicide attempts in first-episode and drug-naïve patients with anxious depression in a Chinese Han population: A large-scale cross-sectional study. J Affect Disord 2024; 344:252-260. [PMID: 37838263 DOI: 10.1016/j.jad.2023.10.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/17/2023] [Accepted: 10/11/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUNDS Anxious depression (AD) has been extensively studied. However, fewer studies have examined sex differences in the prevalence of suicide attempts among AD patients. This study aimed to explore sex differences in suicide attempts and risk factors in patients with AD. METHODS 1380 first episode drug-naïve patients with AD were recruited. Sociodemographic and clinical characteristics were measured using a self-administered demographic questionnaire. The Hamilton Depression Scale (HAMD), Hamilton Anxiety Inventory (HAMA), and positive subscale of the Positive and Negative Syndrome Scale (PANSS) were used to assess patients' clinical symptoms. We also measured the patient's blood glucose, lipids, and thyroid axis hormone levels. RESULTS There were no sex differences in the prevalence of suicide attempts in patients with FEDN anxious depression. In addition, binary logistic regression analysis showed that HAMA score, TSH levels, and TPOAb levels significantly predicted suicide attempts in both male and female patients with AD, while HAMD score significantly predicted suicide attempts in female patients with AD only. CONCLUSIONS The severity of anxiety and higher levels of TSH and TPOAb were associated with an increased risk for suicide attempts in both male and female patients with AD, whereas the severity of depression was only associated with suicide attempts in females.
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Affiliation(s)
- Guoshuai Luo
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin 300222, China
| | - Hongyun Ma
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin 300222, China
| | - Shuo Wang
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin 300222, China
| | - Cong Yao
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin 300222, China
| | - Yaxi Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 3210 Humin Rd, Shanghai 201108, China
| | - Daliang Sun
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin 300222, China.
| | - Xiangyang Zhang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China.
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Schölin L, Knipe D, Bandara P, Eddleston M, Sethi A. Banning highly hazardous pesticides saves the lives of young people, particularly females, in low- and middle-income countries. BMC Public Health 2023; 23:2249. [PMID: 37968702 PMCID: PMC10647157 DOI: 10.1186/s12889-023-17071-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/26/2023] [Indexed: 11/17/2023] Open
Abstract
Pesticide self-poisoning is a public health problem mostly affecting low- and middle-income countries. In Sri Lanka, India and China suicide rates have reduced among young people, particularly females, following highly hazardous pesticides (HHP) bans. This success story requires attention to encourage more research on differential effects of HHP bans.
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Affiliation(s)
- Lisa Schölin
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK.
| | - Duleeka Knipe
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Piumee Bandara
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Michael Eddleston
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Aastha Sethi
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK
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Yan Y, Jiang Y, Liu R, Eddleston M, Tao C, Page A, Wang L, Feng G, Liu S. Impact of pesticide regulations on mortality from suicide by pesticide in China: an interrupted time series analysis. Front Psychiatry 2023; 14:1189923. [PMID: 37732083 PMCID: PMC10507350 DOI: 10.3389/fpsyt.2023.1189923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/08/2023] [Indexed: 09/22/2023] Open
Abstract
Background Pesticide bans and regulatory restrictions have been shown to be effective strategies for preventing suicide in several countries. Suicide and suicide by pesticides have decreased significantly in China over the past two decades. However, whether the reduction was associated with pesticide regulation is unknown. Methods The monthly data on suicide and suicide by pesticide from 2006 to 2018 were obtained from China's Disease Surveillance Point (DSP) system. Information on China's pesticide regulations since 1970 was obtained from Pesticide Action Network International (PAN International), Joint Meeting on Pesticide Management Highly Hazardous Pesticides (JMPM HHP) lists, the website of the Ministry of Agriculture of China, Pesticide Information Network of China, and the Wan Fang database. Change point detection and policy analysis were combined to identify the time of any trend change breakpoint of suicide and suicide by pesticide. Interrupted time series analysis was used to investigate the pre- and post-breakpoint trends of monthly standardized rates in suicide and suicide by pesticide. Results The standardized pesticide suicide rate decreased by 60.5% from 6.50 in 2006 to 2.56 per 100,000 in 2018. Larger declines were evident among people in urban areas (67.3%), female individuals (63.5%), and people aged 15-44 years (68.1%). The effect of policies banning highly hazardous organophosphorus pesticides (HHOP) [rate ratio (RR) = 0.993, 95% CIs (0.991-0.994)] in December 2008 and stopping domestic sales and use of paraquat aqueous solution (RR = 0.992, 95% CIs: 0.990-0.994) in July 2016 were more pronounced than regulating the paraquat-related products (RR = 1.003, 95% CIs: 1.002-1.004) in April 2012. Conclusion Declines in suicide by pesticide in China occurred contemporaneously with regulatory bans and restrictions implemented on several pesticides, particularly in urban areas, among female individuals, and the relatively low age profile. These findings indicate the potential influence of these bans on trends of suicide by pesticides.
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Affiliation(s)
- Yongfu Yan
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yingying Jiang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Rong Liu
- The George Institute for Global Health, Faculty of Medicine, The University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Michael Eddleston
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, United Kingdom
| | - Chuanjiang Tao
- Institute for the Control of Agrochemicals, Ministry of Agriculture and Rural Affairs, Beijing, China
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Lijun Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Guoshuang Feng
- Big Data Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shiwei Liu
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
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Blanco V, Tajes Alonso M, Peleteiro Pensado LF, Naveira Barbeito G, Núñez Arias D, Torres ÁJ, Arrojo M, Páramo M, Otero P, Vázquez FL. Epidemiological characteristics and hospitalization trajectories prior to suicide in Galicia between 2013 and 2016. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023; 16:76-84. [PMID: 38591720 DOI: 10.1016/j.rpsm.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/20/2021] [Accepted: 11/07/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Addressing suicide requires an understanding of regional patterns of epidemiology, with health variables being central. However, the clinical profile of people who commit suicide has received little attention. The objectives of this study were to analyze the sociodemographic, clinical, and forensic characteristics of persons who committed suicide in Galicia between 2013 and 2016, analyze suicide mortality rates, and identify trajectories of hospitalizations and associated variables. MATERIAL AND METHODS A population study was carried out on the 1354 people who died by suicide in Galicia. RESULTS The most common profile was a retired man, 57.9 years old (SD=18.5), from an urban and inner area. 43.6% had been previously hospitalized, 41.6% had been diagnosed with physical disorders, and 26.8% with mental disorders. 48.2% had been prescribed psychiatric medications and 29.6% had received outpatient psychiatric care. The highest prevalence of death by suicide (27.5%) was in 2014, with the predominant method being hanging (59.1%). The average raw rate was 12.3/100,000. Three trajectories of hospitalizations emerged: 94.83% had experienced few hospitalizations; 2.95% an increasing pattern; and 2.22% a decreasing pattern. These trajectories were associated with number of psychiatric appointments, prescription of psychiatric medications, and diagnoses of physical and mental disorders. CONCLUSIONS These findings are crucial for detection and prevention.
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Affiliation(s)
- Vanessa Blanco
- Department of Evolutionary and Educational Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain.
| | | | | | | | | | - Ángela J Torres
- Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Manuel Arrojo
- Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Mario Páramo
- Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Patricia Otero
- Department of Psychology, University of A Coruña, A Coruña, Spain
| | - Fernando L Vázquez
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
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The application of spatial analysis to understanding the association between area-level socio-economic factors and suicide: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02441-z. [PMID: 36805762 DOI: 10.1007/s00127-023-02441-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 02/02/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND Little is known about what impact the use of different spatial methodological approaches may have on understanding the relationship between area-level socio-economic factors and suicide. METHODS In this systematic review, we searched PubMed, Embase, CINAHL and PsycInfo for original empirical studies examining the relationship between socio-economic factors and suicide with a spatial lens, published up to January 22, 2022. Data on applied spatial methods, indicators of socio-economic factors, and risk of suicide related to socio-economic factors were extracted. The protocol for this systematic review was registered with PROSPERO (CRD42021251387). RESULTS A systematic search yielded 6290 potentially relevant results; 58 studies met the inclusion criteria for review. Of the 58 included studies, more than half of the studies (n = 34; 58.6%) used methods that accounted for spatial effects in analyses of the association between socio-economic factors and suicide or examined spatial autocorrelation, while 24 (41.4%) studies applied univariate and multivariate models without considering spatial effects. Bayesian hierarchical models and spatial regression models were commonly used approaches to correct for spatial effects. The risk of suicide relating to socio-economic factors varied greatly by local areas and between studies using various socio-economic indicators. Areas with higher deprivation, higher unemployment, lower income, and lower education level were more likely to have higher suicide risk. There was no significant difference in results between studies using conventional versus spatial statistic methods. CONCLUSION An increasing number of studies have applied spatial methods, including Bayesian spatial models and spatial regression models, to explore the relationship between area-level socio-economic factors and suicide. This review of spatial studies provided further evidence that area-level socio-economic factors are generally inversely associated with suicide risk, with or without accounting for spatial autocorrelation.
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Internet Use and Better-Informed Divorce in China. Behav Sci (Basel) 2023; 13:bs13020177. [PMID: 36829406 PMCID: PMC9952388 DOI: 10.3390/bs13020177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
China has witnessed a rapid expansion in Internet penetration in recent years, with profound impacts on people's family life and marital relationships. This paper aims to examine the causal effects and functionary of information access through Internet on marital stability. This paper identifies a robust association between Internet use and increasing divorce rates in China by using nationally representative, individual-level survey data and province-level aggregate data. Various regression techniques and specifications demonstrated the statistical and economic significance of the association. Given the ever-expanding role of the Internet and the serious consequences of divorce on families and society, it is imperative that we study the underlying mechanisms as the first step toward socially responsible policymaking. Our analysis revealed a significant mediating effect of the self-reported importance of Internet information acquisition, the frequency of chatting with online friends, the frequency of meeting with online friends, and the intensity of Internet use. These findings are consistent with the theory that the increase in divorce decisions is due to better information access and is, therefore, rational and that policies such as a mandatory cooling-off period for divorce may lower societal welfare. We also conducted a series of heterogeneity analyses that showed, among other findings, that the Internet effect is stronger for women.
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Zhu Y, Nam S, Quan L, Baek J, Jeon H, Tang B. Linking suicide and social determinants of health in South Korea: An investigation of structural determinants. Front Public Health 2022; 10:1022790. [PMID: 36388317 PMCID: PMC9641084 DOI: 10.3389/fpubh.2022.1022790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/10/2022] [Indexed: 01/28/2023] Open
Abstract
Introduction Studies have shown that suicide is closely related to various social factors. However, due to the restriction in the data scale, our understanding of these social factors is still limited. We propose a conceptual framework for understanding social determinants of suicide at the national level and investigate the relationships between structural determinants (i.e., gender, employment statuses, and occupation) and suicide outcomes (i.e., types of suicide, places of suicide, suicide methods, and warning signs) in South Korea. Methods We linked a national-level suicide registry from the Korea Psychological Autopsy Center with the Social Determinants of Health framework proposed by the World Health Organization's Commission on Social Determinants of Health. Results First, male and female suicide victims have clear differences in their typical suicide methods (fire vs. drug overdose), primary warning signs (verbal vs. mood), and places of death (suburb vs. home). Second, employees accounted for the largest proportion of murder-suicides (>30%). The proportion of students was much higher for joint suicides than for individual suicides and murder-suicides. Third, among individuals choosing pesticides as their suicide method, over 50% were primary workers. In terms of drug overdoses, professionals and laborers accounted for the largest percentage; the former also constituted the largest proportion in the method of jumping from heights. Conclusion A clear connection exists between the investigated structural factors and various suicide outcomes, with gender, social class, and occupation all impacting suicide.
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Affiliation(s)
- Yongjun Zhu
- Department of Library and Information Science, Yonsei University, Seoul, South Korea,*Correspondence: Yongjun Zhu
| | - Seojin Nam
- Department of Library and Information Science, Sungkyunkwan University, Seoul, South Korea
| | - Lihong Quan
- Department of Media and Communication, Sungkyunkwan University, Seoul, South Korea
| | - Jihyun Baek
- Department of Psychiatry, School of Medicine, Sungkyunkwan University, Samsung Medical Center, Seoul, South Korea
| | - Hongjin Jeon
- Department of Psychiatry, School of Medicine, Sungkyunkwan University, Samsung Medical Center, Seoul, South Korea,Depression Center, Samsung Medical Center, Seoul, South Korea
| | - Buzhou Tang
- Department of Computer Science, Harbin Institute of Technology (Shenzhen), Shenzhen, China
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Guo H, Li W, Wu J, Ho HC. Does air pollution contribute to urban-rural disparity in male lung cancer diseases in China? ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:23905-23918. [PMID: 34817820 DOI: 10.1007/s11356-021-17406-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/03/2021] [Indexed: 06/13/2023]
Abstract
It remains unknown whether exposure to ambient air pollution can be a mediator linking socioeconomic indicator to health outcome. The present study aims to examine the mediation effect of PM2.5 air pollution on the association between urban-rural division and the incidence (mortality) rate of male lung cancer. We performed a nationwide analysis in 353 counties (districts) of China between 2006 and 2015. A structural equation model was developed to determine the mediation effect of exposure to PM2.5. We also tested whether the findings of the mediation effect of exposure to PM2.5 are sensitive to the controls of smoking factors and additional air pollutant, and PM2.5 exposures with different lag structures. According to the results, we found that exposure to PM2.5 significantly mediated the association between urban-rural division and the incidence rate of male lung cancer. Specifically, there were significant associations between urban-rural division, exposure to PM2.5, and the incidence rate of male lung cancer, with PM2.5 exposure accounting for 29.80% of total urban-rural difference in incidence rates of male lung cancer. A similar pattern of results was observed for the mortality rate of male lung cancer. That is, there was a significant mediation effect by PM2.5 on the association of the mortality rate with urban-rural division. The findings of exposure to PM2.5 as a mediator were robust in the three sensitivity analyses. In conclusion, urban-rural difference in exposures to PM2.5 may be a potential factor that contributes to urban-rural disparity in male lung cancer diseases in China. The findings inform that air pollution management and control may be effective measures to alleviate the great difference in male lung cancer diseases between urban and rural areas in China.
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Affiliation(s)
- Huagui Guo
- School of Architecture and Urban-Rural Planning, Fuzhou University, Fuzhou, 350108, China
| | - Weifeng Li
- Department of Urban Planning and Design, The University of Hong Kong, Hong Kong, China
- Shenzhen Institute of Research and Innovation, The University of Hong Kong, Shenzhen, 518057, China
| | - Jiansheng Wu
- Key Laboratory for Urban Habitat Environmental Science and Technology, Shenzhen Graduate School, Peking University, Shenzhen, 518055, China
- Key Laboratory for Earth Surface Processes, Ministry of Education, College of Urban and Environmental Sciences, Peking University, Beijing, 100871, China
| | - Hung Chak Ho
- Department of Urban Planning and Design, The University of Hong Kong, Hong Kong, China.
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Cai Z, Chen M, Ye P, Yip PSF. Socio-economic determinants of suicide rates in transforming China: A spatial-temporal analysis from 1990 to 2015. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 19:100341. [PMID: 35024666 PMCID: PMC8671725 DOI: 10.1016/j.lanwpc.2021.100341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background China has experienced dramatic social changes in the last three decades. This study aimed to investigate socio-economic factors related to suicide rates in China from 1990 to 2015, and examine how the impacts of these factors on suicide rates changed over time. Methods Suicide rates in 31 provinces in mainland China between 1990 and 2015 were obtained from the Global Burden of Disease (GBD) Study 2019. Temporal-spatial modelling was applied to assess the effects of GDP per capita, urbanization, migration, employment, divorce, proportions of children and older adults on provincial overall, male and female suicide rates. Findings The overall suicide rate in China declined from 18·1 /100,000 in 1990 to 8·6 /100,000 in 2015, with considerable spatial variation in the magnitude of decline across provinces. The protective effects of increasing in GDP per capita, and urbanization, on provincial suicide rate were strong in 1990 (log GDP: -3·56 [95% CI: -6·15, -0·96], urbanisation: -0·07 [-0·14, -0·01]), however these effects were negligible by 2015. The association between employment and suicide rates has shifted from positive to negative over the study period, while migration remained a constant risk factor for high suicide rates (0·04 [0.00, 0·09]). Interpretation This study highlighted the dynamic effects of economic and social factors on suicide rates in the context of transforming China. To maintain further reductions in suicide rates cannot rely simply on improving people's materialistic and economic conditions. A more holistic approach to improve overall population well-being is needed. Funding Humanities and Social Sciences Prestigious Fellowship (37000320) and the General Research Fund (17611619) at the University of Hong Kong.
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Affiliation(s)
- Ziyi Cai
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China
| | - Mengni Chen
- Department of Sociology, University of Copenhagen, Denmark
| | - Pengpeng Ye
- National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Paul S F Yip
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China.,Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China
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13
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Hu Y, Huang Y, Wang L, Liu Z, Wang L, Yan J, Zhang M, Lv P, Guan Y, Ma C, Huang Z, Zhang T, Chen H. Disability and Comorbidity of Mood Disorders and Anxiety Disorders With Diabetes and Hypertension: Evidences From the China Mental Health Survey and Chronic Disease Surveillance in China. Front Psychiatry 2022; 13:889823. [PMID: 35669270 PMCID: PMC9163306 DOI: 10.3389/fpsyt.2022.889823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/26/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The China Mental Health Survey was carried out using the same sampling frame with the China Chronic Diseases and Risk Factors Surveillance. This paper explores the relationship between the disability and the comorbidity of mood disorders and anxiety disorders with diabetes and hypertension. METHODS A large-scale nationally representative sample with both mental disorders and chronic diseases was collected from 157 Disease Surveillance Points in 31 provinces across China. Face-to-face interviews were conducted by trained lay interviewers to make diagnoses of mood disorders and anxiety disorders using the Composite International Diagnostic Interview. Diabetes and hypertension were diagnosed from self-report and blood examination or body measurement. Sampling design weights, non-response adjustment weights, and post-stratification adjustment weights were applied during the analyses of comorbidity and disability. RESULTS Totally 15,000 respondents had information of mental disorders and physical diseases. In the patients with mood disorders or anxiety disorders, the weighted prevalence rates of diabetes or hypertension were not higher than those in persons without the above mental disorders, but the weighed disability rates increased when having the comorbidity of hypertension (P < 0.05). The severity of disability was higher among patients with comorbidity of diabetes and anxiety disorders, or hypertension and mood disorders, compared with that among patients without the physical comorbidity (P < 0.05). After adjusted by age, gender and education, patients with comorbidity of mental disorders and physical disorders had the highest disability, followed by the patients with mental disorders only, and physical diseases only. CONCLUSIONS The disability of mood disorders and anxiety disorders comorbid with diabetes and hypertension are more serious than that of any single disease. The relationship of mental and physical diseases is worth exploring in depth for comprehensive and integrated intervention to decrease the disability.
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Affiliation(s)
- Yuanyuan Hu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Yueqin Huang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Limin Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhaorui Liu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Linhong Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jie Yan
- School of Government, Peking University, Beijing, China
| | - Mei Zhang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ping Lv
- Institute of Social Science Survey, Peking University, Beijing, China
| | - Yunqi Guan
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chao Ma
- Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Zhengjing Huang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tingting Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Hongguang Chen
- Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
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14
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Dong R, Haque A, Wu HE, Placide J, Yu L, Zhang X. Sex differences in the association between suicide attempts and glucose disturbances in first-episode and drug naive patients with major depressive disorder. J Affect Disord 2021; 292:559-564. [PMID: 34147968 DOI: 10.1016/j.jad.2021.05.110] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/30/2021] [Accepted: 05/31/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Glucose metabolism is related to depression, but the relationship between blood glucose and suicide attempts in patients with major depressive disorder (MDD) remains unclear. This large-scale sample explores the relationship between suicide attempts and fasting blood glucose, in addition to sex differences in first-episode and drug naive (FEDN) MDD patients. METHODS 1718 FEDN MDD patients diagnosed for the first time were recruited, and their demographic data, clinical data, and blood glucose indicators were collected. 17-item Hamilton Depression Rating Scale (HAMD), 14-item Hamilton Anxiety Rating Scale (HAMA), and positive subscale of the Positive and Negative Syndrome Scale (PANSS) were used to assess their depression, anxiety and psychotic symptoms, respectively. RESULTS The depression, anxiety, psychotic symptoms and blood sugar levels of the suicide attempt group were higher than those of the non-suicide attempt group. Correlation analysis showed that blood glucose was significantly associated with suicide attempts in male and female patients. While binary logistic regression showed that blood glucose levels were significantly associated with suicide attempts in male patients, it showed that suicide attempts were not significantly associated with blood glucose levels in female patients. LIMITATIONS The main limitations are cross-sectional design and inability to control selection bias. CONCLUSIONS In male MDD patients, fasting blood glucose level is a potential biomarker of suicide attempt, which deserves attention to avoid suicide risk. However, in female patients, fasting blood glucose has no significant correlation to suicide attempts.
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Affiliation(s)
- Rui Dong
- Department of Medical Psychology, School of Medical Humanities, Capital Medical University, Beijing, China
| | - Anam Haque
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Hanjing Emily Wu
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - John Placide
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Liling Yu
- Department of Medical Psychology, School of Medical Humanities, Capital Medical University, Beijing, China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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15
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Bai X, Zhou L, Mo Q, Jia C, Ma Z. Understanding the Reasons for Suicide Among Older Adults in Rural China Using In-Depth Interviews. CRISIS 2021; 43:391-397. [PMID: 34406810 DOI: 10.1027/0227-5910/a000799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: Suicide is a complex public health problem. Suicide rates are higher in rural areas than in urban areas and among older adults than any other age group in China. Aims: This study aimed to acquire a comprehensive understanding of rural older adults' reasons for suicide through qualitative exploration and to provide additional insights for suicide prevention work. Method: In-depth interviews were conducted with people familiar with older adults who had died by suicide ("informants"). The data were analyzed using a thematic approach. Results: Data were available for 242 people who died by suicide. Informants identified two or more reasons for suicide among most people who had died. Physical illness, psychological distress, and interpersonal conflicts were the most common reasons. The rate of mental disorders as diagnosed by psychiatrists was higher than that reported by the informants. Limitations: Information bias is inevitable because of the use of proxy informants. Conclusion: The reasons for suicide are complex and diverse, and research on suicide should focus more on the mechanisms of interaction between reasons. Greater attention should be paid to physical and mental health as well as to improving interpersonal and problem-solving skills for older adults in China.
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Affiliation(s)
- Xinyu Bai
- Department of Social Medicine, School of Public Health, Guangxi Medical University, Nanning, PR China
| | - Liang Zhou
- Department of Social Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, PR China
| | - Qiqing Mo
- Department of Social Medicine, School of Public Health, Guangxi Medical University, Nanning, PR China
| | - Cunxian Jia
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, PR China
| | - Zhenyu Ma
- Department of Social Medicine, School of Public Health, Guangxi Medical University, Nanning, PR China
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16
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Xin Q, Paudel D, Li L, Zhang B, Yin H. Relationship between suicide rate and antidepressant prescription: An ecological study in the People's Republic of China. Hum Psychopharmacol 2021; 36:1-9. [PMID: 32976675 DOI: 10.1002/hup.2760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The objective of this study was to estimate the features of suicide rate and its association with antidepressant prescriptions during the past decade in China. METHODS Official data on suicides were obtained and stratified by four age groups, gender, urban/rural areas, and regions (East, Central, and West). The annual antidepressant prescriptions were expressed in pills per 100 persons calculated as the volume of prescriptions divided by the total population. Negative binomial regression was carried out to examine the association between suicide and other variables. RESULTS Suicide rates in each stratum typically decreased from 2008 to 2015, while annual antidepressant prescriptions were generally increased by the year. The suicide rate increased with age and was greater in adult males than in females; higher in the central area and greater in rural than in urban areas. Suicide rates are negatively associated with antidepressant prescriptions including selective serotonin reuptake inhibitors (Incidence rate ratio [IRR] 0.983, 95% confidence interval [CI] 0.983-0.983), serotonin-norepinephrine reuptake inhibitors (IRR 0.951, 95% CI 0.951-0.951), tricyclic antidepressant (IRR 0.925, 95% CI 0.925-0.925) and total antidepressants (IRR 0.990, 95% CI 0.990-0.990) during 2008-2012. CONCLUSION Suicide varied among different studied stratum. Suicide rates are negatively associated with antidepressant prescriptions.
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Affiliation(s)
- Qianqian Xin
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou, China
| | - Dhirendra Paudel
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou, China
| | - Liping Li
- Injury Prevention Research Center, Shantou University Medical College, Shantou, China
| | - Bin Zhang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou, China
| | - Honglei Yin
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou, China
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17
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Lew B, Kõlves K, Osman A, Abu Talib M, Ibrahim N, Siau CS, Chan CMH. Suicidality among Chinese college students: A cross-sectional study across seven provinces. PLoS One 2020; 15:e0237329. [PMID: 32822365 PMCID: PMC7444487 DOI: 10.1371/journal.pone.0237329] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 07/23/2020] [Indexed: 11/28/2022] Open
Abstract
Background Although the suicide rate in China has decreased over the past 20 years, there have been reports that the younger age group has been experiencing an increased incidence of completed suicide. Given that undergraduate groups are at higher risks of suicidality, it is important to monitor and screen for risk factors for suicidal ideation and behaviors to ensure their well-being. Objective To examine the risk and protective factors contributing to suicidality among undergraduate college students in seven provinces in China. Methods We conducted a cross-sectional study involving 13,387 college students from seven universities in Ningxia, Shandong, Shanghai, Jilin, Qinghai, Shaanxi, and Xinjiang. Data were collected using self-report questionnaires. Results Higher scores in the psychological strain, depression, anxiety, stress, and psychache (psychological risk factors for suicidality) and lower scores in self-esteem and purpose in life (psychological protective factors against suicidality) were associated with increased suicidality among undergraduate students in China. Demographic factors which were associated with higher risks of suicidality were female gender, younger age, bad academic results, were an only child, non-participation in school associations, and had an urban household registration. Perceived good health was protective against suicidality. Conclusions Knowing the common risk and protective factors for suicidality among Chinese undergraduate students is useful in developing interventions targeted at this population and to guide public health policies on suicide in China.
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Affiliation(s)
- Bob Lew
- Department of Social Psychology, Faculty of Human Ecology, Putra University of Malaysia, Serdang, Selangor, Malaysia
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Queensland, Australia.,WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Brisbane, Queensland, Australia.,School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Augustine Osman
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas United States of America
| | - Mansor Abu Talib
- Department of Human Development and Family Studies, Putra University of Malaysia, Serdang, Selangor, Malaysia
| | - Norhayati Ibrahim
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ching Sin Siau
- Faculty of Social Sciences and Liberal Arts, UCSI University, Kuala Lumpur, Malaysia
| | - Caryn Mei Hsien Chan
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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18
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Heenan A, Pipe A, Lemay K, Davidson JR, Tulloch H. Cognitive-Behavioral Therapy for Insomnia Tailored to Patients With Cardiovascular Disease: A Pre-Post Study. Behav Sleep Med 2020; 18:372-385. [PMID: 31007057 DOI: 10.1080/15402002.2019.1594815] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: There is little research assessing the use of cognitive-behavioral therapy for insomnia (CBT-I) among patients with cardiovascular disease (CVD), even less on the effects of CBT-I on CVD risk factors such as anxiety and depression, and to our knowledge, only limited studies of the efficacy of CBT-I protocols with cardiac disease-specific modifications. The objective of this study is to evaluate a group-based CBT-I intervention tailored to patients with CVD on sleep quality, duration, and mental health. Participants: A sample of 47 participants (25 men) diagnosed with primary insomnia were included in this study. Methods: This study used a pre-post design comparing outcomes before and after a group intervention. Clinicians in a cardiac center referred CVD patients with self-reported sleep disturbance to the intervention group. Following screening and confirmation of insomnia disorder, participants completed a six-week CBT-I group-based intervention tailored for patients with CVD. Participants completed sleep diaries and questionnaires, including the Insomnia Severity Index, Beck Depression Inventory-II, and Beck Anxiety Inventory, pre- and postintervention. Results: Participants' sleep outcomes (sleep duration, maintenance, efficiency, latency, and quality) were significantly improved and patients reported significantly fewer symptoms of anxiety, depression, and insomnia following the CBT-I intervention (p values < .05). Conclusions: After participating in a CBT-I group intervention tailored for cardiac patients, patients reported improved sleep and significantly lower levels of anxiety and depression. Randomized trials of this intervention are warranted.
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Affiliation(s)
- Adam Heenan
- Division of cardiac prevention and rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Andrew Pipe
- Division of cardiac prevention and rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada.,Department of Medicine, Faculty of Medicine, University of Ottawa, ON, Canada
| | - Kyle Lemay
- Division of cardiac prevention and rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | | | - Heather Tulloch
- Division of cardiac prevention and rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada.,School of Psychology, University of Ottawa, Ottawa, ON, Canada
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19
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Yu X, Zhang W. All-cause mortality rate in China: do residents in economically developed regions have better health? Int J Equity Health 2020; 19:12. [PMID: 31964379 PMCID: PMC6975071 DOI: 10.1186/s12939-020-1128-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 01/13/2020] [Indexed: 02/07/2023] Open
Abstract
Background Urban-rural disparities have been extensively investigated, while most investigators overlooked urban-suburban-rural variations in population health. Although regional disparities in East-West China have been largely discussed, limited attention has been directed to the interaction between regional differences and urban-suburban-rural disparities. This study aims to analyze urban-suburban-rural variations in all-cause mortality rates across four geographic regions in China. Methods Data came from China’s National Census Survey and public statistical yearbooks in 2000 and 2010. Urban districts, county-level cities, and counties were respectively defined as urban, suburban, and rural areas. We obtained 2322 areas, including 2148 areas with two observations and 174 areas with only one observation. Data visualization was performed to depict geographic variations and changes in all-cause mortality rates. Five hierarchical linear regression analyses with generalized estimating equations (GEE) were employed to analyze variations in all-cause mortality rates over time. Demographic and socioeconomic attributes were introduced as covariates. Results Despite an overall decline in all-cause mortality rate, rural residents generally achieved worse health than urban and suburban counterparts. In contrast, urban-suburban disparities could be fully explained by demographic and socioeconomic differences. In addition, Northeastern and Central residents achieved better health than Eastern and Western residents. Last, there existed urban/suburban-rural disparities in all regions, except Northeastern, where urban/suburban-rural disparities were eliminated after controlling for socioeconomic and demographic attributes. Conclusion Even though suburban and rural areas were often merged, there exist urban/suburban-rural disparities in population health. Furthermore, urban/suburban-rural disparities vary across regions.
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Affiliation(s)
- Xuexin Yu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, 37 Guo Xue Alley, Chengdu, 610040, Sichuan, China
| | - Wei Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, 37 Guo Xue Alley, Chengdu, 610040, Sichuan, China.
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20
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Zhu RT, Ma Z, Jia C, Zhou L. Suicide Means Used by the Older Adults in Rural China: A Comparison Between Those Using Pesticides and Other Means. J Geriatr Psychiatry Neurol 2019; 32:319-326. [PMID: 31480983 DOI: 10.1177/0891988719862625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The most frequently used means of committing suicide was pesticide poisoning in rural China, yet little is known about the characteristics and risk factors for suicides committed with pesticides compared to those committed via other means in older adults. METHODS The participants were 242 older adults (aged 60 or older) who had committed suicide in the rural areas of 3 provinces (Shandong, Hunan, and Guangxi) in China. This study was conducted using the psychological autopsy (PA) method. RESULTS In univariate analyses, no statistically significant differences were found between those who committed suicide with pesticide or with other means in terms of demographic and clinical variables except age, prevalence of mental disorders, suicidal intent, number of recent life events, social support, hopelessness, impulsivity, and depressive symptoms (P > .05); age, history of suicide attempts, having pesticides available at home, the total number of life events, and the number of long-term life events were significantly different (P < .05) between the 2 groups. In multivariate logistic regression model, the factors associated with committing suicide with pesticides were the availability of pesticides at home (odds ratio [OR] = 3.48, 95% confidence interval [CI]: 1.99-6.08) and the number of long-term life events (OR = 0.87, 95% CI: 0.78-0.97). CONCLUSION The older adults who committed suicide by pesticides and those using other means are probably the same population. The main determinant of choosing pesticides as suicide means was likely the availability of pesticides at home. Suicide risk among older adults might be reduced by placing appropriate restrictions on access to pesticides.
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Affiliation(s)
- Rong-Ting Zhu
- 1 Department of Social Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,2 Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Zhenyu Ma
- 3 School of Public Health, Guangxi Medical University, Nanning, China
| | - Cunxian Jia
- 4 School of Public Health, Shandong University, Jinan, China
| | - Liang Zhou
- 1 Department of Social Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,2 Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
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21
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Zhong BL, Chan SSM, Liu TB, Chiu HFK. Nonfatal Suicidal Behaviors of Chinese Rural-to-Urban Migrant Workers: Attitude Toward Suicide Matters. Suicide Life Threat Behav 2019; 49:1199-1208. [PMID: 30315652 DOI: 10.1111/sltb.12519] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 07/15/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To examine the attitude toward suicide (ATS) and its influence on nonfatal suicidal behaviors of Chinese rural-to-urban migrant workers (MWs). METHOD Altogether, 3031 MWs completed the positive ATS Scale and structured questions regarding lifetime suicide ideation, plan, and attempt. Mental health help-seeking behaviors of MWs were also investigated. RESULTS Overall, MWs held a more negative ATS than the Chinese general population. The lifetime prevalence of suicide ideation, plan, and attempt was 5.5%, 1.3%, and 1.1%, respectively. After controlling for lifetime depressive disorders and other covariates, a negative ATS was still significantly associated with lower risk of lifetime suicide ideation (OR = 0.32), plan (OR = 0.22), and attempt (OR = 0.26). MWs with a negative ATS were more likely to talk to others and seek help by online/telephone consultation for their mental health and suicidal problems (p < .05). A more positive ATS was significantly associated with male gender, low education level, ethnic minority of Miao, low monthly income, and originating from western China. CONCLUSIONS The majority of MWs hold a negative ATS, which significantly contributes to their relatively low risk of nonfatal suicidal behaviors. The more help-seeking from others and online/telephone consultation in MWs with a negative ATS may lower their risk of nonfatal suicidal behaviors.
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Affiliation(s)
- Bao-Liang Zhong
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China.,Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China.,Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sandra Sau Man Chan
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tie-Bang Liu
- Shenzhen Key Laboratory for Psychological Healthcare, Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
| | - Helen Fung-Kum Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
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22
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Tuliao AP, Holyoak D. Psychometric properties of the perceived stigma towards substance users scale: factor structure, internal consistency, and associations with help-seeking variables. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 46:158-166. [PMID: 31490713 DOI: 10.1080/00952990.2019.1658198] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: Stigma toward substance users is a barrier to seeking treatment.Objective: The aim for this paper was to examine the psychometric properties of the Perceived Stigma Toward Substance Users (PSAS) and its relationship with help-seeking variables.Methods: College students (N = 791; nfemales = 557, 70%) responded to the PSAS and other help-seeking-related measures in an online study.Results: Confirmatory factor analysis supported a unidimensional factor structure and acceptable model fit after modifications (CFI = .961; TLI = .937; RMSEA = .067, 90% C.I. = .050 to .085; SRMR = .035). Results indicated good internal consistency estimates (α = .80; ω = .80). The PSAS was negatively associated with intent to seek treatment for substance issues and willingness to self-disclose negative emotions. The PSAS was also positively correlated with stigma associated with seeking help for mental health issues, attitudes concerning risk associated with help-seeking, self-concealment, anticipated risks associated with seeking treatment. When embedded within a larger path model that predicts intent to seek treatment for substance use issues (CFI = .925; TLI = .895; RMSEA = .061, 90%C.I. = .052 to .069; p close fit = .019; SRMR = .049), the PSAS had an incremental contribution to predicting the criterion variable even after accounting for frequency of alcohol use-related problems, and stigma and attitudes associated with seeking help for general mental health issues.Conclusion: These findings provide further reliability and validity evidence for PSAS, especially in relation to help-seeking variables. Reducing stigma toward substance users can help increase treatment utilization.
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Affiliation(s)
- Antover P Tuliao
- Community, Family, and Addiction Sciences, Texas Tech University, Lubbock, USA
| | - Derek Holyoak
- Community, Family, and Addiction Sciences, Texas Tech University, Lubbock, USA
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Qin P, Du M, Wang S, Zhang X, Wang Y, Yan T, Li L, Xu X, Zheng H, Gao L, Yu D, Niu M, Li H, Wu R, Sun J. The waterfall pattern of suicide mortality in Inner Mongolia for 2008-2015. J Affect Disord 2019; 256:331-336. [PMID: 31202987 DOI: 10.1016/j.jad.2019.05.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/20/2019] [Accepted: 05/27/2019] [Indexed: 02/07/2023]
Abstract
AIM This study aims to determine the characteristics and severity of suicide mortality in Inner Mongolia between 2008 and 2015. METHODS The death data between 2008 and 2015 was collected from the Death Registry System,1 and the suicide mortality were calculated. Suicide mortality for total of eight years and two periods (2008-2011 and 2012-2015) were tested by the X2-test. Logistic regression analysis was used to test the risk of suicide between these two observation periods by gender and region. The age-specific suicide mortality was displayed through a semi-logarithmic line chart using Pearson's correlation coefficients. Then, the prohibited pesticides and proportion of organophosphorus pesticides were calculated. RESULTS The suicide mortality (7.20/105) in 2008-2011 was higher than the suicide mortality (4.84/105) in 2012-2015 (X2 = 62.28, P = 0.00). Intentional self-poisoning by and exposure to pesticides2 and intentional self-harm by hanging3 were the two main ways of suicide, accounting for nearly 80%. The all-cause suicide mortality increased with age (r = 0.837, P = 0.005) in 2008-2011 and (r = 0.863, P = 0.003) in 2012-2015, and suicide mortality was higher in males than in females. LIMITATION The DRS did not provide the pesticides used by people who committed suicide by pesticide poisoning. CONCLUSION Suicide mortality dropped like a waterfall in Inner Mongolia between 2008 and 2015, and the most obvious drop was pesticide suicide.The general drop in suicide mortality, especially the drop in pesticide poisoning suicide mortality, may be attributable to social policies that benefited the residents and the prohibition of selected pesticides. Favorable policies can effectively decrease suicide mortality.
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Affiliation(s)
- Peng Qin
- Hohhot Minzu College, Hohhot, Inner Mongolia Autonomous Region, China
| | - Maolin Du
- Inner Mongolia Medical University, No. 5, Xinhua Street, Hohhot, Inner Mongolia Autonomous Region, China
| | | | - Xingguang Zhang
- Inner Mongolia Medical University, No. 5, Xinhua Street, Hohhot, Inner Mongolia Autonomous Region, China
| | - Yanling Wang
- Inner Mongolia Medical University, No. 5, Xinhua Street, Hohhot, Inner Mongolia Autonomous Region, China
| | - Tao Yan
- Inner Mongolia Medical University, No. 5, Xinhua Street, Hohhot, Inner Mongolia Autonomous Region, China
| | - Lehui Li
- Inner Mongolia Medical University, No. 5, Xinhua Street, Hohhot, Inner Mongolia Autonomous Region, China
| | - Xiaoqian Xu
- Inner Mongolia Medical University, No. 5, Xinhua Street, Hohhot, Inner Mongolia Autonomous Region, China
| | - Huiqiu Zheng
- Inner Mongolia Medical University, No. 5, Xinhua Street, Hohhot, Inner Mongolia Autonomous Region, China
| | - Liqun Gao
- Inner Mongolia Medical University, No. 5, Xinhua Street, Hohhot, Inner Mongolia Autonomous Region, China
| | - Di Yu
- Inner Mongolia Medical University, No. 5, Xinhua Street, Hohhot, Inner Mongolia Autonomous Region, China
| | - Mingzhu Niu
- Inner Mongolia Medical University, No. 5, Xinhua Street, Hohhot, Inner Mongolia Autonomous Region, China
| | - Hongwei Li
- Inner Mongolia Medical University, No. 5, Xinhua Street, Hohhot, Inner Mongolia Autonomous Region, China
| | - Ruijie Wu
- Inner Mongolia Medical University, No. 5, Xinhua Street, Hohhot, Inner Mongolia Autonomous Region, China
| | - Juan Sun
- Inner Mongolia Medical University, No. 5, Xinhua Street, Hohhot, Inner Mongolia Autonomous Region, China.
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Malloch YZ, Hether HJ. The Dark Side of Addiction Support Forums: Impacts of Poor Quality and Insufficient Emotional Support on Perceived Support Availability and Health Efficacy. JOURNAL OF HEALTH COMMUNICATION 2019; 24:432-441. [PMID: 31223066 DOI: 10.1080/10810730.2019.1631913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Research has identified many benefits of participating in online social support forums; however, the potential negative impacts of these communities have rarely been examined. This study explored the negative impacts of low quality (i.e., low person-centered) and insufficient (i.e., under-benefitted) emotional support on online support seekers. Health stigma and perceived support availability were also examined as mediating and moderating variables, respectively, in the model. An online survey of addiction support forum users (N = 321) was conducted. Results showed that for participants with low health stigma, low person-centered support decreased health self-efficacy through reducing perceived online emotional support availability, but under-benefitted support did not impact them. For those with high health stigma, low person-centered emotional support had positive effects on health self-efficacy through increasing perceived support availability, whereas under-benefitted support reduced health self-efficacy through decreasing perceived support availability. Importantly, a considerable proportion of participants (44.86%) reported under-benefitted emotional support. These findings suggest support forum participation can have negative impacts, but not all participants are adversely impacted equally. Instead, moderating variables, such as health stigma, can play an important role. Implications for future research and health care practitioners are discussed.
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Affiliation(s)
- Yining Z Malloch
- a Department of Communication , University of California , Davis , USA
| | - Heather J Hether
- a Department of Communication , University of California , Davis , USA
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Cox MJ, Sewell K, Egan KL, Baird S, Eby C, Ellis K, Kuteh J. A systematic review of high-risk environmental circumstances for adolescent drinking. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1620890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- M. J. Cox
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
| | - K. Sewell
- Laupus Health Sciences Library, East Carolina University, Greenville, NC, USA
| | - K. L. Egan
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
| | - S. Baird
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - C. Eby
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
| | - K. Ellis
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - J. Kuteh
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA
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Loflin MJE, Babson K, Sottile J, Norman SB, Gruber S, Bonn-Miller MO. A cross-sectional examination of choice and behavior of veterans with access to free medicinal cannabis. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 45:506-513. [PMID: 31135227 DOI: 10.1080/00952990.2019.1604722] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: With a rise in public pressure to increase veteran access to medicinal cannabis, free cannabis collectives for military veterans are proliferating across the US. Objectives: The aim of the current study was to document which cannabis formulations and routes of administration are chosen by veterans with increased access to cannabis, and to determine whether cannabis is being used as a substitute for other licit and illicit drugs. Method: The current study collected cross-sectional self-report data on cannabis use, cannabinoid constituent composition, primary indication of use, and substitution practices among a sample of 93 US military veterans (84.9% male) with access to free cannabis. Result: Most of the sample reported using cannabinoids as a substitute for either alcohol, tobacco, prescription medications, or illicit substances, reported that they use cannabis frequently (Modal frequency >4x/day, Modal quantity = 5 to 8 grams/week), and primarily select higher-risk cannabis formulations (i.e., high THC/low CBD, smoked). The majority of the sample reported that they use cannabis to self-treat multiple physical and mental health conditions/symptoms. Conclusions: Results of the current study suggest that military Veterans with reduced barriers to access cannabis could be making both helpful and harmful choices regarding their cannabis use. These findings suggest that more guidance on the selection of cannabis-based products in this population is warranted, particularly as barriers to medicinal cannabis access are reduced.
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Affiliation(s)
| | | | - James Sottile
- c Department of Psychology, Palo Alto University , Palo Alto , CA , USA
| | - Sonya B Norman
- a VA San Diego Healthcare System , San Diego , CA.,d Executive Division, National Center for PTSD , VA , USA
| | - Staci Gruber
- e Harvard Medical School, McLean Hospital , Belmont , MA , USA
| | - Marcel O Bonn-Miller
- f Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA
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27
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Ramamurthy P, Thilakan P. Geographical and Temporal Variation of Suicide in India, 2006-2015: An Investigation of Factors Associated with Suicide Risk Difference across States/Union Territories. Indian J Psychol Med 2019; 41:160-166. [PMID: 30983665 PMCID: PMC6436417 DOI: 10.4103/ijpsym.ijpsym_569_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In India, about 130,000 people died by suicide in the year 2015. It is important to understand the variation of suicide across different parts of India and the trend of suicide rates over the years. The objectives of this study were to determine whether suicide rates in India showed temporal variation in the last decade and to determine whether suicide rates in India showed geographical variation across different states and union territories (UTs). METHODS Data on suicide rates for the years 2006-2015 were collected from the official publication of the National Crime Records Bureau. This study looked for time trend in suicide rates over the years. Further, the variation in suicide rates across different states/UTs in India and the factors associated with the variation were also analyzed. RESULTS The average suicide rate in India for the years 2006-2015 was 10.9/100,000 population. Overall, there was no significant variation in the suicide rate over time in the years studied. The average suicide rate varied widely across the states and UTs, between 0.91 and 43.92 per 100,000 population. The analysis revealed a positive association between suicide rates and accident rates for the above years. In addition, for the year 2011, a positive association between suicide rate and per capita state domestic product was noted. CONCLUSION There was no variation in the suicide rate in India over time. However, there were significant regional differences. Reporting differences and economic factors could partially explain the differences.
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Affiliation(s)
| | - Pradeep Thilakan
- Department of Psychiatry, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry, India
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28
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Zhou L, Wang G, Jia C, Ma Z. Being left-behind, mental disorder, and elderly suicide in rural China: a case-control psychological autopsy study. Psychol Med 2019; 49:458-464. [PMID: 29692283 PMCID: PMC6331683 DOI: 10.1017/s003329171800106x] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/22/2018] [Accepted: 03/22/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Suicide rate among rural elderly is the highest among all age groups in China, yet little is known about the suicide risks in this rapidly growing vulnerable population. METHODS This matched case-control psychological autopsy study was conducted during June 2014 to September 2015. Consecutive samples of suicides aged 60 or above were identified in three provinces (Shandong, Hunan, and Guangxi) in China. Living comparisons were 1:1 matched with the suicides in age (±3 years old), gender, and living location. Risk factors included demographic characteristics, being left-behind, mental disorder, depressive symptoms, stressful life events, and social support. RESULTS A total of 242 suicides and 242 comparisons were enrolled: 135 (55.8%) were male, mean (s.d.) age was 74 (8) years. The most frequently used suicide means were pesticides (125, 51.7%) and hanging (95, 39.3%). Independent risks of suicide included unstable marital status [odds ratio (OR) 4.19, 95% confidence interval (CI) 1.61-10.92], unemployed (compared with employed, OR 4.43, 95% CI 1.09-17.95), depressive symptoms (OR 1.34, 95% CI 1.21-1.48), and mental disorder (OR 6.28, 95% CI 1.75-22.54). Structural equation model indicated that the association between being left-behind and suicide was mediated by mental disorder, depressive symptoms, stressful life events, and social support. CONCLUSIONS Unstable marital status, unemployed, depressive symptoms, and mental disorder are independent risk factors for suicide in rural elderly. Being left-behind can elevate the suicide risk through increasing life stresses, depressive symptoms, mental disorder, and decreasing social support. Elderly suicide may be prevented by restricting pesticides, training rural physicians, treating mental disorders, mitigating life stress, and enhancing social connection.
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Affiliation(s)
- Liang Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Guojun Wang
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Cunxian Jia
- School of Public Health, Shandong University, Jinan, China
| | - Zhenyu Ma
- School of Public Health, Guangxi Medical University, Nanning, China
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29
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Chowdhury FR, Dewan G, Verma VR, Knipe DW, Isha IT, Faiz MA, Gunnell DJ, Eddleston M. Bans of WHO Class I Pesticides in Bangladesh-suicide prevention without hampering agricultural output. Int J Epidemiol 2019; 47:175-184. [PMID: 29024951 PMCID: PMC5837375 DOI: 10.1093/ije/dyx157] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 07/26/2017] [Indexed: 11/27/2022] Open
Abstract
Background Pesticide self-poisoning is a major problem in Bangladesh. Over the past 20-years, the Bangladesh government has introduced pesticide legislation and banned highly hazardous pesticides (HHPs) from agricultural use. We aimed to assess the impacts of pesticide bans on suicide and on agricultural production. Methods We obtained data on unnatural deaths from the Statistics Division of Bangladesh Police, and used negative binomial regression to quantify changes in pesticide suicides and unnatural deaths following removal of WHO Class I toxicity HHPs from agriculture in 2000. We assessed contemporaneous trends in other risk factors, pesticide usage and agricultural production in Bangladesh from 1996 to 2014. Results Mortality in hospital from pesticide poisoning fell after the 2000 ban: 15.1% vs 9.5%, relative reduction 37.1% [95% confidence interval (CI) 35.4 to 38.8%]. The pesticide poisoning suicide rate fell from 6.3/100 000 in 1996 to 2.2/100 000 in 2014, a 65.1% (52.0 to 76.7%) decline. There was a modest simultaneous increase in hanging suicides [20.0% (8.4 to 36.9%) increase] but the overall incidence of unnatural deaths fell from 14.0/100 000 to 10.5/100 000 [25.0% (18.1 to 33.0%) decline]. There were 35 071 (95% CI 25 959 to 45 666) fewer pesticide suicides in 2001 to 2014 compared with the number predicted based on trends between 1996 to 2000. This reduction in rate of pesticide suicides occurred despite increased pesticide use and no change in admissions for pesticide poisoning, with no apparent influence on agricultural output. Conclusions Strengthening pesticide regulation and banning WHO Class I toxicity HHPs in Bangladesh were associated with major reductions in deaths and hospital mortality, without any apparent effect on agricultural output. Our data indicate that removing HHPs from agriculture can rapidly reduce suicides without imposing substantial agricultural costs.
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Affiliation(s)
- Fazle Rabbi Chowdhury
- Department of Medicine, Sylhet MAG Osmani Medical College, Sylhet, Bangladesh.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,OSD, Health Directorate (DGHS), Dhaka, Bangladesh
| | - Gourab Dewan
- Department of Medicine, Rangamati Medical College, Rangamati, Bangladesh
| | - Vasundhara R Verma
- Pharmacology, Toxicology, & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Duleeka W Knipe
- School of Social and Community Medicine, University of Bristol, Bristol, UK.,South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Ishrat Tahsin Isha
- Department of Medicine, Sylhet MAG Osmani Medical College, Sylhet, Bangladesh
| | | | - David J Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Michael Eddleston
- Pharmacology, Toxicology, & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.,South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
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30
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Chen X, Sun Y, Li Z, Yu B, Gao G, Wang P. Historical trends in suicide risk for the residents of mainland China: APC modeling of the archived national suicide mortality rates during 1987-2012. Soc Psychiatry Psychiatr Epidemiol 2019; 54:99-110. [PMID: 30171272 DOI: 10.1007/s00127-018-1593-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 08/24/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE Distinctive and dramatic changes in the history of China with a rapid suicide decline in recent years present an opportunity to investigate the risk of suicide. In this study, we investigated suicide risk with a historical perspective with archived data to inform suicide research and prevention policies and strategies. METHOD Documented age-specific suicide mortality rates in 1987-2012 were decomposed into age, period, and cohort effect using APC-modeling method and intrinsic estimator (IE) technique. The estimated effects were further analyzed by numerical differentiation. RESULTS The data satisfactorily fit the constructed APC models. Cohort effect indicated that suicide risk in China fluctuated at very high levels during 1903-1967, followed by a sharp decline during 1968-1977, and reached the lowest level in 1983-1987 before increased again. Period effect confirmed the declining trend since 1987. Three sunny cohorts with reduced suicide risk and four cloudy cohorts with increased risk were, respectively, associated with significant cultural, social, political, and economic events in China since the 1900s. CONCLUSIONS The mega trends in the suicide risk at the population level are closely related to significant historical events in China. Suicide is anticipated to increase because of the growing risk for the young cohorts (particularly young females) as the country further develops. Study findings suggest the significance of national strategies for suicide prevention and control, including maintenance of social harmony and stability, provision of more opportunities for development, enhancement of social integration, and restriction of suicide facilitating factors.
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Affiliation(s)
- Xinguang Chen
- Global Health Institute, Wuhan University, 299 Bayi Road, Wuchang District, Wuhan, 430072, Hubei, China.,Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Yang Sun
- Global Health Institute, Wuhan University, 299 Bayi Road, Wuchang District, Wuhan, 430072, Hubei, China. .,Department of Public Affairs and Management, School of Political Science and Public Administration, Wuhan University, Wuhan, China.
| | - Zhi Li
- Department of Sociology and Criminology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Bin Yu
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Ge Gao
- Department of Sociology, University of Maryland, College Park, Maryland, USA
| | - Peigang Wang
- Global Health Institute, Wuhan University, 299 Bayi Road, Wuchang District, Wuhan, 430072, Hubei, China
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Snowdon J. Differences between patterns of suicide in East Asia and the West. The importance of sociocultural factors. Asian J Psychiatr 2018; 37:106-111. [PMID: 30173014 DOI: 10.1016/j.ajp.2018.08.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 08/18/2018] [Accepted: 08/19/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare suicide rates and characteristics in East Asian and Western countries. METHOD Data from five East Asian jurisdictions and five English-speaking Western countries were obtained from national offices responsible for collection of statistics. Data were graphed to demonstrate differences between East Asian and Western age patterns of suicide. Relevant literature was reviewed, including observations concerning suicide rates in various non-English-speaking European countries. RESULTS Age patterns and rates of suicide differ between East and West and across time, but with Japan's and the United States patterns progressively becoming more similar. CONCLUSIONS Sociocultural factors affect suicide patterns and rates; choice of method and cohort effects affect rates. Strategies for prevention of suicide should give attention to culture-related precipitants of suicide.
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Affiliation(s)
- John Snowdon
- Discipline of Psychiatry, Sydney Medical School, Jara Unit, Concord Hospital, NSW 2139, Sydney, Australia.
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32
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Sharply Reduced but Still Heavy Self-Harm Burdens in Hubei Province, China, 1990-2015. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020391. [PMID: 29495306 PMCID: PMC5858460 DOI: 10.3390/ijerph15020391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 02/07/2018] [Accepted: 02/23/2018] [Indexed: 11/17/2022]
Abstract
The aims of this study were to describe fatal and non-fatal self-harm burdens, as well as burdens from the main preventable risk factors, and to investigate the different suicide methods in Hubei province in central China utilizing data from both Global Burden of Disease Study 2015 and Hubei Disease Surveillance Points system. All self-harm burdens including mortality, years of life lost (YLLs), prevalence, years lived with disability (YLDs), and disability adjusted life-years (DALYs) consistently demonstrated downward trends in Hubei from 1990 to 2015, with a bigger decline gap observed among females and narrower decreasing amplitudes among the elderly. Hubei experienced much higher age-standardized rates for self-harm mortality (22.0 per 100,000), YLLs (560.1 per 100,000) and DALYs (563.9 per 100,000) than the national (9.0, 292.3 and 295.0 per 100,000 respectively) and global levels (11.5, 453.3 and 457.9 per 100,000 respectively) in 2015. Self-harm burdens have begun shifting from females to males and the elderly suffered more self-harm burdens than other age groups. Alcohol use accounted for 20.9% of all self-harm DALYs for males, whereas intimate partner violence accounted for 24.4% of all self-harm DALYs for females. Poisoning, mainly pesticide self-poisoning, was still the most common method of suicide. Effective interventions by multi-sectoral collaboration are urgently needed to reduce the alarmingly heavy self-harm burdens in Hubei.
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33
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Sha F, Chang Q, Law YW, Hong Q, Yip PSF. Suicide rates in China, 2004-2014: comparing data from two sample-based mortality surveillance systems. BMC Public Health 2018; 18:239. [PMID: 29433460 PMCID: PMC5809896 DOI: 10.1186/s12889-018-5161-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 02/06/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The decreasing suicide rate in China has been regarded as a major contributor to the decline of global suicide rate in the past decade. However, previous estimations on China's suicide rates might not be accurate, since often they were based on the data from the Ministry of Health's Vital Registration ("MOH-VR") System, which is biased towards the better-off population. This study aims to compare suicide data extracted from the MOH-VR System with a more representative mortality surveillance system, namely the Center for Disease Control and Prevention's Disease Surveillance Points ("CDC-DSP") System, and update China's national and subnational suicide rates in the period of 2004-2014. METHODS The CDC-DSP data are obtained from the National Cause-of-Death Surveillance Dataset (2004-2014) and the MOH-VR data are from the Chinese Health Statistics Yearbooks (2005-2012) and the China Health and Family Planning Statistics Yearbooks (2013-2015). First, a negative binomial regression model was used to test the associations between the source of data (CDC-DSP/MOH-VR) and suicide rates in 2004-2014. Joinpoint regression analyses and Kitagawa's decomposition method are then applied to analyze the trends of the crude suicide rates. RESULTS Both systems indicated China's suicide rates decreased over the study period. However, before the two systems merged in 2013, the CDC-DSP System reported significantly higher national suicide rates (IRR = 1.18, 95% Confidence Interval [CI]: 1.13-1.24) and rural suicide rates (IRR = 1.29, 95% CI: 1.21-1.38) than the MOH-VR System. The CDC-DSP System also showed significant reversing points in 2011 (95% CI: 2006-2012) and 2006 (95% CI: 2006-2008) on the rural and urban suicide trends. Moreover, the suicide rates in the east and central urban regions were reversed in 2011 and 2008. CONCLUSIONS The biased MOH-VR System underestimated China's national and rural suicide rates. Although not widely appreciated in the field of suicide research, the CDC-DSP System provides more accurate estimations on China's suicide rates and is recommended for future studies to monitor the reversing trends of suicide rates in China's more developed areas.
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Affiliation(s)
- Feng Sha
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Qingsong Chang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Yik Wa Law
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China.,Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China
| | - Qi Hong
- Department of Public Courses, Shenzhen Institute of Information Technology, Shenzhen, China
| | - Paul S F Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China.
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34
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Helbich M. Toward dynamic urban environmental exposure assessments in mental health research. ENVIRONMENTAL RESEARCH 2018; 161:129-135. [PMID: 29136521 PMCID: PMC5773240 DOI: 10.1016/j.envres.2017.11.006] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/09/2017] [Accepted: 11/02/2017] [Indexed: 05/16/2023]
Abstract
It is increasingly recognized that mental disorders are affected by both personal characteristics and environmental exposures. The built, natural, and social environments can either contribute to or buffer against metal disorders. Environmental exposure assessments related to mental health typically rely on neighborhoods within which people currently live. In this article, I call into question such neighborhood-based exposure assessments at one point in time, because human life unfolds over space and across time. To circumvent inappropriate exposure assessments and to better grasp the etiologies of mental disease, I argue that people are exposed to multiple health-supporting and harmful exposures not only during their daily lives, but also over the course of their lives. This article aims to lay a theoretical foundation elucidating the impact of dynamic environmental exposures on mental health outcomes. I examine, first, the possibilities and challenges for mental health research to integrate people's environmental exposures along their daily paths and, second, how exposures over people's residential history might affect mental health later in life. To push the borders of scientific inquiries, I stress that only such mobility-based approaches facilitate an exploration of exposure duration, exposure sequences, and exposure accumulation.
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Affiliation(s)
- Marco Helbich
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Heidelberglaan 2, 3584 CS Utrecht, The Netherlands.
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35
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Pearson M, Metcalfe C, Jayamanne S, Gunnell D, Weerasinghe M, Pieris R, Priyadarshana C, Knipe DW, Hawton K, Dawson AH, Bandara P, deSilva D, Gawarammana I, Eddleston M, Konradsen F. Effectiveness of household lockable pesticide storage to reduce pesticide self-poisoning in rural Asia: a community-based, cluster-randomised controlled trial. Lancet 2017; 390:1863-1872. [PMID: 28807536 PMCID: PMC5655546 DOI: 10.1016/s0140-6736(17)31961-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 06/27/2017] [Accepted: 07/05/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Agricultural pesticide self-poisoning is a major public health problem in rural Asia. The use of safer household pesticide storage has been promoted to prevent deaths, but there is no evidence of effectiveness. We aimed to test the effectiveness of lockable household containers for prevention of pesticide self-poisoning. METHODS We did a community-based, cluster-randomised controlled trial in a rural area of North Central Province, Sri Lanka. Clusters of households were randomly assigned (1:1), with a sequence computer-generated by a minimisation process, to intervention or usual practice (control) groups. Intervention households that had farmed or had used or stored pesticide in the preceding agricultural season were given a lockable storage container. Further promotion of use of the containers was restricted to community posters and 6-monthly reminders during routine community meetings. The primary outcome was incidence of pesticide self-poisoning in people aged 14 years or older during 3 years of follow-up. Identification of outcome events was done by staff who were unaware of group allocation. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT1146496. FINDINGS Between Dec 31, 2010, and Feb 2, 2013, we randomly assigned 90 rural villages to the intervention group and 90 to the control group. 27 091 households (114 168 individuals) in the intervention group and 26 291 households (109 693 individuals) in the control group consented to participate. 20 457 household pesticide storage containers were distributed. In individuals aged 14 years or older, 611 cases of pesticide self-poisoning had occurred by 3 years in the intervention group compared with 641 cases in the control group; incidence of pesticide self-poisoning did not differ between groups (293·3 per 100 000 person-years of follow-up in the intervention group vs 318·0 per 100 000 in the control group; rate ratio [RR] 0·93, 95% CI 0·80-1·08; p=0·33). We found no evidence of switching from pesticide self-poisoning to other forms of self-harm, with no significant difference in the number of fatal (82 in the intervention group vs 67 in the control group; RR 1·22, 0·88-1·68]) or non-fatal (1135 vs 1153; RR 0·97, 0·86-1·08) self-harm events involving all methods. INTERPRETATION We found no evidence that means reduction through improved household pesticide storage reduces pesticide self-poisoning. Other approaches, particularly removal of highly hazardous pesticides from agricultural practice, are likely to be more effective for suicide prevention in rural Asia. FUNDING Wellcome Trust, with additional support from the American Foundation for Suicide Prevention, Lister Institute of Preventive Medicine, Chief Scientist Office of Scotland, University of Copenhagen, and NHMRC Australia.
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Affiliation(s)
- Melissa Pearson
- Pharmacology, Toxicology and Therapeutics, University/BHF Centre for Cardiovascular Science, and Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK; South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Chris Metcalfe
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Shaluka Jayamanne
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - David Gunnell
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Manjula Weerasinghe
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; Department of Community Medicine, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Ravi Pieris
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Chamil Priyadarshana
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Duleeka W Knipe
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Andrew H Dawson
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Palitha Bandara
- Provincial Department of Health Services, Anuradhapura, North Central Province, Sri Lanka
| | - Dhammika deSilva
- Provincial Department of Health Services, Anuradhapura, North Central Province, Sri Lanka
| | - Indika Gawarammana
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Michael Eddleston
- Pharmacology, Toxicology and Therapeutics, University/BHF Centre for Cardiovascular Science, and Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK; South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
| | - Flemming 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
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Mew EJ, Padmanathan P, Konradsen F, Eddleston M, Chang SS, Phillips MR, Gunnell D. The global burden of fatal self-poisoning with pesticides 2006-15: Systematic review. J Affect Disord 2017; 219:93-104. [PMID: 28535450 DOI: 10.1016/j.jad.2017.05.002] [Citation(s) in RCA: 242] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/03/2017] [Accepted: 05/06/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Agricultural pesticide poisoning is a major contributor to the global burden of suicide. Over the last decade there has been a marked decrease in the incidence of suicide worldwide. It is unclear whether pesticide poisoning still plays a significant role in the global incidence of suicide. METHODS WHO method-specific suicide data were supplemented by a systematic review of the literature between 2006 and 2015, including searches of thirteen electronic databases and Google, citation searching and a review of reference lists and personal collections. Our primary outcome was the proportion of total suicides due to pesticide poisoning. Weighted estimates were calculated for seven WHO regional and income strata. RESULTS We identified data from 108 countries (102 from WHO data, 6 from the literature). A conservative estimate based on these data indicates that there were approximately 110,000 pesticide self-poisoning deaths each year from 2010 to 2014, comprising 13.7% of all global suicides. A sensitivity analysis accounting for under-reporting of suicides in India resulted in an increased estimate of 168,000 pesticide self-poisoning deaths annually, that is, 19.7% of global suicides. The proportion of suicides due to pesticide self-poisoning varies considerably between regions, from 0.9% in low- and middle-income countries in the European region to 48.3% in low- and middle-income countries in the Western Pacific region. LIMITATIONS High quality method-specific suicide data were unavailable for a number of the most populous countries, particularly in the African and Eastern Mediterranean regions. It is likely we have underestimated incidence in these regions. CONCLUSION There appears to have been a substantial decline in fatal pesticide self-poisoning in recent years, largely driven by a reduction in overall suicide rates in China. Nonetheless, pesticide self-poisoning remains a major public health challenge, accounting for at least one-in-seven suicides globally.
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Affiliation(s)
- Emma J Mew
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Prianka Padmanathan
- School of Social and Community Medicine, University of Bristol, Bristol, UK.
| | - Flemming Konradsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Michael Eddleston
- Pharmacology, Toxicology and Therapeutics, University of Edinburgh, Edinburgh, UK.
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences and Department of Public Health, College of Public Health, National Taiwan University, Taipei City, Taiwan.
| | - Michael R Phillips
- Suicide Research and Prevention Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Departments of Psychiatry and Global Health, Emory University, Atlanta, USA.
| | - David Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, UK.
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Knipe DW, Chang SS, Dawson A, Eddleston M, Konradsen F, Metcalfe C, Gunnell D. Suicide prevention through means restriction: Impact of the 2008-2011 pesticide restrictions on suicide in Sri Lanka. PLoS One 2017; 12:e0172893. [PMID: 28264041 PMCID: PMC5338785 DOI: 10.1371/journal.pone.0172893] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/10/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To investigate the effect of 3-year phased bans of the pesticides dimethoate and fenthion in 2008-2010, and paraquat in 2009-2011, on suicide mortality in Sri Lanka. METHODS Age-standardised overall, sex-specific, and method-specific suicide rates were calculated using Sri Lankan police data (1989-2015). Using negative binomial regression models, we estimated the change in the rate and number of suicide deaths in post-ban years (2011-15) compared to those expected based on pre-ban trends (2001-10). FINDINGS Overall suicide mortality dropped by 21% between 2011 and 2015, from 18.3 to 14.3 per 100,000. The decline in pesticide suicides during this same period was larger than for overall suicides: from 8.5 to 4.2 per 100,000, a 50% reduction. This was accompanied by a smaller concurrent rise in non-pesticide suicide mortality with a 2% increase (9.9 to 10.1 per 100,000). In 2015, the ratio between the observed and expected pesticide suicide rates was 0.49 (95% confidence interval [CI] 0.40, 0.62), corresponding to an estimated 937 (95% CI 574, 1389) fewer pesticide suicides than expected from pre-ban suicide rates. Findings were similar in sensitivity analyses using 2008 or 2012 as commencement of the post intervention period. CONCLUSION Bans of paraquat, dimethoate and fenthion in Sri Lanka were associated with a reduction in pesticide suicide mortality and in overall suicide mortality despite a small rise in other methods. This study provides further evidence for the effectiveness of pesticide regulation in limiting the availability of highly hazardous pesticides and thereby reducing the number of global suicides.
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Affiliation(s)
- Duleeka W. Knipe
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- School of Social and Community Medicine, University of Bristol, Canynge Hall, Bristol, United Kingdom
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences and Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Andrew Dawson
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Central Clinical School, University Sydney, Sydney, Australia
| | - Michael 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, United Kingdom
| | - Flemming 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
| | - Chris Metcalfe
- School of Social and Community Medicine, University of Bristol, Canynge Hall, Bristol, United Kingdom
| | - David Gunnell
- School of Social and Community Medicine, University of Bristol, Canynge Hall, Bristol, United Kingdom
- * E-mail:
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Afshari R. Reported association of air pollution and suicide rate could be confounded. Environ Health 2017; 16:16. [PMID: 28245827 PMCID: PMC5331675 DOI: 10.1186/s12940-017-0219-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 02/14/2017] [Indexed: 05/19/2023]
Abstract
A statistical association between ambient air pollution and suicide mortality has been recently reported in Environmental Health, which seems not to be scientifically supported by their data.In this article, very low (unrealistic) suicide rate is reported, which is subjected to selection bias. Their justification is also flawed as high exposure to ambient air pollution in rural areas is lower as compared to urban residents. Weekends, holidays, time of death … are also both air pollution and suicide rate related. Reported statistical association of air pollution and suicide in this study is heavily confound.Please see article under discussion: https://ehjournal.biomedcentral.com/articles/10.1186/s12940-016-0177-1 .
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Affiliation(s)
- R Afshari
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.
- Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, Canada.
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Regional variation in suicide rates in Sri Lanka between 1955 and 2011: a spatial and temporal analysis. BMC Public Health 2017; 17:193. [PMID: 28196502 PMCID: PMC5310090 DOI: 10.1186/s12889-016-3961-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 12/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Between 1955 and 2011 there were marked fluctuations in suicide rates in Sri Lanka; incidence increased six-fold between 1955 and the 1980s, and halved in the early 21st century. Changes in access to highly toxic pesticides are thought to have influenced this pattern. This study investigates variation in suicide rates across Sri Lanka's 25 districts between 1955 and 2011. We hypothesised that changes in the incidence of suicide would be most marked in rural areas due to the variation in availability of highly toxic pesticides in these locations during this time period. METHODS We mapped district-level suicide rates in 1955, 1972, 1980 and 2011. These periods preceded, included and postdated the rapid rise in Sri Lanka's suicide rates. We investigated the associations between district-level variations in suicide rates and census-derived measures of rurality (population density), unemployment, migration and ethnicity using Spearman's rank correlation and negative binomial models. RESULTS The rise and fall in suicide rates was concentrated in more rural areas. In 1980, when suicide rates were at their highest, population density was inversely associated with area variation in suicide rates (r = -0.65; p < 0.001), i.e. incidence was highest in rural areas. In contrast the association was weakest in 1950, prior to the rise in pesticide suicides (r = -0.10; p = 0.697). There was no strong evidence that levels of migration or ethnicity were associated with area variations in suicide rates. The relative rates of suicide in the most rural compared to the most urban districts before (1955), during (1980) and after (2011) the rise in highly toxic pesticide availability were 1.1 (95% CI 0.5 to 2.4), 3.7 (2.0 to 6.9) and 2.1 (1.6 to 2.7) respectively. CONCLUSIONS The findings provide some support for the hypothesis that changes in access to pesticides contributed to the marked fluctuations in Sri Lanka's suicide rate, but the impact of other factors cannot be ruled out.
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Rizzo A‘S, Shilling R. Clinical Virtual Reality tools to advance the prevention, assessment, and treatment of PTSD. Eur J Psychotraumatol 2017; 8:1414560. [PMID: 29372007 PMCID: PMC5774399 DOI: 10.1080/20008198.2017.1414560] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/22/2017] [Indexed: 12/13/2022] Open
Abstract
Numerous reports indicate that the incidence of posttraumatic stress disorder (PTSD) in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) military personnel has created a significant behavioural healthcare challenge. These findings have served to motivate research on how to better develop and disseminate evidence-based treatments for PTSD. The current article presents the use of Virtual Reality (VR) as a clinical tool to address the assessment, prevention, and treatment of PTSD, based on the VR projects that were evolved at the University of Southern California Institute for Creative Technologies since 2004. A brief discussion of the definition and rationale for the clinical use of VR is followed by a description of a VR application designed for the delivery of prolonged exposure (PE) for treating Service Members (SMs) and Veterans with combat- and sexual assault-related PTSD. The expansion of the virtual treatment simulations of Iraq and Afghanistan for PTSD assessment and prevention is then presented. This is followed by a forward-looking discussion that details early efforts to develop virtual human agent systems that serve the role of virtual patients for training the next generation of clinical providers, as healthcare guides that can be used to support anonymous access to trauma-relevant behavioural healthcare information, and as clinical interviewers capable of automated behaviour analysis of users to infer psychological state. The paper will conclude with a discussion of VR as a tool for breaking down barriers to care in addition to its direct application in assessment and intervention.
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Affiliation(s)
- Albert ‘Skip’ Rizzo
- Institute for Creative Technologies, University of Southern California, Los Angeles, CA, USA
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Page A, Liu S, Gunnell D, Astell-Burt T, Feng X, Wang L, Zhou M. Suicide by pesticide poisoning remains a priority for suicide prevention in China: Analysis of national mortality trends 2006-2013. J Affect Disord 2017; 208:418-423. [PMID: 27842298 DOI: 10.1016/j.jad.2016.10.047] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 10/23/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Despite recent declines, suicide remains a priority for China. Ease of availability of high-lethality suicide methods, such as pesticides and firearms, contributes to the overall incidence and is an important target for suicide prevention. This study investigates whether changes in the distribution of methods of suicide have contributed to the recent reduction in suicide in China. METHOD Suicide rates (2006-2013) were calculated using the Chinese Disease Surveillance Points system, stratified by gender, age group, and urban-rural residence, to investigate trends in suicide over the study period. Multilevel negative binomial regression models were used to investigate associations between socio-demographic factors and method-specific suicide. RESULTS The most common method of suicide in China for both males and females was pesticide poisoning, followed by hanging. All methods declined over the study period, with the exception of suicide by jumping in males. Suicide rates for pesticide poisoning and for hanging increased exponentially with age in those aged over ≥45 years in both sexes. Pesticide poisoning declined from 55% to 49% of all suicides, while hanging increased from 27% to 31%. LIMITATIONS This was an ecological study of a time series of suicide rates, with risk factor adjustment being limited to population-level point estimates derived from a single census. CONCLUSIONS Suicide by pesticide poisoning and hanging remain the leading methods of suicide in China. Changes to the safe use of pesticides and targeted prevention initiatives to restrict access, along with socio-economic development and urbanisation, are likely contributors to declines in suicide by pesticide poisoning.
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Affiliation(s)
- Andrew Page
- Centre for Health Research, Western Sydney University, Penrith, NSW, Australia.
| | - Shiwei Liu
- National Center for Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - David Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Thomas Astell-Burt
- School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Xiaoqi Feng
- School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Lijun Wang
- National Center for Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Maigeng Zhou
- National Center for Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Zhong BL, Chiu HFK, Conwell Y. Rates and characteristics of elderly suicide in China, 2013-14. J Affect Disord 2016; 206:273-279. [PMID: 27639861 DOI: 10.1016/j.jad.2016.09.003] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/11/2016] [Accepted: 09/08/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND The number of older adults (OAs) is growing rapidly and the elderly suicide rate (ESR) is highest among all age-groups in China. Examining the epidemiology of elderly suicide (ES) may facilitate population-specific suicide prevention efforts, however, little is known about the patterns of ES in China. OBJECTIVE To describe the rates and characteristics of ES in China during 2013-14. METHODS Suicide mortality data by gender, quinquennial age-group, residence (urban/rural) and geographic location (east/central/west) were obtained from China's Integrated National Mortality Surveillance System for 2013-14. Crude ESRs of OAs aged 65 years or above were standardized to the 2010 China's Census population and adjusted for under-reporting. RESULTS While OAs comprised 8.9% of the Chinese population, they represented 38.2% of suicide deaths. The average annual ESR in China was 34.5 per 100000 in 2013-14. ESRs varied widely across OA subgroups, with the highest rates in central rural men (67.1) and women (53.1), and the lowest rate in eastern urban women (13.6). Male gender (incident rate ratio [IRR]=1.47), every five-year increase in age (IRR=1.33), rural residence (IRR=1.83), and geographic location of central China (IRR=1.93) were significantly associated with increased number of ESs. LIMITATIONS Information on means of ES are lacking in the data source. CONCLUSIONS ESs disproportionately account for a large portion of China's current total suicides, and ESR, particularly in central rural OAs, is very high in China. Prevention of ES should be given priority as an important public health issue in China. Central rural OAs are key target population for current ES prevention.
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Affiliation(s)
- Bao-Liang Zhong
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, PR China; Affiliated Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, PR China
| | - Helen F K Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, PR China.
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
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Zhong BL, Chiu HFK, Conwell Y. Elderly suicide trends in the context of transforming China, 1987-2014. Sci Rep 2016; 6:37724. [PMID: 27886219 PMCID: PMC5123573 DOI: 10.1038/srep37724] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 10/31/2016] [Indexed: 11/09/2022] Open
Abstract
In the context of rapid ageing, understanding the time-trend of elderly suicide (ES) could inform China’s efforts on suicide prevention. We examined time-trends in Chinese ES rates (ESRs) from 1987 to 2014, a period of profound social changes. Suicide rates by residence (rural/urban), gender, and 5-year age-group (65+) in 1987–2014 were provided by the Chinese Ministry of Health. Time-trends were analyzed with joinpoint analysis. The time-trend of national ESRs was downward (average annual percent change [AAPC] = −3.7, P < 0.001): 76.6/100000 in 1987 and 30.2/100000 in 2014. However, the time-trend of corresponding percentages of ESs among the total suicides was monotonically increasing (AAPC = 3.4, P < 0.001): 16.9% in 1987 to 41.2% in 2014. The time-trends in ESRs of both rural and urban men and women were decreasing, but only the rural trends were significant (P < 0.001). Rural-urban and male-female differences in ESRs were decreasing over time (slope = −4.2 and −3.0, P ≤ 0.006), but the rural-urban and male-female ESR differences in 2014 remained large (16.3/100000 and 9.8/100000, P < 0.001). While national ESRs decreased significantly during the past three decades, the current ESR remains high in China. Further, the age-pattern of Chinese suicide is transitioning to elderly predominance. ES, particularly rural ES, should be a public health priority in China.
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Affiliation(s)
- Bao-Liang Zhong
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China.,Affiliated Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Helen F K Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
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The China Mental Health Survey: II. Design and field procedures. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1547-1557. [PMID: 27803977 DOI: 10.1007/s00127-016-1269-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 08/01/2016] [Indexed: 02/05/2023]
Abstract
China Mental Health Survey (CMHS), which was carried out from July 2013 to March 2015, was the first national representative community survey of mental disorders and mental health services in China using computer-assisted personal interview (CAPI). Face-to-face interviews were finished in the homes of respondents who were selected from a nationally representative multi-stage disproportionate stratified sampling procedure. Sample selection was integrated with the National Chronic Disease and Risk Factor Surveillance Survey administered by the National Centre for Chronic and Non-communicable Disease Control and Prevention in 2013, which made it possible to obtain both physical and mental health information of Chinese community population. One-stage design of data collection was used in the CMHS to obtain the information of mental disorders, including mood disorders, anxiety disorders, and substance use disorders, while two-stage design was applied for schizophrenia and other psychotic disorders, and dementia. A total of 28,140 respondents finished the survey with 72.9% of the overall response rate. This paper describes the survey mode, fieldwork organization, procedures, and the sample design and weighting of the CMHS. Detailed information is presented on the establishment of a new payment scheme for interviewers, results of the quality control in both stages, and evaluations to the weighting.
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Li LW, Xu H, Zhang Z, Liu J. An Ecological Study of Social Fragmentation, Socioeconomic Deprivation, and Suicide in Rural China: 2008-2010. SSM Popul Health 2016; 2:365-372. [PMID: 27766307 PMCID: PMC5067073 DOI: 10.1016/j.ssmph.2016.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
China accounts for a large number of suicides worldwide, and most occur in rural areas. Suicide research in China has primarily focused on individual-level risk factors, few have studied the influence of neighborhood contexts. This ecological study examines the association of suicide rates with social fragmentation and socioeconomic deprivation in Chinese rural villages. Data from the community survey of the China Health and Retirement Longitudinal Study were analyzed using negative binomial regression. A total of 307 rural villages were included. The community survey collected data about the villages from local leaders. Suicide counts were measured by the leaders' report of the number of suicide deaths in the villages. Social fragmentation was indicated by out-migration, in-migration and ethnic diversity; socioeconomic deprivation was indicated by physical infrastructure, illiteracy rates and public transit accessibility. The results show that higher incidence rates of suicide occurred in villages with high proportions of out-migration (vs. low), inflow of migrants (vs. no migrants), mixes of Han and ethnic minority residents (vs. Han only), high degrees of infrastructure deficiency (vs. low) and poor access to public transportation (vs. excellent). Villages with higher percentages of older adults also had higher suicide rates. This is one of the first studies to examine the association between neighborhood contexts and suicide in China. The findings have implications for suicide prevention in rural China.
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Affiliation(s)
- Lydia W Li
- University of Michigan School of Social Work, Ann Arbor, MI, USA
| | - Hongwei Xu
- University of Michigan Survey Research Center, Ann Arbor, MI, USA
| | - Zhenmei Zhang
- Michigan State University Department of Sociology, East Lansing, MI. USA
| | - Jinyu Liu
- Columbia University School of Social Work, New York, NY, USA
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Affiliation(s)
- Shiwei Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
| | - Andrew Page
- Centre for Health Research, Western Sydney University, Penrith, NSW 2571, Australia
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Yin H, Xu L, Shao Y, Li L, Wan C. Relationship between suicide rate and economic growth and stock market in the People's Republic of China: 2004-2013. Neuropsychiatr Dis Treat 2016; 12:3119-3128. [PMID: 27994468 PMCID: PMC5153284 DOI: 10.2147/ndt.s116148] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES The objective of this study was to estimate the features of suicide rate and its association with economic development and stock market during the past decade in the People's Republic of China. METHODS Official data were gathered and analyzed in the People's Republic of China during the period 2004-2013. Nationwide suicide rate was stratified by four year age-groups, sex, urban/rural areas, and regions (East, Central, and West). Annual economic indexes including gross domestic product (GDP) per capita and rural and urban income per capita were all adjusted for inflation. Variation coefficient of market index (VCMI) was also included as an economic index to measure the fluctuation of the stock market. Negative binomial regression was performed to examine the time trend of region-level suicide rates and effects of sex, age, urban/rural area, region, and economic index on the suicide rates. RESULTS Suicide rates of each age-group, sex, urban/rural area, and region were generally decreased from 2004 to 2013, while annual GDP per capita and rural and urban income per capita were generally increased by year. VCMI fluctuated largely, which peaked around 2009 and decreased after that time. Negative binomial regression showed that the decreased suicide rate in East and Central rural areas was the main cause of the decrease in suicide rate in the People's Republic of China. Suicide rate in the People's Republic of China for the study period increased with age and was higher in rural than in urban area, higher in males than in females, and the highest in the Central region. When GDP per capita increased by 2,787 RMB, the suicide rate decreased by 0.498 times. VCMI showed no significant relationship with suicide rate in the negative binomial regression. CONCLUSION Suicide rate decreased in 2004-2013; varied among different age-groups, sex, urban/rural areas, and regions; and was negatively associated with the economic growth in the People's Republic of China. Stock market showed no relationship with suicide rate, but this finding needs to be verified in a future study.
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Affiliation(s)
- Honglei Yin
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
- School of Public Health, Southern Medical University, Guangzhou, People’s Republic of China
| | - Lin Xu
- Department of Finance, School of Economics and Commerce, South China University of Technology, Guangzhou, People’s Republic of China
| | - Yechang Shao
- School of Public Health, Southern Medical University, Guangzhou, People’s Republic of China
- Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou, People’s Republic of China
| | - Liping Li
- Injury Prevention Research Center, Shantou University Medical College, Shantou, People’s Republic of China
- Liping Li, Injury Prevention Research Center, Shantou University Medical College, 22 Xinling Road, Shantou 515041, People’s Republic of China, Email
| | - Chengsong Wan
- School of Public Health, Southern Medical University, Guangzhou, People’s Republic of China
- Correspondence: Chengsong Wan, School of Public Health, Southern Medical University, 1023 South Shatai Road, Guangzhou, 510515, People’s Republic of China, Email
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