Intentional isoniazid overdosage among southwestern American Indians

Global incidence of suicide among Indigenous peoples: a systematic review

BACKGROUND

Suicide is the second leading cause of death among adolescents worldwide, and is a major driver of health inequity among Indigenous people in high-income countries. However, little is known about the burden of suicide among Indigenous populations in low- and middle-income nations, and no synthesis of the global data is currently available. Our objective was to examine the global incidence of suicide among Indigenous peoples and assess disparities through comparisons with non-Indigenous populations.

METHODS

We conducted a systematic review of suicide rates among Indigenous peoples worldwide and assessed disparities between Indigenous and non-Indigenous populations. We performed text word and Medical Subject Headings searches in PubMed, MEDLINE, Embase, Cumulative Index of Nursing and Allied Health (CINAHL), PsycINFO, Latin American and Caribbean Health Sciences Literature (LILACS), and Scientific Electronic Library Online (SciELO) for observational studies in any language, indexed from database inception until June 1, 2017. Eligible studies examined crude or standardized suicide rates in Indigenous populations at national, regional, or local levels, and examined rate ratios for comparisons to non-Indigenous populations.

RESULTS

The search identified 13,736 papers and we included 99. Eligible studies examined suicide rates among Indigenous peoples in 30 countries and territories, though the majority focused on populations in high-income nations. Results showed that suicide rates are elevated in many Indigenous populations worldwide, though rate variation is common, and suicide incidence ranges from 0 to 187.5 suicide deaths per 100,000 population. We found evidence of suicide rate parity between Indigenous and non-Indigenous populations in some contexts, while elsewhere rates were more than 20 times higher among Indigenous peoples.

CONCLUSIONS

This review showed that suicide rates in Indigenous populations vary globally, and that suicide rate disparities between Indigenous and non-Indigenous populations are substantial in some settings but not universal. Including Indigenous identifiers and disaggregating national suicide mortality data by geography and ethnicity will improve the quality and relevance of evidence that informs community, clinical, and public health practice in Indigenous suicide prevention.

A review of the interplay between tuberculosis and mental health

AIMS

Tuberculosis and mental illness share common risk factors including homelessness, HIV positive serology, alcohol/substance abuse and migrant status leading to frequent comorbidity. We sought to generate a comprehensive literature review that examines the complex relationship between tuberculosis and mental illness.

METHODS

A literature search was conducted in MedLine, Ovid and Psychinfo, with further examination of the references of these articles. In total 316 articles were identified. It was not possible to conduct a formal meta-analysis due to the absence of randomised controlled data.

RESULTS

Rates of mental illness of up to 70% have been identified in tuberculosis patients. Medications used in the treatment of common mental illnesses, such as depression, may have significant interactions with anti-tuberculosis agents, especially isoniazid and increasingly linezolid. Many medications used in the treatment of tuberculosis can have significant adverse psychiatric effects and some medications such as rifampicin may reduce the effective doses of anti-psychotics y their enzyme induction actions. Treatment with agents such as cycloserine has been associated with depression, and there have been reported cases of psychosis with most anti-tuberculous agents. Mental illness and substance abuse may also affect compliance with treatment, with attendant public health concerns.

CONCLUSIONS

As a result of the common co-morbidity of mental illness and tuberculosis, it is probable that physicians will encounter previously undiagnosed mental illness among patients with tuberculosis. Similarly, psychiatrists are likely to meet tuberculosis among their patients. It is important that both psychiatrists and physicians are aware of the potential for interactions between the drugs used to treat tuberculosis and psychiatric conditions.

Isoniazid poisonings in New York City

We identified 41 New York City residents who had been hospitalized at least overnight between January 1992 and September 1993 because of a toxic isoniazid (INH) exposure. Review of the available medical charts of 33 patients revealed that median age was 19 years, 27 (82%) were females, and 24 (83%) were taking INH chemoprophylaxis for tuberculosis infection. Twenty-two patients had seizures. Twenty-seven (82%) patients had attempted suicide using INH, and another three patients had intentionally misused INH by making up missed doses at one time. All patients survived. Physicians should be aware of the potential for INH toxicity and should assess their patients' current mental and psychosocial status when prescribing it. INH toxicity should be considered when young patients, particularly females, present with unexplained intractable seizures, and treatment with pyridoxine should be given.

Suicide among Native Americans: Further Tribal Data and Considerations

This is an updating of an earlier publication on tribal differences in Native American suicidal behavior. Similarities among these studies are noted, including data sources, the concentration of suicide among the young, intratribal group heterogeneity with respect to suicide, suicide methods employed, and alcohol involvement. Most investigations have relied heavily on single official sources for their data. The implications of obtaining figures from official agencies are explored, particularly with respect to Native American tribes and reservations. Neglected areas of study are noted along with the need for further investigation to facilitate prevention programs.

Suicide among Native Americans: A Compilation of Findings

Suicide among Native Americans has received much attention in the recent literature. These reports have primarily focused upon single, specific tribal groups. While the suicide rate for Indians as a whole is equal to or greater than that for the nation, undue emphasis upon those tribes having especially high suicide rates has created the general impression that all Indian groups have high rates. The wide variations that exist among the tribes are sometimes noted but often they are overlooked or ignored. The results of the available studies of suicide among the various Indian tribal groups are presented here along with some implications for further research.

A Bibliography on Suicide and Suicide Attempts among American Indians and Alaska Natives

Presented here is a bibliography on suicide and self-destruction among American Indians and the native peoples of Alaska. This area of knowledge has been characterized by rapid growth in the last twenty years. The number of existing sources now totals 160 items. All of these works are listed here with a brief documentation of trends in the literature.

Alcohol and Drug Use and Abuse among Indian-Americans: A Review of Issues and Sources

There is much concern that alcohol and drug abuse are among the top problems in the United States generally, and also a “high priority” health and social problem among Indians. For that reason, there have been numerous programs of education, prevention, and treatment directed toward and developed in Indian communities. Nevertheless, many personnel at both national and local levels and in both rural and urban areas lack adequate acquaintance with pertinent conceptual issues and sources on alcohol and drug use and abuse among Indians specifically. The purpose of this article is to help remedy that lack by reviewing the range of literature and presenting an overview of some of the major perspectives which should inform any approach to Indian alcohol and drug use and abuse.