An Exploratory Analysis of Fifteen Years Suicide Trends Using Population-Level Data From Croatian Committed Suicides Registry

Clozapine pharmacovigilance in Croatia: Underreporting of specific adverse drug reactions and excellent reporting of suicide attempts

Croatia has implemented anti-suicide measures due to its high suicide rates. Clozapine has anti-suicidal effects. Using the international database (VigiBase), we explored Croatia's unusual clozapine pharmacovigilance. First, we compared the United Kingdom (UK) with Croatia for clozapine adverse drug reactions (ADRs) and fatal outcomes from clozapine's introduction through January 15, 2023. If the UK is considered 1, and after adjusting for population, Croatia had much lower rates (1 vs. 0.08 for clozapine ADR reports, 1 vs. 0.02 for fatal outcomes and 1 vs. 0.14 for percentage of clozapine reports out of all drug reports). Through 2023, the UK had 52,252 ADR reports and 6,567 fatal outcomes from clozapine-treated patients vs. Croatia with 395 reports and 6 fatal outcomes. The Croatian pharmacovigilance agency (and most national agencies) needs to learn from the UK's agency to better report clozapine ADRs. Second, we analyze suicide behaviors in Croatian clozapine-treated patients reported to VigiBase. Through 2023 the UK reported 537 clozapine-treated patients with at least 1 suicidal behavior versus 95 from Croatia. After adjusting for population, the UK reported a much smaller number of reports of suicidal behavior than Croatia (1 vs. 2.73). This overreporting by Croatian physicians may be a sign of the success of Croatia's anti-suicide measures. The percentage of fatal outcomes in 77 Croatian patients with an intentional overdose was 1.3 % (1/77) vs. 16.8 % in 411 non-Croatian patients, but this is possibly contaminated by early reporting (patients might die after the report). Longitudinal studies of clozapine overdoses in Croatia are needed.

Spatial, geographic, and demographic factors associated with adolescent and youth suicide: a systematic review study

Background

Suicide is a public health issue and a main cause of mortality among adolescents and the youth worldwide, particularly in developing countries.

Objectives

The present research is a systematic review aiming to investigate the spatial, geographical, and demographic factors related to suicide among adolescents and the youth.

Methods

In this systematic review, two researchers examined PsycINFO, Web of Science, Scopus, and PubMed databases on December 7th, 2022 with no time limits from the beginning of publication until 2022 to identify the primary studies on spatial and geographic analysis on adolescent and youth suicides. Once duplicate studies were identified and removed, the titles and abstracts of studies were examined and irrelevant studies were also removed. Finally, 22 studies were reviewed based on the inclusion criteria.

Results

Our findings show that suicide rates are generally higher among men, residents of rural and less densely populated regions, coastal and mountainous regions, natives, 15-29 age group, less privileged populations with social fragmentation, unemployed, divorced or lonely people, those who live in single parent families, people with mental health issues, and those with low levels of education.

Conclusions

Stronger evidence supports the effects of geographic and demographic variables on youth and adolescent suicide rates as compared with spatial variables. These findings suggest that policy makers take spatial and demographic factors into consideration when health systems allocate resources for suicide prevention, and that national policymakers integrate demographic and geographic variables into health service programs.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42023430994.