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Walker AR, Srasuebkul P, Trollor JN, Wand AP, Draper B, Cvejic RC, Moxey A, Reppermund S. Mortality in people living with dementia who self-harmed: An Australian data linkage study. Aust N Z J Psychiatry 2024:48674241278243. [PMID: 39252467 DOI: 10.1177/00048674241278243] [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] [Indexed: 09/11/2024]
Abstract
OBJECTIVES This study aimed to examine mortality for people living with dementia/mild cognitive impairment who self-harmed. METHODS We conducted a retrospective cohort study in New South Wales, Australia, using data ranging from 2001 to 2015. From people who accessed hospital services in the study period, we identified 154,811 people living with dementia/mild cognitive impairment, 28,972 who self-harmed and 1511 who had a record of both dementia/mild cognitive impairment and self-harm. We examined rates, causes and predictors of death for people with dementia/mild cognitive impairment and/or self-harm diagnoses using flexible parametric survival analyses. We explored rates of repeat self-harm in people living with dementia who self-harmed. RESULTS Circulatory disorders accounted for 32.0% of deaths in people with a living with dementia who self-harmed, followed by neoplasms (14.7%), and mental and behavioural disorders (9.6%). Death was more likely for someone who had self-harmed if they developed dementia/mild cognitive impairment. Predictors of death included male sex, greater physical comorbidity, a history of delirium, more previous emergency department presentations and fewer previous mental health ambulatory service days. Greater engagement with outpatient mental health services predicted a decreased likelihood of repeat self-harm. DISCUSSION We found that mortality increases when people who self-harm develop dementia. We argue post-diagnosis support offers a potential opportunity to reduce mortality rates in people with both dementia and self-harm diagnoses.
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Affiliation(s)
- Adrian R Walker
- Department of Developmental Disability Neuropsychiatry, Faculty of Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
- Centre for Big Data Research in Health, Faculty of Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
| | - Preeyaporn Srasuebkul
- National Centre of Excellence in Intellectual Disability Health, Faculty of Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
| | - Julian N Trollor
- National Centre of Excellence in Intellectual Disability Health, Faculty of Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
- Centre for Healthy Brain Ageing, Faculty of Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
| | - Anne Pf Wand
- Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Discipline of Psychiatry & Mental Health, Faculty of Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
- Older People's Mental Health Service, Concord Centre for Mental Health, Sydney Local Health District, Concord, NSW, Australia
| | - Brian Draper
- Centre for Healthy Brain Ageing, Faculty of Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
- Discipline of Psychiatry & Mental Health, Faculty of Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
- Eastern Suburbs Older Persons Community Mental Health Service, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Rachael C Cvejic
- Department of Developmental Disability Neuropsychiatry, Faculty of Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
| | | | - Simone Reppermund
- Department of Developmental Disability Neuropsychiatry, Faculty of Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
- Centre for Healthy Brain Ageing, Faculty of Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
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Cunningham JK, Solomon TGA, Ritchey J, Weiss BD. Alcohol Use Disorder Visits and Suicide Ideation Diagnosis: Racial/Ethnic Differences at Emergency Departments. Am J Prev Med 2023; 65:1113-1123. [PMID: 37348661 DOI: 10.1016/j.amepre.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 06/16/2023] [Accepted: 06/18/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Nationally, suicide ideation prevalence is comparable among White, American Indian/Alaska Native, Black, and Hispanic adults experiencing alcohol use disorder. This study examines whether such comparability extends to the probability of receiving a suicide ideation diagnosis when presenting with alcohol use disorder at emergency departments. The probability of hospitalization following such diagnosis is examined as well. METHODS National Emergency Department Sample (2019) data were used. Logistic and multilevel logistic regression analyses were performed in 2022-2023 with suicide ideation diagnosis and subsequent hospitalization as the outcome variables. Control variables included demographics, payor, alcohol use disorder level, comorbidities, and emergency department facility. Adjusted probabilities were computed. RESULTS Age-adjusted probabilities of suicide ideation diagnoses for American Indian/Alaska Native, Black, and Hispanic patients with alcohol use disorder were 5.4%, 6.7%, and 4.9% (95% CIs=3.7, 7.1; 6.0, 7.4; 4.4, 5.4), respectively; all less than that for White counterparts (8.7%; 95% CI=8.2, 9.2). Among patients with alcohol use disorder plus suicide ideation diagnoses, the age-adjusted probability of hospitalization for American Indians/Alaska Natives (32.4%; 95% CI=20.9, 44.0) was less than that for Whites, Blacks, and Hispanics (49.8%, 52.3%, and 49.9%; 95% CIs=46.7, 52.8; 47.1, 57.5; and 43.9, 55.8, respectively). In regressions with multiple control variables, the racial/ethnic differences remained statistically significant (p<0.05). CONCLUSIONS Diagnosis of suicide ideation, a key step in emergency department suicide prevention care, occurred significantly less often for patients of color with alcohol use disorder than for White counterparts. American Indians/Alaska Natives, the racial/ethnic group known to have the nation's highest suicide rate, had the lowest probability of being hospitalized after a diagnosis of alcohol use disorder plus suicide ideation.
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Affiliation(s)
- James K Cunningham
- Department of Family and Community Medicine, The University of Arizona, Tucson, Arizona; American Indian Research Center for Health, The University of Arizona, Tucson, Arizona.
| | - Teshia G Arambula Solomon
- Department of Family and Community Medicine, The University of Arizona, Tucson, Arizona; American Indian Research Center for Health, The University of Arizona, Tucson, Arizona
| | - Jamie Ritchey
- Tribal Epidemiology Center, Inter Tribal Council of Arizona, Inc., Phoenix, Arizona
| | - Barry D Weiss
- Department of Family and Community Medicine, The University of Arizona, Tucson, Arizona
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Walker AR, Srasuebkul P, Trollor JN, Wand APF, Draper B, Cvejic RC, Moxey A, Reppermund S. Risk factors for dementia and self-harm: A linkage study. Alzheimers Dement 2023; 19:5138-5150. [PMID: 37126409 DOI: 10.1002/alz.13080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/22/2023] [Accepted: 03/11/2023] [Indexed: 05/02/2023]
Abstract
INTRODUCTION People living with dementia experience poor mental health and high rates of self-harm. We investigated risk factors for self-harm in people aged > 40 years living with dementia and risk factors for dementia after self-harm. METHODS Using linked hospital data from New South Wales, Australia, we defined a dementia cohort (n = 154,811) and a self-harm cohort (n = 28,972). Using survival analyses, we investigated predictors of self-harm for the dementia cohort, and predictors of dementia for the self-harm cohort. RESULTS We found self-harm or dementia diagnoses occurred most often within 24 months of a dementia diagnosis or initial self-harm presentation, respectively. Men living with dementia, and people with complex psychiatric profiles, had the greatest risk of self-harm. Men who had self-harmed had the greatest risk of dementia diagnoses. DISCUSSION Men and people with complex psychiatric profiles and dementia may particularly benefit from post-diagnosis mental and behavioral support to reduce risk of self-harm.
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Affiliation(s)
- Adrian R Walker
- The Department of Developmental Disability Neuropsychiatry, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Preeyaporn Srasuebkul
- The Department of Developmental Disability Neuropsychiatry, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Julian N Trollor
- The Department of Developmental Disability Neuropsychiatry, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Centre for Healthy Brain Ageing, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Anne P F Wand
- Speciality of Psychiatry, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Brian Draper
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Eastern Suburbs Older Persons Mental Health Service, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Rachael C Cvejic
- The Department of Developmental Disability Neuropsychiatry, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Annette Moxey
- Dementia Australia, Griffith, Australian Capital Territory, Australia
| | - Simone Reppermund
- The Department of Developmental Disability Neuropsychiatry, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Centre for Healthy Brain Ageing, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
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