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Wyder M, Ray MK, Roennfeldt H, Daly M, Crompton D. How health care systems let our patients down: a systematic review into suicide deaths. Int J Qual Health Care 2021; 32:285-291. [PMID: 32484207 DOI: 10.1093/intqhc/mzaa011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/26/2019] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To synthesize the literature in relation to findings of system errors through reviews of suicide deaths in the public mental health system. DATA SOURCES A systematic narrative meta-synthesis using the PRISMA methodology was conducted. STUDY SELECTION All English language articles published between 2000 and 2017 that reported on system errors identified through reviews of suicide deaths were included. Articles that reported on patient factors, contact with General Practitioners or individual cases were excluded. DATA EXTRACTION Results were extracted and summarized. An overarching coding framework was developed inductively. This coding framework was reapplied to the full data set. RESULTS OF DATA SYNTHESIS Fourteen peer reviewed publications were identified. Nine focussed on suicide deaths that occurred in hospital or psychiatric inpatient units. Five studies focussed on suicide deaths while being treated in the community. Vulnerabilities were identified throughout the patient's journey (i.e. point of entry, transitioning between teams, and point of exit with the service) and centred on information gathering (i.e. inadequate and incomplete risk assessments or lack of family involvement) and information flow (i.e. transitions between different teams). Beyond enhancing policy, guidelines, documentation and regular training for frontline staff there were very limited suggestions as to how systems can make it easier for staff to support their patients. CONCLUSIONS There are currently limited studies that have investigated learnings and recommendations. Identifying critical vulnerabilities in systems and to be proactive about these could be one way to develop a highly reliable mental health care system.
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Affiliation(s)
- Marianne Wyder
- Metro South Health and Hospital Service.,Menzies Health Institute Queensland, Griffith University
| | | | - Helena Roennfeldt
- Menzies Health Institute Queensland, Griffith University.,Centre for Psychiatric Nursing, University of Melbourne, School of Health Sciences
| | - Michael Daly
- Metro South Health and Hospital Service.,Queensland university of Technology
| | - David Crompton
- Metro South Health and Hospital Service.,Menzies Health Institute Queensland, Griffith University
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Abstract
BACKGROUND Psychotic disorders, as well as psychotic symptoms, are associated with a greater lifetime risk of suicidal behavior (SB). It is not known, however, whether psychotic symptoms are independent predictors for short-term SB. METHODS Data were collected from 201 psychiatric inpatients at Mount Sinai Beth Israel Hospital. Self-reported psychotic symptoms were assessed using the Brief Symptom Inventory (BSI). Postdischarge SB defined as an aborted, interrupted, or actual suicide attempt was assessed using the Columbia-Suicide Severity Rating Scale (C-SSRS), during the 4 to 8 weeks following discharge from an inpatient psychiatric unit (n=127, 63% retention). Logistic regressions were performed to assess the relationships between psychotic symptoms and SB, controlling for primary psychiatric disorders. RESULTS Self-reported psychotic symptoms were associated with subsequent postdischarge SB. There was no significant difference between the SB versus no SB groups on the basis of primary psychiatric disorder. Self-reported psychotic symptoms remained an independent and significant predictor of postdischarge SB when the analysis controlled for primary psychiatric disorder. CONCLUSIONS These results suggest that psychotic symptoms are a dimensional predictor of near-term postdischarge SB and are a necessary component of suicide risk assessment during inpatient hospitalization, independent of psychiatric diagnosis.
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Falcone G, Nardella A, Lamis DA, Erbuto D, Girardi P, Pompili M. Taking care of suicidal patients with new technologies and reaching-out means in the post-discharge period. World J Psychiatry 2017; 7:163-176. [PMID: 29043154 PMCID: PMC5632601 DOI: 10.5498/wjp.v7.i3.163] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/07/2017] [Accepted: 07/17/2017] [Indexed: 02/05/2023] Open
Abstract
Suicide is a global public health problem with over one million people dying by suicide each year worldwide. Research efforts have focused on developing and testing novel suicide prevention strategies employing recent technological advances. In order to provide a review regarding the role of new technologies (e.g., postcards/letters, text messages, crisis cards, telephone contacts, online interventions) in suicide prevention, we searched PubMed, ScienceDirect, ResearchGate, and Crisis to identify all papers in English from 1977 to 2016. Our results indicated that brief contact interventions show promise in reducing the number of episodes of repeated self-harm and/or suicide attempts following discharge from the Emergency Department or psychiatric units. Innovative methods of contact (e.g., text messages) are easily implemented by clinicians and received by patients in the period of post discharge and have been shown to be beneficial. However, more research employing randomized clinical trials investigating the potential benefits of these novel suicide prevention methods is warranted. Future researchers should continue improving and testing new technologies in the prevention of suicide.
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Affiliation(s)
- Giulia Falcone
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Adele Nardella
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Dorian A Lamis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30303, United States
| | - Denise Erbuto
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Paolo Girardi
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
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Penn DL, Simpson L, Edie G, Leggett S, Wood L, Hawgood J, Krysinska K, Yellowlees P, De Leo D. Development of ACROSSnet: an online support system for rural and remote community suicide prevention workers in Queensland, Australia. Health Informatics J 2016. [DOI: 10.1177/1460458205058755] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Communication and information technologies can reduce the barriers of distance and space that disadvantage communities in Australia's underserved rural areas, where the health status of residents is often worse than that of their urban counterparts. ACROSSnet (Australians Creating Rural Online Support Systems) is a 3 year collaborative action research project that aims to design and develop an online support system that will assist rural communities in accessing information, education and support regarding suicide and its prevention, whilst considering the challenges of Internet speed, cost and availability that can impede the delivery of online services. The site provides three distinct levels of access: one level for community members, and two further levels for appropriately credentialled mental health workers. In creating this environment, the ACROSSnet team hopes that online communities of practice will develop, engaging participants of different ages, income and education levels, location, and socioeconomic backgrounds.
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Affiliation(s)
- Danielle L. Penn
- Service Leadership Innovation and Research Program, Queensland University of Technology, GPO Box 2434, Brisbane QLD 4001, Australia,
| | - Lyn Simpson
- Service Leadership Innovation and Research Program, Queensland University of Technology, GPO Box 2434, Brisbane QLD 4001, Australia,
| | - Gavin Edie
- Service Leadership Innovation and Research Program, Queensland University of Technology, GPO Box 2434, Brisbane QLD 4001, Australia,
| | - Susan Leggett
- Service Leadership Innovation and Research Program, Queensland University of Technology, GPO Box 2434, Brisbane QLD 4001, Australia,
| | - Leanne Wood
- Service Leadership Innovation and Research Program, Queensland University of Technology, GPO Box 2434, Brisbane QLD 4001, Australia,
| | - Jacinta Hawgood
- Australian Institute for Suicide Research and Prevention (AISRAP), Griffith University, Mt Gravatt Campus, Brisbane QLD 4111, Australia,
| | - Karolina Krysinska
- Australian Institute for Suicide Research and Prevention (AISRAP), Griffith University, Mt Gravatt Campus, Brisbane QLD 4111, Australia,
| | - Peter Yellowlees
- UC Davis, Suite 2631, Administrative Support Building 2450, 48th Street, Sacramento, CA 95817, USA,
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention (AISRAP), Griffith University, Mt Gravatt Campus, Brisbane QLD 4111, Australia,
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Mortality of people suffering from mental illness: a study of a cohort of patients hospitalised in psychiatry in the north of France. Soc Psychiatry Psychiatr Epidemiol 2015; 50:269-77. [PMID: 25028200 DOI: 10.1007/s00127-014-0913-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 05/30/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The mortality of people suffering from psychiatric illnesses is far higher than that of the general population, all categories of diagnosis combined; mortality statistics can be used as an index of quality of care. The aim of this study was to assess the all-cause mortality in psychiatric patients covering all diagnostic groups. METHODS The living or deceased status of 4,417 patients of majority age hospitalised in a public mental health establishment between 2004 and 2007 were requested from French National Institute for Statistics and Economic Studies on 1st January 2011. The cause of death of those people who had died was obtained from French National Institute for Health and Medical Research and comparative standardized mortality ratios (SMR) were established from the population in a region of northern France of the same age in 2006. RESULTS The study population was made up of 54% men and 46% women, median age 41 and 45 years old, respectively. Four hundred and seventy-three people died during the period studied. The SMR were 421 for men (95% CI 378-470) and 330 for women (95% CI 281-388). The highest SMRs were found in patients aged 35-54, with a 20-time higher mortality risk than the general population of the same age. CONCLUSION Our study confirms the considerably higher mortality in psychiatric patients than in general population, particularly in mean age and mostly due to an unnatural cause.
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John A, Dennis M, Kosnes L, Gunnell D, Scourfield J, Ford DV, Lloyd K. Suicide Information Database-Cymru: a protocol for a population-based, routinely collected data linkage study to explore risks and patterns of healthcare contact prior to suicide to identify opportunities for intervention. BMJ Open 2014; 4:e006780. [PMID: 25424996 PMCID: PMC4248097 DOI: 10.1136/bmjopen-2014-006780] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Prevention of suicide is a global public health challenge extending beyond mental health services. Linking routinely collected health and social care system data records for the same individual across different services and over time has enormous potential in suicide research. Most previous research linking suicide mortality data with routinely collected electronic health records involves only one or two domains of healthcare provision such as psychiatric inpatient care. This protocol paper describes the development of a population-based, routinely collected data linkage study: the Suicide Information Database Cymru (SID-Cymru). SID-Cymru aims to contribute to the information available on people who complete suicide. METHODS AND ANALYSIS SID-Cymru will facilitate a series of electronic case-control studies based in the Secure Anonymised Information Linkage (SAIL) Databank. We have identified 2664 cases of suicide in Wales between 2003 and 2011 from routinely collected mortality data using International Classification of Diseases, Tenth Revision, codes X60-X84 (intentional self-harm) and Y10-Y34 (undetermined intent). Each case will be matched by age and sex to at least five controls. Records will be collated and linked from routinely collected health and social data in Wales for each individual. Conditional logistic regression will be applied to produce crude and confounder (including general practice, socioeconomic status) adjusted ORs. ETHICS AND DISSEMINATION The SAIL Databank has the required ethical permissions in place to analyse anonymised data. Ethical approval has been granted by the Information Governance Review Panel (IGRP). Findings will be disseminated through peer-reviewed publications, consultations with stakeholders and national/international conference presentations. The improved understanding of the prior health, nature of previous contacts with services and wider social circumstances of those who complete suicide will assist in prevention policy, service organisation and delivery. SID-Cymru is funded through the National Institute for Social Care and Health Research, Welsh Government (RFS-12-25).
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Affiliation(s)
- Ann John
- College of Medicine, Swansea University, Institute of Life Sciences 2, Swansea, UK
| | - M Dennis
- College of Medicine, Swansea University, Institute of Life Sciences 2, Swansea, UK
| | - L Kosnes
- College of Medicine, Swansea University, Institute of Life Sciences 2, Swansea, UK
| | - D Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - J Scourfield
- School of Social Sciences, Cardiff University, Cardiff, UK
| | - D V Ford
- College of Medicine, Swansea University, Institute of Life Sciences 2, Swansea, UK
| | - K Lloyd
- College of Medicine, Swansea University, Institute of Life Sciences 2, Swansea, UK
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7
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Dougall N, Lambert P, Maxwell M, Dawson A, Sinnott R, McCafferty S, Morris C, Clark D, Springbett A. Deaths by suicide and their relationship with general and psychiatric hospital discharge: 30-year record linkage study. Br J Psychiatry 2014; 204:267-73. [PMID: 24482439 DOI: 10.1192/bjp.bp.112.122374] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Studies have rarely explored suicides completed following discharge from both general and psychiatric hospital settings. Such research might identify additional opportunities for intervention. AIMS To identify and summarise Scottish psychiatric and general hospital records for individuals who have died by suicide. METHOD A linked data study of deaths by suicide, aged ≥15 years from 1981 to 2010. RESULTS This study reports on a UK data-set of individuals who died by suicide (n = 16 411), of whom 66% (n = 10 907) had linkable previous hospital records. Those who died by suicide were 3.1 times more frequently last discharged from general than from psychiatric hospitals; 24% of deaths occurred within 3 months of hospital discharge (58% of these from a general hospital). Only 14% of those discharged from a general hospital had a recorded psychiatric diagnosis at last visit; an additional 19% were found to have a previous lifetime psychiatric diagnosis. Median time between last discharge and death was fourfold greater in those without a psychiatric history. Diagnoses also revealed that less than half of those last discharged from general hospital had had a main diagnosis of 'injury or poisoning'. CONCLUSIONS Suicide prevention activity, including a better psychiatric evaluation of patients within general hospital settings deserves more attention. Improved information flow between secondary and primary care could be facilitated by exploiting electronic records of previous psychiatric diagnoses.
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Affiliation(s)
- Nadine Dougall
- Nadine Dougall, MSc, NMAHP Research Unit, University of Stirling, Stirling; Paul Lambert, PhD, School of Applied Social Science, University of Stirling, Stirling; Margaret Maxwell, PhD, NMAHP Research Unit, University of Stirling, Stirling; Alison Dawson, PhD, School of Applied Social Science, University of Stirling, Stirling; Richard Sinnott, PhD, University of Melbourne, Melbourne; Susan McCafferty, MSc, National eScience Centre, University of Glasgow, Glasgow; Carole Morris, BSc, David Clark BSc, Anthea Springbett, PhD, Information Services Division, NHS National Services Scotland, Edinburgh, UK
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Chou SP, Huang B, Goldstein R, Grant BF. Temporal associations between physical illnesses and mental disorders--results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Compr Psychiatry 2013; 54:627-38. [PMID: 23522830 PMCID: PMC3931424 DOI: 10.1016/j.comppsych.2012.12.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 12/19/2012] [Accepted: 12/31/2012] [Indexed: 10/27/2022] Open
Abstract
Clinical and epidemiologic evidence has documented the significant associations between medical illnesses and psychiatric disorders. However, extensive research has focused on the comorbidity of medical conditions and depression, and most were cross sectional, focused on clinical samples, and grounded in DSM-III or DSM-III-R diagnostic criteria. The current prospective investigation examined associations among medical conditions at baseline and incident psychiatric disorders over a 3-year follow-up, using data from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Overall, the 3-year incidence rates of DSM-IV substance use, mood and anxiety disorders ranged from 0.65% (bipolar II) to 5.2% (alcohol abuse). Multiple regression analysis was conducted to examine the prospective physical-mental associations, while controlling for sociodemographic characteristics, psychological stress and health-related risk factors, and comorbid physical and psychiatric disorders. The present study represents, to our knowledge the largest population-based prospective study examining the physical-mental associations. Our results showed distinctly different patterns of comorbidity of medical illnesses with substance use, mood, and anxiety disorders. Stomach ulcer/gastritis, hypertension and arthritis emerged to be significant predictors of incident psychiatric disorders.
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Affiliation(s)
- S Patricia Chou
- National Institute on Alcohol Abuse and Alcoholism, US National Institutes of Health, Bethesda, MD 20892, USA.
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9
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Park S, Choi JW, Kyoung Yi K, Hong JP. Suicide mortality and risk factors in the 12 months after discharge from psychiatric inpatient care in Korea: 1989-2006. Psychiatry Res 2013; 208:145-50. [PMID: 23058096 DOI: 10.1016/j.psychres.2012.09.039] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 07/06/2012] [Accepted: 09/20/2012] [Indexed: 11/19/2022]
Abstract
This study aimed to determine the suicide mortality within 1 year after discharge from psychiatric inpatient care and identify the risk factors for suicide completion during this period. A total of 8403 patients were admitted to general hospitals in Seoul, Korea, for psychiatric disorders from January 1989 to December 2006. The suicide mortality risk of these patients within 1 year of discharge was compared with that of gender- and age-matched subjects from the general population of Korea. The standardized mortality ratios (SMR) for suicide in the year following discharge were 49.7 for males and 45.5 for females. Patients aged 15-24 years had the highest risk for suicide. Among the different diagnostic groups, patients with personality disorders, schizophrenia, or affective disorders had the highest risk for suicide completion. Suicidal ideation at admission and inpatient stay more than 1 month were also associated with increased risk of suicide. In Korean psychiatric patients, the SMR is much higher in young female patients, a high percentage of patients commit suicide by jumping, and there is a stronger association of long duration of hospitalization and suicide. These factors should be considered in the development and implementation of suicide prevention strategies for Korean psychiatric patients.
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Affiliation(s)
- Subin Park
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
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Cutcliffe J, Links P, Harder H, Bergmans Y, Balderson K, Eynan R, Ambreen M, Neibaum R. Understanding the Risks of Recent Discharge: The Phenomenological Experiences. CRISIS 2012; 33:265-72. [DOI: 10.1027/0227-5910/a000132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Evidence indicates that people whose mental health problems lead them to require psychiatric hospitalization are at a significantly increased risk of suicide, and the period of time immediately following discharge after such hospitalizations appears to be a particularly high-risk time. Aims: This paper reports on phenomenological findings from a federally funded, mixed-methods study that sought to better understand the observed increased risk for suicide following discharge from an inpatient psychiatric service. Methods: A purposive sample of 20 recently discharged former suicidal inpatients was obtained. Data were collected from the participants in hermeneutic interviews lasting between 1 h and 2 h and analyzed according to van Manen’s (1997) interpretation of hermeneutic phenomenology. Results: Two key themes were induced: “Existential Angst at the Prospect of Discharge” and “Trying to Survive While Living Under the Proverbial ‘Sword of Damocles’.” Each of these was comprised of five themes with the second key theme – the focus of this paper – encompassing the following: “Needing Postdischarge Support,” “Feeling Lost, Uncertain and Disorientated,” “Feeling Alone and Isolated,” “Suicide Remains an Option,” and “Engaging in Soothing, Comforting Behaviors.” Conclusions: The authors conclude that early exploration of and reconciling patients’ expectations regarding inpatient care for their suicidality would appear to be an empirically based intervention that could diminish the postdischarge risk for further suicide attempts.
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Affiliation(s)
- John Cutcliffe
- University of Maine, USA; University of Ulster, UK; University of Coimbra, Portugal, and University of Malta, Malta
| | - Paul Links
- University of Toronto and St. Michaels Hospital, Toronto, Canada
| | | | - Yvonne Bergmans
- University of Toronto and St. Michaels Hospital, Toronto, Canada
| | - Ken Balderson
- University of Toronto and St. Michaels Hospital, Toronto, Canada
| | | | | | - Rosanne Neibaum
- University of Toronto and Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Canada
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Park S, Kim SY, Hong JP. Cause-specific mortality of psychiatric inpatients and outpatients in a general hospital in Korea. Asia Pac J Public Health 2012; 27:164-75. [PMID: 22815305 DOI: 10.1177/1010539512452755] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This study aimed to examine the cause-specific excess mortality of psychiatric patients in a general hospital in Korea. Between January 1995 and December 2006, 29 986 patients presented to the outpatient clinic of a general hospital in Seoul, Korea, or were admitted to that hospital for psychiatric disorders. Their cause-specific mortality risk was compared with that of age-matched patients from the general Korean population. The mortality risk of psychiatric patients was 1.6 times higher than that of the general population. Inpatients, younger adults, and patients with alcohol use disorders or schizophrenia had the highest standardized mortality rates (SMRs). Alcohol use disorder was associated with extremely high SMRs of more than 20 for hematological disease and digestive system disease. Effective preventive measures are required to reduce the excess mortality of psychiatric patients, particularly alcohol-dependent patients and younger patients who have been admitted for general psychiatric care.
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Affiliation(s)
- Subin Park
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Seong Yoon Kim
- University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin Pyo Hong
- University of Ulsan College of Medicine, Seoul, Republic of Korea
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Cutcliffe JR, Links PS, Harder HG, Balderson K, Bergmans Y, Eynan R, Ambreen M, Nisenbaum R. Understanding the risks of recent discharge: the phenomenological lived experiences--“existential angst at the prospect of discharge”. CRISIS 2012; 33:21-9. [PMID: 21940246 DOI: 10.1027/0227-5910/a000096] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Evidence indicates that people whose mental health problems lead them to require psychiatric hospitalization are at a significantly increased risk of suicide, and that the time immediately following discharge after such hospitalizations is a particularly high-risk time. AIMS This paper reports on phenomenological findings from a federally funded, mixed-methods study that sought to better understand the observed increased risk for suicide following discharge from an inpatient psychiatric service. METHODS A purposive sample of 20 recently discharged former suicidal inpatients was obtained. Data were collected in hermeneutic interviews lasting between 1 h and 2 h and analyzed according to van (1997) interpretation of hermeneutic phenomenology. RESULTS Two key themes, "existential angst at the prospect of discharge" and "trying to survive while living under the proverbial 'sword of Damocles'" were induced. Each of these was comprised of five themes with the first key theme (which is the focus of this paper) encompassing the following: "Feeling scared, anxious, fearful and/or stressed," "Preparedness," "Leaving the place of safety," "Duality and ambivalence," and "Feel like a burden." CONCLUSIONS Early exploration of and reconciling of patients' expectations regarding inpatient care for their suicidality would be empirically based interventions that could diminish the postdischarge risk for further suicide attempts.
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Links P, Nisenbaum R, Ambreen M, Balderson K, Bergmans Y, Eynan R, Harder H, Cutcliffe J. Prospective study of risk factors for increased suicide ideation and behavior following recent discharge. Gen Hosp Psychiatry 2012; 34:88-97. [PMID: 21997244 DOI: 10.1016/j.genhosppsych.2011.08.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 08/10/2011] [Accepted: 08/12/2011] [Indexed: 10/16/2022]
Abstract
OBJECTIVE The purpose of this study is to prospectively examine the association between predictors from the three thematic areas - suicidality, personal risk factors and patient care factors - and the occurrence of postdischarge suicide ideation and behavior in recently discharged patients. METHODS The design is a prospective cohort study of all patients admitted to an inner city inpatient psychiatric service with a lifetime history of suicidal behavior and current suicidal ideation. Predictors of suicide ideation at 1, 3 and 6 months following discharge and suicide behavior over the 6 months of follow-up were examined. RESULTS The incidence of death by suicide during the study period was 3.3% [95% confidence interval (CI)=0.9%-8.3%], and 39.4% (95% CI=30.0%-49.5%) of the surviving participants reported self-injury or suicide attempts within 6 months of hospital discharge. Risk factors such as recent suicide attempts, levels of depression, hopelessness and impulsivity were predictive of increased suicide ideation or behavior after discharge from the inpatient service. CONCLUSIONS The high risk of suicide ideation, suicide attempts and suicide demonstrated in these recently discharged patients supports the need to develop selective prevention strategies.
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Affiliation(s)
- Paul Links
- Suicide Studies Research Unit at St. Michael's Hospital, Toronto, Ontario, Canada.
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Abstract
This article illustrates the value of specific prescribing practices in three important areas--treatment adherence, prevention of suicide by overdose/accidental overdose, and communication and accountability--in achieving the safe and seamless discharge of psychiatric patients from an inpatient psychiatry unit. Psychiatric patients are at particular risk for adverse clinical events upon discharge from the hospital. Achieving safe and effective prescribing practices in mental health care requires an understanding of the elements that contribute to a patient's successful discharge from an inpatient unit. The implementation of specific prescribing practices, such as open communication with patients and families and collaboration among healthcare providers, can improve adherence to treatment, reduce the risk of overdose and suicide, ensure a seamless transition to the next provider of care, and facilitate best outcomes for patients.
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Lawrence D, Kisely S, Pais J. The epidemiology of excess mortality in people with mental illness. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2010; 55:752-60. [PMID: 21172095 DOI: 10.1177/070674371005501202] [Citation(s) in RCA: 171] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE to investigate the burden of excess mortality among people with mental illness in developed countries, how it is distributed, and whether it has changed over time. METHOD we conducted a systematic search of MEDLINE, restricting our attention to peer-reviewed studies and reviews published in English relating to mortality and mental illness. Because of the large number of studies that have been undertaken during the last 30 years, we have selected a representative cross-section of studies for inclusion in our review. RESULTS there is substantial excess mortality in people with mental illness for almost all psychiatric disorders and all main causes of death. Consistently elevated rates have been observed across settings and over time. The highest numbers of excess deaths are due to cardiovascular and respiratory diseases. With life expectancy increasing in the general population, the disparity in mortality outcomes for people with mental illness is increasing. CONCLUSIONS without the development of alternative approaches to promoting and treating the physical health of people with mental illness, it is possible that the disparity in mortality outcomes will persist.
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Affiliation(s)
- David Lawrence
- Centre for Developmental Health, Curtin University of Technology and Telethon Institute for Child Health Research, Perth, Australia.
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Mai Q, Holman CDJ, Sanfilippo FM, Emery JD, Stewart LM. Do users of mental health services lack access to general practitioner services? Med J Aust 2010; 192:501-6. [PMID: 20438420 DOI: 10.5694/j.1326-5377.2010.tb03607.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2009] [Accepted: 11/22/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare rates of visits to a general practitioner between users and non-users of mental health services (MHS). DESIGN, PARTICIPANTS AND SETTING Population-based retrospective cohort study of 204 727 users and 294 076 matched non-users of MHS in Western Australia from 1 January 1990 to 30 June 2006, based on linked records of the use of MHS, hospital admissions, Medicare claims for GP and specialist services, electoral roll registration and deaths. MAIN OUTCOME MEASURES Adjusted rate ratios (ARRs) for the number of visits to GPs by users of MHS relative to non-users, and for different categories of mental disorders. RESULTS Relative to non-users of MHS, the ARR of visits to GPs by users of MHS was 1.622 (95% CI, 1.613-1.631) overall, and was elevated in each separate category of mental illness. ARRs were highest for alcohol/drug disorders, schizophrenia and affective psychoses (2.404, 1.834 and 1.798, respectively). The results were not changed by location (metropolitan, rural or remote addresses). However, the 4% of MHS users with no fixed address had a very low ARR of visits to GPs (0.058; 95% CI, 0.057-0.060). CONCLUSIONS Users of MHS visit GPs substantially more often than non-users, with the exception of those with no fixed address who seldom see a GP at all.
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Affiliation(s)
- Qun Mai
- University of Western Australia, Perth, WA, Australia.
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Lu CY. Pharmacoepidemiologic research in Australia: challenges and opportunities for monitoring patients with rheumatic diseases. Clin Rheumatol 2009; 28:371-7. [DOI: 10.1007/s10067-009-1102-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Revised: 01/13/2009] [Accepted: 01/14/2009] [Indexed: 10/21/2022]
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Cutcliffe JR, Stevenson C. Never the twain? Reconciling national suicide prevention strategies with the practice, educational, and policy needs of mental health nurses (Part one). Int J Ment Health Nurs 2008; 17:341-50. [PMID: 18789044 DOI: 10.1111/j.1447-0349.2008.00557.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Suicide remains as a distinct global public health problem, and the reduction of rates continues to be a major concern of the governments of many countries; this has given rise to the creation of national suicide prevention strategies. As with any other mental health-related policy document, it behoves mental health nurses to juxtapose these against the realities of their practice and educational needs. To this end, this two part paper draws on national suicide prevention strategy policy directions that appear to speak directly to the practice and/or educational needs of mental health nurses and critiques these. The direction indicating more training in risk assessment is perhaps questionable given that this is already by far the most developed area of the suicidology-focused literature and that our increased knowledge has risk factors that have not so far produced widespread reductions in suicide rates. Furthermore, this additional attention, at least in part, reflects the clear move towards more coercion and control in international mental health policy. The direction indicating that practitioners should use evidence-based interventions to prevent suicide is laudable although difficult to reconcile with practice realities given that there is currently a distinct lack of evidence-based interventions for working with people who are suicidal. As a result, this paper offers some suggested amendments to the national suicide prevention strategies, and the second part of this paper focuses on three more policy directions.
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Mortality of Finnish acute psychiatric hospital patients. Soc Psychiatry Psychiatr Epidemiol 2008; 43:660-6. [PMID: 18478169 DOI: 10.1007/s00127-008-0344-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Accepted: 03/13/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The mortality of psychiatric patients is higher than that of the general population. Earlier studies have typically focused on specific diagnostic categories or causes of death. The aim of this study was to assess the overall mortality in acute psychiatric hospital patients covering all diagnostic groups, with special emphasis on substance abuse. METHODS The sample consisted of all 18-64-year old patients (n = 3,835) treated or evaluated in the acute wards of the Department of Psychiatry at Tampere University Hospital between the years 1999 and 2003, who were followed-up until the end of the year 2005. We assessed the various causes of death according to background variables in bivariate and multivariate analyses and calculated the standardized mortality ratios (SMRs). RESULTS During the study period 379 subjects died (9.9% of the sample). Mortality among men was almost twice as high as among women. Of all deaths, 45.6% were considered to be alcohol or drug related. SMR covering all subjects was 6.55. The SMRs for unnatural causes were higher than those for natural causes. The highest SMRs for unnatural causes of death were found in patients with mood disorders and the highest SMRs for natural causes of death in patients with schizophrenia spectrum disorders. Use of coercive measures was associated with increased mortality. CONCLUSION Mortality among Finnish psychiatric acute hospital patients is considerably higher than in general population. Excessive alcohol consumption plays a major role in causing excess deaths that could be potentially avoided.
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Abstract
Previous research has shown that suicide risk is highest in the year after people have been discharged from a psychiatric hospital. As such, identifying predictors of suicide within this time frame is important. Results from a systematic database search showed that all significant suicide predictors--those found in more than one study--could be grouped into factors related to suicidality, patient care factors, and demographic and psychopathological factors. Increased knowledge of suicide predictors for this particularly high-risk time, identified in this review, can help inform prevention and intervention efforts that may significantly reduce suicide rates.
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Sharma BR, Gupta M, Sharma AK, Sharma S, Gupta N, Relhan N, Singh H. Suicides in Northern India: comparison of trends and review of literature. J Forensic Leg Med 2006; 14:318-26. [PMID: 17112767 DOI: 10.1016/j.jcfm.2006.08.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2006] [Revised: 07/20/2006] [Accepted: 08/10/2006] [Indexed: 11/21/2022]
Abstract
Trends of suicide vary widely according to time, region, age group, sex, and race. Despite mixed trends of increases or decreases in suicide rates around the world, suicide remains an important public-health problem. In an effort to understand and prevent suicide, researchers have investigated medical, psychosocial, cultural, and socio-economic risk factors associated with the environment as a promising line of research. There is now considerable evidence that childhood and family adversities in general such as childhood sexual and physical abuse, witnessing domestic violence, parental separation or divorce and living with substance abusing, mentally ill or criminal family members may be both strongly interrelated and individually related to suicidal behavior in adolescents as well as adults. The approach towards prevention of suicide has to be multidisciplinary. To recognize that adverse childhood experiences that frequently take place as multiple events, identifying and treating those young people who have been exposed to such experiences, promoting increased awareness among parents, teachers, and health professionals of the important role that severe interpersonal difficulties and dysfunctional cognitions can play in the development of suicidal behavior in young people, and helping parents modify their maladaptive child-rearing behavior could help. Child and family support programs, employment support for mothers, and legal guarantees of gender equality, could moderate problems of socio-economic disparity and poverty, which predicts both parents' and children's suicidal behaviors in modern societies.
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Affiliation(s)
- B R Sharma
- Department of Forensic Medicine and Toxicology, Government Medical College and Hospital, # 1156 - B, Sector 32 - B, Chandigarh, India.
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Rock DJ, Greenberg DM, Hallmayer JF. Impact of case fatality on the seasonality of suicidal behaviour. Psychiatry Res 2005; 137:21-7. [PMID: 16209892 DOI: 10.1016/j.psychres.2005.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2004] [Revised: 01/17/2005] [Accepted: 08/03/2005] [Indexed: 11/26/2022]
Abstract
A number of differences exist between the seasonality of suicide and suicidal behaviour. Case fatality is one index of the relationship between these phenomena. The purpose of this study was to use contemporaneous data to examine the impact of case fatality on the seasonality of suicidal behaviour. All deliberate self-harm (ICD9 E950-58) hospitalisations (DSH) and deaths (suicide) for 1984-93 were extracted from the Western Australia case register (N=22 883). Case fatality was calculated by method of suicide. Data were arranged in time series by standardised month according to case fatality; sex and age and analysed using spectral analysis. We found that DSH involving low case fatal methods is seasonal with a spring peak (95% confidence interval). The explained variance of the seasonal rhythm increases with age. Suicide involving high case fatal methods is not seasonal. The increase in DSH seasonality with age may be related to a parallel increase in case fatality.
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Affiliation(s)
- Daniel Joseph Rock
- Centre for Clinical Research in Neuropsychiatry, Graylands Hospital, Locked Bag No. 1, Claremont, 6910, Perth, Western Australia, Australia.
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Ran MS, Wu QH, Conwell Y, Chen EYH, Chan CLW. Suicidal behavior among inpatients with schizophrenia and mood disorders in Chengdu, China. Suicide Life Threat Behav 2005; 34:311-9. [PMID: 15385185 DOI: 10.1521/suli.34.3.311.42784] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study evaluated the characteristics of suicidal behavior (suicide attempt or suicidal ideation) among 230 consecutively admitted inpatients with schizophrenia and mood disorders in a university hospital in China. The rate of lifetime suicidal behavior was found to be significantly higher in patients with mood disorders (62.4%) than in patients with schizophrenia (38.6%). The rate of suicidal behavior was significantly higher in patients with major depressive disorder (86.8%) than those with bipolar disorders (42.6%). Patients with schizophrenia attempted suicide for the first time earlier in life than the patients with mood disorders. Mood disorder patients, especially those with major depressive disorder, had more and more serious suicide attempts than the patients with schizophrenia.
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Affiliation(s)
- Mao-Sheng Ran
- Institute of Mental Health, West China Hospital, West China Medical School of Sichuan University, Chengdu, China.
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Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders. Aust N Z J Psychiatry 2005; 39:1-30. [PMID: 15660702 DOI: 10.1080/j.1440-1614.2005.01516.x] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The Royal Australian and New Zealand College of Psychiatrists is co-ordinating the development of clinical practice guidelines (CPGs) in psychiatry, funded under the National Mental Health Strategy (Australia) and the New Zealand Health Funding Authority. This paper presents CPGs for schizophrenia and related disorders. Over the past decade schizophrenia has become more treatable than ever before. A new generation of drug therapies, a renaissance of psychological and psychosocial interventions and a first generation of reform within the specialist mental health system have combined to create an evidence-based climate of realistic optimism. Progressive neuroscientific advances hold out the strong possibility of more definitive biological treatments in the near future. However, this improved potential for better outcomes and quality of life for people with schizophrenia has not been translated into reality in Australia. The efficacy-effectiveness gap is wider for schizophrenia than any other serious medical disorder. Therapeutic nihilism, under-resourcing of services and a stalling of the service reform process, poor morale within specialist mental health services, a lack of broad-based recovery and life support programs, and a climate of tenacious stigma and consequent lack of concern for people with schizophrenia are the contributory causes for this failure to effectively treat. These guidelines therefore tackle only one element in the endeavour to reduce the impact of schizophrenia. They distil the current evidence-base and make recommendations based on the best available knowledge. METHOD A comprehensive literature review (1990-2003) was conducted, including all Cochrane schizophrenia reviews and all relevant meta-analyses, and a number of recent international clinical practice guidelines were consulted. A series of drafts were refined by the expert committee and enhanced through a bi-national consultation process. TREATMENT RECOMMENDATIONS This guideline provides evidence-based recommendations for the management of schizophrenia by treatment type and by phase of illness. The essential features of the guidelines are: (i) Early detection and comprehensive treatment of first episode cases is a priority since the psychosocial and possibly the biological impact of illness can be minimized and outcome improved. An optimistic attitude on the part of health professionals is an essential ingredient from the outset and across all phases of illness. (ii) Comprehensive and sustained intervention should be assured during the initial 3-5 years following diagnosis since course of illness is strongly influenced by what occurs in this 'critical period'. Patients should not have to 'prove chronicity' before they gain consistent access and tenure to specialist mental health services. (iii) Antipsychotic medication is the cornerstone of treatment. These medicines have improved in quality and tolerability, yet should be used cautiously and in a more targeted manner than in the past. The treatment of choice for most patients is now the novel antipsychotic medications because of their superior tolerability and, in particular, the reduced risk of tardive dyskinesia. This is particularly so for the first episode patient where, due to superior tolerability, novel agents are the first, second and third line choice. These novel agents are nevertheless associated with potentially serious medium to long-term side-effects of their own for which patients must be carefully monitored. Conventional antipsychotic medications in low dosage may still have a role in a small proportion of patients, where there has been full remission and good tolerability; however, the indications are shrinking progressively. These principles are now accepted in most developed countries. (vi) Clozapine should be used early in the course, as soon as treatment resistance to at least two antipsychotics has been demonstrated. This usually means incomplete remission of positive symptomatology, but clozapine may also be considered where there are pervasive negative symptoms or significant or persistent suicidal risk is present. (v) Comprehensive psychosocial interventions should be routinely available to all patients and their families, and provided by appropriately trained mental health professionals with time to devote to the task. This includes family interventions, cognitive-behaviour therapy, vocational rehabilitation and other forms of therapy, especially for comorbid conditions, such as substance abuse, depression and anxiety. (vi) The social and cultural environment of people with schizophrenia is an essential arena for intervention. Adequate shelter, financial security, access to meaningful social roles and availability of social support are essential components of recovery and quality of life. (vii) Interventions should be carefully tailored to phase and stage of illness, and to gender and cultural background. (viii) Genuine involvement of consumers and relatives in service development and provision should be standard. (ix) Maintenance of good physical health and prevention and early treatment of serious medical illness has been seriously neglected in the management of schizophrenia, and results in premature death and widespread morbidity. Quality of medical care for people with schizophrenia should be equivalent to the general community standard. (x) General practitioners (GPs)s should always be closely involved in the care of people with schizophrenia. However, this should be truly shared care, and sole care by a GP with minimal or no specialist involvement, while very common, is not regarded as an acceptable standard of care. Optimal treatment of schizophrenia requires a multidisciplinary team approach with a consultant psychiatrist centrally involved.
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O'Connor N, Warby M, Raphael B, Vassallo T. Changeability, confidence, common sense and corroboration: comprehensive suicide risk assessment. Australas Psychiatry 2004; 12:352-60. [PMID: 15715807 DOI: 10.1080/j.1440-1665.2004.02126.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The authors, in collaboration with NSW Health, have recently developed a comprehensive suicide risk assessment framework. The present paper describes key concepts in the assessment of suicide risk by mental health professionals. METHODS A framework for conducting a comprehensive suicide risk assessment was derived from the literature, incident analysis and clinical experience. The framework underwent a consultation process involving clinicians in NSW area mental health services. The aim was to provide clinicians with a standardized conceptual map for the assessment of suicide risk. A MEDLINE search was conducted for publications dealing with 'suicide' and 'suicide risk assessment' from 1980 to 2002. The recommendations from sentinel event reviews conducted in a NSW area mental health service in the period 1999-2002 were reviewed. The lessons from a visit to a coroner's relatives support group for people who had been bereaved by suicide also informed the development of the guidelines. RESULTS A framework is proposed for the assessment of suicide risk. The framework promotes a reflective style of practice, encouraging clinicians to evaluate their assessment and its limitations. Risk assessment is always undertaken as part of a full clinical assessment and an evaluation of the person's current predicament and psychosocio-cultural context. The concepts of changeability, assessment confidence, common sense and the importance of corroboration are incorporated in the framework. CONCLUSIONS Mental health clinicians can be guided by a framework in suicide risk assessment and documentation. The assessment of suicide risk can generate a suicide risk rating for which minimum standards of care can be mandated.
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Affiliation(s)
- Nick O'Connor
- Area Mental Health, Macquarie Hospital, North Ryde, NSW, Australia.
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Tournier M, Molimard M, Abouelfath A, Cougnard A, Fourrier A, Haramburu F, Bégaud B, Verdoux H. Accuracy of self-report and toxicological assays to detect substance misuse disorders in parasuicide patients. Acta Psychiatr Scand 2003; 108:410-8. [PMID: 14616221 DOI: 10.1046/j.0001-690x.2003.00227.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To assess the accuracy of self-reported substance use and toxicological assays in subjects admitted for Intentional Drug Overdose (IDO), using as a reference diagnosis of substance use disorder. METHOD Self-reported substance use was collected and toxicological assays were carried out in urine samples in 507 patients with IDO. A standardized psychiatric evaluation was performed in 100 randomly selected subjects. RESULTS In routine practice, the emergency department staff did not investigate substance use in nearly one of two patients. Patients' statements and toxicological assays were more specific than sensitive, with lower scores for toxicological assays. Patients' statements made it possible to detect nearly 80% of subjects with substance use disorder. CONCLUSION Identification of substance use disorder in subjects with IDO has strong clinical consequences regarding treatment and prevention of suicidal behaviour. Thus, emergency department staff should be made aware of the value of more systematically exploring self-reported substance use.
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Affiliation(s)
- M Tournier
- Department of Psychiatry, Université Victor Segalen Bordeaux 2, Hôpital Charles Perrens, 121 rue de la Béchade, 33076 Bordeaux cedex, France.
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Levi F, La Vecchia C, Lucchini F, Negri E, Saxena S, Maulik PK, Saraceno B. Trends in mortality from suicide, 1965-99. Acta Psychiatr Scand 2003; 108:341-9. [PMID: 14531754 DOI: 10.1034/j.1600-0447.2003.00147.x] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To analyse trends in mortality from suicide over the period 1965-99. METHOD Data were derived from the WHO database, including data for 47 countries. RESULTS In the European Union (EU), all age suicide mortality peaked at 16.1/100,000 in men in 1980-84, and declined thereafter to 14.4/100,000 in 1995-98. In females, the fall was 29% to reach 4.6/100,000. A similar pattern of trends was observed in several eastern European countries. In contrast, mortality from suicide rose substantially in the Russian Federation, from 37.7/100,000 in males in 1985-89 to 58.3/100,000 in 1995-98 (+55%), and to 9.5/100,000 (+12%) in females. In the USA and most other American countries providing data, no consistent pattern was evident for males, but falls were observed in females. Steady declines were registered for Japan, starting from the highest suicide rates worldwide in the late 1950s. Suicide rates were upwards in Ireland, Italy, Spain, the UK, Cuba, Australia and New Zealand. Substantial rises were observed in a few countries (Ireland, Cuba, Mexico, Australia and New Zealand) for young males. CONCLUSION In spite of mixed trends, suicide remains a significant public health problem worldwide.
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Affiliation(s)
- F Levi
- Cancer Epidemiology Unit, University Institute of Social and Preventive Medicine, Bugnon, Lausanne, Switzerland.
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Abstract
OBJECTIVE To explore the characteristics of psychotic patients with suicide attempts in a Chinese rural community. METHOD An epidemiological investigation of psychotic patients with suicide attempts among 123,572 population (over 15 years of age) was conducted in Xinjin County, Chengdu. RESULTS The rate of suicide attempts was found to be 8.17% among all the psychotic patients (906 cases). Patients with affective psychosis showed a significantly higher rate of suicidal attempts (15.3%) than those with schizophrenia (7.5%) (P < 0.005). Suicide attempts were significantly associated with depression and hopelessness in both schizophrenia and affective psychosis (P < 0.001). Patients with suicide attempts were younger and had an earlier age of onset than those without suicide attempts (P < 0.05). Patients with schizophrenia and affective disorders were the major patients with suicide attempts. CONCLUSION The rate of suicide attempts in psychotic patients may be largely influenced by the illness itself. Community-based services should be necessary for these patients.
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Affiliation(s)
- Mao-Sheng Ran
- Department of Social Work and Social Administration, and Center of Suicide Research and Prevention, The University of Hong Kong, Pokfulam Road, Hong Kong, China.
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Abstract
OBJECTIVE Even in countries whose mental health services are comparatively well resourced, the care offered to those in the early stages of psychotic illnesses is not what it could be. Patients often have to progress to chronicity before receiving adequate interventions, by which stage there has been great potential for harm, not only through the psychosis, but also to the quality of life of the individual who has often missed or not completed adequately, several important developmental tasks. Further, evidence indicates that delay in treatment is positively associated with poorer outcome. This paper puts the case for early intervention in psychosis. METHOD Based on the experience of the Early Psychosis Prevention and Intervention Centre in Melbourne, the paper reviews the evidence for and the criticisms of, early intervention. Using the concept of indicated prevention, it suggests ways in which clinicians can improve the interventions available to those experiencing the onset of psychosis and suggests that pre-psychotic intervention may be possible. RESULTS Evidence discussed in this paper indicates that the development of mental illness is a major health issue in young people; that there is a positive correlation between duration of untreated psychosis and outcome; that it is possible to identify a proportion of those at high risk of developing mental illness; that through intervention it may be possible to reduce the transition rate to illness. CONCLUSION Primary prevention is beyond the capacity of our present knowledge. Indicated prevention in the form of early intervention and optimal, sustained treatment is a paradigm for which there is increasing supportive evidence. It is a paradigm which is appealing to clinicians, patients, families and which has the potential to reduce the secondary impact of serious mental illness such as suicide, stigma, isolation and reduction in social status.
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Affiliation(s)
- Patrick D McGorry
- Early Psychosis Prevention & Intervention Centre, Victoria, Australia.
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