1
|
Benson R, Rigby J, Brunsdon C, Corcoran P, Dodd P, Ryan M, Cassidy E, Colchester D, Hawton K, Lascelles K, de Leo D, Crompton D, Kõlves K, Leske S, Dwyer J, Pirkis J, Shave R, Fortune S, Arensman E. Real-Time Suicide Surveillance: Comparison of International Surveillance Systems and Recommended Best Practice. Arch Suicide Res 2023; 27:1312-1338. [PMID: 36237124 DOI: 10.1080/13811118.2022.2131489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Some countries have implemented systems to monitor suicides in real-time. These systems differ because of the various ways in which suicides are identified and recorded. The main objective of this study was to conduct an international comparison of major real-time suicide mortality surveillance systems to identify joint strengths, challenges, and differences, and thereby inform best-practice criteria at local, national, and international levels. METHODS Five major real-time suicide mortality surveillance systems of various coverage levels were identified and selected for review via an internet-based scoping exercise and prior knowledge of existing systems. Key information including the system components and practices was collated from those organizations that developed and operate each system using a structured template. The information was narratively and critically synthesized to determine similarities and differences between the systems. RESULTS The comparative review of the five established real-time suicide surveillance systems revealed more commonalities than differences overall. Commonalities included rapid, routine surveillance based on minimal, provisional data to facilitate timely intervention and postvention efforts. Identified differences include the timeliness of case submission and system infrastructure. CONCLUSION The recommended criteria could promote replicable components and practices in real-time suicide surveillance while offering flexibility in adapting to regional/local circumstances and resource availability.HIGHLIGHTSEvidence-informed recommendations for current best practice in real-time suicide surveillance.Proposed comprehensive framework can be adapted based on available resources and capacity.Real-time suicide mortality data facilitates rapid data-driven decision-making in suicide prevention.
Collapse
|
2
|
Dwyer J, Spittal MJ, Scurrah K, Pirkis J, Bugeja L, Clapperton A. Structural intervention at one bridge decreases the overall jumping suicide rate in Victoria, Australia. Epidemiol Psychiatr Sci 2023; 32:e58. [PMID: 37721170 PMCID: PMC10539743 DOI: 10.1017/s2045796023000720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/26/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023] Open
Abstract
AIMS There is clear evidence that installing safety barriers is effective in preventing jumping suicides from high-risk bridges with only moderate displacement to other nearby bridges. However, the impact of barriers on jumping suicides across broader geographical areas is not well understood. We examined patterns in jumping suicides across the state of Victoria, Australia, after a safety barrier was installed at the West Gate Bridge which, before the installation of the barrier, was the site of approximately 40% of Victoria's jumping suicides. METHODS We used negative binomial regression analyses on Victorian data from 2000 to 2019 to compare rates of jumping suicides at the West Gate Bridge, other bridges and non-bridge jumping locations before, during and after the West Gate Bridge barrier installation. We conducted linear regression analyses to examine whether the distance travelled from the deceased's usual residence to the location of their jumping suicide changed between the before, during and after barrier installation periods. RESULTS After installation of the barrier, there were no jumping suicides at the West Gate Bridge (rate ratio [RR] = 0.00, 95% credible intervals [95% Cr] = 0.00-0.0001) and there was strong evidence that the rate of jumping suicides at all locations declined by 65% (RR = 0.35, 95% Cr = 0.22-0.54). At other bridges, there was also evidence of a reduction (RR = 0.31, 95% Cr = 0.11-0.70), but there was no evidence of a change at non-bridge locations (RR = 0.74, 95% Cr = 0.39-1.30). CONCLUSION After installation of the safety barrier at the West Gate Bridge, jumping suicide in Victoria decreased overall and at other bridges, and did not appear to change at non-bridge locations. Our findings show that when barriers are installed at a site responsible for a disproportionately high number of jumping suicides, they are not only highly effective at the site where the barriers are installed but can also have a prevention impact beyond the immediate locale at similar sites.
Collapse
Affiliation(s)
- J. Dwyer
- Coroners Prevention Unit, Coroners Court of Victoria, Southbank, VIC, Australia
| | - M. J. Spittal
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - K. Scurrah
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - J. Pirkis
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - L. Bugeja
- Monash Nursing and Midwifery, Monash University, Clayton, VIC, Australia
| | - A. Clapperton
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
3
|
John A, Pirkis J, Gunnell D, Spittal M, Del Pozo Banos M, Arya V, Shin S. Suicide Trends during the COVID-19 pandemic and the International COVID-19 Suicide Prevention Research Collaboration. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
There was and still is much speculation about the COVID-19 pandemic impact on suicide rates. We aimed to assess the effect of the COVID-19 pandemic on suicide rates around the world.
Methods
We sourced real-time suicide data from countries or countries areas through a systematic internet search (official websites of Ministries of health, police agencies, and government-run statistics agencies or equivalents), recourse to our networks (e.g. ICSPRC) and the published literature (a living systematic review). We used an interrupted time-series analysis to model the trend in monthly suicides before COVID-19 in each country or country area, comparing the expected number of suicides derived from the model with the observed number of suicides in the early months of the pandemic (from April 1 to July 31, 2020, in the primary analysis). We have now updated this work to cover the first 15 months of the pandemic and stratified analyses by age and sex and method. We will present findings from the new updated data (35 countries) at the conference.
Results
Initially we sourced data from 21 countries (16 high-income and five upper-middle-income countries). Rate ratios (RRs) and 95% CIs based on the observed versus expected numbers of suicides showed no evidence of a significant increase in risk of suicide since the pandemic began in any country or area. There was statistical evidence of a decrease in suicide compared with the expected number in 12 countries or areas.
Conclusions
This was the first study to examine suicides occurring in the context of the COVID-19 pandemic in multiple countries. Early on high-income and upper-middle-income countries, suicide numbers remained largely unchanged or declined compared with the expected levels based on the pre-pandemic period. We need to remain vigilant and be poised to respond as the longer-term mental health and economic effects of the pandemic unfold. We will present updated findings with more recent data.
Collapse
Affiliation(s)
- A John
- Swansea University Medical School, Swansea University , Swansea, UK
| | - J Pirkis
- Centre for Mental Health, University of Melbourne , Melbourne, Australia
| | - D Gunnell
- National Institute for Health and Care Research Bristol Biomedical Research Centre, University of Bristol , Bristol, UK
| | - M Spittal
- Centre for Mental Health, University of Melbourne , Melbourne, Australia
| | - M Del Pozo Banos
- Swansea University Medical School, Swansea University , Swansea, UK
| | - V Arya
- Centre for Mental Health, University of Melbourne , Melbourne, Australia
| | - S Shin
- Centre for Mental Health, University of Melbourne , Melbourne, Australia
| |
Collapse
|
4
|
Borges G, Garcia JA, Pirkis J, Spittal MJ, Gunnell D, Sinyor M, John A. A state level analyses of suicide and the COVID-19 pandemic in Mexico. BMC Psychiatry 2022; 22:460. [PMID: 35810285 PMCID: PMC9271255 DOI: 10.1186/s12888-022-04095-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/27/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND While suicide rates in high- and middle-income countries appeared stable in the early stages of the pandemic, we know little about within-country variations. We sought to investigate the impact of COVID-19 on suicide in Mexico's 32 states and to identify factors that may have contributed to observed variations between states. METHODS Interrupted time-series analysis to model the trend in monthly suicides before COVID-19 (from Jan 1, 2010, to March 31, 2020), comparing the expected number of suicides derived from the model with the observed number for the remainder of the year (April 1 to December 31, 2020) for each of Mexico's 32 states. Next, we modeled state-level trends using linear regression to study likely contributing factors at ecological level. RESULTS Suicide increased slightly across Mexico during the first nine months of the pandemic (RR 1.03; 95%CI 1.01-1.05). Suicides remained stable in 19 states, increase in seven states (RR range: 1.12-2.04) and a decrease in six states (RR range: 0.46-0.88). Suicide RR at the state level was positively associated with population density in 2020 and state level suicide death rate in 2019. CONCLUSIONS The COVID-19 pandemic had a differential effect on suicide death within the 32 states of Mexico. Higher population density and higher suicide rates in 2019 were associated with increased suicide. As the country struggles to cope with the ongoing pandemic, efforts to improve access to primary care and mental health care services (including suicide crisis intervention services) in these settings should be given priority.
Collapse
Affiliation(s)
- G. Borges
- grid.419154.c0000 0004 1776 9908Instituto Nacional de Psiquiatría Ramon de La Fuente Muñiz, Calzada Mexico Xochimilco 101, 14370 Mexico City, CP Mexico
| | - J. A. Garcia
- grid.451581.c0000 0001 2164 0187Centro de Investigación Y Docencia Económicas (CIDE), Mexico City, Mexico
| | - J. Pirkis
- grid.1008.90000 0001 2179 088XCentre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC Australia
| | - M. J. Spittal
- grid.1008.90000 0001 2179 088XCentre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC Australia
| | - D. Gunnell
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK ,grid.5337.20000 0004 1936 7603National Institute of Health Research Biomedical Research Centre at the University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - M. Sinyor
- grid.413104.30000 0000 9743 1587Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, Canada
| | - A. John
- grid.4827.90000 0001 0658 8800Population Psychiatry, Suicide and Informatics, Medical School, Swansea University, Swansea, UK
| |
Collapse
|
5
|
Currier D, Patton G, Sanci L, Sahabandu S, Spittal M, English D, Milner A, Pirkis J. Socioeconomic Disadvantage, Mental Health and Substance Use in Young Men in Emerging Adulthood. Behav Med 2021; 47:31-39. [PMID: 31241418 DOI: 10.1080/08964289.2019.1622504] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Emerging adulthood is a neglected phase of the life course in health research. Health problems and risk behaviors at this time of life can have long-term consequences for health. The 2016 Lancet Commission on Adolescent Health and Wellbeing reported that the influence of socioeconomic factors was under-researched among adolescents and young adults. Moreover, the influence of socioeconomic factors on health has been little researched specifically in emerging adult men. We aimed to investigate associations between socioeconomic disadvantage and mental health, suicidal behavior, and substance use in young adult Australian men. Logistic regression was used to examine the association between Year 12 (high school) completion and area disadvantage on mental health, suicidal behavior, and substance use in 2,281 young men age 18-25 participating in the Australian Longitudinal Study on Male Health (Ten to Men). In unadjusted analysis both Year 12 non-completion and area disadvantage were associated with multiple adverse outcomes. In adjusted analysis Year 12 non-completion, but not area disadvantage, was associated with poorer mental health, increased odds of suicidal behavior, and substance use. Retaining young men in high school and developing health-promotion strategies targeted at those who do exit education early could both improve young men's mental health and reduce suicidal behavior and substance use in emerging adulthood.
Collapse
Affiliation(s)
- D Currier
- Centre for Mental Health, The University of Melbourne
| | - G Patton
- Centre for Adolescent Health, Murdoch Childrens Research Institute
| | - L Sanci
- Department of General Practice, The University of Melbourne
| | - S Sahabandu
- Centre for Epidemiology and Biostatistics, The University of Melbourne
| | - M Spittal
- Centre for Mental Health, The University of Melbourne
| | - D English
- Centre for Epidemiology and Biostatistics, The University of Melbourne
| | - A Milner
- Centre for Health Equity, The University of Melbourne
| | - J Pirkis
- Centre for Mental Health, The University of Melbourne
| |
Collapse
|
6
|
Borschmann R, Tibble H, Spittal MJ, Preen D, Pirkis J, Larney S, Rosen DL, Young JT, Love AD, Altice FL, Binswanger IA, Bukten A, Butler T, Chang Z, Chen CY, Clausen T, Christensen PB, Culbert GJ, Degenhardt L, Dirkzwager AJE, Dolan K, Fazel S, Fischbacher C, Giles M, Graham L, Harding D, Huang YF, Huber F, Karaminia A, Keen C, Kouyoumdjian FG, Lim S, Møller L, Moniruzzaman A, Morenoff J, O’Moore E, Pizzicato LN, Pratt D, Proescholdbell SK, Ranapurwala SI, Shanahan ME, Shaw J, Slaunwhite A, Somers JM, Spaulding AC, Stern MF, Viner KM, Wang N, Willoughby M, Zhao B, Kinner SA. The Mortality After Release from Incarceration Consortium (MARIC): Protocol for a multi-national, individual participant data meta-analysis. Int J Popul Data Sci 2020; 5:1145. [PMID: 32935053 PMCID: PMC7473255 DOI: 10.23889/ijpds.v5i1.1145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION More than 30 million adults are released from incarceration globally each year. Many experience complex physical and mental health problems, and are at markedly increased risk of preventable mortality. Despite this, evidence regarding the global epidemiology of mortality following release from incarceration is insufficient to inform the development of targeted, evidence-based responses. Many previous studies have suffered from inadequate power and poor precision, and even large studies have limited capacity to disaggregate data by specific causes of death, sub-populations or time since release to answer questions of clinical and public health relevance. OBJECTIVES To comprehensively document the incidence, timing, causes and risk factors for mortality in adults released from prison. METHODS We created the Mortality After Release from Incarceration Consortium (MARIC), a multi-disciplinary collaboration representing 29 cohorts of adults who have experienced incarceration from 11 countries. Findings across cohorts will be analysed using a two-step, individual participant data meta-analysis methodology. RESULTS The combined sample includes 1,337,993 individuals (89% male), with 75,795 deaths recorded over 9,191,393 person-years of follow-up. CONCLUSIONS The consortium represents an important advancement in the field, bringing international attention to this problem. It will provide internationally relevant evidence to guide policymakers and clinicians in reducing preventable deaths in this marginalized population. KEY WORDS Mortality; incarceration; prison; release; individual participant data meta-analysis; consortium; cohort.
Collapse
Affiliation(s)
- R Borschmann
- Justice Health Unit, Centre for Health Equity, The University of Melbourne, 207 Bouverie street, Carlton 3010, Melbourne, Victoria, AUSTRALIA
| | - H Tibble
- Usher Institute of Population Health Sciences and Informatics, Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
| | - MJ Spittal
- University of Melbourne, Melbourne School of Population and Global Health, Melbourne, AUSTRALIA
| | - D Preen
- The University of Western Australia, School of Population and Global Health, Nedlands, AUSTRALIA
| | - J Pirkis
- University of Melbourne, Melbourne School of Population and Global Health, Melbourne, AUSTRALIA
| | - S Larney
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, AUSTRALIA
| | - DL Rosen
- University of North Carolina at Chapel Hill, North Carolina, USA
| | - JT Young
- University of Melbourne, Melbourne School of Population and Global Health, Melbourne, AUSTRALIA
| | - AD Love
- University of Melbourne, Melbourne School of Population Health, Melbourne, AUSTRALIA
| | - FL Altice
- Yale University School of Medicine and Public Health, New Haven, Connecticut, USA
| | - IA Binswanger
- Kaiser Permanente Colorado, Colorado Permanente Medical Group, USA
| | - A Bukten
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway
| | - T Butler
- University of New South Wales, Kirby Institute, Sydney, AUSTRALIA
| | - Z Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, SWEDEN
| | - C-Y Chen
- National Yang-Ming University, Institute of Public Health, TAIWAN
| | - T Clausen
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway
| | - PB Christensen
- Department of Infectious Diseases, Odense University Hospital and Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, DENMARK
| | - GJ Culbert
- Department of Health Systems Science, University of Illinois at Chicago, Chicago, USA
| | - L Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, AUSTRALIA
| | - AJE Dirkzwager
- Netherlands Institute for the Study of Crime and Law Enforcement (NSCR), Amsterdam, NETHERLANDS
| | - K Dolan
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, AUSTRALIA
| | - S Fazel
- University of Oxford, Department of Psychiatry, Medical Sciences Division, Oxford, ENGLAND
| | - C Fischbacher
- NHS National Services, Information Services Division, Edinburgh, SCOTLAND
| | - M Giles
- Edith Cowan University, School of Arts and Humanities, Joondalup, AUSTRALIA
| | - L Graham
- NHS National Services, Information Services Division, Edinburgh, SCOTLAND
| | - D Harding
- University of California Berkeley, USA
| | - Y-F Huang
- Taiwan Centers for Disease Control, Taipei, TAIWAN
| | - F Huber
- Cayenne General Hospital, COREVIH Guyane, and Reseau Kikiwi, Cayenne, French Guiana, FRANCE
| | - A Karaminia
- University of New South Wales, Sydney, AUSTRALIA
| | - C Keen
- University of Melbourne, Melbourne School of Population and Global Health, Melbourne, AUSTRALIA
| | - FG Kouyoumdjian
- McMaster University, Department of Family Medicine, Hamilton, Ontario, CANADA
| | - S Lim
- New York City Department of Health and Mental Hygiene, Bureau of Epidemiology Services, Division of Epidemiology, New York, USA
| | - L Møller
- World Health Organization, Division of Noncommunicable Diseases and Promoting Health through the Life-course, Marmorvej, DENMARK
| | - A Moniruzzaman
- Somers Research Group, Simon Fraser University, Burnaby, British Columbia, CANADA
| | - J Morenoff
- University of Michigan, Department of Sociology, USA
| | - E O’Moore
- Public Health England, London, ENGLAND
| | - LN Pizzicato
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - D Pratt
- University of Manchester, Division of Psychology and Mental Health, School of Health Sciences, Manchester, ENGLAND
| | - SK Proescholdbell
- North Carolina Department of Health and Human Services, North Carolina, USA
| | - SI Ranapurwala
- Department of Epidemiology, University of North Carolina at Chapel Hill, USA
| | - ME Shanahan
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, USA
| | - J Shaw
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester, Manchester, ENGLAND
| | - A Slaunwhite
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, CANADA
| | - JM Somers
- Somers Research Group, Simon Fraser University, Burnaby, British Columbia, CANADA
| | - AC Spaulding
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - MF Stern
- Department of Health Services, University of Washington, Seattle, Washington, USA
| | - KM Viner
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - N Wang
- Institute of Public Health, National Yang-Ming University, TAIWAN
| | - M Willoughby
- University of Melbourne, Melbourne School of Population and Global Health, Melbourne, AUSTRALIA
| | - B Zhao
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, CANADA
| | - SA Kinner
- Murdoch Children’s Research Institute, Centre for Adolescent Health, Melbourne, Victoria, AUSTRALIA
| |
Collapse
|
7
|
Too LS, Pirkis J, Milner A, Spittal MJ. Clusters of suicides and suicide attempts: detection, proximity and correlates. Epidemiol Psychiatr Sci 2017; 26:491-500. [PMID: 27278418 PMCID: PMC6998993 DOI: 10.1017/s2045796016000391] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 05/12/2016] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND A suicide cluster is defined as a higher number of observed cases occurring in space and/or time than would typically be expected. Previous research has largely focused on identifying clusters of suicides, while there has been comparatively limited research on clusters of suicide attempts. We sought to identify clusters of both types of behaviour, and having done that, identify the factors that distinguish suicide attempts inside a cluster from those that were outside a cluster. METHODS We used data from Western Australia from 2000 to 2011. We defined suicide attempts as admissions to hospital for deliberate self-harm and suicides as deaths due to deliberate self-harm. Using an analytic strategy that accounted for the repetition of attempted suicide within a cluster, we performed spatial-temporal analysis using Poisson discrete scan statistics to detect clusters of suicide attempts and clusters of suicides. Logistic regression was then used to compare clustered attempts with non-clustered attempts to identify risk factors for an attempt being in a cluster. RESULTS We detected 350 (1%) suicide attempts occurring within seven spatial-temporal clusters and 12 (0.6%) suicides occurring within two spatial-temporal clusters. Both of the suicide clusters were located within a larger but later suicide attempt cluster. In multivariate analysis, suicide attempts by individuals who lived in areas of low socioeconomic status had higher odds of being in a cluster than those living in areas of high socioeconomic status [odds ratio (OR) = 29.1, 95% confidence interval (CI) = 6.3-135.5]. A one percentage-point increase in the proportion of people who had changed address in the last year was associated with a 60% increase in the odds of the attempt being within a cluster (OR = 1.60, 95% CI = 1.29-1.98) and a one percentage-point increase in the proportion of Indigenous people in the area was associated with a 7% increase in the suicide being within a cluster (OR = 1.07, 95% CI = 1.00-1.13). Age, sex, marital status, employment status, method of harm, remoteness, percentage of people in rented accommodation and percentage of unmarried people were not associated with the odds of being in a suicide attempt cluster. CONCLUSIONS Early identification of and responding to suicide clusters may reduce the likelihood of subsequent clusters forming. The mechanisms, however, that underlie clusters forming is poorly understood.
Collapse
Affiliation(s)
- L. S. Too
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - J. Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - A. Milner
- Deakin Population Health SRC, School of Health and Social Development, Deakin University, Victoria, Australia
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - M. J. Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| |
Collapse
|
8
|
Harris MG, Baxter AJ, Reavley N, Diminic S, Pirkis J, Whiteford HA. Gender-related patterns and determinants of recent help-seeking for past-year affective, anxiety and substance use disorders: findings from a national epidemiological survey. Epidemiol Psychiatr Sci 2016; 25:548-561. [PMID: 26428069 PMCID: PMC7137666 DOI: 10.1017/s2045796015000876] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 09/05/2015] [Indexed: 11/06/2022] Open
Abstract
AIMS To examine: (1) gender-specific determinants of help-seeking for mental health, including health professional consultation and the use of non-clinical support services and self-management strategies (SS/SM) and; (2) gender differences among individuals with unmet perceived need for care. METHOD Analyses focused on 689 males and 1075 females aged 16-85 years who met ICD-10 criteria for a past-year affective, anxiety or substance use disorder in an Australian community-representative survey. Two classifications of help-seeking for mental health in the previous year were created: (1) no health professional consultation or SS/SM, or health professional consultation, or SS/SM only, and; (2) no general practitioner (GP) or mental health professional consultation, or GP only consultation, or mental health professional consultation. Between- and within-gender help-seeking patterns were explored using multinomial logistic regression models. Characteristics of males and females with unmet perceived need for care were compared using chi-square tests. RESULTS Males with mental or substance use disorders had relatively lower odds than females of any health professional consultation (adjusted odds ratio [AOR] = 0.46), use of SS/SM only (AOR = 0.59), and GP only consultation (AOR = 0.29). Notably, males with severe disorders had substantially lower odds than females of any health professional consultation (AOR = 0.29) and GP only consultation (AOR = 0.14). Most correlates of help-seeking were need-related. Many applied to both genders (e.g., severity, disability, psychiatric comorbidity), although some were male-specific (e.g., past-year reaction to a traumatic event) or female-specific (e.g., past-year affective disorder). Certain enabling and predisposing factors increased the probability of health professional consultation for both genders (age 30+ years) or for males (unmarried, single parenthood, reliance on government pension). Males with unmet perceived need for care were more likely to have experienced a substance use disorder and to want medicine or tablets or social intervention, whereas their females peers were more likely to have experienced an anxiety disorder and to want counselling or talking therapy. For both genders, attitudinal/knowledge barriers to receiving the types of help wanted (e.g., not knowing where to get help) were more commonly reported than structural barriers (e.g., cost). CONCLUSIONS Findings suggest a need to address barriers to help-seeking in males with severe disorders, and promote GP consultation. Exploring gender-specific attitudinal/knowledge barriers to receiving help, and the types of help wanted, may assist in designing interventions to increase consultation. Mental health promotion/education efforts could incorporate information about the content and benefits of evidence-based treatments and encourage males to participate in other potentially beneficial actions (e.g., physical activity).
Collapse
Affiliation(s)
- M. G. Harris
- School of Public Health, The University of Queensland, Herston, Queensland 4006, Australia
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Wacol, Queensland 4076, Australia
| | - A. J. Baxter
- School of Public Health, The University of Queensland, Herston, Queensland 4006, Australia
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Wacol, Queensland 4076, Australia
| | - N. Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria 3010, Australia
| | - S. Diminic
- School of Public Health, The University of Queensland, Herston, Queensland 4006, Australia
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Wacol, Queensland 4076, Australia
| | - J. Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria 3010, Australia
| | - H. A. Whiteford
- School of Public Health, The University of Queensland, Herston, Queensland 4006, Australia
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Wacol, Queensland 4076, Australia
| |
Collapse
|
9
|
Pirkis J, Blood RW. Suicide and the media. Part II: Portrayal in fictional media. Crisis 2002; 22:155-62. [PMID: 11848659 DOI: 10.1027/0227-5910.22.4.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The association between the portrayal of suicide in fictional media and actual suicide has been debated since 1774, when it was asserted that Goethe's The Sorrows of Young Werther had led people to take their own lives. Since that time, a plethora of studies considering the association has been conducted. This review considered 34 studies examining the impact of fictional portrayal of suicide (in film and television, music, and plays) on actual suicidal behavior. It asked the question: "Is there any association, and if so, can it be considered causal?" Using strict criteria to establish causality, we found that the evidence was more equivocal than was the case for nonfictional reporting.
Collapse
Affiliation(s)
- J Pirkis
- University of Melbourne, Australia
| | | |
Collapse
|
10
|
Abstract
Numerous studies have considered the association between media reporting and portrayal of suicide and actual suicidal behavior or ideation. This review considered 42 studies that have examined the nonfiction media (newspapers, television, and books). Consideration was given to the extent to which inferences could be made about the relationship between portrayal of suicide in the given media and actual suicidal behavior in terms of: the strength of its association; and the extent to which it could be considered causal. The review demonstrated that there is an association between nonfictional media portrayal of suicide and actual suicide. The association satisfies sufficient of the criteria of consistency, strength, temporality, specificity and coherence for it to be deemed causal.
Collapse
Affiliation(s)
- J Pirkis
- University of Melbourne, Australia
| | | |
Collapse
|
11
|
Abstract
The body of evidence suggests that there is a causal association between nonfictional media reporting of suicide (in newspapers, on television, and in books) and actual suicide, and that there may be one between fictional media portrayal (in film and television, in music, and in plays) and actual suicide. This finding has been explained by social learning theory. The majority of studies upon which this finding is based fall into the media "effects tradition," which has been criticized for its positivist-like approach that fails to take into account of media content or the capacity of audiences to make meaning out of messages. A cultural studies approach that relies on discourse and frame analyses to explore meanings, and that qualitatively examines the multiple meanings that audiences give to media messages, could complement the effects tradition. Together, these approaches have the potential to clarify the notion of what constitutes responsible reporting of suicide, and to broaden the framework for evaluating media performance.
Collapse
Affiliation(s)
- R W Blood
- School of Professional Communication, Division of Communication and Education, University of Canberra, Australian Capital Territory, Australia.
| | | |
Collapse
|
12
|
Abstract
Numerous studies have considered the association between media reporting and portrayal of suicide and actual suicidal behavior or ideation. This review considered 42 studies that have examined the nonfiction media (newspapers, television, and books). Consideration was given to the extent to which inferences could be made about the relationship between portrayal of suicide in the given media and actual suicidal behavior in terms of: the strength of its association; and the extent to which it could be considered causal. The review demonstrated that there is an association between nonfictional media portrayal of suicide and actual suicide. The association satisfies sufficient of the criteria of consistency, strength, temporality, specificity and coherence for it to be deemed causal.
Collapse
Affiliation(s)
- J Pirkis
- University of Melbourne, Australia
| | | |
Collapse
|
13
|
Abstract
The body of evidence suggests that there is a causal association between nonfictional media reporting of suicide (in newspapers, on television, and in books) and actual suicide, and that there may be one between fictional media portrayal (in film and television, in music, and in plays) and actual suicide. This finding has been explained by social learning theory. The majority of studies upon which this finding is based fall into the media "effects tradition," which has been criticized for its positivist-like approach that fails to take into account of media content or the capacity of audiences to make meaning out of messages. A cultural studies approach that relies on discourse and frame analyses to explore meanings, and that qualitatively examines the multiple meanings that audiences give to media messages, could complement the effects tradition. Together, these approaches have the potential to clarify the notion of what constitutes responsible reporting of suicide, and to broaden the framework for evaluating media performance.
Collapse
Affiliation(s)
- R W Blood
- School of Professional Communication, Division of Communication and Education, University of Canberra, Australian Capital Territory, Australia.
| | | |
Collapse
|
14
|
Abstract
OBJECTIVE In Australia, mental health services are delivered by a complex web of public- and private-sector providers. There is a growing recognition that linkages between these groups are not optimal, and a concern that this may lead to poor outcomes. This paper illustrates a conceptual framework for developing, implementing and evaluating programmes concerned with linkages. METHOD Drawing on theoretical and practical literature, this paper identifies different levels of integration, issues in evaluating programmes to address poor linkages, and features of useful evaluations. Within this context, it describes the method by which the Public and Private Partnerships in Mental Health Project (Partnership Project) is being evaluated. Conducted by St Vincent's Mental Health Service and The Melbourne Clinic, this is one of several Demonstration Projects in Integrated Mental Health Care funded under the National Mental Health Strategy. RESULTS Collaboration is hard to conceptualize and collaborative programmes usually have many players and components, and tend to operate within already-complex systems. This creates difficulties for evaluation, in terms of what to measure, how to measure it, and how to interpret findings. In spite of these difficulties, the illustrative example demonstrates a model for evaluating collaborative programmes that is currently working well because it is strongly conceptualized, descriptive, comparative, constructively sceptical, positioned from the bottom up, and collaborative. CONCLUSIONS This model, or aspects of it, could be extended to the evaluation of other mental health programmes and services that have collaborative elements.
Collapse
Affiliation(s)
- J Pirkis
- Program Evaluation Unit, Centre for Health Program Evaluation, University of Melbourne, PO Box 477, West Heidelberg, Victoria 3081, Australia.
| | | | | | | | | | | |
Collapse
|
15
|
Abstract
OBJECTIVE This study aimed to examine access to mental health care for people from non-English-speaking backgrounds relative to that of people from English-speaking backgrounds, in the context of the mental health status of both groups; and to consider whether, if they perceive that they have needs for care, these needs are met. METHOD The study used data from the population-based Australian National Survey of Mental Health and Wellbeing, conducted in 1997. RESULTS People from non-English-speaking backgrounds and English-speaking backgrounds were equally likely to experience anxiety disorders and affective disorders, but the former were less likely to experience substance-use disorders and any mental disorder. When those with each disorder type were considered alone, people from non-English-speaking backgrounds and English-speaking backgrounds were equally likely to use services for mental health problems. When those with perceived needs for care were considered in isolation, there was no difference between birthplace groups in terms of their likelihood of reporting that their needs were fully met. CONCLUSIONS The study had several limitations (i.e. lack of detail on specific ethnic groups and exclusion of potential respondents who could not speak English), which mean that these findings should be interpreted with caution. There is a need to build on this population-based work, by oversampling people from particular non-English speaking communities and ensuring that those who do not speak English are included in population samples. Such work will further clarify the relative ability of people from non-English-speaking backgrounds to access services, and the extent to which their needs are met.
Collapse
Affiliation(s)
- J Pirkis
- Centre for Health Program Evaluation, Department of General Practice and Public Health, University of Melbourne, Po Box 477, West Heidelberg, Victoria 3081, Australia.
| | | | | | | |
Collapse
|
16
|
Abstract
This study examined the self-reported needs of suicidal users of mental health services and the extent to which needs were met. Data on 10,641 adults were available from the Australian National Survey of Mental Health and Wellbeing. In the year before the survey, 245 persons with suicidal ideation used services, 37 of whom had attempted suicide. Suicidal persons reported a range of needs, especially for counseling, medication, and information. More than half of those with suicidal ideation and those who had attempted suicide who reported any needs felt that their needs had not been fully met. Suicidal persons were significantly more likely to perceive that they had needs.
Collapse
Affiliation(s)
- J Pirkis
- Centre for Health Program Evaluation, Department of General Practice and Public Health at the University of Melbourne, Victoria, Australia
| | | | | | | |
Collapse
|
17
|
Abstract
OBJECTIVE Characteristics of patients who committed suicide were examined to provide a picture of the treatment they received before death and to determine whether and how the suicides could have been prevented by the service system. METHODS The unnatural-deaths register was matched to the psychiatric case register in the state of Victoria in Australia to identify suicides by people with a history of public-sector psychiatric service use who committed suicide between July 1, 1989, and June 30, 1994. Data on patient and treatment characteristics were examined by three experienced clinicians, who made judgments about whether the suicide could have been prevented had the service system responded differently. Quantitative and qualitative data were descriptively analyzed. RESULTS A total of 629 psychiatric patients who had committed suicide were identified. Seventy-two percent of the patients were male, 62 percent were under 40 years old, and 51 percent were unmarried. They had a range of disorders, with the most common being schizophrenia or schizoaffective disorder (36 percent). Sixty-seven percent had previously attempted suicide. A total of 311 patients (49 percent) received care within four weeks of death. Twenty percent of the suicides were considered preventable. Key factors associated with preventability were poor staff-patient relationships, incomplete assessments, poor assessment and treatment of depression and psychological problems, and poor continuity of care. CONCLUSIONS Opportunities exist for the psychiatric service system to alter practices at several levels and thereby reduce patient suicides.
Collapse
Affiliation(s)
- P Burgess
- Department of Psychological Medicine at Monash University in Clayton, Victoria, Australia
| | | | | | | |
Collapse
|
18
|
Pirkis J, Burgess P, Dunt D. Suicidal ideation and suicide attempts among Australian adults. Crisis 2000; 21:16-25. [PMID: 10793467 DOI: 10.1027/0227-5910.21.1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Too little is known about suicidal thoughts and behaviors at a population level to recommend appropriate preventive strategies. Using data from the Australian National Survey of Mental Health and Wellbeing (NSMHWB), this study examined rates of, and risk factors for, suicidal ideation and suicide attempts. For 10,641 respondents, the 12-month and lifetime cumulative incidence rates of suicidal ideation were 3.4% and 16.0%, respectively; the 12-month and lifetime cumulative incidence rates of suicide attempts were 0.4% and 3.6%, respectively. 12-month ideation was associated with anxiety disorders (relative risk ratio [RRR] = 3.51; population attributable risk percent [PAR%] = 19.6%), affective disorders (RRR = 11.94; PAR% = 38.8%) and substance abuse disorders (RRR = 1.85; PAR% = 6.1%). Attempts in the past 12 months were also associated with anxiety disorders (RRR = 7.06; PAR% = 37.0%), affective disorders (RRR = 12.24; PAR% = 39.5%), and substance abuse disorders (RRR = 2.09; PAR% = 7.7%). Age, marital status, and disability were associated with ideation; marital status and employment status with attempts. Approximately 12% of ideators in the sample progressed to making an attempt; employment status was the only significant predictor. Reducing suicidal ideation and attempts requires a multi-faceted approach that targets those with mental illness but also adopts population-based strategies that address other factors, such as unemployment.
Collapse
Affiliation(s)
- J Pirkis
- Program Evaluation Unit, University of Melbourne, Victoria, Australia.
| | | | | |
Collapse
|
19
|
Thomson J, Pirkis J, Dunt D. Local register-reminder systems for immunisation in general practice. Aust Fam Physician 2000; 29:16-7. [PMID: 10721536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
|
20
|
Abstract
BACKGROUND This study examined rates of and risk factors associated with suicide attempts by psychiatric patients under active care. It was especially focussed on the relative rates across three standard treatment settings: acute inpatient care, long-stay inpatient care and community-based care. METHODS A total of 12,229 patients in 13,632 episodes of care were rated on the Health of the Nation Outcome Scales (HoNOS) Item 2. For the purposes of the current investigation, a score of 4 was deemed to indicate a suicide attempt. RESULTS Incidence densities per 1000 episode days were 5.4 (95% CI = 4.8-6.1) for patients under care in acute inpatient settings, 0.6 (95% CI = 0.5-0.8) for patients under care in long-stay inpatient settings, and 0.5 (95% CI = 0.5-0.6) for patients under care in community-based arrangements. Predictors varied by treatment setting. Risk was elevated for personality disorders across all settings: 22.7 attempts per 1000 episode days (95% CI = 17.2-30.0) in acute inpatient care; 2.1 (95% CI = 1.0-4.5) in long-stay inpatient care; and 2.3 (95% CI = 1.7-3.0) in community-based care. This effect remained after adjustment for demographics. CONCLUSION Rates of suicide attempts among psychiatric patients are a major issue facing contemporary mental health care systems, and risk factors vary across different treatment settings.
Collapse
Affiliation(s)
- J Pirkis
- Department of General Practice and Public Health, University of Melbourne, West Heidelberg, Victoria, Australia.
| | | | | |
Collapse
|
21
|
Thomson J, Hilditch A, Pirkis J, Dunt D. Immunisation initiatives in general practice. Important lessons from division projects. Aust Fam Physician 1999; 28:1290-7. [PMID: 10650609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
AIM To examine immunisation projects undertaken by divisions of general practice through the Divisions and Project Grants Program in the period from 1993 to mid 1997. METHOD A simple descriptive frequency analysis was conducted of information from the National Information Service Divisions Project database and evaluation reports of the project characteristics and methodology such as: year commenced; duration; location; funding; target groups; intervention; needs assessment; aim(s); study design; measurement (assessment) and outcome(s). RESULTS Forty-four funded immunisation projects were identified and of these, 12 projects with completed evaluation reports were analysed. Most projects were of 12-14 months duration, and were funded for a mean of $56,349 and median of $46,348 for the 44 funded projects and a mean $44,348 and median $40,318 for the 12 with evaluation reports. Most projects included a needs assessment. The main target groups were general practitioners, the general community, and children. Of the wide spectrum of interventions used, education and/or promotion and register and/or reminder systems were the most common. Study designs, the quality of measurement and outcomes were variable. CONCLUSION In the future with the move to outcome based block funding, it will be important for projects to adopt broader target groups, refine and develop interventions and develop greater sustainability through responding to local needs, improving design and evaluation and ongoing funding.
Collapse
Affiliation(s)
- J Thomson
- Department of General Practice and Public Health, University of Melbourne, Victoria
| | | | | | | |
Collapse
|
22
|
Abstract
BACKGROUND Many countries have set targets for suicide reduction, and suggested that mental health care providers and general practitioners have a key role to play. METHOD A systematic review of the literature. RESULTS Among those in the general population who commit suicide, up to 41% may have contact with psychiatric inpatient care in the year prior to death and up to 9% may commit suicide within one day of discharge. The corresponding figures are 11 and 4% for community-based psychiatric care and 83 and 20% for general practitioners. CONCLUSIONS Among those who die by suicide, contact with health services is common before death. This is a necessary but not sufficient condition for clinicians to intervene. More work is needed to determine whether these people show characteristic patterns of care and/or particular risk factors which would enable a targeted approach to be developed to assist clinicians in detecting and managing high-risk patients.
Collapse
Affiliation(s)
- J Pirkis
- Department of General Practice and Public Health, University of Melbourne, Australia.
| | | |
Collapse
|
23
|
Pirkis J, Martyres R, Wyman K, Burge B, Isaac D, Van Doorn H. Integrating general practice and hospital services. Aust Fam Physician 1996; 25:537-42. [PMID: 8857057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate a model of negotiations between six Divisions of General Practice and four teaching hospitals, aimed at creating formal agreements to improve the GP-hospital interface. METHOD The evaluation examined the model's outcomes and participants' experiences. Outcomes were investigated via unstructured interviews with key informants, and analysis of relevant documentation. Participants' experiences were elicited via structured interviews with 11 Divisional members and 14 hospital representatives. RESULTS Progress towards agreements was made in all cases, with a full agreement being reached at one hospital. Negotiations are continuing in the remaining hospitals. Additional outcomes were achieved during the process, and included resources and structural arrangements involving GPs. Participants were satisfied with the model, but certain key issues were identified. CONCLUSION This evaluation suggests that for negotiations between GPs and hospitals to be successful, Divisions must be involved and be representative, hospitals must see value in formal agreements, their structure must be considered and the process must be collaborative. In the current policy context, which emphasises primary care, hospitals and GPs are increasingly likely to start working more cooperatively. This model has significant potential to improve the interface between the two parties, through its formal negotiation process, and could easily be adapted to other settings.
Collapse
|
24
|
Pirkis J, Montalto M. General practitioners in hospitals. Aust Fam Physician 1995; 24:1026-8. [PMID: 7625936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The authors review General Practitioners in Hospitals, a report prepared by the School of Medical Education, University of New South Wales (1993) for the Australian Health Ministers' Advisory Council Medical Workforce Group on Hospital Training and Career Development. The authors acknowledge that this report represents the most comprehensive look at GP involvement in hospitals across Australia, but suggest that its conclusion 'general practitioners play a substantial role in the provision of medical care in public hospitals around Australia' may be an overstatement. They discuss shortcomings associated with the study, including: definitional issues; variation in levels of involvement according to hospital type; potential biases introduced by using self-report of hospital administrators as the source of data; insufficient emphasis being placed on the views of GPs; and the validity of extrapolations.
Collapse
Affiliation(s)
- J Pirkis
- NHMRC National Centre for Health Program Evaluation
| | | |
Collapse
|
25
|
Trinder J, Newman NM, Le Grande M, Whitworth F, Kay A, Pirkis J, Jordan K. Behavioural and EEG responses to auditory stimuli during sleep in newborn infants and in infants aged 3 months. Biol Psychol 1990; 31:213-27. [PMID: 2132679 DOI: 10.1016/0301-0511(90)90035-u] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Two studies were conducted in order to assess EEG and behavioural responsiveness to auditory stimuli as a function of sleep state in infants. The subjects in the first experiment were 11 infants aged 3 months, and in the second study the responsiveness of 8 infants aged 3 months was compared with that of 8 newborn infants. The stimuli ranged in intensity from 36 to 90 dB and were presented using a modification of the method of constant stimuli. The occurrence and intensity of behavioural responses were recorded by a trained observer. Electroencephalogram (EEG) responses were defined as EEG desynchronization and were identified by a Fast Fourier Transform algorithm. The results of the two studies showed that infants were more responsive during active sleep (AS) than during quiet sleep (QS) and gave behavioural responses at lower stimulus intensities than EEG responses. Behavioural responsiveness and EEG responsiveness during AS increased as a function of age, while EEG responsiveness during QS decreased. The marked suppression of EEG responsiveness during QS at 3 months of age is thought to be a consequence of developmental changes in sleep mechanisms--an effect which may have clinical implications.
Collapse
Affiliation(s)
- J Trinder
- Department of Psychology, University of Melbourne, Parkville, Victoria, Australia
| | | | | | | | | | | | | |
Collapse
|