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Miller TR, Weinstock LM, Ahmedani BK, Carlson NN, Sperber K, Cook BL, Taxman FS, Arias SA, Kubiak S, Dearing JW, Waehrer GM, Barrett JG, Hulsey J, Johnson JE. Share of Adult Suicides After Recent Jail Release. JAMA Netw Open 2024; 7:e249965. [PMID: 38728036 PMCID: PMC11087834 DOI: 10.1001/jamanetworkopen.2024.9965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/04/2024] [Indexed: 05/13/2024] Open
Abstract
Importance Although people released from jail have an elevated suicide risk, the potentially large proportion of this population in all adult suicides is unknown. Objective To estimate what percentage of adults who died by suicide within 1 year or 2 years after jail release could be reached if the jail release triggered community suicide risk screening and prevention efforts. Design, Setting, and Participants This cohort modeling study used estimates from meta-analyses and jail census counts instead of unit record data. The cohort included all adults who were released from US jails in 2019. Data analysis and calculations were performed between June 2021 and February 2024. Main Outcomes and Measures The outcomes were percentage of total adult suicides within years 1 and 2 after jail release and associated crude mortality rates (CMRs), standardized mortality ratios (SMRs), and relative risks (RRs) of suicide in incarcerated vs not recently incarcerated adults. Taylor expansion formulas were used to calculate the variances of CMRs, SMRs, and other ratios. Random-effects restricted maximum likelihood meta-analyses were used to estimate suicide SMRs in postrelease years 1 and 2 from 10 jurisdictions. Alternate estimate was computed using the ratio of suicides after release to suicides while incarcerated. Results Included in the analysis were 2019 estimates for 7 091 897 adults (2.8% of US adult population; 76.7% males and 23.3% females) who were released from incarceration at least once, typically after brief pretrial stays. The RR of suicide was 8.95 (95% CI, 7.21-10.69) within 1 year after jail release and 6.98 (95% CI, 4.21-9.76) across 2 years after release. A total of 27.2% (95% CI, 18.0%-41.7%) of all adult suicide deaths occurred in formerly incarcerated individuals within 2 years of jail release, and 19.9% (95% CI, 16.2%-24.1%) of all adult suicides occurred within 1 year of release (males: 23.3% [95% CI, 20.8%-25.6%]; females: 24.0% [95% CI, 19.7%-36.8%]). The alternate method yielded slightly larger estimates. Another 0.8% of adult suicide deaths occurred during jail stays. Conclusions and Relevance This cohort modeling study found that adults who were released from incarceration at least once make up a large, concentrated population at greatly elevated risk for death by suicide; therefore, suicide prevention efforts focused on return to the community after jail release could reach many adults within 1 to 2 years of jail release, when suicide is likely to occur. Health systems could develop infrastructure to identify these high-risk adults and provide community-based suicide screening and prevention.
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Affiliation(s)
- Ted R. Miller
- National Capital Region Center, Pacific Institute for Research and Evaluation (PIRE), Beltsville, Maryland
- Curtin University School of Public Health, Beltsville, Maryland
| | - Lauren M. Weinstock
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Brian K. Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan
| | - Nancy N. Carlson
- School of Counseling, Walden University, Silver Spring, Maryland
| | - Kimberly Sperber
- Complex Health Solutions, Behavioral Health and Wellness, CareSource, Dayton, Ohio
| | - Benjamin Lê Cook
- Harvard Medical School, Cambridge, Massachusetts
- Cambridge Health Alliance, Cambridge, Massachusetts
| | - Faye S. Taxman
- Schar School of Policy and Government, Center for Advancing Correctional Excellence, George Mason University, Fairfax, Virginia
| | - Sarah A. Arias
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
- Butler Hospital, Providence, Rhode Island
| | - Sheryl Kubiak
- Center for Behavioral Health and Justice, Wayne State University School of Social Work, Detroit, Michigan
| | - James W. Dearing
- Department of Communication, Michigan State University, East Lansing
| | - Geetha M. Waehrer
- National Capital Region Center, Pacific Institute for Research and Evaluation (PIRE), Beltsville, Maryland
| | - James G. Barrett
- Harvard Medical School, Cambridge, Massachusetts
- Cambridge Health Alliance, Cambridge, Massachusetts
- Cambridge Police Department, Cambridge, Massachusetts
| | | | - Jennifer E. Johnson
- Charles Stewart Mott Department of Public Health, Michigan State University, East Lansing
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Kaminer Y, Burke R, Zhornitsky S, Gill J, Zajac K, Hesselbrock V. Youth fatal drug overdose and suicide: Trends in Connecticut, 2019-2021. Am J Addict 2024; 33:327-334. [PMID: 38071697 DOI: 10.1111/ajad.13506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/28/2023] [Accepted: 11/28/2023] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Increasing rates of fatal drug overdose (FDO) among youth since 2016 have been driven by fentanyl and polysubstance use. Suicide by youth also increased steadily since 2007. The manner of FDO may be accidental (i.e., unintentional) or suicidal (i.e., intentional). This report examines the rate of youth intentional and unintentional FDO as well as specific drug toxicology in Connecticut, between the years 2019 and 2021, compared to a 2016-2018 report. METHODS We reviewed N = 286 consecutive FDO files of youth, <26 years of age dated for 2019-2021 from the Connecticut Medical Examiner's office. RESULTS FDO attributed to fentanyl increased significantly from 2016 to 2018 to 2019 to 2021. Xylazine FDO emerged in 2019 and reached 16% in 2021. Intentional FDO rates doubled between these periods from 3.8% to 7.7%. Most FDOs involved individuals aged 20-25 years, whereas 10% were among those aged 15-19. For the first time since 2018, FDO among 10-14 years old was detected. Analysis of gender found no differences. Within each gender, however, FDO attributed to fentanyl increased significantly between these periods. The FDO rate for Hispanics increased significantly, while the rate for Whites decreased significantly. DISCUSSION AND CONCLUSIONS The availability of high lethality potential drugs leading to youth FDO including an increasing rate of intentional FDO, is a public health concern. It is prudent to identify modifiable acute high-risk circumstances for intentional FDO and prevention-intervention evidence-based approach to reduce FDO. SCIENTIFIC SIGNIFICANCE This is the first study of FDO among youth examining the manner of death by suicide.
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Affiliation(s)
- Yifrah Kaminer
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Rebecca Burke
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Simon Zhornitsky
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - James Gill
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kristyn Zajac
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Victor Hesselbrock
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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Cano M, Zachmeyer M, Salinas LA, Ferguson KM. Racial/ethnic inequality in homelessness and drug overdose deaths in US States. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02667-5. [PMID: 38597978 DOI: 10.1007/s00127-024-02667-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 03/23/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE This study examined whether state-level racial disproportionality in homelessness is associated with racial disproportionality in overdose mortality. METHODS Counts of individuals experiencing homelessness (2015-2017; by state and racial/ethnic group) were obtained from the US Department of Housing and Urban Development; population estimates and counts of drug overdose deaths (2018-2021; by state and racial/ethnic group) were obtained from the National Center for Health Statistics. Homelessness and overdose mortality disproportionality scores were calculated to indicate the extent to which each racial group was over- or under- represented among those experiencing homelessness, or among overdose deaths, respectively (relative to each racial group's proportional share in the general population). For each racial group examined, ordinary least squares regression models with robust standard errors (SEs) examined associations between state-level disproportionality in homelessness and disproportionality in overdose mortality, adjusting for percent aged 18-64 and US Census Region, as well as disproportionality in educational attainment and unemployment. RESULTS State-level racial disproportionality in homelessness was significantly and positively associated with racial disproportionality in overdose mortality for Black (b = 0.16 [SE = 0.05]; p < .01), American Indian/Alaska Native (b = 0.71 [SE = 0.23]; p < .01), and Hispanic populations (b = 0.17 [SE = 0.05]; p < .01), in models adjusting for region and percent aged 18-64. The significant positive associations in these three populations persisted after adjusting for educational attainment disproportionality, yet the association was no longer significant in the Black population after adjusting for unemployment disproportionality. CONCLUSION States with the highest levels of racial/ethnic minority overrepresentation in homelessness generally also had relatively higher levels of racial/ethnic minority overrepresentation in overdose deaths.
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Affiliation(s)
- Manuel Cano
- Arizona State University, 411 N. Central Ave Suite 863, Phoenix, AZ, 85004, USA.
| | | | - Luis A Salinas
- University of Texas at San Antonio, San Antonio, TX, USA
| | - Kristin M Ferguson
- Arizona State University, 411 N. Central Ave Suite 863, Phoenix, AZ, 85004, USA
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Marks RB, Moreira N, O'Connell KL, Hearne A, Law KC. Suicide While Locked Up in Texas: Risk Factors for Death by Suicide in Custody. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241243366. [PMID: 38591139 DOI: 10.1177/08862605241243366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
In the United States, suicide is a leading cause of death in prisons and jails, with incarcerated individuals being nine times more likely to die by suicide than the general population. Identifying vulnerabilities at each stage of custody (prebooking, jail, prison) and factors that increase suicide risk can improve prevention efforts. A hierarchical binary logistic regression was conducted on data from the Texas Justice Initiative's Deaths in Custody Report. Variables included race/ethnicity, sex, age at death, days in custody, classification of crime as violent or nonviolent, and custody type of prebooking, jail, or prison. Among main effects, when compared to suicide rates in prison, jail suicide deaths were over three and a half times more likely (OR = 3.61), and the period of prebooking emerged as a period of staggering risk of suicide death, with suicides being over 5,000% more likely than at other stages of custody (OR = 50.86). When interactions were entered, Latinx individuals were at a particularly increased risk of suicide death (OR = 10.46), likelihood of suicide death decreased with each year of age (OR = .89), nonviolent offenders were just under three and a half times more likely to die by suicide when compared to violent offenders (OR = 3.45), and each stage of custody was shown to affect the relationship between age-related rates of suicide in different ways. Results call for further investigation into suicide among understudied populations in corrections, such as Latinx individuals, juveniles in the prison system, and nonviolent offenders, to identify the groups at the highest risk of premature death in correctional systems.
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Affiliation(s)
| | | | | | | | - Keyne C Law
- Seattle Pacific University, Seattle, WA, USA
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5
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Susukida R, Nestadt PS, Kharrazi H, Wilcox HC. Prevalence and Correlates of Opioid-Involved Suicides in Maryland. Arch Suicide Res 2024; 28:660-673. [PMID: 37143364 PMCID: PMC10624645 DOI: 10.1080/13811118.2023.2207612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Involvement of opioids in suicides has doubled during the past two decades, worsening a major public health concern. This study examined the characteristics of opioid-involved suicides. METHODS The sample of decedents (N = 12,038) in Maryland between 2006 and 2020 was used to compare the characteristics of opioid-involved suicides (n = 947) with suicides not involving opioids (n = 6,896) and accidental opioid deaths (n = 4,125). Direct comparisons were then made between opioid-involved suicides with and without the additional presence of non-opioid substances. RESULTS Opioid-involved suicides were significantly more likely than suicides not involving opioids to occur among those aged 18-64 years, non-Hispanic Whites, and unemployed or disabled individuals. Opioid-involved suicides were more likely than accidental opioid deaths to occur among females, those aged <18 years, non-Hispanic Whites, and employed individuals. Of all suicides involved opioids, 45% involved other non-opioid substances. Polysubstance opioid suicides were significantly more likely than suicides involving opioids only to occur among non-Hispanic Whites. CONCLUSIONS Significant differences were observed in the demographic groups most at risk for opioid-involved suicide than other suicide or accidental opioid death. Among opioid-involved suicides, polysubstance involvement also represents a distinct group. These findings may enhance the targeting of prevention efforts.
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Affiliation(s)
- Ryoko Susukida
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Paul S. Nestadt
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe St. Baltimore, MD 21287
| | - Hadi Kharrazi
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
- Division of Health Sciences Informatics, Johns Hopkins School of Medicine, 600 N. Wolfe St. Baltimore, MD 21287
| | - Holly C. Wilcox
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe St. Baltimore, MD 21287
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
- Johns Hopkins University School of Education, Education Building, 2800 N. Charles St. Baltimore, MD 21218
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Arakelian M, Barnett B, Weleff J. The Zero Suicide Model in Addiction Treatment Settings: Recognizing the Need for Feasibility and Implementation Data. Psychiatr Serv 2024; 75:378-380. [PMID: 37933133 DOI: 10.1176/appi.ps.20230175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
The Zero Suicide (ZS) model is a promising approach for preventing all suicides across health care settings. ZS provides guidelines for health care systems to implement best practices in suicide prevention. Patients with substance use disorders are at increased risk for suicide, but no known research has investigated how to integrate the ZS model into addiction treatment settings. This Open Forum encourages clinicians and researchers to integrate ZS into such settings and to study its feasibility and effectiveness. ZS integration into addiction treatment may improve both suicide and addiction outcomes, but additional research is needed.
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Affiliation(s)
- Miranda Arakelian
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland Clinic, Cleveland (Arakelian, Barnett); Department of Psychiatry and Psychology, Neurological Institute, Cleveland Clinic, Cleveland (Barnett); Department of Psychiatry, Yale University School of Medicine, New Haven (Weleff)
| | - Brian Barnett
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland Clinic, Cleveland (Arakelian, Barnett); Department of Psychiatry and Psychology, Neurological Institute, Cleveland Clinic, Cleveland (Barnett); Department of Psychiatry, Yale University School of Medicine, New Haven (Weleff)
| | - Jeremy Weleff
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland Clinic, Cleveland (Arakelian, Barnett); Department of Psychiatry and Psychology, Neurological Institute, Cleveland Clinic, Cleveland (Barnett); Department of Psychiatry, Yale University School of Medicine, New Haven (Weleff)
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Dhaubhadel S, Ganguly K, Ribeiro RM, Cohn JD, Hyman JM, Hengartner NW, Kolade B, Singley A, Bhattacharya T, Finley P, Levin D, Thelen H, Cho K, Costa L, Ho YL, Justice AC, Pestian J, Santel D, Zamora-Resendiz R, Crivelli S, Tamang S, Martins S, Trafton J, Oslin DW, Beckham JC, Kimbrel NA, McMahon BH. High dimensional predictions of suicide risk in 4.2 million US Veterans using ensemble transfer learning. Sci Rep 2024; 14:1793. [PMID: 38245528 PMCID: PMC10799879 DOI: 10.1038/s41598-024-51762-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/09/2024] [Indexed: 01/22/2024] Open
Abstract
We present an ensemble transfer learning method to predict suicide from Veterans Affairs (VA) electronic medical records (EMR). A diverse set of base models was trained to predict a binary outcome constructed from reported suicide, suicide attempt, and overdose diagnoses with varying choices of study design and prediction methodology. Each model used twenty cross-sectional and 190 longitudinal variables observed in eight time intervals covering 7.5 years prior to the time of prediction. Ensembles of seven base models were created and fine-tuned with ten variables expected to change with study design and outcome definition in order to predict suicide and combined outcome in a prospective cohort. The ensemble models achieved c-statistics of 0.73 on 2-year suicide risk and 0.83 on the combined outcome when predicting on a prospective cohort of [Formula: see text] 4.2 M veterans. The ensembles rely on nonlinear base models trained using a matched retrospective nested case-control (Rcc) study cohort and show good calibration across a diversity of subgroups, including risk strata, age, sex, race, and level of healthcare utilization. In addition, a linear Rcc base model provided a rich set of biological predictors, including indicators of suicide, substance use disorder, mental health diagnoses and treatments, hypoxia and vascular damage, and demographics.
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Affiliation(s)
| | - Kumkum Ganguly
- Los Alamos National Laboratory, Los Alamos, NM, 87545, USA
| | - Ruy M Ribeiro
- Los Alamos National Laboratory, Los Alamos, NM, 87545, USA
| | - Judith D Cohn
- Los Alamos National Laboratory, Los Alamos, NM, 87545, USA
| | - James M Hyman
- Los Alamos National Laboratory, Los Alamos, NM, 87545, USA
| | | | - Beauty Kolade
- Los Alamos National Laboratory, Los Alamos, NM, 87545, USA
| | - Anna Singley
- Los Alamos National Laboratory, Los Alamos, NM, 87545, USA
| | | | | | - Drew Levin
- Sandia National Laboratory, Albuquerque, NM, 87123, USA
| | - Haedi Thelen
- Sandia National Laboratory, Albuquerque, NM, 87123, USA
| | - Kelly Cho
- Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, USA
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Lauren Costa
- Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, USA
| | - Yuk-Lam Ho
- Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, USA
| | - Amy C Justice
- VA Connecticut Healthcare System, Yale Schools of Medicine and Public Health, Yale University, West Haven, CT, USA
| | - John Pestian
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Daniel Santel
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Rafael Zamora-Resendiz
- Applied Mathematics and Computational Research Division, Lawrence Berkeley National Laboratory, 1 Cyclotron Rd, Berkeley, CA, 94720, USA
| | - Silvia Crivelli
- Applied Mathematics and Computational Research Division, Lawrence Berkeley National Laboratory, 1 Cyclotron Rd, Berkeley, CA, 94720, USA
| | - Suzanne Tamang
- Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Susana Martins
- Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
| | - Jodie Trafton
- Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
| | - David W Oslin
- Cpl Michael J Crescenz VA Medical Center, VISN 4 Mental Illness Research, Education, and Clinical Center; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA
| | - Jean C Beckham
- Durham Veterans Affairs (VA) Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Nathan A Kimbrel
- Durham Veterans Affairs (VA) Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Simon DH, Masters RK. Institutional Failures as Structural Determinants of Suicide: The Opioid Epidemic and the Great Recession in the United States. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024:221465231223723. [PMID: 38235534 DOI: 10.1177/00221465231223723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
We investigate recent trends in U.S. suicide mortality using a "structural determinants of health" framework. We access restricted-use multiple cause of death files to track suicide rates among U.S. Black, White, American Indian/Alaska Native, and Latino/a men and women between 1990 and 2017. We examine suicide deaths separately by poisonings and nonpoisonings to illustrate that (1) women's suicide rates from poisonings track strongly with increases in prescription drug availability and (2) nonpoisoning suicide rates among all adult Americans track strongly with worsening economic conditions coinciding with the financial crash and Great Recession. These findings suggest that institutional failures elevated U.S. suicide risk between 1990 and 2017 by increasing access to more lethal means of self-harm and by increasing both exposure and vulnerability to economic downturns. Together, these results support calls to scale up to focus on the structural determinants of U.S. suicide.
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Myhre MØ, Walby FA, Bramness JG, Mehlum L. The temporal association between suicide and comorbid mental disorders in people treated for substance use disorders: a National registry study. Addict Sci Clin Pract 2023; 18:59. [PMID: 37821976 PMCID: PMC10568834 DOI: 10.1186/s13722-023-00415-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/06/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND The time after contact with specialized health services for mental health and substance use is associated with an increased risk of suicide, where temporal aspects of suicide and comorbid mental disorders in patients with substance use disorders could be associated. This study aimed to examine the temporal association between time from last treatment contact to suicide and comorbid mental disorders in patients with substance use disorders. METHODS This study is a historical prospective case series using nationwide registry data. It included 946 individuals registered the year before suicide with a substance use disorder (F10-F19) in Norway's specialized health services for treating substance use and mental health disorders between 2010 and 2020. The outcome was the number of weeks from the last contact with services to suicide. The exposure was comorbid mental disorders divided into 'no comorbid mental disorder'; 'psychosis or bipolar disorders' (F20-F31), 'depressive or anxiety disorders' (F32-F49); and 'personality disorders' (F60-F69). Covariates included gender, age, last diagnosed substance use disorder, registered deliberate self-harm last year, and the number of in- and outpatient contacts the previous year. RESULTS The number of weeks from last service contact to suicide differed (p = < 0.001) between patients with no comorbid mental disorders (Median = 7; IQR 2-23), psychosis or bipolar disorders (Median = 2; IQR = 1-7), depressive or anxiety disorders (Median = 3; IQR = 1-11) and personality disorders (Median = 1; IQR = 1-5.5). Significantly decreased adjusted incidence rate ratios (aIRR) were found for psychosis or bipolar disorders [aIRR = 0.67 (95% CI 0.53-0.85)] and personality disorders [aIRR = 0.56 (0.42-0.77)] compared to no comorbid mental disorder when adjusted for individual characteristics and service contact. For depressive and anxiety disorders compared to no comorbid mental disorder, the association was significant when adjusted for individual characteristics [aIRR = 0.55 (0.46-0.66)]. CONCLUSIONS While patients with substance use disorders generally died by suicide a short time after contact with services, patients with comorbid mental disorders died an even shorter time after such contact and significantly shorter than patients without such comorbidities.
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Affiliation(s)
- Martin Ø Myhre
- National Centre for Suicide Research and Prevention, Institute for Clinical Medicine, University of Oslo, Sognsvannveien 21, 0372, Oslo, Norway.
| | - Fredrik A Walby
- National Centre for Suicide Research and Prevention, Institute for Clinical Medicine, University of Oslo, Sognsvannveien 21, 0372, Oslo, Norway
| | - Jørgen G Bramness
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
- UiT- The Arctic University of Norway, Tromsø, Norway
- Norwegian National Competency Centre for Drug Abuse and Mental Illness, Brumunddal, Norway
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute for Clinical Medicine, University of Oslo, Sognsvannveien 21, 0372, Oslo, Norway
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Choi NG, Choi BY, Marti CN. Physical Health Problems as a Suicide Precipitant: Associations With Other Risk Factors and Suicide Methods in Three Age Groups of Older Decedents. Innov Aging 2023; 7:igad073. [PMID: 37554949 PMCID: PMC10406434 DOI: 10.1093/geroni/igad073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Indexed: 08/10/2023] Open
Abstract
Background and Objectives Physical health problems are a significant late-life suicide precipitant. This study's purpose was to examine differences in (i) other suicide precipitants and psychiatric/substance use problems, and (ii) suicide methods (firearms, hanging/suffocation, and poisoning) in 3 age groups (55-64, 65-74, and 75+) of older suicide decedents who had physical health problems as a suicide precipitant. Research Design and Methods Data came from the 2017-2019 U.S. National Violent Death Reporting System (N = 34,912; 27,761 males [79.5%] and 7,151 females [20.5%]). Generalized linear models for a Poisson distribution with a log link were used to examine the study questions. Results Physical health problems were a suicide precipitant for 25.8%, 41.9%, and 57.7% of the 55-64, 65-74, and 75+ age groups, respectively, and were associated with a higher likelihood of having had depressed mood (IRR = 1.38, 95% CI: 1.33-1.43) and other substance use problems (IRR = 1.22, 95% CI: 1.13-1.31). Interaction effects showed that when job/finance/housing problems, depressed mood, or any psychiatric disorders were co-present with physical health problems, the age group differences in the predicted rates of physical health problems were diminished. Physical health problems were also positively associated with firearm and poisoning use, but negatively associated with hanging/suffocation. Interaction effects indicated that the predicted rates of firearm and poisoning use significantly increased among those aged 55-64 with than without physical health problems. Discussion and Implications In all 3 age groups of older suicide decedents, physical health problems were the predominant suicide precipitant, and those with physical health problems had elevated depressed mood. Assessment of suicide risk, affordable and accessible health, and mental health services, restriction of access to lethal suicide methods, and policy-based suicide prevention approaches for older adults with physical health problems are needed.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - Bryan Y Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
- Department of Emergency Medicine, BayHealth, Dover, Delware, USA
| | - C Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
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He SDQ, Lee JH, Prahlow JA. COVID-19-Related Suicides-Public Health Role of Forensic Pathologists. Am J Forensic Med Pathol 2023; 44:00000433-990000000-00091. [PMID: 37318125 PMCID: PMC10627398 DOI: 10.1097/paf.0000000000000850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
ABSTRACT Concerns about potential increases in suicidal behavior during the coronavirus disease 2019 (COVID-19) pandemic arose in response to reported widespread mental health deterioration. Although early data did not corroborate such concerns, suicide remains a significant cause of preventable deaths worldwide and is of significant interest to public health in the setting of a pandemic. In this study, we present 17 cases of COVID-19-related suicides seen in our West Michigan Medical Examiner's office from 2020 to 2022, which exhibit the complex relationship between mental health and pandemic-related psychological, social, and economic stressors. The relationships were generally categorized as increased anxiety and/or stress due to COVID-19 (5/17 [29.4%]), the loss of social support and/or social isolation occurring as a result of COVID-19 restrictions (5/17 [29.4%]), financial concerns or loss of income as a result of COVID-19 policies (3/17 [17.6%]), grief related specifically to COVID-19 (2/17 [11.8%]), and purported neuropsychiatric sequelae of a prior COVID-19 infection (2/17 [11.8%]). By examining these cases, we highlight ways in which public health systems might prepare for and respond to mental health crises during current or future pandemics and the need for increased collaboration between forensic pathologists and epidemiologists in collating high-quality data during death investigations.
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Fusaroli M, Pelletti G, Giunchi V, Pugliese C, Bartolucci M, Necibi EN, Raschi E, De Ponti F, Pelotti S, Poluzzi E. Deliberate Self-Poisoning: Real-Time Characterization of Suicidal Habits and Toxidromes in the Food and Drug Administration Adverse Event Reporting System. Drug Saf 2023; 46:283-295. [PMID: 36689131 PMCID: PMC9869307 DOI: 10.1007/s40264-022-01269-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Deliberate self-poisoning (DSP) using drugs is the preferred method of suicide at a global level. Its investigation is hampered by limited sample sizes and data reliability. We investigate the role of the US FDA Adverse Event Reporting System (FAERS), a consolidated pharmacovigilance database, in outlining DSP habits and toxidromes. METHODS We retrieved cases of 'intentional overdose' and 'poisoning deliberate' from the FAERS (January 2004-December 2021). Using descriptive and disproportionality analyses, we estimated temporal trends, potential risk factors, toxidromes, case-fatality rates and lethal doses (LDs) for the most frequently reported drugs. RESULTS We retrieved 42,103 DSP cases (17% fatal). Most cases were submitted in winter. Reports of DSP involved younger people, psychiatric conditions, and alcohol use, compared with non-DSP, and fatality was higher in men and older patients. Suspected drugs were mainly antidepressants, analgesics, and antipsychotics. Multiple drug intake was recorded in more than 50% of the reports, especially analgesics, psychotropics, and cardiovascular agents. The most frequently reported drugs were paracetamol, promethazine, amlodipine, quetiapine, and metformin. We estimated LD25 for paracetamol (150 g). CONCLUSION Worldwide coverage of the FAERS complements existing knowledge about DSP and may drive tailored prevention measures to timely address the DSP phenomenon and prevent intentional suicides.
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Affiliation(s)
- Michele Fusaroli
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Guido Pelletti
- Legal Medicine Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Valentina Giunchi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Chiara Pugliese
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Mattia Bartolucci
- Department of Statistical Sciences, University of Bologna, Bologna, Italy
| | - Elena Narmine Necibi
- School of Emergency Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Emanuel Raschi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Fabrizio De Ponti
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Susi Pelotti
- Legal Medicine Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Elisabetta Poluzzi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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13
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Rockett IR, Ali B, Caine ED, Shepard DS, Banerjee A, Nolte KB, Connery HS, Larkin GL, Stack S, White FM, Jia H, Cossman JS, Feinberg J, Stover AN, Miller TR. Escalating costs of self-injury mortality in the 21st century United States: an interstate observational study. BMC Public Health 2023; 23:285. [PMID: 36755229 PMCID: PMC9906586 DOI: 10.1186/s12889-023-15188-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 02/02/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Estimating the economic costs of self-injury mortality (SIM) can inform health planning and clinical and public health interventions, serve as a basis for their evaluation, and provide the foundation for broadly disseminating evidence-based policies and practices. SIM is operationalized as a composite of all registered suicides at any age, and 80% of drug overdose (intoxication) deaths medicolegally classified as 'accidents,' and 90% of corresponding undetermined (intent) deaths in the age group 15 years and older. It is the long-term practice of the United States (US) Centers for Disease Control and Prevention (CDC) to subsume poisoning (drug and nondrug) deaths under the injury rubric. This study aimed to estimate magnitude and change in SIM and suicide costs in 2019 dollars for the United States (US), including the 50 states and the District of Columbia. METHODS Cost estimates were generated from underlying cause-of-death data for 1999/2000 and 2018/2019 from the US Centers for Disease Control and Prevention's (CDC's) Wide-ranging ONline Data for Epidemiologic Research (WONDER). Estimation utilized the updated version of Medical and Work Loss Cost Estimation Methods for CDC's Web-based Injury Statistics Query and Reporting System (WISQARS). Exposures were medical expenditures, lost work productivity, and future quality of life loss. Main outcome measures were disaggregated, annual-averaged total and per capita costs of SIM and suicide for the nation and states in 1999/2000 and 2018/2019. RESULTS 40,834 annual-averaged self-injury deaths in 1999/2000 and 101,325 in 2018/2019 were identified. Estimated national costs of SIM rose by 143% from $0.46 trillion to $1.12 trillion. Ratios of quality of life and work losses to medical spending in 2019 US dollars in 2018/2019 were 1,476 and 526, respectively, versus 1,419 and 526 in 1999/2000. Total national suicide costs increased 58%-from $318.6 billion to $502.7 billion. National per capita costs of SIM doubled from $1,638 to $3,413 over the observation period; costs of the suicide component rose from $1,137 to $1,534. States in the top quintile for per capita SIM, those whose cost increases exceeded 152%, concentrated in the Great Lakes, Southeast, Mideast and New England. States in the bottom quintile, those with per capita cost increases below 70%, were located in the Far West, Southwest, Plains, and Rocky Mountain regions. West Virginia exhibited the largest increase at 263% and Nevada the smallest at 22%. Percentage per capita cost increases for suicide were smaller than for SIM. Only the Far West, Southwest and Mideast were not represented in the top quintile, which comprised states with increases of 50% or greater. The bottom quintile comprised states with per capita suicide cost increases below 24%. Regions represented were the Far West, Southeast, Mideast and New England. North Dakota and Nevada occupied the extremes on the cost change continuum at 75% and - 1%, respectively. CONCLUSION The scale and surge in the economic costs of SIM to society are large. Federal and state prevention and intervention programs should be financed with a clear understanding of the total costs-fiscal, social, and personal-incurred by deaths due to self-injurious behaviors.
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Affiliation(s)
- Ian R.H. Rockett
- grid.268154.c0000 0001 2156 6140Department of Epidemiology and Biostatistics, West Virginia University School of Public Health, One Medical Center Drive, Morgantown, WV 26506-9190 USA ,grid.412750.50000 0004 1936 9166Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY 14642 USA
| | - Bina Ali
- grid.280247.b0000 0000 9994 4271Pacific Institute for Research and Evaluation, 4061 Powder Mill Rd, Beltsville, MD 20705 USA
| | - Eric D. Caine
- grid.412750.50000 0004 1936 9166Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY 14642 USA
| | - Donald S. Shepard
- grid.253264.40000 0004 1936 9473Cost and Value Group, Heller School for Social Policy and Management, Brandeis University, 415 South St, Waltham, MA 02453 USA
| | - Aniruddha Banerjee
- grid.257413.60000 0001 2287 3919Department of Geography, Indiana University-Purdue University at Indianapolis, Cavanaugh Hall 441, 425 University Blvd., Indianapolis, IN 46202 USA
| | - Kurt B. Nolte
- grid.266832.b0000 0001 2188 8502Department of Pathology, University of New Mexico School of Medicine, MSC08-4640, Albuquerque, NM 87131 USA
| | - Hilary S. Connery
- grid.240206.20000 0000 8795 072XMcLean Hospital, 115 Mill Street, Mail Stop 222, Belmont, MA 02478-1064 USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, 2 West, Room 305, 401 Park Drive, Boston, MA 02215 USA
| | - G. Luke Larkin
- grid.261103.70000 0004 0459 7529Northeast Ohio Medical University, 4209 St. Rt. 44, PO Box 95, Rootstown, OH 44272 USA
| | - Steven Stack
- grid.254444.70000 0001 1456 7807Department of Criminology and Criminal Justice, Wayne State University, 3293 Faculty/Administration Building (FAB) 656 W. Kirby St, Detroit, MI 48202 USA ,grid.254444.70000 0001 1456 7807Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Tolan Park Medical Building, 3901 Chrysler Service Drive, Detroit, MI 48201-2167 USA
| | - Franklin M.M. White
- grid.55602.340000 0004 1936 8200Department of Community Health and Epidemiology, Dalhousie University, 5790 University Ave, Halifax, NS B3H 1V7 Canada
| | - Haomiao Jia
- grid.21729.3f0000000419368729Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032 USA ,grid.21729.3f0000000419368729School of Nursing, Columbia University, 560 W 168th St, New York, NY 10032 USA
| | - Jeralynn S. Cossman
- grid.215352.20000000121845633College for Health, Community and Policy, University of Texas-San Antonio, One UTSA Circle, San Antonio, TX 78249-3209 USA
| | - Judith Feinberg
- grid.268154.c0000 0001 2156 6140Departments of Behavioral Medicine and Psychiatry and Medicine, Infectious Diseases, West Virginia University School of Medicine, 30 Chestnut Ridge Rd, Morgantown, WV 26506 USA
| | - Amanda N. Stover
- grid.266856.90000 0001 0291 7689Eshelman School of Pharmacy, University of North Carolina at Asheville, One University Heights, 2214 Kerr Hall, Asheville, NC 28804 USA
| | - Ted R. Miller
- grid.280247.b0000 0000 9994 4271Pacific Institute for Research and Evaluation, 4061 Powder Mill Rd, Beltsville, MD 20705 USA ,grid.1032.00000 0004 0375 4078Centre for Population Health Research, Curtin University, 208 Kent St, Bentley, WA 6102 Australia
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Cano M, Oh S, Osborn P, Olowolaju SA, Sanchez A, Kim Y, Moreno AC. County-level predictors of US drug overdose mortality: A systematic review. Drug Alcohol Depend 2023; 242:109714. [PMID: 36463764 DOI: 10.1016/j.drugalcdep.2022.109714] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 11/21/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND This systematic review summarized published literature on county-level predictors of drug overdose mortality in the United States (US). METHODS Peer-reviewed studies and doctoral dissertations published in English between 1990 and July 19, 2022 were identified from PubMed, Web of Science, ProQuest Dissertations & Theses, PsycINFO, CINAHL, and EconLit. Eligible studies examined at least one county-level predictor of drug overdose mortality in US counties. Two reviewers independently completed screening, quality assessment (with an adapted National Institutes of Health Quality Assessment Tool), and data extraction. Results were qualitatively summarized and grouped by predictor categories. RESULTS Of 56 studies included, 42.9% were subnational, and 53.6% were limited to opioid overdose. In multiple studies, measures related to opioid prescribing, illness/disability, economic distress, mining employment, incarceration, family distress, and single-parent families were positively associated with drug overdose mortality outcomes, while measures related to cannabis dispensaries, substance use treatment, social capital, and family households were negatively associated with drug overdose mortality outcomes. Both positive and negative associations were documented for smoking, uninsurance, healthcare professional shortage status, physicians per capita, unemployment, income, poverty, educational attainment, racial composition, and rurality. Findings within studies also differed by subpopulation (by race/ethnicity, gender, age, or rurality) and the type of drugs involved in overdose. CONCLUSIONS The findings of this review provide relatively mixed evidence regarding many county-level predictors of overdose mortality, several of which also vary between subpopulations, supporting the importance of additional research to elucidate pathways through which the county context may shape risk of fatal overdose.
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Affiliation(s)
- Manuel Cano
- School of Social Work, Arizona State University, USA.
| | - Sehun Oh
- College of Social Work, The Ohio State University, USA
| | | | | | - Armando Sanchez
- Department of Social Work, University of Texas at San Antonio, USA
| | - Yeonwoo Kim
- Department of Kinesiology, University of Texas at Arlington, USA; School of Social Work, University of Texas at Arlington, USA
| | - Alberto Cano Moreno
- Department of Public Policy, Universidad Autónoma del Estado de Hidalgo, México
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15
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Anthony KM, Ertl A, Leavitt RA, Crosby AE, Diduk-Smith RM, Matthews KA. Detection of Suicide Clusters using Small-Area Geographic Data from the Virginia Violent Death Reporting System, 2010 - 2015. VIRGINIA JOURNAL OF PUBLIC HEALTH 2023; 8:5. [PMID: 38873403 PMCID: PMC11174135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Introduction From 1999 to 2020, the suicide rate in Virginia increased from 13.1 to 15.9 per 100,000 persons aged 10 years and older. Few studies have examined spatial patterns of suicide geographies smaller than the county level. Methods We analyzed data from suicide decedents aged ≥10 years from 2010 through 2015 in the Virginia Violent Death Reporting System. We identified spatial clusters of high suicide rates using spatially adaptive filtering with standardized mortality ratio (SMR) significantly higher than the state SMR (p < 0.001). We compared demographic characteristics, method of injury, and suicide circumstances of decedents within each cluster to decedents outside any cluster. Results We identified 13 high-risk suicide clusters (SMR between 1.7 and 2.0). Suicide decedents in the clusters were more likely to be older (40+ years), non-Hispanic white, widowed/divorced/separated, and less likely to have certain precipitating suicide circumstances than decedents outside the clusters. Suicide by firearm was more common in four clusters, and suicide by poisoning was more common in two clusters compared to the rest of the state. Conclusions There are important differences between geographic clusters of suicide in Virginia. These results suggest that place-specific risk factors for suicide may be relevant for targeted suicide prevention.
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Affiliation(s)
- Kurtis M. Anthony
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control
| | - Allison Ertl
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control
| | - Rachel A. Leavitt
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control
| | - Alexander E. Crosby
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control
| | | | - Kevin A. Matthews
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control
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16
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Shiue KY, Naumann RB, Proescholdbell S, Cox ME, Aurelius M, Austin AE. Differences in overdose deaths by intent: Unintentional & suicide drug poisonings in North Carolina, 2015-2019. Prev Med 2022; 163:107217. [PMID: 35998765 DOI: 10.1016/j.ypmed.2022.107217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/23/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022]
Abstract
Comprehensive fatal overdose prevention requires an understanding of the fundamental causes and context surrounding drug overdose. Using a social determinants of health (SDOH) framework, this descriptive study examined unintentional and self-inflicted (i.e., suicide) overdose deaths in North Carolina (NC), focusing on specific drug involvement and contextual factors. Unintentional and suicide overdose deaths were identified using 2015-2019 NC death certificate data. Specific drug involvement was assessed by searching literal text fields for drug mentions. County-level contextual factors were obtained from NC Institute of Medicine and County Health Rankings, encompassing five SDOH domains (economic stability, social/community context, health care access/quality, education access/quality, neighborhood/built environment). Descriptive statistics were calculated by intent for drug involvement and a variety of contextual factors. During 2015-2019, 9% of NC drug overdose deaths were self-inflicted and 89% were unintentional (2% other/undetermined). Unintentional overdoses largely involved illicit drugs [fentanyl (47%), cocaine (33%), heroin (29%)]. Suicide overdoses frequently involved prescription opioids [oxycodone (18%), hydrocodone (10%)] and antidepressants (32%). Overall, overdose deaths tended to occur in under-resourced counties across all SDOH domains, though unintentional overdoses occurred more often among residents of under-resourced counties than suicide overdoses, with differences most pronounced for economic stability-related factors. There are notable distinctions between unintentional and suicide overdose deaths in demographics and drug involvement, though the assessment of SDOH demonstrated that overdose mortality is broadly associated with marginalization across all domains. These findings highlight the value of allocating resources to prevention and intervention approaches that target upstream causes of overdose (e.g., housing first, violence prevention programs).
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Affiliation(s)
- Kristin Y Shiue
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599-7435, United States; Injury Prevention Research Center, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd, Chapel Hill, NC 27514, United States.
| | - Rebecca B Naumann
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599-7435, United States; Injury Prevention Research Center, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd, Chapel Hill, NC 27514, United States
| | - Scott Proescholdbell
- Injury and Violence Prevention Branch, Division of Public Health, North Carolina Department of Health and Human Services, 1915 Mail Service Center, Raleigh, NC 27699-1915, United States
| | - Mary E Cox
- Injury and Violence Prevention Branch, Division of Public Health, North Carolina Department of Health and Human Services, 1915 Mail Service Center, Raleigh, NC 27699-1915, United States
| | - Michelle Aurelius
- Office of the Chief Medical Examiner, Division of Public Health, North Carolina Department of Health and Human Services, 4312 District Drive, Raleigh, NC 27607, United States
| | - Anna E Austin
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd, Chapel Hill, NC 27514, United States; Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 401 Rosenau Hall, CB #7445, Chapel Hill, NC 27599-7445, United States
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17
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Choi NG, Marti CN, Choi BY. Job loss, financial strain, and housing problems as suicide precipitants: Associations with other life stressors. SSM Popul Health 2022; 19:101243. [PMID: 36203475 PMCID: PMC9530609 DOI: 10.1016/j.ssmph.2022.101243] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 09/23/2022] [Accepted: 09/25/2022] [Indexed: 11/17/2022] Open
Abstract
Previous research has shown that job loss, financial strain, and/or loss of housing (JFH) in midlife elevate suicide risk. In this study based on the 2017–2019 National Violent Death Reporting System, we examined other suicide precipitants and contributors of decedents whose suicide was in part precipitated by JFH and the circumstances under which they died. First, we examined all adult decedents (N = 94,454; 74,042 males [78.4%] and 20,412 females [21.6%]) and then focused on decedents age 45–64 (N = 34,208; 25,640 males [75%] and 8568 females [25.0%]). The 45–64 age group had the highest rate of JFH (22.0% for males and 15.1% for females) as a suicide precipitant. The results of generalized linear models for all adult suicide decedents of both sexes showed that the 45–64 age group (IRR = 2.02, 95% CI = 1.89–2.16), compared to 65+ age group, and relationship problems, mental disorders, and alcohol problems were associated with significantly higher risk of JFH-precipitated suicide. In male decedents age 45–64, JFH was positively associated with depressed mood (IRR = 1.95, 95% CI = 1.85–2.06), alcohol problems (IRR = 1.14, 95% CI = 1.07–1.21), and number of crises (IRR = 1.48, 95% CI = 1.43–1.53). In female decedents age 45–64, JFH was positively associated with relationship problems (IRR = 1.19, 95% CI = 1.05–1.35), legal problems (IRR = 1.27, 95% CI = 1.06–1.54), depressed mood (IRR = 1.78, 95% CI = 1.59–1.99), and number of crises (IRR = 1.58, 95% CI = 1.48–1.68). In both sexes, the risk of JFH was also positively associated with a college education. In female decedents, JFH risk was higher among divorced or never-married individuals. Coroner/medical examiner and law enforcement agency reports show that some experienced depression and started misusing alcohol and/or other substances following a job loss, but others had these problems throughout life, which caused/contributed to JFH. These findings show the significance of suicide prevention approaches at both systemic (generous unemployment insurance, housing subsidies) and individual (treatment of depression and alcohol/substance misuse problems and social support/connection) levels. 16.2% of male and 13.0% of female suicide decedents age 18+ in 2017–2019 had job/finance/housing problems (JFH). Among decedents age 45–64, 22.0% of male and 15.1% of female had JFH. JFH was positively associated with number of crises, depressed mood, and relationship and alcohol problems in both sexes. Suicide prevention approaches are needed at both systemic and individual levels.
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Affiliation(s)
- Namkee G. Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, 78712, USA
- Corresponding author. UT Steve Hicks School of Social Work, 1925 San Jacinto Blvd, Austin, TX 78712, USA.
| | - C. Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, 78712, USA
| | - Bryan Y. Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine and BayHealth, Dover, DE, 19901, USA
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18
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Distinguishing clinical factors associated with unintentional overdose, suicidal ideation, and attempted suicide among opioid use disorder in-patients. J Psychiatr Res 2022; 153:245-253. [PMID: 35841821 DOI: 10.1016/j.jpsychires.2022.06.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/15/2022] [Accepted: 06/24/2022] [Indexed: 01/11/2023]
Abstract
Opioid and other drug-related overdoses and suicides are leading causes of injury death and represent a significant public health threat in the United States (U.S.). This study examined clinical factors of three patient groups from two inpatient addiction treatment facilities in Appalachian West Virginia (n = 66). Patients were classified as having: 1) unintentional overdose(s) (OD), 2) suicidal ideation or suicide attempt(s) (SI/SA), and 3) suicidal ideation or suicide attempt, and unintentional overdose (SI/SA/OD). Multinomial logistic regression models were used to determine whether adverse childhood experiences, self-injurious behaviors, substance use history, overdose history, and past year stressful life events were differentially associated with history of SI/SA/OD. Participants in the OD group were more likely to have used heroin in the 24-h preceding their most recent overdose compared to either the SI/SA or SI/SA/OD groups. The multivariable model found participants with history of SI/SA had higher adverse childhood experience scores and more participants with history of SI/SA endorsed childhood physical abuse and teen dating violence. Overall, there are characteristics that distinguish unintentional overdose from suicidal ideation and attempt. Patients with SI/SA/OD appear to have greater clinical severity. More thorough evaluation of drugs involved in overdose and history of self-injury may help distinguish future risk and inform treatment planning.
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19
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Rahman N, Mozer R, McHugh RK, Rockett IRH, Chow CM, Vaughan G. Using natural language processing to improve suicide classification requires consideration of race. Suicide Life Threat Behav 2022; 52:782-791. [PMID: 35384040 DOI: 10.1111/sltb.12862] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/25/2022] [Accepted: 03/22/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To improve the accuracy of classification of deaths of undetermined intent and to examine racial differences in misclassification. METHODS We used natural language processing and statistical text analysis on restricted-access case narratives of suicides, homicides, and undetermined deaths in 37 states collected from the National Violent Death Reporting System (NVDRS) (2017). We fit separate race-specific classification models to predict suicide among undetermined cases using data from known homicide cases (true negatives) and known suicide cases (true positives). RESULTS A classifier trained on an all-race dataset predicts less than half of these cases as suicide. Importantly, our analysis yields an estimated suicide rate for the Black population comparable with the typical detection rate for the White population, indicating that misclassification excess is endemic for Black suicide. This problem may be mitigated by using race-specific data. Our findings, based on the statistical text analysis, also reveal systematic differences in the phrases identified as most predictive of suicide. CONCLUSIONS This study highlights the need to understand the reasons underlying suicide rate differences and for further testing of strategies to reduce misclassification, particularly among people of color.
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Affiliation(s)
- Nusrat Rahman
- Department of Natural and Applied Sciences, Bentley University, Waltham, Massachusetts, USA.,Health Thought Leadership Network, Bentley University, Waltham, Massachusetts, USA
| | - Reagan Mozer
- Department of Mathematical Sciences, Bentley University, Waltham, Massachusetts, USA
| | - R Kathryn McHugh
- Division of Alcohol, Drugs and Addiction, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Ian R H Rockett
- Department of Epidemiology and Biostatistics, West Virginia University, Morgantown, West Virginia, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Clifton M Chow
- Department of Mathematical Sciences, Bentley University, Waltham, Massachusetts, USA.,Academic Technology Center, Bentley University, Waltham, Massachusetts, USA
| | - Gregory Vaughan
- Department of Mathematical Sciences, Bentley University, Waltham, Massachusetts, USA
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20
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Perry SW, Rainey JC, Allison S, Bastiampillai T, Wong ML, Licinio J, Sharfstein SS, Wilcox HC. Achieving health equity in US suicides: a narrative review and commentary. BMC Public Health 2022; 22:1360. [PMID: 35840968 PMCID: PMC9284959 DOI: 10.1186/s12889-022-13596-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 06/07/2022] [Indexed: 11/16/2022] Open
Abstract
Suicide rates in the United States (US) reached a peak in 2018 and declined in 2019 and 2020, with substantial and often growing disparities by age, sex, race/ethnicity, geography, veteran status, sexual minority status, socioeconomic status, and method employed (means disparity). In this narrative review and commentary, we highlight these many disparities in US suicide deaths, then examine the possible causes and potential solutions, with the overarching goal of reducing suicide death disparities to achieve health equity. The data implicate untreated, undertreated, or unidentified depression or other mental illness, and access to firearms, as two modifiable risk factors for suicide across all groups. The data also reveal firearm suicides increasing sharply and linearly with increasing county rurality, while suicide rates by falls (e.g., from tall structures) decrease linearly by increasing rurality, and suicide rates by other means remain fairly constant regardless of relative county urbanization. In addition, for all geographies, gun suicides are significantly higher in males than females, and highest in ages 51–85 + years old for both sexes. Of all US suicides from 1999–2019, 55% of male suicides and 29% of female suicides were by gun in metropolitan (metro) areas, versus 65% (Male) and 42% (Female) suicides by gun in non-metro areas. Guns accounted for 89% of suicides in non-metro males aged 71–85 + years old. Guns (i.e., employment of more lethal means) are also thought to be a major reason why males have, on average, 2–4 times higher suicide rates than women, despite having only 1/4—1/2 as many suicide attempts as women. Overall the literature and data strongly implicate firearm access as a risk factor for suicide across all populations, and even more so for male, rural, and older populations. To achieve the most significant results in suicide prevention across all groups, we need 1) more emphasis on policies and universal programs to reduce suicidal behaviors, and 2) enhanced population-based strategies for ameliorating the two most prominent modifiable targets for suicide prevention: depression and firearms.
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Affiliation(s)
- Seth W Perry
- Department of Psychiatry and Behavioral Sciences, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA. .,Department of Neuroscience & Physiology, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA. .,Department of Neurosurgery, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA. .,Department of Public Health and Preventive Medicine, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA.
| | - Jacob C Rainey
- Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Stephen Allison
- Department of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Tarun Bastiampillai
- Department of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Mind and Brain Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.,Department of Psychiatry, Monash University, Clayton, Australia
| | - Ma-Li Wong
- Department of Psychiatry and Behavioral Sciences, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA.,Department of Neuroscience & Physiology, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA.,Department of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Julio Licinio
- Department of Psychiatry and Behavioral Sciences, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA.,Department of Neuroscience & Physiology, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA.,Department of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Department of Medicine, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA.,Department of Pharmacology, College of Medicine, State University of New York (SUNY, Upstate Medical University, Syracuse, NY, USA
| | - Steven S Sharfstein
- Sheppard Pratt Health System, Baltimore, MD, USA.,Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Holly C Wilcox
- Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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21
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Archambault L, Jutras-Aswad D, Touré EH, Artunduaga AC, Roy S, Barbeau D, Perreault M. Profiles of Patients with Opioid Use Disorders Presenting a History of Suicidal Ideations and Attempts. Psychiatr Q 2022; 93:637-650. [PMID: 35235127 DOI: 10.1007/s11126-022-09978-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2022] [Indexed: 01/20/2023]
Abstract
Suicide rates are higher for people with an opioid use disorder, compared to the general population. This study aims to characterize opioid agonist treatment entrants who present a history of suicidal ideations or suicide attempts, according to concurrent comorbidity profiles, in an opioid use disorder treatment facility. A chart review design was used. Data was collected from 202 patient files. Bivariate and multivariate analyses were conducted. In multivariate analysis, patients with a diagnosis or symptoms of a mood disorder were 2.48 [1.01 - 6.11] times more likely to report suicidal ideations and 2.64 [1.05 - 6.62] times more likely to report suicide attempts. Those with a diagnosis or symptoms of an anxiety disorder were 2.41 [1.01 - 5.81] times more likely to report suicidal ideations. Patients who report chronic pain were 2.59 [1.06 - 6.35] times more likely to report suicidal ideations as well. The probability to report suicide attempts was 5.09 [1.16 - 22.4] times higher for those with a confirmed or suspected personality disorder. Clinicians should bear in mind the high suicide rates in people with opioid use disorder, as well as the importance of addressing suicidal risk and providing easy access to mental health and chronic pain treatment as part of the service offer in opioid agonist treatment. Future research should focus on evaluating the effectiveness of treatments aimed at addressing the needs of opioid agonist treatment patients with interrelated mental health and pain comorbidity profiles to reduce risks associated with suicide.
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Affiliation(s)
- Léonie Archambault
- Sherbrooke University, Sherbrooke, QC, Canada.,Douglas Research Center, 6875 Boulevard Lasalle, Montreal, QC, H4H 1R3, Canada
| | - Didier Jutras-Aswad
- Centre hospitalier de l'Université de Montréal Research Center, Montréal, QC, Canada.,Department of Psychiatry and Addictology, Université de Montréal, Montreal, QC, Canada
| | | | | | - Stéphane Roy
- CIUSSS du Centre-Sud-de-L'île-de-Montréal, Montreal, QC, Canada
| | - David Barbeau
- CIUSSS du Centre-Sud-de-L'île-de-Montréal, Montreal, QC, Canada
| | - Michel Perreault
- Douglas Research Center, 6875 Boulevard Lasalle, Montreal, QC, H4H 1R3, Canada. .,McGill University, 845 Sherbrooke St W, Montreal, QC, Canada.
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22
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Connery HS, Weiss RD, Griffin ML, Trinh CD, Kim J, Rockett IRH, McHugh RK. Suicidal motivations among opioid overdose survivors: Replication and extension. Drug Alcohol Depend 2022; 235:109437. [PMID: 35427980 PMCID: PMC9106902 DOI: 10.1016/j.drugalcdep.2022.109437] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Several studies suggest suicidal motivation may contribute to opioid overdose fatalities in people with opioid use disorder. In this study, we sought to replicate and extend prior findings suggesting that a desire to die is common prior to nonfatal opioid overdose in people with opioid use disorder. METHODS Adults receiving inpatient detoxification and stabilization who reported a history of opioid overdose (N = 60) completed questions about suicidal cognition prior to their most recent overdose. RESULTS Approximately 45% reported some desire to die prior to their most recent overdose, with 20% reporting they had some intention to die. The correlation between these ratings was of a moderate magnitude (ρ = 0.58). Almost 40% of the sample perceived no risk of overdose prior to their most recent overdose event, suggesting a significant underestimation of risk in this population. CONCLUSIONS Desire to die was common in adults with opioid use disorder prior to nonfatal opioid overdose events, and 1 in 5 people with a history of opioid overdose reported intention to die prior to their most recent opioid overdose. Careful assessment of suicidal cognition in this population may improve prevention of opioid overdose deaths.
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Affiliation(s)
- Hilary S. Connery
- McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA,Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Roger D. Weiss
- McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA,Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Margaret L. Griffin
- McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA,Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | | | - Jungjin Kim
- McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA,Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Ian R. H. Rockett
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown; Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - R. Kathryn McHugh
- McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA,Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
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23
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Abstract
We introduce an approach to identify latent topics in large-scale text data. Our approach integrates two prominent methods of computational text analysis: topic modeling and word embedding. We apply our approach to written narratives of violent death (e.g., suicides and homicides) in the National Violent Death Reporting System (NVDRS). Many of our topics reveal aspects of violent death not captured in existing classification schemes. We also extract gender bias in the topics themselves (e.g., a topic about long guns is particularly masculine). Our findings suggest new lines of research that could contribute to reducing suicides or homicides. Our methods are broadly applicable to text data and can unlock similar information in other administrative databases. There is an escalating need for methods to identify latent patterns in text data from many domains. We introduce a method to identify topics in a corpus and represent documents as topic sequences. Discourse atom topic modeling (DATM) draws on advances in theoretical machine learning to integrate topic modeling and word embedding, capitalizing on their distinct capabilities. We first identify a set of vectors (“discourse atoms”) that provide a sparse representation of an embedding space. Discourse atoms can be interpreted as latent topics; through a generative model, atoms map onto distributions over words. We can also infer the topic that generated a sequence of words. We illustrate our method with a prominent example of underutilized text: the US National Violent Death Reporting System (NVDRS). The NVDRS summarizes violent death incidents with structured variables and unstructured narratives. We identify 225 latent topics in the narratives (e.g., preparation for death and physical aggression); many of these topics are not captured by existing structured variables. Motivated by known patterns in suicide and homicide by gender and recent research on gender biases in semantic space, we identify the gender bias of our topics (e.g., a topic about pain medication is feminine). We then compare the gender bias of topics to their prevalence in narratives of female versus male victims. Results provide a detailed quantitative picture of reporting about lethal violence and its gendered nature. Our method offers a flexible and broadly applicable approach to model topics in text data.
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24
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Fine KL, Rickert ME, O’Reilly LM, Sujan AC, Boersma K, Chang Z, Franck J, Lichtenstein P, Larsson H, D’Onofrio BM, Quinn PD. Initiation of Opioid Prescription and Risk of Suicidal Behavior Among Youth and Young Adults. Pediatrics 2022; 149:184742. [PMID: 35128560 PMCID: PMC9624202 DOI: 10.1542/peds.2020-049750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Opioids are involved in an increasing proportion of suicide deaths. This study examined the association between opioid analgesic prescription initiation and suicidal behavior among young people. METHODS We analyzed Swedish population-register data on 1 895 984 individuals ages 9 to 29 years without prior recorded opioid prescriptions. We identified prescriptions dispensed from January 2007 onward and diagnosed self-injurious behavior and death by suicide through December 2013. We first compared initiators with demographically matched noninitiators. To account for confounding, we applied an active comparator design, which examined suicidal behavior among opioid initiators relative to prescription nonsteroidal antiinflammatory drug (NSAID) initiators while inverse-probability-of-treatment weighting with individual and familial covariates. RESULTS Among the cohort, 201 433 individuals initiated opioid prescription. Relative to demographically matched noninitiators, initiators (N = 180 808) had more than doubled risk of incident suicidal behavior (hazard ratio = 2.64; 95% confidence interval [CI], 2.47-2.81). However, in the active comparator design, opioid initiators (N = 86 635) had only 19% relatively greater risk of suicidal behavior compared with NSAID initiators (N = 255 096; hazard ratio = 1.19; 95% CI,: 1.11-1.28), corresponding to a weighted 5-year cumulative incidence of 2.2% (95% CI, 2.1-2.4) for opioid and 1.9% (95% CI, 1.9-2.0) for NSAID initiators. Most sensitivity analyses produced comparable results. CONCLUSIONS Opioid initiation may make only a small contribution to the elevated risk of suicidal behavior among young people receiving pharmacologic pain management. In weighing benefits and harms of opioid initiation, our results suggest that increased risk of suicidal behavior may not be a major concern.
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Affiliation(s)
| | - Martin E. Rickert
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
| | - Lauren M. O’Reilly
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
| | - Ayesha C. Sujan
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
| | - Katja Boersma
- Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work
| | - Zheng Chang
- Departments of Medical Epidemiology and Biostatistics
| | - Johan Franck
- Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Henrik Larsson
- School of Medical Sciences, Örebro University, Örebro, Sweden,Departments of Medical Epidemiology and Biostatistics
| | - Brian M. D’Onofrio
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana,Departments of Medical Epidemiology and Biostatistics
| | - Patrick D. Quinn
- Department of Applied Health Science, School of Public Health,Address correspondence to Patrick D. Quinn, PhD, Department of Applied Health Science, School of Public Health, Indiana University, 1025 E. 7 St., Room 116, Bloomington, IN 47405. E-mail:
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25
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Lange S, Rehm J, Tran A, L. Bagge C, Jasilionis D, Kaplan MS, Meščeriakova-Veliulienė O, Štelemėkas M, Probst C. Comparing gender-specific suicide mortality rate trends in the United States and Lithuania, 1990-2019: putting one of the "deaths of despair" into perspective. BMC Psychiatry 2022; 22:127. [PMID: 35177011 PMCID: PMC8851770 DOI: 10.1186/s12888-022-03766-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 02/07/2022] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION The increase in the suicide mortality rate among middle-aged adults in the United States (US) has been well documented. Aside from a few studies from the United Kingdom, it is unclear whether the suicide mortality rate trend in the US is also occurring in other developed countries. Accordingly, we aimed to compare the suicide mortality rate trends over the past 30 years in the US to a country in the European Union-Lithuania. METHODS Joinpoint regression analyses were performed to identify secular trends in the gender-specific age-standardized suicide mortality rate among individuals 15 + years of age, as well as middle-aged adults (45-54 years of age), and suicide mortality rate ratio for men-to-women. RESULTS Age-standardized suicide mortality rates among middle-aged adults in the US increased annually, on average, by 0.89% (95% CI: 0.66%, 1.12%) among men and 1.21% (95% CI: 0.75%, 1.66%) among women between 1990 and 2019. In contrast to the US, there was an overall downward trend in the suicide mortality rates among middle-aged adults in Lithuania across the study period. The average annual percent change in the suicide mortality rate ratio for men-to-women were not statistically significant for either country. CONCLUSION The suicide mortality rate trend in the US does not appear to be an indicator of an upcoming global trend, but rather should be regarded as a cautionary example of what other countries should strive to avoid.
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Affiliation(s)
- Shannon Lange
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada. .,Campbell Family Mental Health Research Institute, CAMH, 250 College Street, Toronto, ON, M5T 1R8, Canada. .,Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON, M5T 1R8, Canada.
| | - Jürgen Rehm
- grid.155956.b0000 0000 8793 5925 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON M5S 2S1 Canada ,grid.155956.b0000 0000 8793 5925Campbell Family Mental Health Research Institute, CAMH, 250 College Street, Toronto, ON M5T 1R8 Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON M5T 3M7 Canada ,grid.4488.00000 0001 2111 7257Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8 Canada ,grid.17063.330000 0001 2157 2938Institute of Medical Science, Medical Sciences Building, University of Toronto, King’s College Circle, Room 2374, Toronto, ON M5S 1A8 Canada ,grid.13648.380000 0001 2180 3484Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany ,grid.448878.f0000 0001 2288 8774Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya str., 8, b. 2, 119992 Moscow, Russian Federation
| | - Alexander Tran
- grid.155956.b0000 0000 8793 5925 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON M5S 2S1 Canada
| | - Courtney L. Bagge
- grid.214458.e0000000086837370Department of Psychiatry, University of Michigan Medical School, 2800 Plymouth Road, Ann Arbor, MI 48109 USA ,grid.418356.d0000 0004 0478 7015Center for Clinical Management Research, Department of Veterans Affairs, 2215 Fuller Road, Ann Arbor, MI 48105 USA
| | - Domantas Jasilionis
- grid.419511.90000 0001 2033 8007Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Konrad-Zuse-Str. 1, 18057 Rostock, Germany ,grid.19190.300000 0001 2325 0545Demographic Research Centre, Faculty of Social Sciences, Vytautas Magnus University, Jonavos g. 66, 44191 Kaunas, Lithuania
| | - Mark S. Kaplan
- grid.19006.3e0000 0000 9632 6718Luskin School of Public Affairs, University of California, Los Angeles, 337 Charles E Young Drive East, Los Angeles, CA 90095 USA
| | - Olga Meščeriakova-Veliulienė
- grid.45083.3a0000 0004 0432 6841Department of Health Management, Faculty of Public Health, Lithuanian University of Health Sciences, Tilžės 18, 47181 Kaunas, Lithuania
| | - Mindaugas Štelemėkas
- grid.45083.3a0000 0004 0432 6841Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Tilžės 18, 47181 Kaunas, Lithuania ,grid.45083.3a0000 0004 0432 6841Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Tilžės 18, 47181 Kaunas, Lithuania
| | - Charlotte Probst
- grid.155956.b0000 0000 8793 5925 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON M5S 2S1 Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8 Canada ,grid.7700.00000 0001 2190 4373 Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
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26
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Schechter M, Goldblatt MJ, Ronningstam E, Herbstman B. The Psychoanalytic Study of Suicide, Part I: An Integration of Contemporary Theory and Research. J Am Psychoanal Assoc 2022; 70:103-137. [PMID: 35451317 DOI: 10.1177/00030651221086622] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Psychodynamic psychotherapy has an important role in suicide prevention. The psychoanalytic study of suicide has taught us a great deal about the human experience and the process of suicidality. There is also much to be learned from other fields of study and from empirical research that can be integrated into psychoanalytic therapies. Central to the psychoanalytic approach to suicide has been understanding the patient's internal subjective experience of unbearable emotional or psychic pain and the urgent need for relief. Emotional pain can include intense affects such as shame, humiliation, self-hate, and rage. Factors that can increase vulnerability to suicidal states include problems with early attunement, dissociation and deficits in bodily love and protection, conscious and unconscious fantasy, and certain character traits and dynamics. Empirical research has confirmed many basic psychoanalytic concepts about suicide, including escape from unbearable pain as the primary driver of suicidal behavior, the role of dissociation in increasing risk of bodily attack, and the importance of unconscious processes. Further research into implicit processes and their role in the suicidal process holds potential to improve suicide risk assessment and to enhance psychotherapy by bringing otherwise inaccessible material into the treatment.
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27
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Rockett IRH, Jia H, Ali B, Banerjee A, Connery HS, Nolte KB, Miller T, White FMM, DiGregorio BD, Larkin GL, Stack S, Kõlves K, McHugh RK, Lulla VO, Cossman J, De Leo D, Hendricks B, Nestadt PS, Berry JH, D’Onofrio G, Caine ED. Association of State Social and Environmental Factors With Rates of Self-injury Mortality and Suicide in the United States. JAMA Netw Open 2022; 5:e2146591. [PMID: 35138401 PMCID: PMC8829661 DOI: 10.1001/jamanetworkopen.2021.46591] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Self-injury mortality (SIM) combines suicides and the preponderance of drug misuse-related overdose fatalities. Identifying social and environmental factors associated with SIM and suicide may inform etiologic understanding and intervention design. OBJECTIVE To identify factors associated with interstate SIM and suicide rate variation and to assess potential for differential suicide misclassification. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used a partial panel time series with underlying cause-of-death data from 50 US states and the District of Columbia for 1999-2000, 2007-2008, 2013-2014 and 2018-2019. Applying data from the Centers for Disease Control and Prevention, SIM includes all suicides and the preponderance of unintentional and undetermined drug intoxication deaths, reflecting self-harm behaviors. Data were analyzed from February to June 2021. EXPOSURES Exposures included inequity, isolation, demographic characteristics, injury mechanism, health care access, and medicolegal death investigation system type. MAIN OUTCOMES AND MEASURES The main outcome, SIM, was assessed using unstandardized regression coefficients of interstate variation associations, identified by the least absolute shrinkage and selection operator; ratios of crude SIM to suicide rates per 100 000 population were assessed for potential differential suicide misclassification. RESULTS A total of 101 325 SIMs were identified, including 74 506 (73.5%) among males and 26 819 (26.5%) among females. SIM to suicide rate ratios trended upwards, with an accelerating increase in overdose fatalities classified as unintentional or undetermined (SIM to suicide rate ratio, 1999-2000: 1.39; 95% CI, 1.38-1.41; 2018-2019: 2.12; 95% CI, 2.11-2.14). Eight states recorded a SIM to suicide rate ratio less than 1.50 in 2018-2019 vs 39 states in 1999-2000. Northeastern states concentrated in the highest category (range, 2.10-6.00); only the West remained unrepresented. Least absolute shrinkage and selection operator identified 8 factors associated with the SIM rate in 2018-2019: centralized medical examiner system (β = 4.362), labor underutilization rate (β = 0.728), manufacturing employment (β = -0.056), homelessness rate (β = -0.125), percentage nonreligious (β = 0.041), non-Hispanic White race and ethnicity (β = 0.087), prescribed opioids for 30 days or more (β = 0.117), and percentage without health insurance (β = -0.013) and 5 factors associated with the suicide rate: percentage male (β = 1.046), military veteran (β = 0.747), rural (β = 0.031), firearm ownership (β = 0.030), and pain reliever misuse (β = 1.131). CONCLUSIONS AND RELEVANCE These findings suggest that SIM rates were associated with modifiable, upstream factors. Although embedded in SIM, suicide unexpectedly deviated in proposed social and environmental determinants. Heterogeneity in medicolegal death investigation processes and data assurance needs further characterization, with the goal of providing the highest-quality reports for developing and tracking public health policies and practices.
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Affiliation(s)
- Ian R. H. Rockett
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Haomiao Jia
- Department of Biostatistics, Mailman School of Public Health and School of Nursing, Columbia University, New York, New York
| | - Bina Ali
- Pacific Institute for Research and Evaluation, Calverton, Maryland
| | - Aniruddha Banerjee
- Department of Geography, Indiana University–Purdue University at Indianapolis
| | - Hilary S. Connery
- McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Kurt B. Nolte
- Departments of Pathology and Radiology, University of New Mexico School of Medicine, Albuquerque
- Departments of Pathology and Radiology, University of New Mexico School of Medicine, Albuquerque
| | - Ted Miller
- Pacific Institute for Research and Evaluation, Calverton, Maryland
- Centre for Population Health Research, Curtin University, Perth, Australia
| | - Franklin M. M. White
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | | | | | - Steven Stack
- Departments of Criminal Justice and Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, Mount Gravatt, Australia
- WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Mount Gravatt, Australia
| | - R. Kathryn McHugh
- McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Vijay O. Lulla
- Department of Geography, Indiana University–Purdue University at Indianapolis
| | - Jeralynn Cossman
- College for Health, Community and Policy, University of Texas, San Antonio
| | - Diego De Leo
- Slovene Centre for Suicide Research and Department of Psychology, University of Primorska, Koper, Slovenia
| | - Brian Hendricks
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown
| | - Paul S. Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - James H. Berry
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown
| | - Gail D’Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Eric D. Caine
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
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28
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Cano M, Agan A, Bandoian L, Larochelle L. Individual and County-Level Disparities in Drug and Opioid Overdose Mortality for Hispanic Men in Massachusetts and the Northeast United States. Subst Use Misuse 2022; 57:1131-1143. [PMID: 35459423 DOI: 10.1080/10826084.2022.2064507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study aimed to identify individual- and county-level inequalities that may underlie disparities in drug overdose mortality for Hispanic men in Massachusetts and the broader Northeast region. METHODS The study first used data from the State Unintentional Drug Overdose Reporting System to compare the 635 Hispanic and 3593 Non-Hispanic (NH) White men who died of unintentional/undetermined opioid-related overdoses in Massachusetts in 2016-2018. Next, the study used 2015-2019 data from the Multiple Cause of Death online platform to: a) compare rates of drug overdose mortality in Hispanic versus NH White men in 54 counties in the Northeast United States; and b) examine associations with inequalities in poverty, educational attainment, unemployment, and uninsurance (from 2015-2019 American Community Survey data). RESULTS At the individual level, in Massachusetts, Hispanic and NH White men who died of opioid-related overdose differed in terms of educational attainment, birthplace, urbanicity, substance use disorder treatment history, and specific drugs involved in death. At the county level, in the Northeast region, each one-standard deviation increase in the ratio of the Hispanic to NH White poverty rate was associated with a 27% increase in the ratio of Hispanic to NH White male overdose mortality; each one-standard deviation increase in the ratio of the Hispanic to NH White unemployment rate was associated with a 43% increase in the ratio of Hispanic to NH White male overdose mortality. CONCLUSIONS Findings underscore the importance of equitable interventions and efforts to address inequalities in social determinants of health for Hispanic populations in the Northeast.
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Affiliation(s)
- Manuel Cano
- Department of Social Work, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Anna Agan
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Lisa Bandoian
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Lauren Larochelle
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
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Chrzanowska A, Man N, Darke S, Degenhardt L, Farrell M, Moran L, Peacock A. Unintentional and intentional drug poisoning deaths, Australia, 2012-2016: Drug pattern profile and demographic characteristics. Drug Alcohol Depend 2021; 229:109112. [PMID: 34628104 DOI: 10.1016/j.drugalcdep.2021.109112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/22/2021] [Accepted: 09/26/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Identifying differences in unintentional versus intentional drug poisoning deaths can inform targeted prevention. This study aimed to: compare unintentional versus intentional drug poisoning deaths by drug involvement, age and sex; describe patterns of drug involvement by intent; and describe common drug patterns by age and sex. METHODS Cases comprised deaths among Australians aged ≥15 where drug poisoning was the underlying cause (Cause of Death Unit Record File 2012-2016). Sex, age, and drug involvement were analysed by intent using logistic regression. RESULTS Of 7994 deaths, 71% were unintentional and 24% intentional. Compared with unintentional deaths, intentional deaths were more likely among females (OR 1.31 [95% CI 1.16-1.48]) and those aged 55+ (1.50 [1.25-1.81] for 55-64 years; 3.79 [3.07-4.66] for 65+ years, compared to 35-44 years), and were more likely to involve hypnosedatives (2.11 [1.87-2.39]), other psychotropic medicines (1.58 [1.39-1.78]), non-opioid analgesics and anaesthetics (1.48 [1.25-1.73]). Common unintentional profiles comprised: opioids (excluding heroin); heroin; alcohol; opioids with hypnosedatives; opioids with hypnosedatives and other psychotropic medicines; stimulants; other psychotropic medicines; and opioids with other psychotropic medicines. Unintentional deaths involving heroin or stimulants only had a greater proportion of males (79.0% and 83.4%, respectively) and younger individuals aged 15-34 (30.3% and 39.5%, respectively). Common intentional profiles comprised: hypnosedatives; other psychotropic medicines; opioids (excluding heroin); hypnosedatives with other psychotropic medicines; opioids with hypnosedatives; and opioids with hypnosedatives and other psychotropic medicines. CONCLUSION The demographic and drug involvement profile of intentional and unintentional deaths were distinct, suggesting different approaches to prevention are necessary.
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Affiliation(s)
- Agata Chrzanowska
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
| | - Nicola Man
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Lauren Moran
- Australian Bureau of Statistics, Belconnen, ACT, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; School of Psychology, University of Tasmania, Hobart, Australia
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30
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Dai Z, Abate MA, Groth CP, Rucker T, Kraner JC, Mock AR, Smith GS. Fentanyl and other opioid involvement in methamphetamine-related deaths. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 48:226-234. [PMID: 34752718 DOI: 10.1080/00952990.2021.1981919] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Methamphetamine-related deaths have been rising along with those involving synthetic opioids, mostly fentanyl and fentanyl analogs (FAs). However, the extent to which methamphetamine involvement in deaths differs from those changes occurring in synthetic opioid involvement is unknown. OBJECTIVES To determine the patterns and temporal changes in methamphetamine-related deaths with and without other drug involvement. METHODS Data from all methamphetamine-related deaths in West Virginia from 2013 to 2018 were analyzed. Quasi-Poisson regression analyses over time were conducted to compare the rates of change in death counts among methamphetamine and fentanyl//FA subgroups. RESULTS A total of 815 methamphetamine-related deaths were analyzed; 572 (70.2%) were male and 527 (64.7%) involved an opioid. The proportion of methamphetamine only deaths stayed relatively flat over time although the actual numbers of deaths increased. Combined fentanyl/FAs and methamphetamine were involved in 337 deaths (41.3%) and constituted the largest increase from 2013 to 2018. The modeling of monthly death counts in 2017-2018 found that the average number of deaths involving fentanyl without methamphetamine significantly declined (rate of change -0.025, p < .001), while concomitant fentanyl with methamphetamine and methamphetamine only death counts increased significantly (rate of change 0.056 and 0.057, respectively, p < .001). CONCLUSIONS Fentanyl and FAs played an increasingly significant role in methamphetamine-related deaths. The accelerating number of deaths involving fentanyl/FAs and methamphetamine indicates the importance of stimulants and opioids in unintentional deaths. Comprehensive surveillance efforts should continue to track substance use patterns to ensure that appropriate prevention programs are undertaken.
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Affiliation(s)
- Zheng Dai
- School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Marie A Abate
- School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - Caroline P Groth
- School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Tori Rucker
- School of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - James C Kraner
- West Virginia Department of Health and Human Resources, West Virginia Office of the Chief Medical Examiner, Charleston, WV, USA
| | - Allen R Mock
- West Virginia Department of Health and Human Resources, West Virginia Office of the Chief Medical Examiner, Charleston, WV, USA
| | - Gordon S Smith
- School of Public Health, West Virginia University, Morgantown, WV, USA
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The contribution of method choice to gender disparity in suicide mortality: A population-based study in Hong Kong and the United States of America. J Affect Disord 2021; 294:17-23. [PMID: 34256181 DOI: 10.1016/j.jad.2021.06.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND In most countries, more females than males attempt suicide, yet suicide mortality is typically higher for males. The aim of this study was to investigate how suicide method choice contributed to gender disparity in suicide mortality. METHODS This study used population-based data collected in Hong Kong (HK) and the United States of America (USA) (2007-2014), comprising suicide deaths and medically treated suicide attempts. We calculated suicide rates, suicide act rates, and case fatality rates (CFRs), by gender and suicide method in HK and the USA respectively. Decomposition analysis was used to quantify the contribution of gender differences in method choice and method-specific CFRs to the excess male suicide rates in each region. RESULTS Gender disparity in suicide mortality was mostly driven by gender differences in method used in suicide acts. In HK, gender difference in choosing jumping as the method in suicide acts explained 44.5% of the gender imbalance in suicide rates, whilst in USA, 62.4% of male excess in suicide rates was explained by gender difference in using firearms in suicide acts. LIMITATIONS Cases of suicide attempts in this study were restricted to those severe enough to require medical attention. CONCLUSION Gender-specific suicide method choice largely determined gender patterns in suicide. Our findings highlighted the importance of developing locally tailored suicide prevention strategies targeting commonly used and highly lethal suicide methods. Future research is needed to explore underlying reasons for gender differences in method choice.
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Pergolizzi J, Breve F, Magnusson P, Nalamasu R, LeQuang JAK, Varrassi G. Suicide by Opioid: Exploring the Intentionality of the Act. Cureus 2021; 13:e18084. [PMID: 34692299 PMCID: PMC8523441 DOI: 10.7759/cureus.18084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/18/2021] [Indexed: 11/26/2022] Open
Abstract
Opioid toxicity can result in life-threatening respiratory depression. Opioid-overdose mortality in the United States is high and increasing, but it is difficult to determine what proportion of those deaths might actually be suicides. The exact number of Americans who died of an opioid overdose but whose deaths might be classified as suicide remains unknown. It is important to differentiate between those who take opioids with the deliberate and unequivocal objective of committing suicide, that is, those with active intent, from those with passive intent. The passive-intent group understands the risks of opioid consumption and takes dangerous amounts, but with a more ambiguous attitude toward suicide. Thus, among decedents of opioid overdose, a large population dies by accident, whereas a small population dies intending to commit suicide; but between them exists a sub-population with equivocal intentions, waxing and waning between their desire to live and the carelessness about death. There may be a passive as well as active intent to commit suicide, but less is known about the passive motivation. It is important for public health efforts aimed at reducing both suicides and opioid-use disorder to better understand the range of motivations behind opioid-related suicides and how to combat them.
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Affiliation(s)
| | - Frank Breve
- Department of Pharmacy, Temple University, Philadelphia, USA
| | - Peter Magnusson
- Cardiology, Center of Research and Development Region Gävleborg, Uppsala University, Gävle, SWE.,Medicine, Cardiology Research Unit, Karolinska Institutet, Stockholm, SWE
| | - Rohit Nalamasu
- Department of Physical Medicine and Rehabilitation, University of Nebraska Medical Center, Omaha, USA
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Bai R, Xie B, Cong B, Ma CL, Wen D. Epidemiological Characteristics of Sedative-Hypnotics and Opioid Painkillers at High-Frequency Exposure. FA YI XUE ZA ZHI 2021; 37:694-698. [PMID: 35187923 DOI: 10.12116/j.issn.1004-5619.2020.300702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Drug poisoning has a high incidence and serious consequences in medical institutions; its epidemiological characteristics also directly affect the changes in national laws and policies and the implementation of local management policies. Chinese statistics on drug-related abnormal death cases generally come from judicial appraisal centers and medical units. However, due to differences in work content and professional restrictions, there are differences in information management forms, which makes it difficult for appraisers to conduct a professional and systematic analysis of drug-related cases. This article focuses on the analysis of epidemiological characteristics of sedative-hypnotics and opioid painkillers and their exposure patterns in cases of poisoning death by analyzing the annual report of the American Association of Poison Control Center, combined with the characteristics of drug exposure in China.
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Affiliation(s)
- Rui Bai
- Hebei Key Laboratory of Forensic Medicine, Collaborative Innovation Center of Forensic Medical Molecular Identification, College of Forensic Medicine, Hebei Medical University, Shijiazhuang 050017, China
| | - Bing Xie
- Hebei Key Laboratory of Forensic Medicine, Collaborative Innovation Center of Forensic Medical Molecular Identification, College of Forensic Medicine, Hebei Medical University, Shijiazhuang 050017, China
| | - Bin Cong
- Hebei Key Laboratory of Forensic Medicine, Collaborative Innovation Center of Forensic Medical Molecular Identification, College of Forensic Medicine, Hebei Medical University, Shijiazhuang 050017, China
| | - Chun-Ling Ma
- Hebei Key Laboratory of Forensic Medicine, Collaborative Innovation Center of Forensic Medical Molecular Identification, College of Forensic Medicine, Hebei Medical University, Shijiazhuang 050017, China
| | - Di Wen
- Hebei Key Laboratory of Forensic Medicine, Collaborative Innovation Center of Forensic Medical Molecular Identification, College of Forensic Medicine, Hebei Medical University, Shijiazhuang 050017, China
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34
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Harris BR. Suicide as a hidden contributor to the opioid crisis and the role that primary care and emergency medicine play in addressing it. Prev Med 2021; 148:106572. [PMID: 33894231 DOI: 10.1016/j.ypmed.2021.106572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/16/2021] [Accepted: 04/20/2021] [Indexed: 11/17/2022]
Abstract
Deaths from overdose have risen dramatically over the past decade, driven mainly by opioids. In response, the Centers for Disease Control and Prevention released guidance on safe prescribing, safe storage of medications, Medication-Assisted Treatment (MAT), and the use of Naloxone to reverse an overdose. Even with this guidance, overdose deaths continue to rise. Suicide prevention is a strategy that may help address this problem. Suicide rose 32.4% between 1999 and 2019, from 10.5 to 13.9 per 100,000. Closely linked to overdose, the suicide rate among those with opioid use disorder is 87 per 100,000 population, six times that of the general US population. With multiple shared individual-level risk factors, strict standards for case ascertainment, and high potential for misclassification of opioid suicides, the distinction between overdose and suicide is often unclear, and the number of suicides is likely underestimated. The Surgeon General recently released a call to action for a public health approach to suicide prevention. Primary care and emergency departments have a major role to play. This commentary describes suicide as a hidden contributor to the opioid crisis; the rationale for integration of suicide prevention in primary care and emergency departments; and screening, education, brief intervention, and follow up and monitoring techniques that these settings can employ. Done effectively, this strategy has the potential to save countless lives.
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Affiliation(s)
- Brett R Harris
- University at Albany School of Public Health, Rensselaer, NY, United States.
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35
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Mercado MC, Stone DM, Kokubun CW, Trudeau ART, Gaylor E, Holland KM, Bartholow BN. Inconsistencies in Overdose Suicide Death Investigation Practice and Potential Remedies Using Technology: A Centers for Disease Control and Prevention Consultation Meeting Summary. Acad Forensic Pathol 2021; 11:83-93. [PMID: 34567327 PMCID: PMC8408809 DOI: 10.1177/19253621211022464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 05/02/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION It is widely accepted that suicides-which account for more than 47 500 deaths per year in the United States-are undercounted by 10% to 30%, partially due to incomplete death scene investigations (DSI) and varying burden-of-proof standards across jurisdictions. This may result in the misclassification of overdose-related suicides as accidents or undetermined intent. METHODS Virtual and in-person meetings were held with suicidologists and DSI experts from five states (Spring-Summer 2017) to explore how features of a hypothetical electronic DSI tool may help address these challenges. RESULTS Participants envisioned a mobile DSI application for cell phones, tablets, or laptop computers. Features for systematic information collection, scene description, and guiding key informant interviews were perceived as useful for less-experienced investigators. DISCUSSION Wide adoption may be challenging due to differences in DSI standards, practices, costs, data privacy and security, and system integration needs. However, technological tools that support consistent and complete DSIs could strengthen the information needed to accurately identify overdose suicides.
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Affiliation(s)
- Melissa C. Mercado
- Melissa C. Mercado, PhD, 4770 Buford Hwy NE, MS-64, Atlanta, GA 30341-3717,
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36
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Snowdon J. Spain's suicide statistics: do we believe them? Soc Psychiatry Psychiatr Epidemiol 2021; 56:721-729. [PMID: 32918553 DOI: 10.1007/s00127-020-01948-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 09/01/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE There is a widespread belief that suicides around the world are under-counted. A substantial proportion of suicides may have been inappropriately registered as accidental or of undetermined cause or intent. There is reason to explore to what extent low suicide rates in some nations could be partly attributable to under-counting. METHODS Mortality statistics of most countries are available on-line. Numbers of suicide deaths in Spain, and in England and Wales (E & W), in male and female 5-year age groups, in each year between 2014 and 2018, were documented, along with deaths coded to ICD-10 accident or 'undetermined death' categories. Crude mortality rates were calculated using official population figures. Single year suicide, undetermined death, and non-transport accidental death rates of 12 other nations were calculated. RESULTS Spain's crude suicide rate per 100,000 remains low (7.89) compared to other nations; its event of undetermined intent (EUI) death rate was 0.09 (contrasting with E & W's 1.74). Its accidental poisoning rate is much lower than that of E & W. The study showed much higher rates of ill-defined/unknown cause deaths in late life in Spain (both genders) than in E & W, and age-associated increases in accidental drowning rates parallel with increased suicide by drowning. CONCLUSIONS Reportedly low suicide rates in Spain could be partly attributable to increased rates of 'hidden suicide' (accidental drowning, male accidental poisoning, and possibly ill-defined/unknown cause deaths, but not EUIs). It would be appropriate (and not just in Spain) to increase numbers of verbal and/or forensic autopsies in questionable 'undetermined' cases.
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Affiliation(s)
- John Snowdon
- Discipline of Psychiatry, Sydney Medical School, Sydney, Australia. .,Centre for Mental Health, Concord Hospital, Sydney, Australia.
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37
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Opioids and Suicide: Opportunities for Comprehensive Prevention. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 26:291-293. [PMID: 32235210 DOI: 10.1097/phh.0000000000001161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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38
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Gold KJ, Schwenk TL, Sen A. Physician Suicide in the United States:Updated Estimates from the National Violent Death Reporting System. PSYCHOL HEALTH MED 2021; 27:1563-1575. [PMID: 33861665 DOI: 10.1080/13548506.2021.1903053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Physician suicide and well-being are critical issues but studies use varying methodologies and suicide is frequently underreported. This study sought to update data on physician suicides in the United States. The National Violent Death Reporting System (NVDRS) at the Centers for Disease Control collects details about violent deaths. The study used 2010-2015 data from 27 NVDRS states to identify suicide deaths among physicians or non-physicians and calculate annual standardized mortality rates (SMR). Of 63,780 victims total, there were 357 physicians identified over 6 years, (307 men and 50 women). If results are extrapolated to all 50 states, there would be approximately 119 physician suicides annually. The SMR for physicians overall was not statistically different from that of non-physicians. This is the first study in 16 years to update estimated physician suicide rates in the United States. The research used strict criteria to identify physicians so results likely represent the lower boundary of physician suicides. Findings show that physician suicide is not significantly lower than that of non-physicians and emphasizes the importance of focusing on structural changes to reduce stigma around mental health in the medical community.
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Affiliation(s)
- Katherine J Gold
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States of America.,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | | | - Ananda Sen
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States of America.,Department of Biostatistics, University of Michigan, Ann Arbor, MI
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Bensley KMK, Kerr WC, Barnett SB, Mulia N. Postmortem screening of opioids, benzodiazepines, and alcohol among rural and urban suicide decedents. J Rural Health 2021; 38:77-86. [PMID: 33817837 DOI: 10.1111/jrh.12574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE Fatal suicides involving opioids are increasingly common, particularly in rural areas. As co-use of opioids with other substances contributes significantly to mortality risk, we examined whether positive screens for opioids with other substances is more prevalent among rural versus urban suicide deaths, as this could have implications for public health strategies to reduce overdose suicides. METHODS Data from all states reporting opioid-related overdose suicides in the National Violent Death Reporting System from 2012 to 2015 were used. Relative risk ratios were obtained using multinomial logistic regression, comparing opioid-only to (1) opioid and alcohol, (2) opioid and benzodiazepines, and (3) opioid, alcohol, and benzodiazepines suicides across rurality. Models were fit using robust standard errors and fixed effects for year of death, adjusting for individual, county, and state-level covariates. FINDINGS There were 3,781 opioid-overdose suicide decedents (42% female) tested for all 3 substances during the study period. Unadjusted prevalence of positive screens in decedents varied across rurality (P = .022). Urban decedents were more likely to test positive for opioids alone, while rural decedents were more to likely test positive for opioids and benzodiazepines. CONCLUSIONS Rural suicides are associated with increased opioid and benzodiazepine positive screens. These findings suggest the need for rural-focused interventions to support appropriate co-prescribing, better health education for providers about risks associated with drug mixing, and more linkages with mental health services.
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Affiliation(s)
- Kara Marie Kubiak Bensley
- School of Public Health, University of California, Berkeley, California, USA.,Alcohol Research Group, Public Health Institute, Emeryville, California, USA
| | - William C Kerr
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA
| | - Sarah Beth Barnett
- School of Public Health, University of California, Berkeley, California, USA.,Alcohol Research Group, Public Health Institute, Emeryville, California, USA
| | - Nina Mulia
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA
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40
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Harris BR, Tracy M, Comber KG, Pechenik S, Carruthers JW. Suicide safer care in behavioral health settings: A comparative analysis of perceptions, training completion, and practice between mental health and substance use disorder treatment providers. J Subst Abuse Treat 2021; 126:108330. [PMID: 34116821 DOI: 10.1016/j.jsat.2021.108330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/02/2020] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Despite prevention and treatment efforts, opioid overdose deaths continue to rise in the United States and totaled 46,802 in 2018. This public health crisis is closely linked with suicide, with those who misuse opioids at six times the risk of death by suicide. Suicide prevention in substance use disorder (SUD) treatment may be a critical step in saving lives and promoting recovery among those at risk for opioid overdose. METHODS We distributed an electronic survey to clinicians in mental health and SUD treatment in nine health systems across New York State from November 2018 to January 2019. The goal of the survey was to assess attitudes, perceptions, practice, and training needs among SUD treatment providers and how they differ from those of mental health providers. RESULTS A total of 633 clinicians responded to the survey (62.4% response rate). Seventy-one percent of SUD providers reported working with a client who attempted suicide. Even so, less than half of SUD providers reported routinely screening new (48.9%) or existing patients (25.6%) for suicidal thoughts/behaviors; overall, 28.4% of SUD providers reported low levels of action to address suicide risk, compared to 9.0% of mental health providers (p < 0.001). Perceived self-efficacy and effectiveness at reducing a patient's risk of suicide and training completion were strongly associated with routine delivery of suicide safer care in adjusted logistic regression models. CONCLUSIONS The results of this study identify key areas for targeted training and technical assistance to increase the provision of quality suicide safer care in SUD treatment.
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Affiliation(s)
- Brett R Harris
- University at Albany School of Public Health, One University Place, Rensselaer, NY 12144, USA.
| | - Melissa Tracy
- University at Albany School of Public Health, One University Place, Rensselaer, NY 12144, USA.
| | - Katharine G Comber
- New York State Office of Mental Health, 44 Holland Avenue, Albany, NY 12229, USA.
| | - Sigrid Pechenik
- New York State Office of Mental Health, 44 Holland Avenue, Albany, NY 12229, USA.
| | - Jay W Carruthers
- New York State Office of Mental Health, 44 Holland Avenue, Albany, NY 12229, USA.
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Rockett IR, Caine ED, Banerjee A, Ali B, Miller T, Connery HS, Lulla VO, Nolte KB, Larkin GL, Stack S, Hendricks B, McHugh RK, White FM, Greenfield SF, Bohnert AS, Cossman JS, D'Onofrio G, Nelson LS, Nestadt PS, Berry JH, Jia H. Fatal self-injury in the United States, 1999-2018: Unmasking a national mental health crisis. EClinicalMedicine 2021; 32:100741. [PMID: 33681743 PMCID: PMC7910714 DOI: 10.1016/j.eclinm.2021.100741] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Suicides by any method, plus 'nonsuicide' fatalities from drug self-intoxication (estimated from selected forensically undetermined and 'accidental' deaths), together represent self-injury mortality (SIM)-fatalities due to mental disorders or distress. SIM is especially important to examine given frequent undercounting of suicides amongst drug overdose deaths. We report suicide and SIM trends in the United States of America (US) during 1999-2018, portray interstate rate trends, and examine spatiotemporal (spacetime) diffusion or spread of the drug self-intoxication component of SIM, with attention to potential for differential suicide misclassification. METHODS For this state-based, cross-sectional, panel time series, we used de-identified manner and underlying cause-of-death data for the 50 states and District of Columbia (DC) from CDC's Wide-ranging Online Data for Epidemiologic Research. Procedures comprised joinpoint regression to describe national trends; Spearman's rank-order correlation coefficient to assess interstate SIM and suicide rate congruence; and spacetime hierarchical modelling of the 'nonsuicide' SIM component. FINDINGS The national annual average percentage change over the observation period in the SIM rate was 4.3% (95% CI: 3.3%, 5.4%; p<0.001) versus 1.8% (95% CI: 1.6%, 2.0%; p<0.001) for the suicide rate. By 2017/2018, all states except Nebraska (19.9) posted a SIM rate of at least 21.0 deaths per 100,000 population-the floor of the rate range for the top 5 ranking states in 1999/2000. The rank-order correlation coefficient for SIM and suicide rates was 0.82 (p<0.001) in 1999/2000 versus 0.34 (p = 0.02) by 2017/2018. Seven states in the West posted a ≥ 5.0% reduction in their standardised mortality ratios of 'nonsuicide' drug fatalities, relative to the national ratio, and 6 states from the other 3 major regions a >6.0% increase (p<0.05). INTERPRETATION Depiction of rising SIM trends across states and major regions unmasks a burgeoning national mental health crisis. Geographic variation is plausibly a partial product of local heterogeneity in toxic drug availability and the quality of medicolegal death investigations. Like COVID-19, the nation will only be able to prevent SIM by responding with collective, comprehensive, systemic approaches. Injury surveillance and prevention, mental health, and societal well-being are poorly served by the continuing segregation of substance use disorders from other mental disorders in clinical medicine and public health practice. FUNDING This study was partially funded by the National Centre for Injury Prevention and Control, US Centers for Disease Control and Prevention (R49CE002093) and the US National Institute on Drug Abuse (1UM1DA049412-01; 1R21DA046521-01A1).
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Affiliation(s)
- Ian R.H. Rockett
- Department of Epidemiology, West Virginia University School of Public Health, Morgantown, WV, United States
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, United States
| | - Eric D. Caine
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, United States
| | - Aniruddha Banerjee
- Department of Geography, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana, United States
| | - Bina Ali
- Pacific Institute for Research and Evaluation, Calverton, Maryland, United States
| | - Ted Miller
- Pacific Institute for Research and Evaluation, Calverton, Maryland, United States
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Hilary S. Connery
- McLean Hospital, Belmont, Massachusetts, United States
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States
| | - Vijay O. Lulla
- Department of Geography, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana, United States
| | - Kurt B. Nolte
- Department of Pathology and Radiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
| | - G. Luke Larkin
- Northeast Ohio Medical University, Rootstown, Ohio, United States
| | - Steven Stack
- Department of Criminal Justice, Wayne State University, Detroit, Michigan, United States
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan, United States
| | - Brian Hendricks
- Department of Epidemiology, West Virginia University School of Public Health, Morgantown, WV, United States
| | - R. Kathryn McHugh
- McLean Hospital, Belmont, Massachusetts, United States
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States
| | - Franklin M.M. White
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shelly F. Greenfield
- McLean Hospital, Belmont, Massachusetts, United States
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States
| | - Amy S.B. Bohnert
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, United States
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, United States
| | - Jeralynn S. Cossman
- College for Health, Community and Policy, University of Texas-San Antonio, San Antonio, Texas, United States
| | - Gail D'Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, United States
| | - Lewis S. Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States
| | - Paul S. Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - James H. Berry
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - Haomiao Jia
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, United States
- School of Nursing, Columbia University, New York, New York, United States
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42
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Hansen A, Slavova D, Cooper G, Zummer J, Costich J. An emergency department medical record review for adolescent intentional self-harm injuries. Inj Epidemiol 2021; 8:3. [PMID: 33413622 PMCID: PMC7791795 DOI: 10.1186/s40621-020-00293-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/24/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Non-suicidal self-injury and suicide attempts are increasing problems among American adolescents. This study developed a definition for identifying intentional self-harm (ISH) injuries in emergency department (ED) records coded with International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes. The definition is based on the injury-reporting framework proposed by the Centers for Disease Control and Prevention. The study sought to estimate the definition's positive predictive value (PPV), and the proportion of ISH injuries with intent to die (i.e., suicide attempt). METHODS The study definition, based on first-valid external cause-of-injury ICD-10-CM codes X71-X83, T14.91, T36-T65, or T71, captured 207 discharge records for initial encounters for ISH in one Kentucky ED. Medical records were reviewed to confirm provider-documented diagnosis for ISH, and identify intent to die or suicide ideation. The PPV of the study definition for capturing provider-documented ISH injuries was reported with its 95% confidence interval (95% CI). RESULTS The estimated PPV for the study definition to capture ISH injuries was 88.9%, 95% CI (83.8%, 92.8%). The estimated percentage of ISH with intent to die was 45.9, 95% CI (47.1, 61.0%). The ICD-10-CM code "suicide attempt" (T14.91) captured only 7 cases, but coding guidelines restrict assignment of this code to cases in which the mechanism of the suicide attempt is unknown. CONCLUSIONS The proposed case definition supported a robust PPV for ISH injuries. Our findings add to the evidence that the current ICD-10-CM coding system and coding guidelines do not allow identification of ISH with intent to die; modifications are needed to address this issue.
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Affiliation(s)
- Anna Hansen
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA
- Department of Sociology, University of Kentucky, Lexington, USA
- College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Dessi Slavova
- College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Gena Cooper
- Department of Emergency Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Jaryd Zummer
- Department of Emergency Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Julia Costich
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA.
- Department of Health Management & Policy, College of Public Health, University of Kentucky, 111 Washington Ave, Lexington, KY, 40536-0003, USA.
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43
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Ali B, Rockett IRH, Miller TR, Leonardo JB. Racial/Ethnic Differences in Preceding Circumstances of Suicide and Potential Suicide Misclassification Among US Adolescents. J Racial Ethn Health Disparities 2021; 9:296-304. [PMID: 33415703 DOI: 10.1007/s40615-020-00957-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/23/2020] [Accepted: 12/27/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE There is a paucity of research on racial/ethnic differences in preceding circumstances of suicide among adolescents aged 10-19 years and consequential potential misclassification of suicide deaths (i.e., manner of death classified as injury of undetermined intent). This study (1) examined preceding circumstances of suicide among non-Hispanic White, non-Hispanic Black, non-Hispanic Asian/Pacific Islander (A/PI), non-Hispanic American Indian/Alaskan Native (AI/AN), and Hispanic adolescent decedents; and (2) investigated potential suicide misclassification of racial/ethnic minority decedents. METHODS We used data from the 2006-2015 National Violent Death Reporting System Restricted Access Database. Multivariable logistic regression analyses examined differences in depressed mood, mental health problem and treatment, crisis in the past 2 weeks, problems with school, intimate partner, family relationship, and other relationships (e.g., friend) among racial/ethnic minority decedents compared to White decedents. A separate logistic regression analysis assessed potential suicide misclassification of racial/ethnic minority decedents relative to White counterparts. RESULTS Adjusting for sex and suicide history and circumstances, all racial/ethnic minority decedents had significantly lower odds of documented mental health problem and treatment compared to White decedents. Racial/ethnic differences in relationship problems were also identified. Black decedents had significantly higher odds of manner-of-death classification as undetermined intent than did White decedents, suggesting greater likelihood of suicide misclassification. CONCLUSIONS Circumstances contributing to suicide among adolescents differ by race/ethnicity, indicating the need for culturally tailored suicide prevention efforts.
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Affiliation(s)
- Bina Ali
- Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Suite 900, Calverton, MD, 20705, USA.
| | - Ian R H Rockett
- Department of Epidemiology, West Virginia University, Morgantown, WV, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Ted R Miller
- Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Suite 900, Calverton, MD, 20705, USA.,School of Public Health, Curtin University, Perth, Australia
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44
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Ali B, Rockett I, Miller T. Variable Circumstances of Suicide Among Racial/Ethnic Groups by Sex and Age: A National Violent-Death Reporting System Analysis. Arch Suicide Res 2021; 25:94-106. [PMID: 31538548 DOI: 10.1080/13811118.2019.1661894] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Suicide rates vary by race/ethnicity, but little is known about how the circumstances that contribute to suicide differ across racial/ethnic groups. This study investigated suicide circumstances among non-Hispanic Whites, non-Hispanic Blacks, non-Hispanic Asian/Pacific Islanders, non-Hispanic Native American/Alaskan Natives, and Hispanics by sex and age. Using de-identified National Violent Death Reporting System (NVDRS) Restricted Access Database files from 2006-2015, we examined proximal circumstances of suicide among decedents aged 10 years and older. Hierarchical logistic regression analysis revealed racial/ethnic differentials in non-alcohol substance abuse problem, intimate partner problem, and physical health problem across sex and age, controlling for potential confounders. Study findings highlight priority areas for suicide interventions.
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45
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Evidence for Underregistration of Suicide. Case Rep Psychiatry 2020; 2020:8873893. [PMID: 33274101 PMCID: PMC7676976 DOI: 10.1155/2020/8873893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/13/2020] [Accepted: 11/06/2020] [Indexed: 11/29/2022] Open
Abstract
In this case report, we will present two cases in which the Dutch municipal coroner registered a natural death, but treating psychiatrists doubted the validity of this decision on the grounds of clinical data and investigation. For both cases, we present evidence that deaths likely resulted from suicide, raising serious doubts about the accuracy of the registered cause of death. According to the WHO bulletin on suicide prevention, the national registration of suicide is unsatisfactory in many countries. The Netherlands is listed by the WHO as having one of the most accurate registration procedures. Nevertheless, there are indications that national registration, even in the Dutch system, is not infallible. In this case report, we present several ways in which the registration process is liable to error and evidence for underregistration of suicide rates.
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46
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O'Reilly LM, Froberg BA, Gian CT, D'Onofrio BM, Simon KI. The Affordable Care Act Young Adult Mandate and Suicidal Behavior. Med Care Res Rev 2020; 79:17-27. [PMID: 33213274 DOI: 10.1177/1077558720974144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article aimed to determine the association between the Affordable Care Act young adult mandate and suicidal behavior. From 2007 to 2013, we used the Nationwide/National Inpatient Sample and National Poison Data System to examine suicide attempt, and Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research to examine suicide. We aggregated each outcome by quarter/year and conducted a difference-in-differences linear regression to compare young adults aged 19 to 25 years with those 27 to 29 years before and after implementation. There were not statistically significant associations between the mandate and suicide attempt inpatient hospitalizations (unstandardized beta coefficient [b] = -0.72, p = .12, standard error [SE] = 0.42) and percentage of poisoning cases due to suspected suicidal intent (b = 0.23, p = .19, SE = 0.16). There was a statistically significant association when examining suicide prevalence (b = -0.03, p = .01, SE = 0.001). The results suggest that health insurance may buffer against but is unlikely to reverse the increasing suicide rate.
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Affiliation(s)
| | - Blake A Froberg
- Indiana University School of Medicine, Indianapolis, IN, USA
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47
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Kaminer Y, Burke R, Gill J. Determining Youth Intentional Fatal Drug Intoxication: The Case for a Psychological Autopsy to Complement the Medical Examiner’s Report. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2020. [DOI: 10.1080/1067828x.2020.1837322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Yifrah Kaminer
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Rebecca Burke
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - James Gill
- University of Connecticut School of Medicine, Farmington, CT, USA
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48
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Rockett IRH, Caine ED, Connery HS, Nolte KB. Overcoming the limitations of 'accident' as a manner of death for drug overdose mortality: case for a death certificate checkbox. Inj Prev 2020; 27:375-378. [PMID: 32917742 DOI: 10.1136/injuryprev-2020-043830] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/23/2020] [Accepted: 07/25/2020] [Indexed: 01/21/2023]
Abstract
Collectively, the epidemic increases in the United States of opioid-related deaths and suicides during the first two decades of the 21st century have exposed shortcomings in current forensic and epidemiological approaches for determining and codifying manner of death-a vital function fulfilled by medical examiners, coroners and nosologists-the foundation for the National Violent Death Reporting System (NVDRS), an incident-based surveillance system providing individual-level information on decedent characteristics, manner, cause and circumstances of suicide, homicide and other violent injury deaths. Drug intoxication deaths are generally classified as 'accidents' or unintentional, a fundamental mischaracterisation; most arose from repetitive self-harm behaviours related to substance acquisition and misuse. Moreover, given the burden of affirmative evidence required to determine suicide, many of these 'accidents' likely reflected unrecognised intentional acts-that is, suicides. Addition of a simple checkbox for self-injury mortality on the death certificate would enrich the National Death Index and NVDRS, and in turn, inform prevention and clinical research, and enhance the evaluation of prevention programmes and therapeutic regimens.
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Affiliation(s)
- Ian R H Rockett
- Epidemiology, West Virginia University, Morgantown, West Virginia, USA .,Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Eric D Caine
- Injury Control Research Center for Suicide Prevention, University of Rochester Medical Center, Rochester, New York, USA.,Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Hilary S Connery
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts, USA.,Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Kurt B Nolte
- Pathology and Radiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
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49
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Foth T. Humanitarian reason and the movement for overdose prevention sites: The NGOization of the Opioid "Crisis". Nurs Philos 2020; 22:e12324. [PMID: 32781487 DOI: 10.1111/nup.12324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/11/2020] [Accepted: 07/18/2020] [Indexed: 11/26/2022]
Abstract
In August 2017, a group of activists erected in Ottawa's downtown a tent as a first overdose prevention site as a response to what the public and the activists perceived as an epidemic-a devastating wave of opioid and fentanyl overdoses in Canada. The Ontario premier was urged to declare an emergency that would provide increased funding for harm reduction and also send a message to survivors and families that the lives of their loved ones mattered. Thus, the discourses around the so-called opioid crisis used a language of moral sentiments to legitimate political action. This "new humanitarianism" is considered a priori as good, but in this article, I ask what is politically at stake if we base our actions on the logic of humanitarian reason. The new universalism of humanitarian organizations is based on the individualism of human rights and thus on a moral imperative that replaces the political. Initiatives like the OPS movement often fill the gaps in social services in the absence of the state and address social problems as emergencies and public health issues, thereby transforming them into medical problems-performing the medicalization of sociopolitical problems. This is what I call the NGOization of the opioid crisis. This form of humanitarianism is a universalism of the temporal present without any universal promise for a better future or the amelioration of human conditions-it is a humanitarianism of emergency. What characterizes new humanitarianism is that it responds to situations of suffering that are the result of increasing inequality and injustices without addressing the root causes of this suffering. Not addressing these causes means to be complicit in perpetuating the inequalities and to restrict visions of possible alternatives.
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Affiliation(s)
- Thomas Foth
- Faculty of Health sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
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50
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Gicquelais RE, Jannausch M, Bohnert AS, Thomas L, Sen S, Fernandez AC. Links between suicidal intent, polysubstance use, and medical treatment after non-fatal opioid overdose. Drug Alcohol Depend 2020; 212:108041. [PMID: 32470753 PMCID: PMC7336718 DOI: 10.1016/j.drugalcdep.2020.108041] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Suicidal thinking during non-fatal overdose may elevate risk for future completed suicide or intentional overdose. Long-term outcomes following an intentional non-fatal overdose may be improved through specific intervention and prevention responses beyond those designed for unintentional overdoses, yet little research has assessed suicidal intent during overdoses or defined characteristics that differentiate these events from unintentional overdoses. METHODS Patients with a history of opioid overdose (n = 274) receiving residential addiction treatment in the Midwestern United States completed self-report surveys to classify their most recent opioid overdose as unintentional, actively suicidal (wanted to die), or passively suicidal (didn't care about the risks). We characterized correlates of intent using descriptive statistics and prevalence ratios. We also examined how intent related to thoughts of self-harm at the time of addiction treatment. RESULTS Of opioid overdoses, 51 % involved suicidal intent (44 % passive and 7 % active). Active suicidal intent was positively associated with hospitalization. Active/passive intent (vs. no intent, aPR: 2.2, 95 % CI: 1.4-3.5) and use of ≥5 substances (vs. 1 substance, aPR: 3.6, 95 % CI: 1.2-10.6) at the last opioid overdose were associated with having thoughts of self-harm or suicide in the 2 weeks before survey completion in adjusted models. Participants who reported active/passive intent more commonly used cocaine or crack (27 %) with opioids during their last overdose relative to unintentional overdoses (16 %). CONCLUSIONS Over half of opioid overdoses among individuals in addiction treatment involved some degree of suicidal thinking. Identifying patients most at risk will facilitate better targeting of suicide prevention and monitoring services.
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Affiliation(s)
- Rachel E. Gicquelais
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA,Corresponding author at: Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, E7133A, Baltimore, MD, 21205, USA.
| | - Mary Jannausch
- Veterans Affairs Center for Clinical Management Research, 2215 Fuller Road, Ann Arbor, MI 48105, USA
| | - Amy S.B. Bohnert
- Veterans Affairs Center for Clinical Management Research, 2215 Fuller Road, Ann Arbor, MI 48105, USA,Department of Psychiatry, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA,Department of Anesthesiology, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Laura Thomas
- Veterans Affairs Center for Clinical Management Research, 2215 Fuller Road, Ann Arbor, MI 48105, USA,Department of Psychiatry, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Srijan Sen
- Department of Psychiatry, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA,Molecular and Behavioral Neuroscience Institute, University of Michigan, 205 Zina Pitcher Place, Ann Arbor, MI 48109, USA
| | - Anne C. Fernandez
- Department of Psychiatry, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
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