Relation between parasuicide, suicide, psychiatric admissions, and socioeconomic deprivation

Socioeconomic deprivation and suicide in Appalachia: The use of three socioeconomic deprivation indices to explain county-level suicide rates

OBJECTIVE

West Virginia's (WV) suicide rate is 50% higher than the national average and is the highest in the Appalachian Region. Appalachia has several social factors that have contributed to greater socioeconomic deprivation, a known contributor of suicide. Given WV's high prevalence of suicide and poverty, the current study aims to examine the relationship between socioeconomic deprivation and suicide rates in WV.

METHODS

The Townsend Deprivation Index (TDI), Social Deprivation Index (SDI), and Social Vulnerability Index (SVI) measured socioeconomic deprivation. Negative binomial regression models assessed the relationship between socioeconomic deprivation scores, individual index items, and suicide rates. Model comparisons evaluated the indices' ability to assess suicide rates. A backward selection strategy identified additional key items for examining suicide rates.

RESULTS

There was a significant increase in suicide rates for every 10% increase in TDI (β = 0.04; p < 0.01), SDI (β = 0.03; p = 0.04), and SVI scores (β = 0.05; p < 0.01). Household overcrowding and unemployment had a positive linear relationship with suicide in TDI (β = 0.04, p = 0.02; β = 0.07, p = 0.01), SDI (β = 0.10, p = 0.02; β = 0.01, p<0.01), and the SVI (β = 0.10, p = 0.02; β = 0.03, p<0.01). The backwards selection strategy identified additional key items included by the SVI when assessing suicide.

CONCLUSION

Greater socioeconomic deprivation, measured by the TDI, SDI, and SVI, was significantly associated with higher suicide rates. Expanding unemployment benefits and increasing the availability of affordable housing, especially in rural areas, may be useful in reducing suicide rates. Our results suggest racial and ethnic minorities and adults living with a disability may benefit from targeted suicide prevention strategies.

Contextual influences on deliberate self-harm among Chinese university undergraduates: A representative nationwide study

BACKGROUND

Numerous studies have identified factors associated with deliberate self-harm (DSH), but environmental influences have largely been neglected. This study explored regional and university contextual factors that impact DSH among undergraduate students in China.

METHODS

Subjects in this observational cross-sectional study totaled 5016 undergraduate students, who were identified through multistage survey sampling in 22 Chinese universities. Individual-level data were obtained through a self-administered questionnaire, and environmental variables were extracted from the National Bureau of Statistics database. Multilevel logistic regression models were used to examine regional correlates of DSH.

RESULTS

The overall prevalence of self-reported DSH in the study sample was 7.5 % (95 % CI: 4.1 %, 10.9 %). The full multilevel logistic model showed university rank and city size were inversely associated with DSH prevalence (Adjusted Odds Ratio (AOR): 0.24 and 0.55). Regional unemployment rates were positively associated with DSH prevalence (AOR: 1.98, 95 % CI: 1.48, 2.65).

DISCUSSION

Contextual disparities appear to contribute to DSH among Chinese undergraduates. Preventive initiatives must focus on redressing imbalances in the allocation of social and economic resources across universities and regions.

It's not just in my head: An intersectional, social and systems-based framework in gender and sexuality diversity

BACKGROUND

The mental health and well-being of gender and sexuality diverse (GSD) people needs to be understood within a socio-political and cultural context.

AIMS

In this paper, an intersectional, social and system-based framework for understanding the mental health and well-being of GSD people is presented, for practitioners within this field to consider GSD mental health experiences and challenges within context.

MATERIALS AND METHODS

Starting with a consideration of the current landscape of understanding, pivotal theories and understandings within the field are outlined. The need for a framework that centralises intersectionality and broader systemic considerations is presented.

RESULTS

The framework provided has an explicit focus on four key features: (1) intersectionality, (2) institutions, policies and laws, (3) people and groups and (4) social stories.

DISCUSSION

Consideration of each of these 'circles of influence' can help practitioners to understand the multi-layered and intersectional experience of GSD folk and allows for an understanding of potential intervention at both an individual and systemic and societal level.

CONCLUSION

Use of such a framework in practice goes above and beyond what is currently available by centralising the role and impact of such wider systemic variables through an intersectional lens. The framework can be applicable worldwide given its flexibility to consider and apply pertinent policies, laws, people, groups and social stories within a particular country or culture.

Associations between social fragmentation, socioeconomic deprivation and suicide risk across 1887 municipalities in Japan, 2009-2017: a spatial analysis using the Bayesian hierarchical model

OBJECTIVE

Previous studies have indicated that spatial variation in suicide mortality is associated with area-specific socioeconomic characteristics, such as socioeconomic deprivation and social fragmentation. However, most of these studies have been conducted in the West and findings from Asian countries are limited. This study aims to investigate associations between socioeconomic characteristics and suicide mortality rates across 1887 municipalities in Japan between 2009 and 2017. We also assessed these associations by gender and age group.

METHODS

Suicide data were obtained from the suicide statistics of the Ministry of Health, Labour and Welfare in Japan and included information on the number of suicides by gender, age and municipality location. Social fragmentation, socioeconomic deprivation and urbanicity were used as socioeconomic characteristics in this study and were created from survey data obtained from the 2010 census. Bayesian hierarchical models were used to examine associations between socioeconomic characteristics and suicide risk.

RESULTS

Suicide rates were significantly higher in municipalities with higher levels of deprivation, with a rate ratio of 1.13 (95% credible interval: 1.10 to 1.17) in the highest quartile compared with the lowest. Higher levels of urbanicity had significantly lower suicide rates, with a rate ratio of 0.79 (95% credible interval: 0.77 to 0.82) in the highest quartile compared with the lowest. However, associations between exposures and suicide varied considerably by gender and age. Among both men and women aged 0-39 years, fragmentation was significantly associated with suicide, with rate ratios of 1.07 and 1.15 for men and women, respectively, in the highest quartile compared with the lowest.

CONCLUSION

Suicide prevention in Japan should particularly focus on areas with high levels of deprivation or low levels of urbanicity. Furthermore, young Japanese people residing in the most fragmented municipalities were also at high risk of suicide, and appropriate measures need to be taken.

Characterizing Unusual Spatial Clusters of Male Mental Health Emergencies Occurring During the First National COVID-19 "Lockdown" in the East Midlands Region, UK: A Geospatial Analysis of Ambulance 999 Data

The widespread psychological effects of contagion mitigation measures associated with the novel coronavirus disease 2019 (COVID-19) are well known. Phases of "lockdown" have increased levels of anxiety and depression globally. Most research uses methods such as self-reporting that highlight the greater impact of the pandemic on the mental health of females. Emergency medical data from ambulance services may be a better reflection of male mental health. We use ambulance data to identify unusual clusters of high rates of male mental health emergencies occurring in the East Midlands of the United Kingdom during the first national "lockdown" and to explore factors that may explain clusters. Analysis of more than 5,000 cases of male mental health emergencies revealed 19 unusual spatial clusters. Binary logistic regression analysis (χ2 = 787.22, df = 20, p ≤ .001) identified 16 factors that explained clusters, including proximity to "healthy" features of the physical landscape, urban and rural dynamics, and socioeconomic condition. Our findings suggest that the factors underlying vulnerability of males to severe mental health conditions during "lockdown" vary within and between rural and urban spaces, and that the wider "hinterland" surrounding clusters influences the social and physical access of males to services that facilitate mental health support. Limitations on social engagement to mitigate effects of the pandemic are likely to continue. Our approach could inform delivery of emergency services and the development of community-level services to support vulnerable males during periods of social isolation.

A Longitudinal Change Patterns of Depression and Its Relationship with Socioeconomic Deprivation among Middle-Aged Adults in South Korea

This study aimed to identify the longitudinal pattern changes of South Koreans’ midlife depression and determine the impact of socioeconomic deprivation on the observed change in patterns. In total, 3975 middle-aged individuals were examined by conducting a latent class growth analysis and multinomial logistic regression analysis on seven years of Korea Welfare Panel data (2012–2018) using STATA 16.0 (StataCorp LLC, College Station, TX, USA). The change patterns of midlife depression were classified into normal depression reduction group, mild depression maintenance group, and serious depression increase group. The impact of the experience of socioeconomic deprivation on the classified change patterns was examined using the normal depression reduction group as the reference group. It was found that the higher an individual’s nutritional, housing, occupational/economic, and healthcare deprivation, the higher their risk of mild depression maintenance or serious depression increase. The serious depression increase group showed higher relative risk ratios in all domains. Comprehensive and integrated social welfare services, such as stable income, housing welfare, and healthcare services, should be provided along with appropriate clinical interventions for depression alleviation that account for the pattern changes in midlife depression.

Does neighbourhood identification buffer against the effects of socioeconomic disadvantage on self-harm?

BACKGROUND

Socioeconomic disadvantage and lack of group belonging (i.e., social identity) have been linked to poor mental health. However, no research has investigated the relationship between neighbourhood identity and self-harm, nor whether identifying with one's neighbourhood can mitigate the effects of economic stress on self-harm.

METHODS

Pre-registered secondary data analysis of a large (N = 3412) community health survey conducted in disadvantaged areas of North West England.

RESULTS

Despite the sample having a relatively high and therefore restricted level of disadvantage, individual and geographic indicators of disadvantage, as well as neighbourhood identification, were unique and strong predictors of self-harm thoughts and behaviours across several analyses. Specifically, experiencing disadvantage and disidentification predicted significantly higher odds of self-harm and self-harm thoughts. No consistent interactive effects emerged.

LIMITATIONS

The cross-sectional design limits firm conclusions regarding causal effects of neighbourhood identity and disadvantage on self-harm. However, causal direction is supported by past research and theory. The data is self-report, which is subject to response bias. The sample was also recruited from a region of the UK with low numbers of residents from ethnic minority backgrounds.

CONCLUSIONS

The results are consistent with past research indicating an association between social identity and better mental health, but for the first time extend these effects to self-harm. The findings demonstrate the importance of considering social and economic factors when attempting to prevent suicide and understand and treat self-harm thoughts.

Illusory Essences: A Bias Holding Back Theorizing in Psychological Science

The reliance in psychology on verbal definitions means that psychological research is unusually moored to how humans think and communicate about categories. Psychological concepts (e.g., intelligence, attention) are easily assumed to represent objective, definable categories with an underlying essence. Like the “vital forces” previously thought to animate life, these assumed essences can create an illusion of understanding. By synthesizing a wide range of research lines from cognitive, clinical, and biological psychology and neuroscience, we describe a pervasive tendency across psychological science to assume that essences explain phenomena. Labeling a complex phenomenon can appear as theoretical progress before there is sufficient evidence that the described category has a definable essence or known boundary conditions. Category labels can further undermine progress by masking contingent and contextual relationships and obscuring the need to specify mechanisms. Finally, we highlight examples of promising methods that circumvent the lure of essences and suggest four concrete strategies for identifying and avoiding essentialist intuitions in theory development.

The Risk Factors Predicting Suicidal Ideation Among Perinatal Women in Japan

INTRODUCTION

The aim of the present study was to elucidate the foreseeable risk factors for suicidal ideation among Japanese perinatal women.

METHODS

This cohort study was conducted in Nagoya, Japan, from July 2012 to March 2018. The Edinburgh Postnatal Depression Scale (EPDS) questionnaire was conducted at four time points: early pregnancy, late pregnancy, 5 days postpartum, and 1 month postpartum. A total of 430 women completed the questionnaires. A logistic regression analysis was performed using the presence of suicidal ideation on the EPDS as an objective variable. The explanatory variables were age, presence of physical or mental disease, smoking and drinking habits, education, hospital types, EPDS total score in early pregnancy, bonding, and quality and amount of social support, as well as the history of major depressive disorder (MDD).

RESULTS

The rate of participants who were suspected of having suicidal ideation at any of the four time points was 11.6% (n=52), with the highest (n=25, 5.8%) at late pregnancy. For suicidal ideation, education level (OR: 1.19; 95% CI: 1.00-1.41; p=0.047), EPDS total points in the pregnancy period (OR: 1.25; 95% CI: 1.16-1.34; p < 0.000), a history of MDD (OR: 2.16; 95% CI: 1.00-4.79; p=0.049), and presence of mental disease (OR: 2.39; 95% CI: 1.00-5.70; p=0.049) were found to be risk factors for suicidal ideation. Age [odds ratio (OR): 0.88; 95% confidence interval (CI): 0.80-0.95; p=.002] and quality of social support (OR: 0.77; 95% CI: 0.60-0.99; p=.041) were found to be protective factors.

CONCLUSION

Based on these results, effective preventive interventions, such as increasing the quality of social support and confirming the history of depression, should be carried out in pregnant depressive women at the early stage of the perinatal period.

Pluralism and incommensurability in suicide research

This paper examines the complex research landscape of contemporary suicidology from a philosophy of science perspective. I begin by unpacking the methods, concepts, and assumptions of some of the prominent approaches to studying suicide causation, including psychological autopsy studies, epidemiological studies, biological studies, and qualitative studies. I then analyze the different ways these approaches partition the causes of suicide, with particular emphasis on the ways they conceptualize the domain of mental disorder. I argue that these different ways of partitioning the causal space and conceptualizing mental disorder result in incommensurabilities between the approaches. These incommensurabilities restrict the degrees to which the different approaches can be integrated, thus lending support to explanatory pluralism in the study of suicide causation. They also shed light on some of the philosophical underpinnings of the disagreement between mainstream suicidology and the emerging area of critical suicidology.

Spatial patterning and correlates of self-harm in Manchester, England

AIMS

To investigate the spatial distribution of self-harm incidence rates, their socioeconomic correlates and sex/age differences using data on self-harm presentations to emergency departments from The Manchester Self-Harm Project (2003-2013).

METHODS

Smoothed standardised incidence ratios for index self-harm episodes (n = 14 771) and their associations with area-level socioeconomic factors across 258 small areas (median population size = 1470) in the City of Manchester municipality were estimated using Bayesian hierarchical models.

RESULTS

Higher numbers and rates of self-harm were found in the north, east and far southern zones of the city, in contrast to below average rates in the city centre and the inner city zone to the south of the centre. Males and females aged 10-24, 25-44 and 45-64 years showed similar geographical patterning of self-harm. In contrast, there was no clear pattern in the group aged 65 years and older. Fully adjusted analyses showed a positive association of self-harm rates with the percentage of the unemployed population, households privately renting, population with limiting long-term illness and lone-parent households, and a negative association with the percentage of ethnicity other than White British and travel distance to the nearest hospital emergency department. The area-level characteristics investigated explained a large proportion (four-fifths) of the variability in area self-harm rates. Most associations were restricted to those aged under 65 years and some associations (e.g. with unemployment) were present only in the youngest age group.

CONCLUSIONS

The findings have implications for allocating prevention and intervention resources targeted at high-risk groups in high incidence areas. Targets for area-based interventions might include tackling the causes and consequences of joblessness, better treatment of long-term illness and consideration of the accessibility of health services.

Geographical Patterns in Drug-Related Mortality and Suicide: Investigating Commonalities in English Small Areas

There are increasing concerns regarding upward trends in drug-related deaths in a number of developed societies. In some countries, these have been paralleled by upward trends in suicide. Of frequent concern to public health policy are local variations in these outcomes, and the factors underlying them. In this paper, we consider the geographic pattern of drug-related deaths and suicide for 2012-2016 across 6791 small areas in England. The aim is to establish the extent of commonalities in area risk factors between the two outcomes, with a particular focus on impacts of deprivation, fragmentation and rurality.

Against a high-risk strategy in the prevention of suicide

Standard approaches to the prevention of suicide have concentrated on the rigorous assessment and management of suicidal risk. Using deliberate self-harm as a specific example, we discuss the relative merits of this ‘high-risk’ strategy and compare it with a population-based preventive strategy. We conclude that a combined approach offers the best hope for reducing the rate of suicide, although it may not fit easily with medical models of care.

Poverty, social inequality and mental health

The World Health Organization has described poverty as the greatest cause of suffering on earth. This article considers the direct and indirect effects of relative poverty on the development of emotional, behavioural and psychiatric problems, in the context of the growing inequality between rich and poor. The problems of children in particular are reviewed. Targets to reduce inequality have been set both nationally and internationally.

Mapping suicide mortality in Ohio: A spatial epidemiological analysis of suicide clusters and area level correlates

Previous studies have investigated spatial patterning and associations of area characteristics with suicide rates in Western and Asian countries, but few have been conducted in the United States. This ecological study aims to identify high-risk clusters of suicide in Ohio and assess area level correlates of these clusters. We estimated spatially smoothed standardized mortality ratios (SMR) using Bayesian conditional autoregressive models (CAR) for the period 2004 to 2013. Spatial and spatio-temporal scan statistics were used to detect high-risk clusters of suicide at the census tract level (N=2952). Logistic regression models were used to examine the association between area level correlates and suicide clusters. Nine statistically significant (p<0.05) high-risk spatial clusters and two space-time clusters were identified. We also identified several significant spatial clusters by method of suicide. The risk of suicide was up to 2.1 times higher in high-risk clusters than in areas outside of the clusters (relative risks ranged from 1.22 to 2.14 (p<0.01)). In the multivariate model, factors strongly associated with area suicide rates were socio-economic deprivation and lower provider densities. Efforts to reduce poverty and improve access to health and mental health medical services on the community level represent potentially important suicide prevention strategies.

Comparing social group identifications and socioeconomic deprivation as predictors of psychological distress: Evidence from a Scottish primary care sample

Social group identification and socioeconomic deprivation have both been linked to self-reported depressive symptoms in general population samples; however, no study to date has explored the strength of the joint predictive value of these factors within a mental health population. The current study explored the impact of social group identifications and socioeconomic deprivation, together with important clinical and demographic variables, on psychological distress in a Scottish mental health sample. Participants (N = 976) were recruited from referrals to a computerized cognitive behavioural therapy (cCBT) programme in Scotland, 'Beating the Blues' (BtB) over a 25-month period. Participants completed the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM) as a measure of psychological distress and three versions of the group identifications scale (GIS), one for each of three groups: family, community, and a social group of choice. Demographic information and clinical information were collected on commencing BtB. Higher numbers of group identifications were significantly associated with lower psychological distress. Additionally, increased socioeconomic deprivation was significantly associated with more severe psychological distress; however, interestingly, the association was not as strong as that of group identifications. Identifying with fewer social groups predicts more severe psychological symptom presentations, even more so than living in a greater state of socioeconomic deprivation.

Inequality in Addiction and Mental Disorders in 6818 Suicide Attempts: Determine of Positive Contribution of Determinants by Decomposition Method

BACKGROUND

Unpleasant health outcomes are common in deprived communities and have been shown a direct connection between socioeconomic status and wellbeing but, the effect of the socioeconomic status on suicide is currently controversial. This study explored the relationship of the socioeconomic status and addiction and mental disorders in suicide attempts and decomposed inequalities into its determinants to calculating share of contribution to the inequality.

METHODS

This cross-sectional study recognized 546 suicide deaths and 6818 attempted suicides from 1 Jan 2010 to 31 Dec 2014 in Ilam Province, West of Iran. Inequality measured by concentration index (CI) and decomposing contribution in inequality. All analysis was performed by standard statistical software, Stata (Ver. 11.2).

RESULTS

The pooled rate of death in people with suicide attempts was 8.0% and that of having a history of suicide was 5.2%. The overall CI for addiction was -0.233 (95% CI= -0.383 to -0.084), and the CI for mental disorders was 0.0006 (95% CI = -0.009 to 0.010). The more amount of contribution to socioeconomic inequality in suicide attempts because of age group of < 25 yr (26%), socioeconomic level (23%), and marital status (22%).

CONCLUSION

Addiction and mental disorders were distributed among suicide attempters unequally and gap between advantaged and disadvantaged attempted suicide confirmed by our results. Addiction prevention-related policies and programmers' should be focus on disadvantaged groups.

Differential associations between Social Anxiety Disorder, family cohesion, and suicidality across racial/ethnic groups: Findings from the National Comorbidity Survey-Adolescent (NCS-A)

The proposed research seeks to introduce a novel model relating Social Anxiety Disorder (SAD) and suicide outcomes (i.e., passive suicidal ideation, active suicidal ideation, and suicide attempts) in diverse adolescents. This model posits that family cohesion is one pathway by which suicide risk is increased for socially anxious youth, and predicts that the relationships between these variables may be of different strength in Latino and White subgroups and across gender. Data from a sample of Latino (n=1922) and non-Hispanic White (hereafter referred to as White throughout) (n=5648) male and female adolescents who participated in the National Comorbidity Survey-Adolescent were used for this study. Analyses were conducted using generalized structural equation modeling. Results showed that the mediation model held for White females. Further examination of direct pathways highlighted SAD as a risk factor unique to Latinos for active suicidal ideation and suicide attempt, over and above comorbid depression and other relevant contextual factors. Additionally, family cohesion showed a strong association with suicide outcomes across groups, with some inconsistent findings for White males. Overall, it appears that the mechanism by which SAD increases risk for suicidality is different across groups, indicating further need to identify relevant mediators, especially for racial/ethnic minority youth.

Socio-demographic characteristics, clinical profile and prevalence of existing mental illness among suicide attempters attending emergency services at two hospitals in Hawassa city, South Ethiopia: a cross-sectional study

BACKGROUND

Suicide is a major public health problem worldwide. It contributes for more than one million deaths each year. Since previous suicidal attempt was considered as the best predictor of future suicide, identifying factors behind suicidal attempt are helpful to design suicide prevention strategies. The aim of this study was to assess socio-demographic characteristics, clinical profile and prevalence of existing mental illness among patients presenting with suicidal attempt to emergency services of general hospitals in South Ethiopia.

METHODS

We conducted a cross-sectional study on patients presenting with complications of suicidal attempt to emergency departments of two general hospitals in Hawassa city from November, 2014 to August, 2015. Data was collected using semi-structured questionnaire which contained socio-demographic and clinical variables. The Mini International Neuropsychiatric Interview version 5 (MINI PLUs) was used to assess the prevalence of existing mental illness among study participants. Data was entered and analyzed using IBM SPSS statistics 21 software package.

RESULTS

A total of 96 individuals were assessed, of whom 56 (58.3%) were females. The mean age of study participants was 21.5 (8.0) years. The majority, 75 (78.1%), of the study participants were aged below 25 years. Ingesting pesticide poisons and corrosive agent were used by the majority to attempt suicide. Mental illness was found in only three (3.1%) of the study participants. Impulsivity (the time between decision to attempt suicide and the actual attempt of less than 5 min) was reported by 30 (31.2%) of the study participants, of whom 18 (60%) were males. Males were found three times more likely to attempt suicide impulsively than women (COR = 3.0, 95% CI 1.2-7.3). Quarreling with family members, facing financial crisis, and having unplanned and unwanted pregnancy were reported by the majority of study participants as immediate reasons to attempt suicide.

CONCLUSIONS

The presence of stressful life events and impulsivity behind suicidal behavior of the younger generation implies that designing suicide prevention strategies for this group is crucial. Moreover, further research is needed to systematically examine the relationship between the presence of mental illness and suicidal attempt with a larger sample size and more robust methodology.

Socioeconomic deprivation and the clinical management of self-harm: a small area analysis

PURPOSE

Socioeconomic deprivation is associated with increased rates of self-harm but its association with levels of clinical care has not previously been explored. The aim of the current study was to investigate socioeconomic differences in the clinical management of people who self-harm.

METHODS

Cross-sectional analysis of 3607 people presenting to a large inner-city hospital following self-harm.

RESULTS

People living in the least deprived quintile were more likely to receive a psychosocial assessment (most vs. least deprived: 63.51 vs. 70.14%). This effect persisted in our fully adjusted model (OR 1.45, CI 1.15-1.82, p = 0.002). Mediation analysis suggested this association was in large part explained by higher rates of self-discharge in people presenting from areas of higher deprivation.

CONCLUSIONS

Compared to those from more deprived areas, people from less deprived areas are more likely to receive a psychosocial assessment when presenting to hospital following self-harm. The occurrence of higher rates of self-discharge from emergency departments among those from more deprived areas may explain the association.

The Association Among Individual and Contextual Factors and Unmet Healthcare Needs in South Korea: A Multilevel Study Using National Data

Objectives

The objective of this study is to investigate associations between contextual characteristics and unmet healthcare needs in South Korea after accounting for individual factors.

Methods

The present study used data from the 2012 Korean Community Health Survey (KCHS) of 228 902 adults residing within 253 municipal districts in South Korea. A multilevel analysis was conducted to investigate how contextual characteristics, defined by variables that describe the regional deprivation, degree of urbanity, and healthcare supply, are associated with unmet needs after controlling for individual-level variables.

Results

Of the surveyed Korean adults, 12.1% reported experiencing unmet healthcare needs in the past. This figure varied with the 253 districts surveyed, ranging from 2.6% to 26.2%. A multilevel analysis found that the association between contextual characteristics and unmet needs varied according to the factors that caused the unmet needs. The degree of urbanity was associated with unmet need due to “financial burden” (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.42 to 0.66 for rural vs. metropolitan), but not unmet need due to “service not available when needed.” There were no significant associations between these unmet need measures and regional deprivation. Among individual-level variables, income level showed the highest association with unmet need due to “financial burden” (OR, 5.63; 95% CI, 4.76 to 6.66), while employment status showed a strong association with unmet need due to “service not available when needed.”

Conclusions

Our finding suggests that different policy interventions should be considered for each at-risk population group to address the root cause of unmet healthcare needs.

The influence of social deprivation as measured by the CNI on psychiatric admissions

The purpose of this study was to examine the importance of social deprivation for psychiatric admissions and its correlation with two different deprivation scores. Care Need Index (CNI) and Townsend scores were calculated at the small area level in Malmö, a city in southern Sweden. Admission rates for all psychiatric inpatients from Malmö aged 20 - 79 years, admitted to the psychiatric and alcohol clinics from 1 January 1991 to 31 December 1994, were calculated. The relationship between the CNI and psychiatric admissions was analysed by applying a Poisson regression model. The results are shown as incidence density ratios (IDR) with 95% confidence intervals (CI). From the most deprived areas, the first psychiatric admission rate was more than four times higher than in the most affluent areas. The rates of second and third admission were even higher. Admissions to the alcohol clinic were similar to psychiatric admissions, but the most deprived areas had first admission rates about ten times higher than in the most affluent areas. About 27% of first admissions, including patients from both psychiatric and alcohol clinics, had a diagnosis of psychosis, and 43% were substance abusers. There were differences between the patients' diagnoses in different areas. The correlation between the CNI and Townsend scores was very high. The most important finding of this study is the strong correlation between social deprivation, based on different deprivation indices, and first admissions to psychiatric and alcohol clinics.

Impact of the recent recession on self-harm: Longitudinal ecological and patient-level investigation from the Multicentre Study of Self-harm in England

BACKGROUND

Economic recessions are associated with increases in suicide rates but there is little information for non-fatal self-harm.

AIMS

To investigate the impact of the recent recession on rates of self-harm in England and problems faced by patients who self-harm.

METHOD

Analysis of data from the Multicentre Study of Self-harm in England for 2001-2010 and local employment statistics for Oxford, Manchester and Derby, including interrupted time series analyses to estimate the effect of the recession on rates of self-harm.

RESULTS

Rates of self-harm increased in both genders in Derby and in males in Manchester in 2008-2010, but not in either gender in Oxford, results which largely followed changes in general population unemployment. More patients who self-harm were unemployed in 2008-10 compared to before the recession. The proportion in receipt of sickness or disability allowances decreased. More patients of both genders had employment and financial problems in 2008-2010 and more females also had housing problems, changes which were also largely found in employed patients.

LIMITATIONS

We have assumed that the recession began in 2008 and information on problems was only available for patients having a psychosocial assessment.

CONCLUSIONS

Increased rates of self-harm were found in areas where there were greater rises in rates of unemployment. Work, financial and housing problems increased in people who self-harmed. Changes in welfare benefits may have contributed.

DECLARATION OF INTEREST

None.

Risk factors for repetition of a deliberate self-harm episode within seven days in adolescents and young adults: A population-level record linkage study in Western Australia

OBJECTIVE

The risk of repetition of deliberate self-harm peaks in the first 7 days after a deliberate self-harm episode. However, thus far no studies have examined the risk factors for repeating deliberate self-harm during this short-term period. We aimed to investigate the effects of socio-demographic factors, self-harm method and mental health factors in adolescents (10-19 years old) and young adults (20-29 years old).

METHODS

We used data linkage of population-wide administrative records from hospital inpatients and emergency departments to identify all the deliberate self-harm-related episodes that occurred in adolescents and young adults in Western Australia from 2000 to 2011. Logistic regression with generalised estimating equations was used for the analyses.

RESULTS

The incidence of repeating deliberate self-harm within the first 7 days after an index episode was 6% (403/6,768) in adolescents and 8% (842/10,198) in young adults. Socio-demographic risk factors included female gender and socioeconomic disadvantage. Compared with non-poisoning, self-poisoning predicted increased risk of having a repeated deliberate self-harm episode in males, but not in females. Borderline personality, impulse-control and substance use disorders diagnosed within one week before and one week after an index deliberate self-harm episode conferred the highest risk, followed by depressive and anxiety disorders. Having a preceding deliberate self-harm episode up to 7 days before an index episode was a strong predictor for the future repetition of a deliberate self-harm episode.

CONCLUSION

Having a repeated deliberate self-harm episode within the first 7 days was related to a wide range of factors present at an index deliberate self-harm episode including socio-demographic characteristics, deliberate self-harm method and co-existing psychiatric conditions. These factors can inform risk assessments tailored to adolescents and young adults respectively to reduce the repetition of deliberate self-harm within a short but critical period, potentially contributing to reduce the repetition of deliberate self-harm in the long term.

Social Welfare Centers Protect Outpatients with Mood Disorders from Risk of Hospital Admission

Background

South Korea faces difficulties in the management of mental disorders, and those difficulties are expected to gradually worsen. Therefore, we analyzed the relationship between social welfare centers and hospital admission after outpatient treatment for mood disorders.

Methods

We used data from the National Health Insurance Service National Sample Cohort 2002–2013, which included all medical claims filed for the 50,160 patients who were newly diagnosed with a mood disorder among the 1,025,340 individuals in a nationally representative sample. We performed a logistic regression analysis using generalized estimating equation (GEE) models to examine the relationship between social welfare centers and hospital admission after outpatient treatment for mood disorders (ICD-10: F3).

Results

There was a 3.9% admission rate among a total of 99,533 person-years. Outpatients who lived in regions with more social welfare centers were less likely to be admitted to a hospital (per increase of five social welfare centers per 100,000 people; OR: 0.958; 95% CI: 0.919–0.999). Social welfare centers had an especially strong protective effect on patients with relatively mild mood disorders and those who were vulnerable to medical expenditures.

Conclusions

Considering the protective role of social welfare centers in managing patients with mood disorders, health-policy makers need to consider strategies for activating mental healthcare.

General Practitioners' Accounts of Patients Who Have Self-Harmed: A Qualitative, Observational Study

Abstract.Background: The relationship between self-harm and suicide is contested. Self-harm is simultaneously understood to be largely nonsuicidal but to increase risk of future suicide. Little is known about how self-harm is conceptualized by general practitioners (GPs) and particularly how they assess the suicide risk of patients who have self-harmed. Aims: The study aimed to explore how GPs respond to patients who had self-harmed. In this paper we analyze GPs’ accounts of the relationship between self-harm, suicide, and suicide risk assessment. Method: Thirty semi-structured interviews were held with GPs working in different areas of Scotland. Verbatim transcripts were analyzed thematically. Results: GPs provided diverse accounts of the relationship between self-harm and suicide. Some maintained that self-harm and suicide were distinct and that risk assessment was a matter of asking the right questions. Others suggested a complex inter-relationship between self-harm and suicide; for these GPs, assessment was seen as more subjective. In part, these differences appeared to reflect the socioeconomic contexts in which the GPs worked. Conclusion: There are different conceptualizations of the relationship between self-harm, suicide, and the assessment of suicide risk among GPs. These need to be taken into account when planning training and service development.

Correlations of indoor second-hand smoking, household smoking rules, regional deprivation and children mental health: Scottish Health Survey, 2013

It has been known that second-hand smoking and deprivation could cluster together affecting child health. However, little is known on the role of household smoking rules. Therefore, it was aimed to study the relationships among indoor second-hand smoking, household smoking rules, deprivation level and children mental health in a country-wide and population-based setting. Data was retrieved from and analysed in Scottish Health Survey, 2013. Information on demographics, indoor second-hand smoking status, household smoking rules, deprivation level and child mental health by Strengths and Difficulties Questionnaire was obtained by household interview through parents. Statistical analysis included chi-square test and survey-weighted logistic regression modelling. Of 1019 children aged 4-12, 17.9% (n = 182) lived in the 15% most deprivation areas. Deprived areas tended to be where indoor smoking occurred (p < 0.001). The top three sub-regions of the 15% most deprivation for Scottish children are greater Glasgow, Ayrshire & Arran and Forth Valley while the top three sub-regions of exposure to the indoor second-hand smoking are Fife, Forth Valley and Ayrshire & Arran. The top three sub-regions with indoor smoking allowed are greater Glasgow, Western Isles and Borders. Children emotional and behavioural problems were reduced when the strict household smoking rules (not allowed or outdoor areas) applied. One in six Scottish children lived in the 15% most deprivation areas and exposed to indoor second-hand smoking that could have led to emotional and behavioural problems. Public health programs promoting strict household smoking rules should be encouraged in order to optimise children mental health.

Impact of socioeconomic deprivation on rate and cause of death in severe mental illness

BACKGROUND

Socioeconomic status has important associations with disease-specific mortality in the general population. Although individuals with Severe Mental Illnesses (SMI) experience significant premature mortality, the relationship between socioeconomic status and mortality in this group remains under investigated. We aimed to assess the impact of socioeconomic status on rate and cause of death in individuals with SMI (schizophrenia and bipolar disorder) relative to the local (Glasgow) and wider (Scottish) populations.

METHODS

Cause and age of death during 2006-2010 inclusive for individuals with schizophrenia or bipolar disorder registered on the Glasgow Psychosis Clinical Information System (PsyCIS) were obtained by linkage to the Scottish General Register Office (GRO). Rate and cause of death by socioeconomic status, measured by Scottish Index of Multiple Deprivation (SIMD), were compared to the Glasgow and Scottish populations.

RESULTS

Death rates were higher in people with SMI across all socioeconomic quintiles compared to the Glasgow and Scottish populations, and persisted when suicide was excluded. Differences were largest in the most deprived quintile (794.6 per 10,000 population vs. 274.7 and 252.4 for Glasgow and Scotland respectively). Cause of death varied by socioeconomic status. For those living in the most deprived quintile, higher drug-related deaths occurred in those with SMI compared to local Glasgow and wider Scottish population rates (12.3% vs. 5.9%, p = <0.001 and 5.1% p = 0.002 respectively). A lower proportion of deaths due to cancer in those with SMI living in the most deprived quintile were also observed, relative to the local Glasgow and wider Scottish populations (12.3% vs. 25.1% p = 0.013 and 26.3% p = <0.001). The proportion of suicides was significantly higher in those with SMI living in the more affluent quintiles relative to Glasgow and Scotland (54.6% vs. 5.8%, p = <0.001 and 5.5%, p = <0.001).

CONCLUSIONS

Excess mortality in those with SMI occurred across all socioeconomic quintiles compared to the Glasgow and Scottish populations but was most marked in the most deprived quintiles when suicide was excluded as a cause of death. Further work assessing the impact of socioeconomic status on specific causes of premature mortality in SMI is needed.

Attention-deficit hyperactivity disorder increases the risk of deliberate self-poisoning: A population-based cohort

BACKGROUND

Children with attention-deficit hyperactivity disorder (ADHD) may suffer marked impairment in early adulthood, increasing their risk for serious self-harmful behaviors. Deliberate self-poisoning (DSP) is the most common form of deliberate self-harm. An association may exist between ADHD diagnosis and subsequent DSP events. The purpose of study was to determine whether children and adolescents with ADHD are at a greater risk for DSP than are age-matched controls.

METHODS

Claims data from the Taiwan National Health Insurance Database were used to conduct a retrospective cohort analysis of emergency department visits. The study cohort contained 3685 patients with ADHD (<8years old). Each ADHD patient was frequency matched based on sex, age, urbanization, parental occupation, and index year to 10 control patients without ADHD. A Cox proportional-hazards regression model was used to estimate the risk of DSP in the ADHD and comparison cohorts.

RESULTS

The risk of developing DSP was significantly higher in the ADHD cohort than in the comparison cohort (P<.0001 for log-rank test). After adjusting for potential confounders, the regression model showed that the ADHD patients were at a 4.65-fold greater risk of developing DSP than the control patients were (HR=4.65, 95% CI: 2.41-8.94).

CONCLUSION

Children with ADHD are at greater risk of developing DSP. Identifying risk factors of DSP is crucial efforts to implement prevention strategies. The identification of the underlying cause of increased DSP among ADHD patients warrants further investigation.

Deliberate self-poisoning presenting to an emergency medicine network in South-East melbourne: a descriptive study

Background. Deliberate self-poisoning (DSP) comprises a small but significant proportion of presentations to the emergency department (ED). However, the prevalence and patient characteristics of self-poisoning attendances to EDs in Victoria have not been recently characterised. Aim. To identify and compare the characteristics of adult patients presenting to the three EDs of Monash Health following DSP. Methods. Retrospective clinical audit of adult DSP attendances between 1st July 2009 and 30th June 2012. Results. A total of 3558 cases over three years were identified fulfilling the search criteria. The mean age of patients was 36.3 years with the largest numbers aged between 18 and 30 (38%). About 30% of patients were born overseas. Forty-eight percent were discharged home, 15% were admitted to ED short stay units, and 5% required ICU admission. The median ED length of stay was 359 minutes (IQR 231–607). The most frequently reported substances in DSP were benzodiazepines (36.6%), paracetamol (22.2%), and antipsychotics (12.1%). Exposure to more than one substance for the episode of DSP was common (47%). Conclusion. This information may help identify the trends in poisoning substances used for DSP in Victoria, which in turn may provide clinicians with information to provide more focused and targeted interventions.

Prevalence of nonsuicidal self-injury in nonclinical samples: systematic review, meta-analysis and meta-regression

Published prevalence estimates of nonsuicidal self-injury (NSSI) among nonclinical samples are highly heterogeneous, raising concerns about their reliability and hindering attempts to explore the alleged increase in NSSI over time. Accordingly, the objectives of this study were to investigate the influence of methodological factors on heterogeneity in NSSI prevalence estimates, explore changes over time, and estimate overall international NSSI prevalence. Results showed that methodological factors contributed over half (51.6%) of the heterogeneity in prevalence estimates, and, after adjusting for these factors, NSSI prevalence did not increase over time. Overall, pooled NSSI prevalence was 17.2% among adolescents, 13.4% among young adults, and 5.5% among adults. Clearly, development of standardized methodology in NSSI research is crucial if accurate estimates are desired.

Individual- and area-level influence on suicide risk: a multilevel longitudinal study of Swedish schoolchildren

BACKGROUND

Characteristics related to the areas where people live have been associated with suicide risk, although these might reflect aggregation into these communities of individuals with mental health or social problems. No studies have examined whether area characteristics during childhood are associated with subsequent suicide, or whether risk associated with individual characteristics varies according to childhood neighbourhood context.

METHOD

We conducted a longitudinal study of 204,323 individuals born in Sweden in 1972 and 1977 with childhood data linked to suicide (n = 314; 0.15%) up to age 26-31 years. Multilevel modelling was used to examine: (i) whether school-, municipality- or county-level characteristics during childhood are associated with later suicide, independently of individual effects, and (ii) whether associations between individual characteristics and suicide vary according to school context (reflecting both peer group and neighbourhood effects).

RESULTS

Associations between suicide and most contextual measures, except for school-level gender composition, were explained by individual characteristics. There was some evidence of cross-level effects of individual- and school-level markers of ethnicity and deprivation on suicide risk, with qualitative interaction patterns. For example, having foreign-born parents increased the risk for individuals raised in areas where they were in a relative minority, but protected against suicide in areas where larger proportions of the population had foreign-born parents.

CONCLUSIONS

Characteristics that define individuals as being different from most people in their local environment as they grow up may increase suicide risk. If robustly replicated, these findings have potentially important implications for understanding the aetiology of suicide and informing social policy.

Clinical features associated with suicide attempts versus suicide gestures in an inpatient sample

The objective of this study was to test whether suicide attempters and suicide gesturers can be clinically differentiated. A total of 150 subjects who had attempted suicide at least once, had made a suicide gesture, had suicidal ideation, and/or had engaged in non-suicidal self-injury were recruited from the inpatient service of the Jiménez Díaz Foundation (Madrid, Spain). A multinomial regression analysis was conducted. Histrionic and antisocial personality disorders were risk factors specific to suicide gestures. Narcissistic personality disorder was specifically associated with suicide attempts. Borderline personality disorder was associated with both suicide gestures and attempts. A high level of impulsiveness was a risk factor specific to suicide attempts.

CONCLUSION

Suicide attempters and suicide gesturers are two distinct, although partially overlapping, populations.

Assessing the impact of socioeconomic variables on small area variations in suicide outcomes in England

Ecological studies of suicide and self-harm have established the importance of area variables (e.g., deprivation, social fragmentation) in explaining variations in suicide risk. However, there are likely to be unobserved influences on risk, typically spatially clustered, which can be modeled as random effects. Regression impacts may be biased if no account is taken of spatially structured influences on risk. Furthermore a default assumption of linear effects of area variables may also misstate or understate their impact. This paper considers variations in suicide outcomes for small areas across England, and investigates the impact on them of area socio-economic variables, while also investigating potential nonlinearity in their impact and allowing for spatially clustered unobserved factors. The outcomes are self-harm hospitalisations and suicide mortality over 6,781 Middle Level Super Output Areas.

Premature death after self-harm: a multicentre cohort study

BACKGROUND

People who self-harm have an increased risk of premature death. The aim of this study was to investigate cause-specific premature death in individuals who self-harm, including associations with socioeconomic deprivation.

METHODS

We undertook a cohort study of patients of all ages presenting to emergency departments in Oxford, Manchester, and Derby, UK, after self-poisoning or self-injury between Jan 1, 2000, and Dec 31, 2007. Postcodes of individuals' place of residence were linked to the Index of Multiple Deprivation 2007 in England. Mortality information was supplied by the Medical Research Information Service of the National Health Service. Patients were followed up to the end of 2009. We calculated age-standardised mortality ratios (SMRs) and years of life lost (YLL), and we tested for associations with socioeconomic deprivation.

FINDINGS

30 950 individuals presented with self-harm and were followed up for a median of 6·0 years (IQR 3·9-7·9). 1832 (6·1%) patients died before the end of follow-up. Death was more likely in patients than in the general population (SMR 3·6, 95% CI 3·5-3·8), and occurred more in males (4·1, 3·8-4·3) than females (3·2, 2·9-3·4). Deaths due to natural causes were 2-7·5 times more frequent than was expected. For individuals who died of any cause, mean YLL was 31·4 years (95% CI 30·5-32·2) for male patients and 30·7 years (29·5-31·9) for female patients. Mean YLL for natural-cause deaths was 25·9 years (25·7-26·0) for male patients and 25·5 years (25·2-25·8) for female patients, and for external-cause deaths was 40·2 years (40·0-40·3) and 40·0 years (39·7-40·5), respectively. Disease of the circulatory (13·1% in males; 13·0% in females) and digestive (11·7% in males; 17·8% in females) systems were major contributors to YLL from natural causes. All-cause mortality increased with each quartile of socioeconomic deprivation in male patients (χ(2) trend 39·6; p<0·0001), female patients (13·9; p=0·0002), and both sexes combined (55·4; p<0·0001). Socioeconomic deprivation was related to mortality in both sexes combined from natural causes (51·0; p<0·0001) but not from external causes (0·30; p=0·58). Alcohol problems were associated with death from digestive-system disease, drug misuse with mental and behavioural disorders, and physical health problems with circulatory-system disease.

INTERPRETATION

Physical health and life expectancy are severely compromised in individuals who self-harm compared with the general population. In the management of self-harm, clinicians assessing patients' psychosocial problems should also consider their physical needs.

FUNDING

Department of Health Policy Research Programme.

Spatial clusters of suicide in the municipality of São Paulo 1996-2005: an ecological study

BACKGROUND

In a classical study, Durkheim mapped suicide rates, wealth, and low family density and realized that they clustered in northern France. Assessing others variables, such as religious society, he constructed a framework for the analysis of the suicide, which still allows international comparisons using the same basic methodology. The present study aims to identify possible significantly clusters of suicide in the city of São Paulo, and then, verify their statistical associations with socio-economic and cultural characteristics.

METHODS

A spatial scan statistical test was performed to analyze the geographical pattern of suicide deaths of residents in the city of São Paulo by Administrative District, from 1996 to 2005. Relative risks and high and/or low clusters were calculated accounting for gender and age as co-variates, were analyzed using spatial scan statistics to identify geographical patterns. Logistic regression was used to estimate associations with socioeconomic variables, considering, the spatial cluster of high suicide rates as the response variable. Drawing from Durkheim's original work, current World Health Organization (WHO) reports and recent reviews, the following independent variables were considered: marital status, income, education, religion, and migration.

RESULTS

The mean suicide rate was 4.1/100,000 inhabitant-years. Against this baseline, two clusters were identified: the first, of increased risk (RR=1.66), comprising 18 districts in the central region; the second, of decreased risk (RR=0.78), including 14 districts in the southern region. The downtown area toward the southwestern region of the city displayed the highest risk for suicide, and though the overall risk may be considered low, the rate climbs up to an intermediate level in this region. One logistic regression analysis contrasted the risk cluster (18 districts) against the other remaining 78 districts, testing the effects of socioeconomic-cultural variables. The following categories of proportion of persons within the clusters were identified as risk factors: singles (OR=2.36), migrants (OR=1.50), Catholics (OR=1.37) and higher income (OR=1.06). In a second logistic model, likewise conceived, the following categories of proportion of persons were identified as protective factors: married (OR=0.49) and Evangelical (OR=0.60).

CONCLUSIONS

This risk/ protection profile is in accordance with the interpretation that, as a social phenomenon, suicide is related to social isolation. Thus, the classical framework put forward by Durkheim seems to still hold, even though its categorical expression requires re-interpretation.

Family size and perinatal circumstances, as mental health risk factors in a Scottish birth cohort

PURPOSE

Higher maternal parity and younger maternal age have each been observed to be associated with subsequent offspring suicidal behaviour. This study aimed to establish if these, and other variables from the perinatal period, together with family size, are also associated with other psychiatric morbidity.

METHODS

Linked datasets of the Scottish Morbidity Record and Scottish death records were used to follow up, into young adulthood, a birth cohort of 897,685. In addition to the index maternity records, mothers' subsequent pregnancy records were identified, allowing family size to be estimated. Three independent outcomes were studied: suicide, self-harm, and psychiatric hospital admission. Data were analysed using Cox regression.

RESULTS

Younger maternal age and higher maternal parity were independently associated with increased risk in offspring of suicide, of self-harm and of psychiatric admission. Risk of psychiatric admission was higher amongst those from families of three or more, but, compared with only children, those with two or three siblings had a lower risk of self harm.

CONCLUSION

Perinatal and family composition factors have a broad influence on mental health outcomes. These data suggest that the existence of younger, as well as elder siblings may be important.

Shared characteristics of suicides and other unnatural deaths following non-fatal self-harm? A multicentre study of risk factors

BACKGROUND

Mortality, including suicide and accidents, is elevated in self-harm populations. Although risk factors for suicide following self-harm are often investigated, rarely have those for accidents been studied. Our aim was to compare risk factors for suicide and accidents.

METHOD

A prospective cohort (n=30 202) from the Multicentre Study of Self-harm in England, 2000-2007, was followed up to 2010 using national death registers. Risk factors for suicide (intentional self-harm and undetermined intent) and accidents (narcotic poisoning, non-narcotic poisoning, and non-poisoning) following the last hospital presentation for self-harm were estimated using Cox models.

RESULTS

During follow-up, 1833 individuals died, 378 (20.6%) by suicide and 242 (13.2%) by accidents. Independent predictors of both suicide and accidents were: male gender, age 35 years (except accidental narcotic poisoning) and psychiatric treatment (except accidental narcotic poisoning). Factors differentiating suicide from accident risk were previous self-harm, last method of self-harm (twofold increased risks for cutting and violent self-injury versus self-poisoning) and mental health problems. A risk factor specific to accidental narcotic poisoning was recreational/illicit drug problems, and a risk factor specific to accidental non-narcotic poisoning and non-poisoning accidents was alcohol involvement with self-harm.

CONCLUSIONS

The similarity of risk factors for suicide and accidents indicates common experiences of socio-economic disadvantage, life problems and psychopathology resulting in a variety of self-destructive behaviour. Of factors associated with the accidental death groups, those for non-narcotic poisoning and other accidents were most similar to suicide; differences seemed to be related to criteria coroners use in reaching verdicts. Our findings support the idea of a continuum of premature death.

Religious beliefs along the suicidal path in northern Taiwan

This study aimed to understand the current inclinations toward depression and compulsion for members of four different religious groups, and to predict religious beliefs along the suicide path through analyzing the lifetime prevalence of suicidal ideation and suicide attempts for members of these religious groups. Participants in this cross-sectional study, which adopted purposive sampling, were members of Christianity, Catholicism, Buddhism, and Taoism in northern Taiwan. In the case of suicide experiences, suicides among people one knows, and tendency toward compulsion and depression, there are statistical differences between the four religions. According to the results, some people with suicidal tendency will attend religious activities; therefore, we predict that religious beliefs play an important role in suicide prevention.

Sociodemographic profile, clinical factors, and mode of attempt in suicide attempters in consultation liaison psychiatry in a tertiary care center

BACKGROUND

The objective was to study the sociodemographic data, psychiatric disorder, precipitating events, and mode of attempt in suicide attempted patients referred to consultation liaison psychiatric services.

SETTINGS AND DESIGN

A prospective study of 6-month duration was done in a tertiary care center in India.

MATERIALS AND METHODS

During the 6-month period all referrals were screened for the presence of suicide attempters in consultation liaison services. Those who fulfilled the criteria for suicide attempters were evaluated by using semistructured pro forma containing sociodemographic data, precipitating events, mode of attempt, and psychiatric diagnosis by using ICD-10.

RESULTS

The male-to-female ratio was similar. Adult age, urban background, employed, matriculation educated were more represented in this study. More than 80% of all attempters had psychiatric disorder. Majority had a precipitating event prior to suicide attempt. The most common method of attempt was by use of corrosive.

CONCLUSIONS

Majority of suicide attempter patients had mental illness. Early identification and treatment of these disorders would have prevented morbidity and mortality associated with this. There is a need of proper education of relatives about keeping corrosive and other poisonous material away from patients as it was being commonest mode of attempt.

The spatial pattern of suicide in the US in relation to deprivation, fragmentation and rurality

Analysis of geographical patterns of suicide and psychiatric morbidity has demonstrated the impact of latent ecological variables (such as deprivation, rurality). Such latent variables may be derived by conventional multivariate techniques from sets of observed indices (for example, by principal components), by composite variable methods or by methods which explicitly consider the spatial framework of areas and, in particular, the spatial clustering of latent risks and outcomes. This article considers a latent random variable approach to explaining geographical contrasts in suicide in the US; and it develops a spatial structural equation model incorporating deprivation, social fragmentation and rurality. The approach allows for such latent spatial constructs to be correlated both within and between areas. Potential effects of area ethnic mix are also included. The model is applied to male and female suicide deaths over 2002–06 in 3142 US counties.

Analyzing the effects of place on injury: Does the choice of geographic scale and zone matter?

BACKGROUND

Recent studies have shown that the morbidity and mortality associated with injury of pedestrians are inversely related to socio-economic status (SES). However, in drawing inferences from this association, investigators have paid little attention to the modifiable artifacts related to scale and how the data are partitioned. The purpose of this population-based study was to identify the relation between SES and incidence patterns of pedestrian injury at 4 different geographic scales.

METHODS

We used a Poisson generalized linear model, stratified by age and sex, to analyze the relation between each of 4 area measures of SES and incidence patterns of pedestrian injuries occurring in metropolitan Vancouver between 1 January 2001 and 31 March 2006. The 4 area measures of SES were based on boundaries of dissemination areas, census tracts, custom-defined census tracts (generated by reassignment of dissemination area boundaries by means of a geographic information system) and census subdivisions of the Canadian census. We measured the SES of the location where the injury occurred with the Vancouver Area Neighbourhood Deprivation Index.

RESULTS

A total of 262 injuries in adults (18 years of age or older) were analyzed. Among adult men, the odds ratio (OR) for injury of pedestrians at the scale of dissemination area was 4.93 (95% confidence interval [CI] 2.89-8.42) for areas having the lowest SES relative to those with the highest SES. For the same population, the OR for injury was lower with increasing aggregation of data: 2.33 (95% CI 1.45-3.74) when census tracts were used, 3.26 (95% CI 2.06-5.16) when modified census tracts were used and 1.27 (95% CI 0.47-3.45) when census subdivisions were used. Among adult women, the OR for pedestrian injury by SES was highest at the scale of census subdivision within medium-low SES areas (4.33, 95% CI 1.23-15.22). At the census subdivision scale, the relation between SES and incidence pattern of injury was not consistent with findings at smaller geographic scales, and the OR for injury decreased with each increase in SES.

INTERPRETATION

In this analysis, there was significant variability when different administrative boundaries were applied as proxy measures of the effects of place on incidence patterns of injury. The hypothesized influence of SES on prevalence of pedestrian injury followed a statistically significant socio-economic gradient when analyzed using small-area boundaries of the census. However, researchers should be aware of the inherent variability that remains even among the more homogenous population units.