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Peterson A, Smith-Morris C. Teen Perspectives on Suicides and Deaths in an Affluent Community: Perfectionism, Protection, and Exclusion. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:456. [PMID: 38673367 PMCID: PMC11050056 DOI: 10.3390/ijerph21040456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024]
Abstract
Clusters of youth suicide and death are tragic for communities and present long-term consequences for the surviving youths. Despite an awareness of community-based patterns in youth suicide, our understanding of the social and community factors behind these events remains poor. While links between poverty and suicide have been well documented, wealthy communities are rarely targeted in suicide research. In response to this gap, we conducted ethnographic research in a wealthy U.S. town that, over a recent 10-year period, witnessed at least four youth suicides and seven more youth accidental deaths. Our interviews (n = 30) explored community values and stressors, interpersonal relationships, and high school experiences on participant perceptions of community deaths. Youth participants characterize their affluent community as having (1) perfectionist standards; (2) permissive and sometimes absent parents; (3) socially competitive and superficial relationships; and (4) a "bubble" that is protective but also exclusionary. Our qualitative findings reveal network influence in teen suicides and accidental deaths in a wealthy community. Greater attention paid to the negative effects of subcultural values and stressors in affluent communities is warranted. Further, our work promotes the value of ethnographic, community-based methodologies for suicidology and treatment.
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Affiliation(s)
- Abigail Peterson
- Department of Anthropology, Southern Methodist University, Dallas, TX 75275, USA
- School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Carolyn Smith-Morris
- Peter O’Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, TX 75390, USA;
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Hunter S, Farmer G, Benny C, Smith BT, Pabayo R. The association between social fragmentation and deaths attributable to alcohol, drug use, and suicide: Longitudinal evidence from a population-based sample of Canadian adults. Prev Med 2023; 175:107688. [PMID: 37652109 DOI: 10.1016/j.ypmed.2023.107688] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/25/2023] [Accepted: 08/27/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Social fragmentation has been theorized and empirically associated with suicide in prior research. However, less is known about whether social fragmentation is associated with deaths attributed to alcohol use or drug use. This research examined the association between social fragmentation and risk for deaths attributable to alcohol use, drug use, and suicide (collectively known as deaths of despair) among Canadian adults. METHODS A weighted sample representing 15,324,645 Canadians within 288 census divisions between 2006 and 2019 was used. Mortality data from the Canadian Vital Statistics Database (alcoholic liver disease, drug use, and suicide) was linked with census division socioeconomic data from the 2006 Canadian census using the Canadian Census Health and Environment Cohorts. Social fragmentation at the census division was created based on the Congdon Index. Cox-proportional hazard regression with survey weights and the sandwich estimator were used to account for clustering of individuals (level-1) nested within census divisions (level-2). RESULTS After adjusting for individual and census division confounders, social fragmentation was positively associated with all-cause mortality (HR = 1.04; 95% CI: 1.02, 1.07), suicide (HR = 1.09; 95%CI: 1.01, 1.18), drug overdose related mortality (HR = 1.13; 95%CI: 1.03, 1.24), and deaths of despair (HR = 1.10; 95% CI: 1.04, 1.16), and not significantly associated with alcohol related liver disease (HR = 1.06; 95% CI: 0.91, 1.23). CONCLUSION Social fragmentation is associated with an increased hazard of deaths of despair among Canadian adults. Efforts to improve social cohesion in areas that are highly socially fragmented need to be evaluated.
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Affiliation(s)
- Stephen Hunter
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, AB T6G 1C9, Canada.
| | - Gregory Farmer
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, AB T6G 1C9, Canada; Provincial Population and Public Health, Alberta Health Services, 10030 107 St NW, Edmonton, AB T5J 3E4, Canada
| | - Claire Benny
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON M5G 1V2, Canada
| | - Brendan T Smith
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON M5G 1V2, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St, Room 500, Toronto, ON M5T 3M7, Canada
| | - Roman Pabayo
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, AB T6G 1C9, Canada
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Dykxhoorn J, Hayes J, Ashok K, Sörberg Wallin A, Dalman C. Objective and subjective neighbourhood characteristics and suicidality: a multilevel analysis. Psychol Med 2023; 53:1166-1175. [PMID: 34231453 PMCID: PMC7614302 DOI: 10.1017/s0033291721002579] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 05/27/2021] [Accepted: 06/08/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Characteristics of the neighbourhood environment, including population density, social fragmentation, and trust, have been linked to mental health outcomes. Using a longitudinal population-based cohort, we explored the relationship between objective and subjective neighbourhood characteristics and the odds of suicidal thoughts and attempts. METHODS We conducted a longitudinal study of 20764 participants living in Stockholm County who participated in the Stockholm Public Health Survey. We used multilevel modelling to examine if suicidal thoughts and attempts were associated with neighbourhood characteristics, independent of individual associations. We included objective and subjective measures to explore if there was a different relationship between these measures of the neighbourhood environment and suicidality. RESULTS Associations between neighbourhood factors and suicidality were predominantly explained by individual characteristics, with the exception of neighbourhood-level deprivation and average residential trust. Each unit increase of deprivation was linked to increased odds of suicidal thoughts [Odds ratio (OR) 1.04, 95% confidence interval (CI) 1.00-1.07] and attempts (OR 1.11, 95% CI 1.06-1.17). Decreasing residential trust was associated with increased odds of suicide attempts (OR 1.09, 95% CI 1.02-1.17). There was no evidence that neighbourhood-level fragmentation or average trust in public and political institutions had an independent effect on suicidality once individual and sociodemographic factors were accounted for. CONCLUSIONS This study showed that much of the neighbourhood-level variation in suicidal thoughts and attempts could be explained by compositional factors, including sociodemographic clustering within neighbourhoods. The independent effect of neighbourhood-level deprivation and average residential trust provide evidence that the neighbourhood context may exert an independent effect on suicidality beyond the impact of individual characteristics.
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Affiliation(s)
- Jennifer Dykxhoorn
- Division of Psychiatry, UCL, London, UK
- Department of Primary Care and Population Health, UCL, London, UK
| | | | | | | | - Christina Dalman
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
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Yeung CY, Men YV, Caine ED, Yip PSF. The differential impacts of social deprivation and social fragmentation on suicides: A lesson from Hong Kong. Soc Sci Med 2022; 315:115524. [PMID: 36413859 DOI: 10.1016/j.socscimed.2022.115524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/02/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Little research has conducted to examine the association between social deprivation and social fragmentation, overall and method-specific suicide risk, and how these associations may change over time. This study investigated the association between social deprivation and social fragmentation with overall and method-specific suicide in Hong Kong from 1999 to 2018. METHODS Suicide death data of each small tertiary planning unit (STPU) was obtained from the Census and Statistics Department of Hong Kong. Socio-economic characteristics in STPU level were obtained from Census and Bi-census. Exploratory principal component analysis was used to construct the social deprivation (SDI) and social fragmentation indices (SFI) based on the socio-economic characteristics. Bayesian hierarchical modelling was conducted to explore the association between SDI and SFI with overall and method-specific suicide over time, controlling for population density and male-to-female ratio. RESULTS Higher risk of suicide was generally observed around Kowloon Peninsula and some parts in the Northern, Northwestern and Southwestern areas depending on methods. The effect of SDI and SFI on suicide risk varied by years and methods. In 2014-2018, for every 10% increase in SDI, the suicide risk for overall, jumping, hanging, and charcoal burning elevated by 22% (95%Crl = 10%-37%), 26% (95%Crl = 12%-41%), 31% (95%Crl = 14%-51%), and 21% (95%Crl = 4%-42%) respectively. CONCLUSION Spatial variations and effects of SDI and SFI on overall and method-specific suicide risks varied by different periods. SDI was observed to be a stronger factor in the recent years. Situations should be monitored, and interventions should be implemented and adjusted accordingly to the changes.
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Affiliation(s)
- Cheuk Yui Yeung
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
| | - Yu Vera Men
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Eric D Caine
- University of Rochester Medical Center, 300 Crittenden Blvd., Rochester, NY 14642, USA
| | - Paul Siu Fai Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China; Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, 2/F, the Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong SAR, China.
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Spatial analysis of mental health and suicide clustering among older adults in North Carolina: An exploratory analysis. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Impact of subjective and objective neighbourhood characteristics and individual socioeconomic position on allostatic load: A cross-sectional analysis of an all-age UK household panel study. Health Place 2022; 78:102930. [DOI: 10.1016/j.healthplace.2022.102930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 10/14/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022]
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Yoshioka E, Hanley S, Sato Y, Saijo Y. Associations between social fragmentation, socioeconomic deprivation and suicide risk across 1887 municipalities in Japan, 2009-2017: a spatial analysis using the Bayesian hierarchical model. BMJ Open 2022; 12:e063255. [PMID: 36041759 PMCID: PMC9438050 DOI: 10.1136/bmjopen-2022-063255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Eiji Yoshioka
- Department of Social Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Sharon Hanley
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yukihiro Sato
- Department of Social Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Yasuaki Saijo
- Department of Social Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
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Martínez-Alés G, Gimbrone C, Rutherford C, Kandula S, Olfson M, Gould MS, Shaman J, Keyes KM. Role of Firearm Ownership on 2001-2016 Trends in U.S. Firearm Suicide Rates. Am J Prev Med 2021; 61:795-803. [PMID: 34420829 PMCID: PMC8608719 DOI: 10.1016/j.amepre.2021.05.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION In the U.S., state-level household firearm ownership is strongly associated with firearm suicide mortality rates. Whether the recent increases in firearm suicide are explained by state-level household firearm ownership rates and trends remains unknown. METHODS Mortality data from the U.S. National Vital Statistics System and an estimate of state-level household firearm ownership rate were used to conduct hierarchical age-period-cohort (random-effects) modeling of firearm suicide mortality between 2001 and 2016. Models were adjusted for individual-level race and sex and for state-level poverty rate, unemployment rate, median household income in U.S. dollars, population density, and elevation. RESULTS Between 2001 and 2016, the crude national firearm suicide mortality rate increased from 6.8 to 8.0 per 100,000, and household firearm ownership rate remained relatively stable, at around 40%. Both variables were markedly heterogeneous and correlated at the state level. Age-period-cohort models revealed period effects (affecting people across ages) and cohort effects (affecting specific birth cohorts) underlying the recent increases in firearm suicide. Individuals born after 2000 had higher firearm suicide rates than most cohorts born before. A 2001-2006 decreasing period effect was followed, after 2009, by an increasing period effect that peaked in 2015. State-level household firearm ownership rates and trends did not explain cohort effects and only minimally explained period effects. CONCLUSIONS State-level firearm ownership rates largely explain the state-level differences in firearm suicide but only marginally explain recent increases in firearm suicide. Although firearms in the home increase firearm suicide risk, the recent national rise in firearm suicide might be the result of broader, more distal causes of suicide risk.
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Affiliation(s)
- Gonzalo Martínez-Alés
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York; Department of Psychiatry, La Paz University Hospital, Madrid, Spain.
| | - Catherine Gimbrone
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York
| | - Caroline Rutherford
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York
| | - Sasikiran Kandula
- Department of Environmental Health Sciences (EHS), Columbia University Mailman School of Public Health, Columbia University, New York, New York
| | - Mark Olfson
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York; Department of Psychiatry, Columbia University, New York, New York
| | - Madelyn S Gould
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York; Department of Psychiatry, Columbia University, New York, New York
| | - Jeffrey Shaman
- Department of Environmental Health Sciences (EHS), Columbia University Mailman School of Public Health, Columbia University, New York, New York
| | - Katherine M Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, Columbia University, New York, New York
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Dynamics of Open Green Areas in Polish and Romanian Cities during 2006–2018: Insights for Spatial Planners. REMOTE SENSING 2021. [DOI: 10.3390/rs13204041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Studying green urban infrastructure is important because of its ecosystem services, contributing to the welfare and comfort of citizens, mitigation of climate changes, and sustainability goals. Urban planning can increase or diminish the performance of ecosystem services. Despite numerous studies on the green infrastructure–services–planning nexus, there are very few concrete planning recommendations. This study aims to provide such recommendations for a broader audience by analyzing the dynamic of open green areas in Polish and Romanian cities, connected with its drivers. A novel approach including mathematical modeling and geostatistical analyses was applied to Urban Atlas and statistical yearbooks data. The results indicated that open green areas were lost and fragmented in all Romanian and Polish cities during 2006–2018. The drivers included urban built-up areas, population and density, the number of building permits, number of new dwellings completed, number of employees, and total length of roads. The study also revealed a tremendous lack of consistent datasets across the countries using the same statistical indicators. Based on the findings, planners should aim to preserve and develop urban greenery and maintain its continuity. City managers should use more research and decision-making policy developers to develop targeted policies and scientists should develop planning manuals.
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Precarious Suicide Behavior According to Housing Price Gap: A Case Study on South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189877. [PMID: 34574800 PMCID: PMC8470716 DOI: 10.3390/ijerph18189877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/13/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022]
Abstract
In 2018, the suicide rate in South Korea was the highest among the Organisation for Economic Co-operation and Development countries, and socioeconomic inequality has intensified. This study analyzes the impact relationship between suicidal impulses and economic inequality in South Korea. This study measures suicidal impulses thoughts National Health Survey Data and economic inequality based on the housing prices gap in the country. The primary analysis results were as follows: First, suicidal impulses were positively associated with the high index of housing price inequality; this correlation has become tight in recent years. Second, it was confirmed that the higher the income level, the higher the correlation between suicidal impulses with the index of housing price inequality. Third, the correlation between housing price inequality with suicidal impulse increased consistently in highly urbanized areas, but the statistical significance was low in non-urban areas.
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Goodman ML, Seidel SE, Gibson D, Lin G, Patel J, Keiser P, Gitari S. Intimate Partnerships, Suicidal Ideation and Suicide-Related Hospitalization Among Young Kenyan Men. Community Ment Health J 2020; 56:1225-1238. [PMID: 32020388 PMCID: PMC9307072 DOI: 10.1007/s10597-020-00572-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/01/2020] [Indexed: 11/29/2022]
Abstract
The first study focused on a three-month chart review containing information on suicide attempts (n = 34) admitted to a local mission hospital in Meru County, Kenya. The second study utilized a cross-sectional survey administered to men 18-34 years old (n = 532) residing in rural Kenya. Data posit intimate partnership discord as salient to suicide ideation and behavior. Men who reported their partner status was "divorced" had four-times the odds of reporting suicide ideation than other partnership states, an association significantly mediated by loneliness. Violent conflict tactics predicted suicidal ideation, mediated by loneliness and decreased marital satisfaction.
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Affiliation(s)
- Michael L Goodman
- Department of Internal Medicine, University of Texas, Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA.
| | - Sarah E Seidel
- Sodzo International, 4100 Main Street, Houston, TX, 77002, USA
| | - Derrick Gibson
- Department of Internal Medicine, University of Texas, Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Gwen Lin
- Department of Internal Medicine, University of Texas, Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Janki Patel
- Department of Internal Medicine, University of Texas, Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Philip Keiser
- Department of Internal Medicine, University of Texas, Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Stanley Gitari
- Community Health Department, Maua Methodist Hospital, Maua, Meru County, Kenya
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Regional Variation of Suicide Mortality in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155433. [PMID: 32731583 PMCID: PMC7432038 DOI: 10.3390/ijerph17155433] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/21/2020] [Accepted: 07/24/2020] [Indexed: 01/22/2023]
Abstract
South Korea’s suicide rate is the highest among the members of the Organization for Economic Cooperation and Development. This study seeks to verify regional variation in suicide rates in South Korea and to identify correlating factors. We used age-adjusted suicide rates for 252 administrative districts, and a Community Health Survey, national representative data, and other national representative data such as censuses were used to obtain information on socioeconomic, health related and social integration variables according to each administrative district. Regional variation in suicide rates was analyzed by using Extremal Quotient (EQ), and multiple linear regression analyses were used to investigate associations between variation in suicide rates and regional socioeconomic, public service factors and health related factors. The average suicide rate from 252 regions was 142.7 per 100,000 people. The highest region was Hongchun-gun (217.8) and the lowest was Gwachen-si (75.5). The EQ was 2.89, meaning that there is significant regional variation in suicide rates. Financial independence (β = −0.662, p < 0.001), social welfare budget (β = −0.754, p < 0.001) and divorce rates (β = 17.743, p < 0.001) were significant, along with other adjusted variables. This study suggests considering these factors in order to reduce suicide rates in South Korea.
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Factors Associated with Regional Years of Life Lost (YLLs) due to Suicide in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17144961. [PMID: 32660073 PMCID: PMC7400422 DOI: 10.3390/ijerph17144961] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/25/2020] [Accepted: 07/07/2020] [Indexed: 01/06/2023]
Abstract
South Korea’s suicide rate has remained among the highest in the world for some years, and there is also a gap in suicide rates among regions within the country. This study investigates the differences in years of life lost (YLLs) due to suicide in 250 districts and the factors associated with regional YLLs in South Korea in 2016. The relationships between YLLs due to suicide by region and factors such as population characteristics, health behaviors, socioeconomic factors, and mental health resources in the community were examined through multiple linear regression analysis. The gap between districts with the highest and lowest YLL due to suicide per 100,000 people was more than a 7-times difference. Factors related to YLLs due to suicide by region were physical activity rates and community mental healthcare centers, and there were differences in these factors according to gender. In conclusion, to prevent suicide at the community level, it is necessary to consider gender in establishing intervention strategies. The community needs to play an active role in promoting mental health and reducing suicide among local residents and to continue to invest in the support and management of those at high risk of suicide.
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Manzo K, Hobbs GR, Gachupin FC, Stewart J, Knox SS. Reservation-Urban Comparison of Suicidal Ideation/Planning and Attempts in American Indian Youth. THE JOURNAL OF SCHOOL HEALTH 2020; 90:439-446. [PMID: 32212169 DOI: 10.1111/josh.12891] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 05/04/2019] [Accepted: 06/16/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Our aim was to identify sex- and location-specific risk factors for suicide ideation/planning and attempts among American Indian youth. METHODS Biennial data for 6417 American Indian high school students attending reservation and urban schools were extracted from the Montana volunteer sample Youth Risk Behavior Survey data for pooled years 2003 to 2011. Logistic regression was used to identify sex- and school location-specific risk behaviors and psychosocial factors for past 12-month ideation/planning and past 12-month attempts. RESULTS Contrary to our hypothesis, the prevalence of ideation/planning and attempts did not significantly differ between reservation/urban location; however, risk factors associated with suicidality did. Sadness/hopelessness was associated with both outcomes for all groups. However, violent victimization was associated with both outcomes only among girls. Lack of school safety was associated with attempts but not ideation/planning among all students. There were distinct differences in risk factors associated with both outcomes among boys. CONCLUSIONS The results indicate differences and similarities in risk behaviors and psychosocial factors associated with suicidality by sex and reservation/urban setting. Implications include screening potentially at-risk students for depression, violent victimization, substance use, and school safety and use of the findings by tribal and school programs in designing prevention and intervention programs.
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Affiliation(s)
- Karen Manzo
- Native American Studies Program, West Virginia University, PO Box 6284, Morgantown, WV, 26506-6284
| | - Gerald R Hobbs
- Department of Statistics, West Virginia University, Morgantown, WV, 26505
| | - Francine C Gachupin
- Department of Family and Community Medicine, University of Arizona, 655 N Alvernon Way Ste #228, PO Box 210,491, Tucson, AZ, 85711-1823
| | - Jera Stewart
- Independent Contractor, P.O. Box 41 St, Ignatius, MT, 59865
| | - Sarah S Knox
- Department of Epidemiology, West Virginia University, Member West Virginia University Cancer Center 1 Medical Center Drive, PO Box 9190, Morgantown, WV, 26506-9190
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Steeg S, Webb RT, Ibrahim S, Appleby L, Kapur N. Suicide rates and voting choice in the UK's 2016 national Brexit referendum on European Union membership: cross-sectional ecological investigation across England's local authority populations. BJPsych Open 2020; 6:e57. [PMID: 32475363 PMCID: PMC7345594 DOI: 10.1192/bjo.2020.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Individual- and area-level risk factors for suicide are relatively well-understood but the role of macro social factors such as alienation, social fragmentation or 'anomie' is relatively underresearched. Voting choice in the 2016 referendum on the UK's membership of the European Union (EU) provides a potential measure of anomie. AIMS To examine associations between percentage 'Leave' votes in the EU referendum and suicide rates in 2015-2017, the period just prior to, and following, the referendum. METHOD National cross-sectional ecological study of 315 English local authority populations. Associations between voting choice in the EU referendum and age-standardised suicide rates, averaged for the years 2015, 2016 and 2017, were examined. RESULTS Overall there was a weak, but statistically significant, positive correlation between the local authority-level percentage 'Leave' vote in 2016 and the suicide rate 2015-2017: Pearson's correlation coefficient, r = 0.17; P = 0.003. This relationship was explained by populations having an older age distribution, being more deprived and lacking ethnic diversity. However, there was divergence (likelihood ratio test for interaction, χ2 = 7.2, P = 0.007) in the observed associations between London and the provincial regions with Greater London having a moderately strong negative association (r = -0.40; P = 0.02) and the rest of England a weak positive association (r = 0.17; P = 0.004). CONCLUSIONS Deprivation, older age distribution and a lack of ethnic diversity seems to explain raised suicide risk in Brexit-voting communities. A greater sense of alienation among people feeling 'left behind'/'left out' may have had some influence too, although multilevel modelling of individual- versus area-level data are needed to examine these complex relationships. The incongruent ecological relationship observed for London likely reflect its distinct social, economic and health context.
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Affiliation(s)
- Sarah Steeg
- Centre for Mental Health and Safety, Manchester Academic Health Science Centre, University of Manchester, UK
| | - Roger T Webb
- Centre for Mental Health and Safety, Manchester Academic Health Science Centre, University of Manchester; and NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
| | - Saied Ibrahim
- Centre for Mental Health and Safety, Manchester Academic Health Science Centre, University of Manchester, UK
| | - Louis Appleby
- Centre for Mental Health and Safety, Manchester Academic Health Science Centre, University of Manchester, UK
| | - Nav Kapur
- Centre for Mental Health and Safety, Manchester Academic Health Science Centre, University of Manchester; NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester; and Greater Manchester Mental Health NHS Foundation Trust, UK
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16
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Maung HH. Pluralism and incommensurability in suicide research. STUDIES IN HISTORY AND PHILOSOPHY OF BIOLOGICAL AND BIOMEDICAL SCIENCES 2020; 80:101247. [PMID: 31902654 DOI: 10.1016/j.shpsc.2019.101247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 11/29/2019] [Accepted: 12/27/2019] [Indexed: 06/10/2023]
Abstract
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.
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Affiliation(s)
- Hane Htut Maung
- Department of Philosophy, School of Social Sciences, Humanities Bridgeford Street, University of Manchester, Manchester, M13 9PL, UK.
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17
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Schneider A, Hampel R, Ladwig KH, Baumert J, Lukaschek K, Peters A, Breitner S. Impact of meteorological parameters on suicide mortality rates: A case-crossover analysis in Southern Germany (1990-2006). THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 707:136053. [PMID: 31863976 DOI: 10.1016/j.scitotenv.2019.136053] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/27/2019] [Accepted: 12/09/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND There is evidence for a seasonal pattern of suicides with peaks in spring and early summer; however, only a limited number of studies has investigated whether daily changes in meteorological variables may trigger suicides. METHODS Daily fatal suicide (N = 10,595) and meteorological data were available for four Bavarian cities and ten counties (Germany) for 1990-2006. City/county-specific immediate, delayed and cumulative effects of air temperature, sunshine duration, and cloud cover on suicides were analyzed using a time-stratified case-crossover approach; city/county-specific effects were then combined using random effects meta-analysis. Potential effect modifiers were specific weather conditions, personal or regional characteristics, and season. RESULTS A 5 °C increase in air temperature on the day before a suicide compared to the control days was associated with a 5.7% (95% confidence interval (CI): 0.6; 11.0) higher suicide risk. Further, the suicide risk was 6.5% (95% CI: 0.2; 13.3) higher on days with low/medium cloud cover (0-6 oktas) compared to days with high cloud cover (7-8 oktas). While daily changes in temperature were not associated with suicides in spring, we found a higher suicide risk in summer, autumn, and winter in association with temperature increases. The effects of cloud cover were strongest in summer and autumn and on days with temperature above the median (>8.8 °C). Sunshine duration was not associated with suicides. CONCLUSION We found a higher risk for suicides in association with short-term increases in air temperature on the day before the event compared to the control days and on days with low to medium cloud cover. This may highlight times when people are more likely to commit suicide.
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Affiliation(s)
- Alexandra Schneider
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | - Regina Hampel
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | - Karl-Heinz Ladwig
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, 85764 Neuherberg, Germany; Department for Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Munich, Germany
| | - Jens Baumert
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | - Karoline Lukaschek
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, 85764 Neuherberg, Germany; Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, München, Germany
| | - Susanne Breitner
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, 85764 Neuherberg, Germany; Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, München, Germany.
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Abstract
Self-harm has become one of the leading causes of mortality in developed countries. The overall rate for suicide in Canada is 11.3 per 100,000 according to Statistics Canada in 2015. Between 2000 and 2007 the lowest rates of suicide in Canada were in Ontario, one of the most urbanized regions in Canada. However, the interaction between land use, landscape and self-harm has not been significantly studied for urban cores. It is thus of relevance to understand the impacts of land-use and landscape on suicidal behavior. This paper takes a spatial analytical approach to assess the occurrence of self-harm along one of the densest urban cores in the country: Toronto. Individual self-harm data was gathered by the National Ambulatory Care System (NACRS) and geocoded into census tract divisions. Toronto’s urban landscape is quantified at spatial level through the calculation of its land use at different levels: (i) land use type, (ii) sprawl metrics relating to (a) dispersion and (b) sprawl/mix incidence; (iii) fragmentation metrics of (a) urban fragmentation and (b) density and (iv) demographics of (a) income and (b) age. A stepwise regression is built to understand the most influential factors leading to self-harm from this selection generating an explanatory model.
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19
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Kessler RC, Bauer MS, Bishop TM, Demler OV, Dobscha SK, Gildea SM, Goulet JL, Karras E, Kreyenbuhl J, Landes SJ, Liu H, Luedtke AR, Mair P, McAuliffe WHB, Nock M, Petukhova M, Pigeon WR, Sampson NA, Smoller JW, Weinstock LM, Bossarte RM. Using Administrative Data to Predict Suicide After Psychiatric Hospitalization in the Veterans Health Administration System. Front Psychiatry 2020; 11:390. [PMID: 32435212 PMCID: PMC7219514 DOI: 10.3389/fpsyt.2020.00390] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/17/2020] [Indexed: 12/11/2022] Open
Abstract
There is a very high suicide rate in the year after psychiatric hospital discharge. Intensive postdischarge case management programs can address this problem but are not cost-effective for all patients. This issue can be addressed by developing a risk model to predict which inpatients might need such a program. We developed such a model for the 391,018 short-term psychiatric hospital admissions of US veterans in Veterans Health Administration (VHA) hospitals 2010-2013. Records were linked with the National Death Index to determine suicide within 12 months of hospital discharge (n=771). The Super Learner ensemble machine learning method was used to predict these suicides for time horizon between 1 week and 12 months after discharge in a 70% training sample. Accuracy was validated in the remaining 30% holdout sample. Predictors included VHA administrative variables and small area geocode data linked to patient home addresses. The models had AUC=.79-.82 for time horizons between 1 week and 6 months and AUC=.74 for 12 months. An analysis of operating characteristics showed that 22.4%-32.2% of patients who died by suicide would have been reached if intensive case management was provided to the 5% of patients with highest predicted suicide risk. Positive predictive value (PPV) at this higher threshold ranged from 1.2% over 12 months to 3.8% per case manager year over 1 week. Focusing on the low end of the risk spectrum, the 40% of patients classified as having lowest risk account for 0%-9.7% of suicides across time horizons. Variable importance analysis shows that 51.1% of model performance is due to psychopathological risk factors accounted, 26.2% to social determinants of health, 14.8% to prior history of suicidal behaviors, and 6.6% to physical disorders. The paper closes with a discussion of next steps in refining the model and prospects for developing a parallel precision treatment model.
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Affiliation(s)
- Ronald C Kessler
- Deparment of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | - Mark S Bauer
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States.,Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA, United States
| | - Todd M Bishop
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, United States
| | - Olga V Demler
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Steven K Dobscha
- VA Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, United States.,Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States
| | - Sarah M Gildea
- Deparment of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | - Joseph L Goulet
- Pain, Research, Informatics, Multimorbidities & Education Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Elizabeth Karras
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, United States
| | - Julie Kreyenbuhl
- VA Capitol Healthcare Network (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, MD, United States.,Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Sara J Landes
- South Central Mental Illness Research Education Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Howard Liu
- Deparment of Health Care Policy, Harvard Medical School, Boston, MA, United States.,Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, United States
| | - Alex R Luedtke
- Department of Statistics, University of Washington, Seattle, WA, United States.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Patrick Mair
- Department of Psychology, Harvard University, Cambridge, MA, United States
| | | | - Matthew Nock
- Department of Psychology, Harvard University, Cambridge, MA, United States
| | - Maria Petukhova
- Deparment of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | - Wilfred R Pigeon
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, United States.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
| | - Nancy A Sampson
- Deparment of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | - Jordan W Smoller
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Lauren M Weinstock
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
| | - Robert M Bossarte
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, United States.,West Virginia University Injury Control Research Center and Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, WV, United States
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20
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Elbogen EB, Molloy K, Wagner HR, Kimbrel N, Beckham JC, Van Male L, Leinbach J, Bradford DW. Psychosocial protective factors and suicidal ideation: Results from a national longitudinal study of veterans. J Affect Disord 2020; 260:703-709. [PMID: 31561113 PMCID: PMC6878990 DOI: 10.1016/j.jad.2019.09.062] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/02/2019] [Accepted: 09/11/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND This study investigates the empirical association between psychosocial protective factors and subsequent suicidal ideation in veterans. METHODS We conducted a national longitudinal survey in which participants were randomly drawn from over one million U.S. military service members who served after September 11, 2001. Data were provided by a total of 1090 veterans representative of all 50 states and all military branches in two waves of data collection one year apart (79% retention rate). RESULTS In chi-square analyses, psychosocial protective factors at wave 1 (employment, meeting basic needs, self-care, living stability, social support, spirituality, resilience, and self-determination) were significantly related to lower suicidal ideation at wave 2. In multivariable analyses controlling for covariates at wave 1 including suicidal ideation, the total number of protective factors endorsed at wave 1 significantly predicted reduced odds of suicidal ideation at wave 2. In multivariable analysis examining individual risk and protective factors, again controlling for covariates, results showed that money to cover basic needs and higher psychological resilience at wave 1 were associated with significantly lower odds of suicidal ideation at wave 2. LIMITATIONS The study measured the link between psychosocial protective factors and suicidal ideation but not suicide attempts, which would be an important next step for this research. CONCLUSIONS The results indicate that psychosocial rehabilitation and holistic approaches targeting financial well-being, homelessness, resilience, self-care, social support, spirituality, and work may offer a promising avenue in both veteran and non-veteran populations for treatment safety planning as well as suicide risk management and prevention.
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Affiliation(s)
- Eric B. Elbogen
- Durham VA Health Care System, Durham, NC,VISN 6 Mental Illness Research, Education, and Clinical Center (MIRECC), Durham VA Medical Center, Durham, NC,Department of Psychiatry, Duke University Medical Center, Durham, NC
| | - Kiera Molloy
- Department of Psychiatry, Duke University Medical Center, Durham, NC
| | - H. Ryan Wagner
- Durham VA Health Care System, Durham, NC,VISN 6 Mental Illness Research, Education, and Clinical Center (MIRECC), Durham VA Medical Center, Durham, NC,Department of Psychiatry, Duke University Medical Center, Durham, NC
| | - Nathan Kimbrel
- Durham VA Health Care System, Durham, NC,VISN 6 Mental Illness Research, Education, and Clinical Center (MIRECC), Durham VA Medical Center, Durham, NC,Department of Psychiatry, Duke University Medical Center, Durham, NC
| | - Jean C. Beckham
- Durham VA Health Care System, Durham, NC,VISN 6 Mental Illness Research, Education, and Clinical Center (MIRECC), Durham VA Medical Center, Durham, NC,Department of Psychiatry, Duke University Medical Center, Durham, NC
| | - Lynn Van Male
- Veterans Health Administration, Office of Mental Health and Suicide Prevention, Washington, DC,Oregon Health & Sciences University, Department of Psychiatry, Portland, OR
| | - Jonathan Leinbach
- Durham VA Health Care System, Durham, NC,Department of Psychiatry, Duke University Medical Center, Durham, NC
| | - Daniel W. Bradford
- Durham VA Health Care System, Durham, NC,Department of Psychiatry, Duke University Medical Center, Durham, NC
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21
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Song J, Park S, Lee K, Hong HJ. Influence of Area-Level Characteristics on the Suicide Rate in Korean Adolescents. Psychiatry Investig 2019; 16:800-807. [PMID: 31693841 PMCID: PMC6877454 DOI: 10.30773/pi.2019.0025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 08/06/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE We aimed to investigate the influence of area-level factors on adolescent suicide and to determine which variables differ according to age and sex. METHODS We selected variables that were available for collection through an online database from 2005 to 2015 in the Korean Statistical Information Service and the Korea Labor Institute. We used administrative districts of Korea in 2017 for geographical classification. We examined the relationships between regional suicide rates and area-level variables in male and female subjects aged 10-14 years and 15-19 years. In addition, we analyzed area-level variables in adolescents aged 15-19 years according to sex. RESULTS Our findings indicated that several area-level variables affected adolescent suicide rates, varying according to age and sex. Economic problems were shown to be more associated with suicide in male adolescents than in female adolescents. On the other hand, social fragmentation and health services were shown to be more associated with suicide in females. CONCLUSION Suicide in adolescents was attributable to area-level factors such as economic status, social fragmentation, and community health services. By identifying area-level variables affecting adolescent suicide rates, we will be able to contribute to implement mental health policies related to adolescent suicide.
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Affiliation(s)
- Jungeun Song
- Department of Psychiatry, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Seongjun Park
- Department of Social Welfare, University of Seoul, Seoul, Republic of Korea
| | - Kangwoo Lee
- Suicide and School Mental Health Institute, Anyang, Republic of Korea
| | - Hyun Ju Hong
- Suicide and School Mental Health Institute, Anyang, Republic of Korea.,Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
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Steelesmith DL, Fontanella CA, Campo JV, Bridge JA, Warren KL, Root ED. Contextual Factors Associated With County-Level Suicide Rates in the United States, 1999 to 2016. JAMA Netw Open 2019; 2:e1910936. [PMID: 31490540 PMCID: PMC6735416 DOI: 10.1001/jamanetworkopen.2019.10936] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
IMPORTANCE Understanding geographic and community-level factors associated with suicide can inform targeted suicide prevention efforts. OBJECTIVES To estimate suicide rates and trajectories, assess associated county-level contextual factors, and explore variation across the rural-urban continuum. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included all individuals aged 25 to 64 years who died by suicide from January 1, 1999, to December 31, 2016, in the United States. Spatial analysis was used to map excess risk of suicide, and longitudinal random-effects models using negative binomial regression tested associations of contextual variables with suicide rates as well as interactions among county-level contextual variables. Data analyses were conducted between January 2019 and July 2019. EXPOSURE County of residence. MAIN OUTCOMES AND MEASURES Three-year county suicide rates during an 18-year period stratified by rural-urban location. RESULTS Between 1999 and 2016, 453 577 individuals aged 25 to 64 years died by suicide in the United States. Decedents were primarily male (349 082 [77.0%]) with 101 312 (22.3%) aged 25 to 34 years, 120 157 (26.5%) aged 35 to 44 years, 136 377 (30.1%) aged 45 to 54 years, and 95 771 (21.1%) aged 55 to 64 years. Suicide rates were higher and increased more rapidly in rural than in large metropolitan counties. The highest deprivation quartile was associated with higher suicide rates compared with the lowest deprivation quartile, especially in rural areas, although this association declined during the period studied (rural, 1999-2001: incidence rate ratio [IRR], 1.438; 95% CI, 1.319-1.568; P < .001; large metropolitan, 1999-2001: 1.208; 95% CI, 1.149-1.270; P < .001; rural, 2014-2016: IRR, 1.121; 95% CI, 1.032-1.219; P = .01; large metropolitan, 2014-2016: IRR, 0.942; 95% CI, 0.887-1.001; P = .06). The presence of more gun shops was associated with an increase in county-level suicide rates in all county types except the most rural (rural: IRR, 1.001; 95% CI, 0.999-1.004; P = .40; micropolitan: IRR, 1.005; 95% CI, 1.002-1.007; P < .001; small metropolitan: IRR, 1.010; 95% CI, 1.006-1.014; P < .001; large metropolitan: IRR, 1.012; 95% CI, 1.006-1.018; P < .001). High social capital was associated with lower suicide rates than low social capital (IRR, 0.917; 95% CI, 0.891-0.943; P < .001). High social fragmentation, an increasing percentage of the population without health insurance, and an increasing percentage of veterans in a county were associated with higher suicide rates (high social fragmentation: IRR, 1.077; 95% CI, 1.050-1.103; P < .001; percentage of population without health insurance: IRR, 1.005; 95% CI, 1.004-1.006; P < .001; percentage of veterans: IRR, 1.025; 95% CI, 1.021-1.028; P < .001). CONCLUSIONS AND RELEVANCE This study found that suicide rates have increased across the nation and most rapidly in rural counties, which may be more sensitive to the impact of social deprivation than more metropolitan counties. Improving social connectedness, civic opportunities, and health insurance coverage as well as limiting access to lethal means have the potential to reduce suicide rates across the rural-urban continuum.
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Affiliation(s)
- Danielle L. Steelesmith
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus
| | - Cynthia A. Fontanella
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus
| | - John V. Campo
- Rockefeller Neuroscience Institute, Behavioral Medicine and Psychiatry, West Virginia University, Morgantown
| | - Jeffrey A. Bridge
- Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio
- Departments of Pediatrics, Psychiatry, and Behavioral Health, The Ohio State University, Columbus
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López-Contreras N, Rodríguez-Sanz M, Novoa A, Borrell C, Medallo Muñiz J, Gotsens M. Socioeconomic inequalities in suicide mortality in Barcelona during the economic crisis (2006-2016): a time trend study. BMJ Open 2019; 9:e028267. [PMID: 31455702 PMCID: PMC6719772 DOI: 10.1136/bmjopen-2018-028267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES This study aimed to analyse trends in socioeconomic inequalities in suicide mortality in Barcelona before and after the start of the economic crisis that started at the end of 2008, including both individual factors and contextual factors of the deceased's neighbourhood of residence. DESIGN This is a trend study of three time periods: pre-economic crisis (2006-2008), early crisis (2009-2012) and late crisis (2013-2016). SETTING Total Barcelona residents between 2006 and 2016 (≥25 years of age) and death data derived from the Judicial Mortality Registry of Barcelona. PARTICIPANTS 996 deaths by suicide between 2006 and 2016 were analysed. PRIMARY AND SECONDARY OUTCOME MEASURES The outcomes were age-standardised suicide mortality rates and the associations (relative and absolute risk) between suicide mortality and individual and contextual characteristics for the three time periods. RESULTS From 2006 to 2008, men with a lower educational level were more likely to commit suicide than better educated men (relative risk (RR)=1.46; 95% CI 1.11 to 1.91). This difference disappeared after the onset of the crisis. We found no differences among women. From 2013 to 2016, suicide risk increased among men living in neighbourhoods with higher unemployment levels (RR=1.57; 95% CI 1.09 to 2.25) and among women living in neighbourhoods with a higher proportion of elderly people living alone (RR=2.13; 95% CI 1.15 to 3.93). CONCLUSIONS We observed risks for suicide among men living in neighbourhoods of Barcelona with higher unemployment levels and among women living in neighbourhoods with a higher proportion of elderly people living alone. Inequalities in suicide mortality according to educational level tended to disappear during the crisis among men. Thus, it is important to continue to monitor suicide determinants especially in times of economic crisis.
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Affiliation(s)
- Natalia López-Contreras
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Maica Rodríguez-Sanz
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Àrea de Recerca, Docència i Comunicació, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Institut d'Investigació Biomèdica (IIB) de Sant Pau, Barcelona, Spain
| | - Ana Novoa
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Institut d'Investigació Biomèdica (IIB) de Sant Pau, Barcelona, Spain
| | - Carme Borrell
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica (IIB) de Sant Pau, Barcelona, Spain
- Gerència, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Jordi Medallo Muñiz
- Clinical Service, Catalonian Institute of Legal Medicine and Forensic Science, Barcelona, Spain
| | - Mercè Gotsens
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Lin CY, Hsu CY, Gunnell D, Chen YY, Chang SS. Spatial patterning, correlates, and inequality in suicide across 432 neighborhoods in Taipei City, Taiwan. Soc Sci Med 2019; 222:20-34. [DOI: 10.1016/j.socscimed.2018.12.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/01/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
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Grigoroglou C, Munford L, Webb RT, Kapur N, Ashcroft DM, Kontopantelis E. Spatial distribution and temporal trends in social fragmentation in England, 2001-2011: a national study. BMJ Open 2019; 9:e025881. [PMID: 30679299 PMCID: PMC6347895 DOI: 10.1136/bmjopen-2018-025881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Social fragmentation is commonly examined in epidemiological studies of mental illness as high levels of social fragmentation are often found in areas with high prevalence of mental illness. In this study, we examine spatial and temporal patterns of social fragmentation and its underlying indicators in England over time. SETTING Data for social fragmentation and its underlying indicators were analysed over the decennial Censuses (2001-2011) at a small area geographical level (mean of 1500 people). Degrees of social fragmentation and temporal changes were spatially visualised for the whole of England and its 10 administrative regions. Spatial clustering was quantified using Moran's I; changes in correlations over time were quantified using Spearman's ranking correlation. RESULTS Between 2001 and 2011, we observed a strong persistence for social fragmentation nationally (Spearman's r=0.93). At the regional level, modest changes were observed over time, but marked increases were observed for two of the four social fragmentation underlying indicators, namely single people and those in private renting. Results supported our hypothesis of increasing spatial clustering over time. Moderate regional variability was observed in social fragmentation, its underlying indicators and their clustering over time. CONCLUSION Patterns of social fragmentation and its underlying indicators persisted in England which seem to be driven by the large increases in single people and those in private renting. Policies to improve social cohesion may have an impact on the lives of persons who experience mental illness. The spatial aspect of social fragmentation can inform the targeting of health and social care interventions, particularly in areas with strong social fragmentation clustering.
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Affiliation(s)
- Christos Grigoroglou
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
- Manchester Academic Health Sciences Centre [MAHSC], Manchester, UK
| | - Luke Munford
- Manchester Academic Health Sciences Centre [MAHSC], Manchester, UK
- Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Roger T Webb
- Manchester Academic Health Sciences Centre [MAHSC], Manchester, UK
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Nav Kapur
- Manchester Academic Health Sciences Centre [MAHSC], Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- Centre for Suicide Prevention, Division of Psychology and Mental Health, University of Manchester, Manchester, Greater Manchester, UK
- Greater Manchester Mental Health Trust, Manchester, UK
| | - Darren M Ashcroft
- Manchester Academic Health Sciences Centre [MAHSC], Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Evangelos Kontopantelis
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
- Manchester Academic Health Sciences Centre [MAHSC], Manchester, UK
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Grigoroglou C, Munford L, Webb RT, Kapur N, Doran T, Ashcroft DM, Kontopantelis E. Association between a national primary care pay-for-performance scheme and suicide rates in England: spatial cohort study. Br J Psychiatry 2018; 213:600-608. [PMID: 30058517 DOI: 10.1192/bjp.2018.143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pay-for-performance policies aim to improve population health by incentivising improvements in quality of care.AimsTo assess the relationship between general practice performance on severe mental illness (SMI) and depression indicators under a national incentivisation scheme and suicide risk in England for the period 2006-2014. METHOD Longitudinal spatial analysis for 32 844 small-area geographical units (lower super output areas, LSOAs), using population-structure adjusted numbers of suicide as the outcome variable. Negative binomial models were fitted to investigate the relationship between spatially estimated recorded quality of care and suicide risk at the LSOA level. Incidence rate ratios (IRRs) were adjusted for deprivation, social fragmentation, prevalence of depression and SMI as well as other 2011 Census variables. RESULTS No association was found between practice performance on the mental health indicators and suicide incidence in practice localities (IRR=1.000, 95% CI 0.998-1.002). IRRs indicated elevated suicide risks linked with area-level social fragmentation (1.030; 95% CI 1.027-1.034), deprivation (1.013, 95% CI 1.012-1.014) and rurality (1.059, 95% CI 1.027-1.092). CONCLUSIONS Primary care has an important role to play in suicide prevention, but we did not observe a link between practices' higher reported quality of care on incentivised mental health activities and lower suicide rates in the local population. It is likely that effective suicide prevention needs a more concerted, multiagency approach. Better training in suicide prevention for general practitioners is also essential. These findings pertain to the UK but have relevance to other countries considering similar programmes.Declaration of interestNone.
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Affiliation(s)
- Christos Grigoroglou
- NIHR School for Primary Care Research,Centre for Primary Care,Division of Population Health, Health Services Research and Primary Care,University of Manchester, Manchester Academic Health Sciences Centre (MAHSC),UK
| | - Luke Munford
- Research Fellow in Health Economics,Centre for Health Economics,Division of Population Health, Health Services Research and Primary Care,University of Manchester, Manchester Academic Health Sciences Centre (MAHSC),UK
| | - Roger T Webb
- Professor in Mental Health Epidemiology,Centre for Mental Health and Safety,University of Manchester, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC),UK
| | - Nav Kapur
- Professor of Psychiatry and Population Health,Centre for Suicide Prevention,University of Manchester, Greater Manchester Mental Health Trust and NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC),UK
| | - Tim Doran
- Professor of Health Policy,Department of Health Sciences,University of York,UK
| | - Darren M Ashcroft
- Professor of Pharmacoepidemiology,Centre for Pharmacoepidemiology and Drug Safety,School of Health Sciences,Faculty of Biology, Medicine and Health,University of Manchester, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC),UK
| | - Evangelos Kontopantelis
- Professor of Data Science and Health Services Research,Faculty of Biology, Medicine and Health,University of Manchester, Manchester Academic Health Sciences Centre (MAHSC),UK
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Abstract
BACKGROUND Deaths from suicide, as recorded within the Northern Ireland Coroner's Office for the years 2005-2011 inclusive, were analysed in terms of standardised mortality ratios (SMRs), within Wards and Local Government Districts (LGDs). The aim of the study is to examine factors relating to the ecological context of the area within which the person resided at time of death. Area deprivation, religious composition and age structure are examined in terms of SMRs, while controlling for the number of individuals living within a designated area. METHODS Random-intercept Poisson regression models were used in conjunction with empirical Bayes prediction to examine area effects. RESULTS Considerable variation occurs between the numbers of recorded deaths within each area. A strong association is shown between deprivation and the number of deaths by suicide within an area. There was considerable variation at the LGD level in terms of the number of deaths, but once the nested nature of Wards was taken into account and adjusted for level of deprivation, the variation between LGD was no longer statistically significant. When adjusted for the number of individuals within each age group, the number of deaths in the younger and middle-aged groups did not show a statistical difference (0.05 level), nor did the religious composition of the area in terms of the number of recorded deaths. CONCLUSIONS Based on SMRs, using empirical Bayes prediction, area effects were shown to be substantial, especially in urban locations where there are high rates of deprivation.
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Affiliation(s)
- B Bunting
- Bamford Centre,Psychology Research Institute,Ulster University
| | - C Corry
- National Suicide Research Foundation,University College Cork
| | - S O'Neill
- Bamford Centre,Psychology Research Institute,Ulster University
| | - A Moore
- Environmental Sciences Research Institute,Ulster University
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Henschke N, Lorenz E, Pokora R, Michaleff ZA, Quartey JNA, Oliveira VC. Understanding cultural influences on back pain and back pain research. Best Pract Res Clin Rheumatol 2017; 30:1037-1049. [PMID: 29103548 DOI: 10.1016/j.berh.2017.08.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 06/15/2017] [Accepted: 08/08/2017] [Indexed: 12/29/2022]
Abstract
Low back pain is highly prevalent and places a considerable burden on individuals, their families and communities. This back pain burden is unequally distributed around the world and within populations. Clinicians and researchers addressing back pain should be aware of the cultural, social and political context of back pain patients and how this context can influence pain perception, disability and health care use. Culture, which influences the beliefs and behaviour of individuals within a social group, could be considered an important contributor to the unequal distribution of back pain. However, there is paucity of high-quality research exploring the influence of culture on the experience and management of back pain. Further development and testing of specific tools, assessment methods and communication strategies are needed to improve our understanding of how cultural practices, values and identifications affect those dealing with back pain.
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Affiliation(s)
- Nicholas Henschke
- Musculoskeletal Division, The George Institute for Global Health, Sydney, Australia.
| | - Eva Lorenz
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Roman Pokora
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Zoe A Michaleff
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, United Kingdom.
| | - Jonathan N A Quartey
- Department of Physiotherapy, School of Allied Health Sciences, College of Health Sciences, University of Ghana, Ghana.
| | - Vinicius Cunha Oliveira
- Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.
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Social Capital is Associated With Late HIV Diagnosis: An Ecological Analysis. J Acquir Immune Defic Syndr 2017; 73:213-21. [PMID: 27632146 DOI: 10.1097/qai.0000000000001043] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Late HIV diagnosis is associated with higher medical costs, early mortality among individuals, and HIV transmission in the population. Even under optimal configurations of stable or declining HIV incidence and increase in HIV case findings, no change in proportion of late HIV diagnosis is projected after year 2019. We investigated the association among social capital, gender, and late HIV diagnosis. METHODS We conduct ecological analyses (ZIP code, N = 166) using negative binomial regression of gender-specific rates of late HIV diagnoses (an AIDS defining illness or a CD4 count ≤200 cell/μL within 12 months of a new HIV diagnosis) in 2005 and 2006 obtained from the New York City HIV Surveillance Registry, and social capital indicators (civic engagement, political participation, social cohesion, and informal social control) from the New York Social Indicators Survey, 2004. RESULTS Overall, low to high political participation and social cohesion corresponded with significant (P < 0.0001) decreasing trends in late HIV diagnosis rates. Among men [relative risk (RR) = 0.66, 95% CI: (0.47 to 0.98)] and women [RR = 0.43, 95% CI: (0.28 to 0.67)], highest political participation was associated with lower relative odds of late HIV diagnosis, independent of income inequality. Highest informal social control [RR = 0.67, 95% CI: (0.48 to 0.93)] among men only and moderate social cohesion [RR = 0.71, 95% CI: (0.55 to 0.92)] among women only were associated with the outcome adjusting for social fragmentation, income inequality, and racial composition. DISCUSSION The magnitude of association between social capital and late HIV diagnosis varies by gender and by social capital indicator.
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Spatial Patterns and Neighborhood Characteristics of Overall Suicide Clusters in Florida From 2001 to 2010. Am J Prev Med 2017; 52:e1-e7. [PMID: 27692756 DOI: 10.1016/j.amepre.2016.07.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 07/11/2016] [Accepted: 07/11/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Although spatial examination of mortality and morbidity is becoming more common in health studies, the investigation of suicide death clusters within the neighborhood context is underutilized. The purpose of this ecological study is to detect high- and low-risk clusters of suicide deaths in Florida and determine which neighborhood characteristics distinguish clusters from non-clusters. METHODS The scan statistic method was used to detect overall clusters of completed suicides in Florida from 2001 to 2010. Regression analysis was used to investigate the association of neighborhood characteristics with identified clusters. All data synthesis and statistical analyses were conducted in 2015. RESULTS Twenty-four high-risk and 25 low-risk clusters were identified. The risk of suicide was up to 3.4 times higher in high-risk clusters than in areas outside of clusters (relative risk ranged from 1.36 to 3.44, p≤0.05). Low-risk clusters were associated with 30%-94% decreased risk of suicide (relative risk ranged from 0.06 to 0.70, p≤0.05). Areas with high levels of elderly concentration and household singularity were more likely to be in high-risk clusters, whereas areas with higher economic deprivation and residential density were more likely to be in low-risk clusters. CONCLUSIONS This study identified general suicide patterns across space in the state of Florida and described the characteristics of those areas.
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Huynh C, Ferland F, Blanchette-Martin N, Ménard JM, Fleury MJ. Factors Influencing the Frequency of Emergency Department Utilization by Individuals with Substance Use Disorders. Psychiatr Q 2016; 87:713-728. [PMID: 26875101 DOI: 10.1007/s11126-016-9422-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study assessed the characteristics of individuals with substance use disorders (ISUDs) according to their frequency of emergency department (ED) utilization, and examined which variables were associated with an increase in ED visits using Andersen's model. Data linkage of administrative databanks from three sources [addiction rehabilitation centre registry, physician billing systems, and hospital discharge databank] for 4526 ISUDs was performed. Predisposing, enabling and need factors associated with number of ED visits were determined using a negative binomial regression model and generalised estimating equations. The rate of ED utilization for this population was 9.6 %. Increased number of ED visits was associated with the following variables: older age, social fragmentation, number of consultations with general practitioners, number of consultations with psychiatrists, number of consultations with other types of physicians, alcohol abuse, drug abuse, schizophrenia, anxiety disorders, personality disorders, co-occurring substance dependence and mental disorders, co-occurring substance dependence and chronic physical disorders, and co-occurring mental health disorders and chronic physical disorders. By contrast, a diagnosis of substance dependence, co-occurring drug and alcohol abuse, and a co-occurring diagnosis of substance dependence with mental health and chronic physical disorders decreased ED visits. Efforts to reduce avoidable use of EDs should focus on chronic-disease management and other related strategies aimed at reinforcing services to ISUDs in the community, especially for ISUDs with a co-occurring diagnosis of either mental health disorders or chronic physical disorders.
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Affiliation(s)
- Christophe Huynh
- Centre de réadaptation en dépendance de Montréal - Institut universitaire, 950, rue de Louvain Est, Montreal, QC, H2M 2E8, Canada.
| | - Francine Ferland
- Centre de réadaptation en dépendance de Québec, 2525, chemin de la Canardière, Quebec, QC, G1J 2G3, Canada.,Centre de réadaptation en dépendance de Chaudière-Appalaches, 419, Dorimène-Desjardins, Lévis, QC, G6V 5V3, Canada
| | - Nadine Blanchette-Martin
- Centre de réadaptation en dépendance de Québec, 2525, chemin de la Canardière, Quebec, QC, G1J 2G3, Canada.,Centre de réadaptation en dépendance de Chaudière-Appalaches, 419, Dorimène-Desjardins, Lévis, QC, G6V 5V3, Canada
| | - Jean-Marc Ménard
- Centre de réadaptation en dépendance Domrémy-de-la-Mauricie-Centre-du-Québec, 440 rue des Forges, Trois-Rivières, QC, G9A 2H5, Canada
| | - Marie-Josée Fleury
- Centre de réadaptation en dépendance de Montréal - Institut universitaire, 950, rue de Louvain Est, Montreal, QC, H2M 2E8, Canada.,Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre, Quebec, Canada
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Werbeloff N, Markou M, Hayes JF, Pitman AL, Osborn DPJ. Individual and area-level risk factors for suicidal ideation and attempt in people with severe depression. J Affect Disord 2016; 205:387-392. [PMID: 27585905 DOI: 10.1016/j.jad.2016.08.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/06/2016] [Accepted: 08/14/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Previous research has identified several risk factors that are strongly associated with suicidal behavior in patients with severe depression. However, the effects of area-level characteristics on suicidal ideation and attempt in this population remain unclear. METHODS The Clinical Record Interactive Search (CRIS) database was used to identify 2587 patients with severe depression who received secondary mental health services from the Camden & Islington NHS Foundation Trust. Stepwise multivariable logistic regression models were used to examine associations between socio-demographic characteristics, clinical variables, area-level measures, and suicidal ideation and attempt as separate outcomes. RESULTS Both suicidal ideation and attempts were common among this cohort of severely depressed individuals (70.5% and 37.7%, respectively). While several individual socio-demographic and clinical characteristics were associated with both outcomes, particularly past psychiatric admission (suicidal ideation: adjusted OR=2.86, 95% CI: 2.26-3.62; suicide attempt: adjusted OR=4.00, 95% CI: 3.30-4.89), neither social deprivation nor ethnic density (measured at the area-level) was associated with risk for either outcome. LIMITATIONS Data were not collected specifically for research purposes and hence information on some potential confounders was not available. Additionally, information was restricted to individuals who accessed secondary mental health services in a defined catchment area and period. The study therefore does not take into account individuals who did not access mental health services. CONCLUSIONS The variation in risk for suicidal ideation and attempt among severely depressed individuals is explained by differences in individual socio-demographic and clinical characteristics, most notably past psychiatric admission and substance misuse, and not by area-level measures.
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Affiliation(s)
- Nomi Werbeloff
- UCL Division of Psychiatry, University College London, Gower St, London WC1E 6BT, United Kingdom; Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 Saint Pancras Way, London NW1 0PE, United Kingdom.
| | - Maria Markou
- UCL Division of Psychiatry, University College London, Gower St, London WC1E 6BT, United Kingdom
| | - Joseph F Hayes
- UCL Division of Psychiatry, University College London, Gower St, London WC1E 6BT, United Kingdom; Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 Saint Pancras Way, London NW1 0PE, United Kingdom
| | - Alexandra L Pitman
- UCL Division of Psychiatry, University College London, Gower St, London WC1E 6BT, United Kingdom; Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 Saint Pancras Way, London NW1 0PE, United Kingdom
| | - David P J Osborn
- UCL Division of Psychiatry, University College London, Gower St, London WC1E 6BT, United Kingdom; Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 Saint Pancras Way, London NW1 0PE, United Kingdom
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Joo Y. Spatiotemporal study of elderly suicide in Korea by age cohort. Public Health 2016; 142:144-151. [PMID: 27613224 DOI: 10.1016/j.puhe.2016.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 07/25/2016] [Accepted: 07/26/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study analyzed the spatiotemporal pattern and spatial diffusion of elderly suicide by age cohort, in Korea. STUDY DESIGN The research investigated the elderly suicide rates of the 232 municipal units in South Korea between 2001 and 2011. METHODS The Gi* score, which is a spatially weighted indicator of area attributes, was used to identify hot spots and the spatiotemporal pattern of elderly suicide in the nation during the last 10 years. The spatial Markov matrix and spatial dynamic panel data model were employed to identify and estimate the diffusion effect. RESULTS The suicide rate among elderly individuals 75 years and older was substantially higher than the rate for those between 65 and 74 years of age; however, the spatial patterns of the suicide clusters were similar between the two groups. From 2001 to 2011, the spatial distribution of elderly suicide hot spots differed each year. For both age cohorts, elderly suicide hot spots developed around the north area of South Korea in 2001 and moved to the mid-east area and the mid-western coastal area over 10 years. The spatial Markov matrix indicates that the change in the suicide rate of one area was affected by the suicide rates of neighbouring areas from the previous year, which suggests that suicide increase in one area inflates a neighbouring area's suicide rate over time. Using a spatial dynamic panel data model, elderly suicide diffusion effects were found to be statistically significant for both age cohorts even after economic and demographic indicators and a time variable are included. For individuals 75 years and older, the diffusion effect appeared to be larger. CONCLUSIONS This study demonstrates that elderly suicide can spread spatially over time in both age cohorts. Thus, it is necessary to design a place-based and age-differentiated intervention policy that precisely considers the spatial diffusion of elderly suicide.
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Affiliation(s)
- Y Joo
- Department of Environmental Planning, Environmental Planning Institute, Seoul National University, #220, 1 Gwanak-ro, Gwanak-gu, Seoul 151-742, Republic of Korea.
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Sun BQ, Zhang J. Economic and Sociological Correlates of Suicides: Multilevel Analysis of the Time Series Data in the United Kingdom. J Forensic Sci 2016; 61:345-351. [PMID: 27404607 DOI: 10.1111/1556-4029.13033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 02/13/2015] [Accepted: 03/28/2015] [Indexed: 12/01/2022]
Abstract
For the effects of social integration on suicides, there have been different and even contradictive conclusions. In this study, the selected economic and social risks of suicide for different age groups and genders in the United Kingdom were identified and the effects were estimated by the multilevel time series analyses. To our knowledge, there exist no previous studies that estimated a dynamic model of suicides on the time series data together with multilevel analysis and autoregressive distributed lags. The investigation indicated that unemployment rate, inflation rate, and divorce rate are all significantly and positively related to the national suicide rates in the United Kingdom from 1981 to 2011. Furthermore, the suicide rates of almost all groups above 40 years are significantly associated with the risk factors of unemployment and inflation rate, in comparison with the younger groups.
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Affiliation(s)
- Bruce Qiang Sun
- PACM & Department of Mathematics, State University of New York Buffalo State, Buffalo, NY
| | - Jie Zhang
- Department of Sociology, Shandong University School of Public Health and the Center for Suicide Prevention Research, China, State University of New York Buffalo State, Buffalo, NY
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O'Farrell IB, Corcoran P, Perry IJ. The area level association between suicide, deprivation, social fragmentation and population density in the Republic of Ireland: a national study. Soc Psychiatry Psychiatr Epidemiol 2016; 51:839-47. [PMID: 27059662 DOI: 10.1007/s00127-016-1205-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 03/16/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE Numerous studies have examined the ecological relationship between suicide and area level determinants such as deprivation and social fragmentation. In Ireland, there is considerable geographic variation in the rates of suicide. However, there is a dearth of Irish studies investigating the geographic variability of suicide. METHODS The Irish Central Statistics Office (CSO) provided data relating to all deaths by suicide and deaths of undetermined intent that occurred from 2009 to 2011. Negative binomial regression was used to examine the relationship between area level suicide rates and measures of deprivation, social fragmentation and population density that were taken from the 2011 National Census. RESULTS Overall deprivation had the strongest independent effect on small-area rates of suicide, with the most deprived areas showing the greatest risk of suicide (risk ratio = 2.1; 95 % CI 1.70-2.52). Low population density (rurality) was associated with an increased risk suicide in males across both age groups and among females in the older 40-64-year age group. Conversely, a weak association between high population density (urbanicity) and increased suicide risk was found among females in the 15-39-year age group. Associations with social fragmentation only became apparent in the sub group analysis. Social fragmentation was associated with an elevated risk of suicide in the older 40-64 age group, with this effect being most pronounced among females. CONCLUSION The findings of this study demonstrate marked geographical inequalities in the distribution of suicide in Ireland and highlight the importance of targeting suicide prevention resources in the most deprived areas.
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Affiliation(s)
- I B O'Farrell
- Department of Epidemiology and Public Health, Western Gateway Building, University College Cork, Cork, Republic of Ireland.
| | - P Corcoran
- Department of Epidemiology and Public Health, Western Gateway Building, University College Cork, Cork, Republic of Ireland.,National Suicide Research Foundation, Western Gateway Building, University College Cork, Cork, Republic of Ireland.,Department of Obstetrics and Gynaecology, 5th Floor, Cork University Maternity Hospital, Wilton, Cork, Republic of Ireland
| | - I J Perry
- Department of Epidemiology and Public Health, Western Gateway Building, University College Cork, Cork, Republic of Ireland
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Linsley KR, Schapira MA, Schapira K, Lister C. Changes in risk factors for young male suicide in Newcastle upon Tyne, 1961-2009. BJPsych Bull 2016; 40:136-41. [PMID: 27280034 PMCID: PMC4887731 DOI: 10.1192/pb.bp.114.048884] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims and method To ascertain differences in patterns of suicide in young men over three decades (1960s, 1990s and 2000s) and discuss implications for suicide prevention. Data on suicides and open verdicts in men aged 15-34 were obtained from coroner's records in Newcastle upon Tyne and analysed using SPSS software. Results An increase in suicide rates from the first to the second decade was followed by a fall in the third decade. This was associated with an increasing proportion of single men, those living alone, unemployment, consumption of alcohol, use of hanging, previous suicide attempt and history of treatment for mental illness. Clinical implications This study highlights the need for more interventions and focus to be given to young males in the suicide prevention area and is of high importance in the field of public health. Areas that could be tackled include reducing access to means of suicide, reducing alcohol use, support for relationship difficulties, engagement with mental health services and management of chronic illness.
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Yang S, Kestens Y, Dahhou M, Daniel M, Kramer MS. Neighborhood deprivation and maternal psychological distress during pregnancy: a multilevel analysis. Matern Child Health J 2016; 19:1142-51. [PMID: 25398620 DOI: 10.1007/s10995-014-1623-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Maternal psychosocial distress is conceptualized as an important factor underlying the association between neighborhood deprivation and pregnancy outcomes. However, empirical studies to examine effects of neighborhood deprivation on psychosocial distress during pregnancy are scant. Based on a large multicenter cohort of pregnant women in Montreal, we examined (1) the extent to which psychosocial distress is clustered at the neighborhood-level, (2) the extent to which the clustering is explained by neighborhood material or social deprivation, and (3) whether associations between neighborhood deprivation and psychosocial distress persist after accounting for neighborhood composition (individual-level characteristics) using multilevel analyses. For 5,218 women residing in 740 neighborhoods, a prenatal interview at 24-26 gestational weeks measured both general and pregnancy-related psychological distress using well-validated scales: perceived stress, social support, depressive symptoms, optimism, commitment to the pregnancy, pregnancy-related anxiety, and maternal locus-of-control. Neighborhood deprivation indices were linked to study participants by their residential postal code. Neighborhood-level clustering (intraclass correlation) ranged from 1 to 2 % for perceived stress (lowest), optimism, pregnancy-related anxiety, and commitment to pregnancy to 4-6 % for perceived social support, depressive symptoms, and maternal locus of control (highest). Neighborhood material deprivation explained far more of the clustering (23-75 %) than did social deprivation (no more than 4 %). Although both material and social deprivation were associated with psychological distress in unadjusted analyses, the associations disappeared after accounting for individual-level socioeconomic characteristics. Our results highlight the importance of accounting for individual-level socioeconomic characteristics in studies of potential neighborhood effects on maternal mental health.
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Affiliation(s)
- Seungmi Yang
- Department of Pediatrics, Research Institute of McGill University Health Centre, McGill University, Montreal, QC, Canada,
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Van Dyck D, Teychenne M, McNaughton SA, De Bourdeaudhuij I, Salmon J. Relationship of the perceived social and physical environment with mental health-related quality of life in middle-aged and older adults: mediating effects of physical activity. PLoS One 2015; 10:e0120475. [PMID: 25799269 PMCID: PMC4370752 DOI: 10.1371/journal.pone.0120475] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 01/22/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mental health conditions are among the leading non-fatal diseases in middle-aged and older adults in Australia. Proximal and distal social environmental factors and physical environmental factors have been associated with mental health, but the underlying mechanisms explaining these associations remain unclear. The study objective was to examine the contribution of different types of physical activity in mediating the relationship of social and physical environmental factors with mental health-related quality of life in middle-aged and older adults. METHODS Baseline data from the Wellbeing, Eating and Exercise for a Long Life (WELL) study were used. WELL is a prospective cohort study, conducted in Victoria, Australia. Baseline data collection took place in 2010. In total, 3,965 middle-aged and older adults (55-65 years, 47.4% males) completed the SF-36 Health Survey, the International Physical Activity Questionnaire, and a questionnaire on socio-demographic, social and physical environmental attributes. Mediation analyses were conducted using the MacKinnon product-of-coefficients test. RESULTS Personal safety, the neighbourhood physical activity environment, social support for physical activity from family or friends, and neighbourhood social cohesion were positively associated with mental health-related quality of life. Active transportation and leisure-time physical activity mediated 32.9% of the association between social support for physical activity from family or friends and mental health-related quality of life. These physical activity behaviours also mediated 11.0%, 3.4% and 2.3% respectively, of the relationship between the neighbourhood physical activity environment, personal safety and neighbourhood social cohesion and mental health-related quality of life. CONCLUSIONS If these results are replicated in future longitudinal studies, tailored interventions to improve mental health-related quality of life in middle-aged and older adults should use a combined strategy, focusing on increasing physical activity as well as social and physical environmental attributes.
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Affiliation(s)
- Delfien Van Dyck
- Research Foundation Flanders, Egmontstraat 5, 1000 Brussels, Belgium
- Ghent University, Department of Movement and Sports Sciences, Watersportlaan 2, 90000 Ghent, Belgium
| | - Megan Teychenne
- Deakin University, Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Sarah A. McNaughton
- Deakin University, Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Ilse De Bourdeaudhuij
- Ghent University, Department of Movement and Sports Sciences, Watersportlaan 2, 90000 Ghent, Belgium
| | - Jo Salmon
- Deakin University, Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, 221 Burwood Highway, Burwood, Victoria 3125, Australia
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Lawson F, Schuurman N, Amram O, Nathens AB. A geospatial analysis of the relationship between neighbourhood socioeconomic status and adult severe injury in Greater Vancouver. Inj Prev 2015; 21:260-5. [PMID: 25694418 PMCID: PMC4518736 DOI: 10.1136/injuryprev-2014-041437] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 01/21/2015] [Indexed: 11/19/2022]
Abstract
Background Every year, injuries cost the Canadian healthcare system billions of dollars and result in thousands of emergency room visits, hospitalisations and deaths. The purpose of this study was to explore the relationship between neighbourhood socioeconomic status (NSES) and the rates of all-cause, unintentional and intentional severe injury in Greater Vancouver adults. A second objective was to determine whether the identified associations were spatially consistent or non-stationary. Methods Severe injury cases occurring between 2001 and 2006 were identified using the British Columbia's Coroner's Service records and the British Columbia Trauma Registry, and mapped by census dissemination areas using a geographical information system. Descriptive statistics and exploratory spatial data analysis methods were used to gain a better understanding of the data sets and to explore the relationship between the rates of severe injury and two measures of NSES (social and material deprivation). Ordinary least squares and geographically weighted regression were used to model these relationships at the global and local levels. Results Inverse relationships were identified between both measures of NSES and the rates of severe injury with the strongest associations located in Greater Vancouver's most socioeconomically deprived neighbourhoods. Social deprivation was found to have a slightly stronger relationship with the rates of severe injury than material deprivation. Conclusions Results of this study suggest that policies and programmes aimed at reducing the burden of severe injury in Greater Vancouver should take into account social and material deprivation, and should target the most socioeconomically deprived neighbourhoods in Greater Vancouver.
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Affiliation(s)
- Fiona Lawson
- Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Nadine Schuurman
- Department of Geography, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Ofer Amram
- Department of Geography, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Avery B Nathens
- Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Hsu CY, Chang SS, Lee EST, Yip PSF. "Geography of suicide in Hong Kong: spatial patterning, and socioeconomic correlates and inequalities". Soc Sci Med 2015; 130:190-203. [PMID: 25706063 DOI: 10.1016/j.socscimed.2015.02.019] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Past urban research on Western nations tends to show high suicide rates in inner city and socioeconomically deprived areas. However, little is known about geographic variations in suicide in non-Western cities. We used Bayesian hierarchical models to estimate smoothed standardised mortality ratios (2005-2010) for suicide in people aged 10 years or above in each geographic unit in Hong Kong at two levels, i.e. large street block (n = 1639; median population = 1860) and small tertiary planning unit group (n = 204; median population = 14,850). We further analysed their associations with a range of area socioeconomic characteristics and a deprivation index. The "city centre" of Hong Kong, a generally non-deprived area, showed mostly below average suicide rates. However, there were high rates concentrating in some socioeconomically deprived, densely populated areas, including some inner city areas, across the city. Males had greater geographic variations in rates than females, except the elderly group. The use of smaller geographic units revealed finer detailed suicide distribution than the use of larger units, and showed that suicide rates were associated with indicators of socioeconomic deprivation (population with non-professional jobs and low median household income), and social fragmentation (proportions of unmarried adults and divorced/separated adults), but not with Gini coefficient. Sex/age groups had different associations with suicide rates. Areas in the most deprived quintile had a suicide rate more than two times higher than the least deprived. The association between suicide and deprivation was stronger in males than females and more marked in the younger populations compared to the elderly. The spatial distribution of suicide in Hong Kong showed distinct patterning and a stronger association with income compared to findings from Western countries. Suicide prevention strategies should consider tackling the marked socioeconomic gradient in suicide and high risk in young and middle-aged males living in deprived areas.
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Affiliation(s)
- Chia-Yueh Hsu
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam Road, Pokfulam, Hong Kong SAR, China; Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Shu-Sen Chang
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam Road, Pokfulam, Hong Kong SAR, China; Institute of Health Policy and Management, and Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan; Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, 5 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Esther S T Lee
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, 5 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Paul S F Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam Road, Pokfulam, Hong Kong SAR, China; Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, 5 Sassoon Road, Pokfulam, Hong Kong SAR, China.
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Flouri E, Midouhas E, Joshi H, Sullivan A. Neighbourhood social fragmentation and the mental health of children in poverty. Health Place 2014; 31:138-45. [PMID: 25532101 DOI: 10.1016/j.healthplace.2014.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 11/10/2014] [Accepted: 11/21/2014] [Indexed: 11/19/2022]
Abstract
Using data from 7,776 Millennium Cohort Study children in England, we examined the role of neighbourhood social fragmentation in trajectories of emotional/behavioural problems at ages three, five and seven, and in moderating the association of children's emotional/behavioural problems with neighbourhood poverty, family poverty and adverse family events. Allowing for key background characteristics, social fragmentation generally added little to explain child outcomes, but there were fewer conduct problems among children in poor neighbourhoods with less fragmentation. Surprisingly, in less fragmented neighbourhoods poor families tended to feel less safe and more distressed, which was associated with children's conduct problems.
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Affiliation(s)
- Eirini Flouri
- UCL Institute of Education, University College London, 25 Woburn Square, London WC1H 0AA, UK..
| | - Emily Midouhas
- UCL Institute of Education, University College London, 25 Woburn Square, London WC1H 0AA, UK
| | - Heather Joshi
- UCL Institute of Education, University College London, 25 Woburn Square, London WC1H 0AA, UK
| | - Alice Sullivan
- UCL Institute of Education, University College London, 25 Woburn Square, London WC1H 0AA, UK
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Resource Use and Deprivation: Geographical Analysis of the Ecological Footprint and Townsend Index for England. SUSTAINABILITY 2014. [DOI: 10.3390/su6084749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Randall JR, Doku D, Wilson ML, Peltzer K. Suicidal behaviour and related risk factors among school-aged youth in the Republic of Benin. PLoS One 2014; 9:e88233. [PMID: 24505443 PMCID: PMC3914941 DOI: 10.1371/journal.pone.0088233] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 01/06/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Research on factors associated with suicidal ideation and suicide attempts has been conducted largely in developed countries. Research on West African countries in particular is lacking. METHODS Data were obtained from the Global School-based Health Survey conducted in Benin in 2009. This was a cross-sectional study of three grades, spanning Junior and Senior High, which sampled a total of 2,690 adolescents. Data on the occurrence of demographic, psycho-social and socio-environmental risk factors were tested using multinomial logistic regression for their association with suicidal ideation and suicide attempts. RESULTS The survey indicated that 23.2% had thought about suicide and 28.3% had made a suicide attempt in the previous year. Anxiety, loneliness, being bullied, alcohol misuse, illicit drug use, and lack of parental support were independently related to the ideation outcomes, suicidal ideation without planning and suicidal ideation with planning. Multinomial regression analysis, using one suicide attempt and multiple suicide attempts as outcomes, revealed that female sex, anxiety, loneliness, being physically attacked, and illicit drug use were associated these outcomes. DISCUSSION The prevalence of suicide attempts reported in the survey is relatively high. It is possible that there are cultural factors that could explain this finding. Our research indicates that many factors are related to the occurrence of suicidal ideation and suicide attempts among youth in Benin. Illicit drug use and violence in particular are associated with a high rate of suicide attempts in Benin. Measures to address these issues may reduce the risk of self-inflicted violence.
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Affiliation(s)
- Jason R. Randall
- Centre for Injury Prevention and Community Safety (CIPCS), PeerCorps Trust Fund, Dar es Salaam, Tanzania
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - David Doku
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Michael L. Wilson
- Centre for Injury Prevention and Community Safety (CIPCS), PeerCorps Trust Fund, Dar es Salaam, Tanzania
- Unit of Adolescent Psychiatry, Turku University Hospital, Department of Adolescent Psychiatry, University of Turku, Turku, Finland
| | - Karl Peltzer
- Human Sciences Research Council, Pretoria, South Africa
- Department of Psychology, University of Limpopo, Mangkwang-E, South Africa
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Zammit S, Gunnell D, Lewis G, Leckie G, Dalman C, Allebeck P. Individual- and area-level influence on suicide risk: a multilevel longitudinal study of Swedish schoolchildren. Psychol Med 2014; 44:267-277. [PMID: 23611138 DOI: 10.1017/s0033291713000743] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- S Zammit
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK
| | - D Gunnell
- School of Social and Community Medicine, University of Bristol, UK
| | - G Lewis
- School of Social and Community Medicine, University of Bristol, UK
| | - G Leckie
- Centre for Multilevel Modelling, University of Bristol, UK
| | - C Dalman
- Department of Public Health Sciences, Karolinska Institute, Sweden
| | - P Allebeck
- Department of Public Health Sciences, Karolinska Institute, Sweden
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Yur'yev A, Värnik P, Sisask M, Leppik L, Lumiste K, Värnik A. Some aspects of social exclusion: do they influence suicide mortality? Int J Soc Psychiatry 2013; 59:232-8. [PMID: 22205377 DOI: 10.1177/0020764011431792] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The current study is aimed to assess the relationship between the 'economic/employment' and 'social/welfare' dimensions of social exclusion and suicide mortality in Europe. METHODS Suicide rates for 26 countries were obtained from the WHO. Data on social expenditure were obtained from the OECD database. Employment rates and GDP were obtained from the Total Economy Database. Questions about citizens' attitudes towards different aspects of social exclusion were taken from the European Social Survey. Structural equation modelling was applied to research the theoretical structure of the variables. RESULTS All variables are statistically significant in male and female models except of the relationships between 'economic/employment' and 'social/welfare' dimensions and female suicides; and the relationship between 'employment rates' and 'economic/employment' dimension. Suicide mortality rates among both males and females are influenced negatively by 'economic/employment' and 'social/welfare' dimensions. Among females, the influence of 'social/welfare' dimension is stronger compared to the 'economic/employment' dimension. The remaining influence of GDP is positive in both models. CONCLUSIONS Both 'economic/employment' and 'social/welfare' dimensions of social exclusion significantly influence suicide mortality among males. The influence of 'economic/employment' and 'social/welfare' dimensions of social exclusion on female suicide mortality is controversial. Social exclusion might be considered as a risk factor for suicide mortality in Europe.
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Takagi D, Kondo K, Kondo N, Cable N, Ikeda K, Kawachi I. Social disorganization/social fragmentation and risk of depression among older people in Japan: Multilevel investigation of indices of social distance. Soc Sci Med 2013; 83:81-9. [DOI: 10.1016/j.socscimed.2013.01.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Revised: 12/10/2012] [Accepted: 01/01/2013] [Indexed: 10/27/2022]
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Milner A, Hjelmeland H, Arensman E, Leo DD. Social-Environmental Factors and Suicide Mortality: A Narrative Review of over 200 Articles. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/sm.2013.32021] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wilson ML, Dunlavy AC, Viswanathan B, Bovet P. Suicidal expression among school-attending adolescents in a middle-income sub-Saharan country. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 9:4122-34. [PMID: 23202835 PMCID: PMC3524616 DOI: 10.3390/ijerph9114122] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 10/30/2012] [Accepted: 11/01/2012] [Indexed: 11/26/2022]
Abstract
We investigated correlates for suicidal expression among adolescents in the Seychelles. Data on 1,432 students (52% females) were derived from the Global School-based Health Survey. Participants were divided into three groups: those with no suicidal behavior (N = 1,199); those with suicide ideation/SI (N = 89); and those reporting SI with a plan to carry out a suicide attempt/SISP (N = 139), each within a 12-month recall period. Using multinomial logistic regression, we examined the strength of associations with social, behavioral and economic indicators while adjusting for covariates. Sixteen percent of school-attending adolescents reported a suicidal expression (10% with a plan/6.2% without). Those reporting SI were younger (relative risk ratio RRR = 0.81; CI = 0.68-0.96), indicated signs of depression (RRR = 1.69; CI = 1.05-2.72) and loneliness (RRR=3.36; CI = 1.93-5.84). Tobacco use (RRR = 2.34; CI = 1.32-4.12) and not having close friends (RRR = 3.32; CI = 1.54-7.15) were significantly associated with SI. Those with SISP were more likely to be female (RRR = 0.47; 0.30-0.74), anxious (RRR = 3.04; CI = 1.89-4.88) and lonely (RRR = 1.74; CI = 1.07-2.84). Having no close friends (RRR = 2.98; 1.56-5.69) and using tobacco (RRR = 2.41; 1.48-3.91) were also strongly associated. Having parents who were understanding was protective (RRR = 0.50; CI = 0.31-0.82). Our results suggest that school health promotion programs may benefit from targeting multiple factors associated with suicidal expression. More research, particularly multilevel designs are needed to identify peer and family influences which may modify associations with suicidality.
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Affiliation(s)
- Michael L. Wilson
- Centre for Injury Prevention and Community Safety (CIPCS), PeerCorps Trust Fund, P.O. Box 22499 Dar es Salaam, Tanzania;
| | - Andrea C. Dunlavy
- Centre for Injury Prevention and Community Safety (CIPCS), PeerCorps Trust Fund, P.O. Box 22499 Dar es Salaam, Tanzania;
| | | | - Pascal Bovet
- Ministry of Health, Victoria, Republic of Seychelles; ;
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV) Lausanne 1010, Switzerland
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Elderly suicide rates: the importance of a non-linear relationship with distal risk and protective factors. Int Psychogeriatr 2012; 24:1363-7. [PMID: 22583544 DOI: 10.1017/s1041610212000750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The elderly population size is increasing worldwide due to prolonged life expectancy and falling birth rates. Traditionally, suicide rates increase with age. For example, a recent cross-national study of 62 developing and developed countries reported an increase in suicide rates with aging in males and females in 25 and 27 countries respectively (Shah, 2007a). Thus, suicides in the elderly are an important public health concern. While much is known about proximal (individual level) risk and protective factors for elderly suicides (e.g. Conwell et al., 1991; Cattell and Jolley, 1995; Harwood et al., 2001), less is known about more distal (societal or population level) risk and protective factors (Rehkopf and Buka, 2006). Moreover, detailed knowledge of these distal factors may have greater public health relevance for the development of comprehensive prevention strategies (Knox et al., 2004).
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50
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Weighing the contributions of material and social area deprivation to preterm birth. Soc Sci Med 2012; 75:1032-7. [DOI: 10.1016/j.socscimed.2012.04.033] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 03/15/2012] [Accepted: 04/26/2012] [Indexed: 11/17/2022]
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