Predição de suicídio entre adolescentes a partir da última década pré-pandêmica em Mato Grosso / Prediction of suicides among teenagers from the last pre- pademic decade in Mato Grosso / Predicción del suicidios en adolescentes de la última década pre-pedémica en Mato Grosso

Objetivo: analisar a predição de suicídios entre adolescentes a partir da última década pré-pandêmica em Mato Grosso. Método: trata-se de estudo ecológico e retrospectivo. A coleta de dados ocorreu em janeiro de 2021, referente ao recorte temporal de 2009 a 2019. Utilizou-se dados secundários do Sistema de Informação sobre Mortalidade via Secretaria Estadual de Saúde de Mato Grosso. Para análise dos dados, utilizou-se o programa STATA 14.0. Resultados: a predição de suicídios entre os adolescentes de Mato Grosso revelou predominância do sexo masculino, cor não branca e com oito anos ou mais de escolaridade. Os suicídios em Mato Grosso apresentam estabilidade em relação ao sexo. Quanto a cor, o Centro-Oeste possui maior disparidade quando comparado ao Mato Grosso. Todavia, ambos exibem comportamentos epidemiológicos semelhantes na escolaridade. Conclusão: a partir da última década pré- pandêmica, previu o crescimento de casos de suicídios entre adolescentes em Mato Grosso, e que não se assemelha à totalidade do perfil esperado para a região Centro-Oeste.

Objective: to analyze the prediction of suicides among adolescents from the last pre-pandemic decade in Mato Grosso. Method: this is an ecological and retrospective study. Data collection took place in January 2021, referring to the time frame from 2009 to 2019. Secondary data from the Mortality Information System via the Mato Grosso State Health Department were used. For data analysis, the STATA 14.0 program was used. Results: the prediction of suicides among adolescents in Mato Grosso revealed a predominance of males, non-white and with eight or more years of schooling. Suicides in Mato Grosso show stability in relation to gender. As for color, the Midwest has greater disparity when compared to Mato Grosso. However, both exhibit similar epidemiological behavior in schooling. Conclusion: from the last pre-pandemic decade, it predicted the growth of suicide cases among adolescents in Mato Grosso, which does not resemble the entire profile expected for the Midwest region.

Objetivo: analizar la predicción de suicidios entre adolescentes de la última década pre-pandemia en Mato Grosso. Método: se trata de un estudio ecológico y retrospectivo. La recolección de datos ocurrió en enero de 2021, con referencia al período de 2009 a 2019. Se utilizaron datos secundarios del Sistema de Información de Mortalidad a través de la Secretaría de Estado de Salud de Mato Grosso. Para el análisis de datos se utilizó el programa STATA 14.0. Resultados: la predicción de suicidios entre los adolescentes de Mato Grosso reveló un predominio del sexo masculino, no blancos y con ocho o más años de escolaridad. Suicidios en Mato Grosso muestran estabilidad en relación al género. En cuanto al color, el Centro-Oeste tiene mayor disparidad en comparación con Mato Grosso. Sin embargo, ambos exhiben un comportamiento epidemiológico similar en la escolaridad. Conclusión: a partir de la última década previa a la pandemia, se predijo el crecimiento de los casos de suicidio entre los adolescentes de Mato Grosso, lo que no se asemeja a todo el perfil esperado para la región del Centro- Oeste.

Risk factors associated with suicide among hepatocellular carcinoma patients: A surveillance, epidemiology, and end results analysis.

BACKGROUND: Throughout the world, hepatocellular carcinoma (HCC) remains the primary type of liver cancer. The suicide risk was higher among patients with HCC than the general population. Hence, the purpose of this study was to confirm the suicide rates, standardized mortality ratios (SMRs), and the potential risk factors associated with suicide among HCC patients. METHODS: HCC patients were collected from the Surveillance, Epidemiology, and End Results (SEER) database during 1975-2016. Suicide rates and SMRs among these patients were calculated, and the general population of the United States (U.S.) during 1975-2016 was used as a reference. Univariable and multivariable Cox regression were taken to find out the underlying risk factors of suicide in HCC patients. RESULTS: There were 70 suicides identified among 102,567 individuals with HCC observed for 160,500.88 person years. The suicide rate was 43.61 per 100,000 person-years, and SMR was 2.26 (95% CI: 1.78-2.84). On Cox regression, year of diagnosis (1975-1988 vs. 2003-2016, HR: 3.00, 95% CI: 1.01-8.89, P = 0.047; 1989-2002 vs. 2003-2016, HR: 1.92, 95% CI: 1.10-3.34, P = 0.021), gender (male vs. female, HR: 8.72, 95% CI: 2.73-27.81, P < 0.001), age at diagnosis (63-105 years old vs. 0-55 years old, HR: 2.28, 95% CI: 1.21-4.31, P = 0.011), race (white race vs. American Indian/Alaska Native, Asian/Pacific Islander, HR: 3.02, 95% CI: 1.35-6.76, P = 0.007) were independent risk factors of suicide among HCC patients. CONCLUSIONS: Diagnosed in the early years (1975-2002), male sex, the older age (63-105 years old), white race, survival months (＜2 months) were significantly associated with suicide among HCC patients. For the sake of preventing suicide behaviors, the government, clinicians, and family members should take adequate measures to decrease the rate of suicide, especially in patients with high-risk factors of suicide.

Risk factors associated with suicide among leukemia patients: A Surveillance, Epidemiology, and End Results analysis.

Previous studies have found that the risk of suicide is higher in patients diagnosed with cancer than in the general population. We aimed to identify potential risk factors associated with suicide in leukemia patients by analyzing data obtained from the Surveillance, Epidemiology, and End Results (SEER) database. We screened the SEER database for leukemia patients added between 1975 and 2017, and calculated their suicide rate and standardized mortality rate (SMR) relative to the total United States population from 1981 to 2017 as a reference. Univariate and multivariate Cox regression analyses were used to determine the risk factors for suicide in leukemia patients. We collected 142,386 leukemia patients who had been added to the SEER database from 1975 to 2017, of whom 191 patients committed suicide over an observation period of 95,397 person-years. The suicide rate of leukemia patients was 26.41 per 100,000 person-years, and hence the SMR of the suicided leukemia patients was 2.16 (95% confidence interval [CI] = 1.85-2.47). The univariate and multivariate Cox regression analyses showed that a high risk of suicide was associated with male sex (vs. female: hazard ratio [HR] = 4.41, 95% CI = 2.93-6.63, p < 0.001), older age at diagnosis (60-69 years vs. ≤39 years: HR = 2.60, 95% CI = 1.60-4.23, p < 0.001; 70-79 years vs. ≤39 years: HR = 2.84, 95% CI = 1.72-4.68, p < 0.001; ≥80 years vs. ≤39 years: HR = 2.94, 95% CI = 1.65-5.21, p < 0.001), white race (vs. black: HR = 6.80, 95% CI = 1.69-27.40, p = 0.007), acute myeloid leukemia (vs. lymphocytic leukemia: HR = 1.59, 95% CI = 1.09-2.33, p = 0.016), unspecified and other specified leukemia (vs. lymphocytic leukemia: HR = 2.72, 95% CI = 1.55-4.75, p < 0.001), and living in a small city (vs. large city: HR = 2.10, 95% CI = 1.23-3.60, p = 0.007). Meanwhile, being a non-Hispanic black (vs. Hispanic: HR = 0.06, 95% CI = 0.01-0.62, p = 0.019) was a protective factor for suicide. Male sex, older age at diagnosis, white race, and acute myeloid leukemia were risk factors for suicide in leukemia patients, while being a non-Hispanic black was a protective factor. Medical workers should, therefore, provide targeted preventive measures to leukemia patients with a high risk of suicide.

Suicide in Elderly Patients with Hip Fracture: A South Korean Nationwide Cohort Study.

BACKGROUND: The purpose of the present study was to evaluate the incidence rate (IR) of suicide in elderly patients with hip fracture on the basis of a nationwide cohort and to analyze the change in the hazard ratio for suicide after hip fracture over time in comparison with a control group. METHODS: Patients with hip fracture and their matched controls were selected from the National Health Insurance Service-Senior cohort (NHIS-Senior) of the Republic of Korea. The NHIS-Senior consists of 558,147 people selected by a 10% simple random-sampling method from a total of 5.5 million subjects ≥60 years of age in 2002. Risk-set matching (1:2) on the propensity score was performed with use of a nearest neighbor matching algorithm with a maximum caliper of 0.1 for the hazard components. The IR of suicide and 95% confidence interval (CI) were calculated on the basis of a generalized linear model with a Poisson distribution. The effect size was presented as a hazard ratio (HR) with use of the Cox proportional-hazard model with a robust variance estimator that accounts for clustering within matched pairs. RESULTS: A total of 11,477 patients with hip fracture and 22,954 matched controls were included. The mean duration of follow-up was 4.59 years, generating 158,139 person-years. During follow-up, a total of 170 suicides were identified. Comparisons at up to 180 days and 365 days showed that patients with hip fracture were at higher risk for suicide than matched controls (p = 0.009 and 0.004, respectively; stratified log-rank test). During the first 180 days of follow-up, 14 suicides were identified in patients with hip fracture during 11,152 person-years (IR, 266.1 per 100,000 person-years; 95% CI, 157.6 to 449.4). Patients with hip fracture were 2.97 times more likely to kill themselves than their matched controls during the same period (HR = 2.97; 95% CI, 1.32 to 6.69). CONCLUSIONS: Hip fracture in elderly patients increased suicide risk within a year. A new approach to psychiatric evaluation and management is needed in elderly patients with hip fracture. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Relationship of the high proportion of suicidal acts involving ingestion of pesticides to the low male-to-female ratio of suicide rates in China.

AIMS: The 2014 World Health Organization report on global suicide identified large differences in the male-to-female ratio of suicide rates between countries: most high-income countries (HICs) report ratios of 3:1 or higher while many low- and middle-income countries (LMICs) - including China and India - report ratios of less than 1.5:1. Most authors suggest that gender-based social-cultural factors lead to higher rates of suicidal behaviour among women in LMICs and, thus, to relatively high female suicide rates. We aim to test an alternative hypothesis: differences in the method and case-fatality of suicidal behaviour - not differences in the rates of suicidal behaviour - are the main determinants of higher female suicide rates in LMICs. METHODS: A prospective registry of suicide attempts treated in all 14 general hospitals in a rural county in China was established and data from the registry were integrated with population and mortality data from the same county from 2009 to 2014. RESULTS: There were 160 suicides and 1010 medically-treated suicidal attempts in the county; 84% of female suicides and 58% of male suicides ingested pesticides while 73% of female attempted suicides and 72% of male attempted suicides ingested pesticides. The suicide rate (per 100 000 person-years of exposure) was 8.4 in females and 9.1 in males (M:F ratio = 1.08:1) while the incidence of 'serious suicidal acts' (i.e. those that result in death or received treatment in a hospital) was 81.5 in females and 47.7 in males (M:F ratio = 0.59:1). The case-fatality of serious suicidal acts was higher in males than in females (19 v. 10%), increased with age, was highest for violent methods (92%), intermediate for pesticide ingestion (13%) and lowest for other methods (5%). CONCLUSIONS: The incidence of medically serious suicidal behaviour among females in rural China was similar to that reported in HICs, but the case-fatality was much higher, primarily because most suicidal acts involved the ingestion of pesticides, which had a higher case-fatality than methods commonly used by women in HICs. These findings do not support sociological explanations for the relatively high female suicide rate in China but, rather, suggest that gender-specific method choice and the case-fatality of different methods are more important determinants of the demographic profile of suicide rates. Further research that involves ongoing monitoring of the changing incidence, demographic profile and case-fatality of different suicidal methods in urban and rural parts of both LMICs and HICs is needed to confirm this hypothesis.

Mortalidade por suicídio entre crianças indígenas no Brasil / Mortality from suicide in indigenous children in Brazil / Mortalidad por suicidio entre niños indígenas en Brasil

Resumo: O objetivo deste trabalho foi descrever as características, a distribuição e as taxas de mortalidade por suicídio entre crianças indígenas no Brasil, comparativamente as não indígenas. Realizou-se um estudo descritivo, compreendendo os anos de 2010 a 2014, utilizando dados dos sistemas nacionais de informação. Foram selecionados os óbitos de pessoas com idades de 10 a 14 anos, cuja causa básica foi classificada como "lesões autoprovocadas voluntariamente". O enforcamento foi o meio utilizado com mais frequência, tanto entre indígenas como entre não indígenas, embora tenha sido mais frequente no primeiro grupo. Entre indígenas, a ocorrência de suicídio em hospital ou outros estabelecimentos de saúde foi menor do que o observado entre os não indígenas. Aproximadamente, 3/4 dos suicídios entre crianças indígenas ocorreram em 17 municípios. A taxa de mortalidade por suicídio entre crianças indígenas foi de 11,0/100 mil (8,4-14,3), 18,5 (10,9-31,6) vezes maior do que a observada entre as não indígenas, 0,6/100 mil (0,5-0,6), sem diferenças entre meninos e meninas. Este trabalho evidenciou, pela primeira vez, em escala nacional, especificidades das características do suicídio indígena, suas elevadas taxas, bem como identificou ainda áreas prioritárias para intervenções.

Abstract: This study aimed to describe the characteristics, distribution, and mortality rates from suicide in indigenous children in Brazil compared to non-indigenous children. This descriptive study covered the years from 2010 to 2014, using national databases. The study collected deaths in individuals 10 to 14 years of age whose underlying cause was "inentional self-inflicted injury". Hanging was the most frequently used means in both indigenous and non-indigenous children, although it was more frequent in the former. Among indigenous children, suicides in hospitals or other healthcare establishments were less common than in non-indigenous. Approximately three-fourths of suicides in indigenous children occurred in just 17 municipalities. The mortality rate from suicide among indigenous children was 11.0/100,000 (8.4-14.3), or 18.5 times higher (10.9-31.6) than in non-indigenous, which was 0.6/100,000 (0.5-0.6), with no differences between boys and girls. This study showed for the first time on a national scale the specific characteristics of suicide in indigenous children, with high rates, and also identified priority areas for interventions.

Resumen: El objetivo de este trabajo fue describir las características, distribución y tasas de mortalidad por suicidio entre niños indígenas en Brasil, en comparación con los no indígenas. Se realizó un estudio descriptivo, desde el año 2010 hasta el 2014, utilizando datos de los sistemas nacionales de información. Se seleccionaron los fallecimientos de personas con edades comprendidas de 10 a 14 años, cuya causa básica de fallecimiento se clasificó como "lesiones auto provocadas voluntariamente". El ahorcamiento fue el medio utilizado con más frecuencia, tanto entre indígenas como entre no indígenas, aunque haya sido más frecuente en el primer grupo. Entre indígenas, la ocurrencia de suicidios en hospitales u otros establecimientos de salud fue menor de lo que se observó entre los no indígenas. Aproximadamente, 3/4 de los suicidios entre niños indígenas se produjeron en 17 municipios. La tasa de mortalidad por suicidio entre niños indígenas fue de 11,0/100 mil (8,4-14,3), 18,5 (10,9-31,6) veces mayor que la observada entre los no indígenas, 0,6/100 mil (0,5-0,6), sin diferencias entre niños y niñas. Este trabajo evidenció, por primera vez, en escala nacional, especificidades de las características del suicidio indígena, sus elevadas tasas, así como, incluso, se identificaron áreas prioritarias para intervenciones.

Caracterização da mortalidade por suicídio entre indígenas e não indígenas em Roraima, Brasil, 2009-2013 / Caracterización de la mortalidad por suicidio entre indígenas y no-indígenas de Roraima, Brasil, 2009-2013 / Characteristics of suicide mortality among indigenous and non-indigenous people in Roraima, Brazil, 2009-2013

Resumo OBJETIVO: descrever características e taxas da mortalidade por suicídio entre indígenas e não indígenas em Roraima, Brasil. MÉTODOS: estudo descritivo, com dados do Sistema de Informações sobre Mortalidade (SIM) sobre suicídios ocorridos em maiores de 10 anos de idade, registrados no período 2009-2013; as taxas de mortalidade por suicídio foram ajustadas por sexo e idade. RESULTADOS: foram registrados 170 suicídios, 17,1% em indígenas; as medianas das idades foram de 24 para indígenas e de 29 anos para não indígenas; quatro municípios concentraram 25/29 dos suicídios entre indígenas; os 141 suicídios entre não indígenas distribuíram-se em 13/15 municípios do estado; as taxas de mortalidade por suicídio foram de 15,0/100 mil indígenas e de 8,6/100 mil não indígenas. CONCLUSÃO: evidenciaram-se especificidades étnico-raciais na mortalidade por suicídio; entre os indígenas, as taxas foram mais elevadas, predominaram idades menores e as mortes concentraram-se em menor número de municípios, na comparação com os não indígenas.

Resumen OBJETIVO: describir características y tasas de mortalidad por suicidios entre indígenas y no-indígenas en Roraima. MÉTODOS: se realizó un estudio descriptivo con datos del Sistema de Información de Mortalidad, referente a suicidios en mayores de 10 años, entre 2009-2013; las tasas de mortalidad por suicidio se ajustaron por sexo y edad. RESULTADOS: se registraron 170 suicidios, 17.1% indígenas; las medias de edad fueron 24 años entre indígenas y 29 entre no-indígenas; cuatro municipios concentran 25/29 suicidios entre los indios; los 141 suicidios entre los no-indígenas se distribuyeron en 13/15 municipios en el estado; las tasas de mortalidad por suicidio fueron 15.0/100.000 entre indígena y 8.6/100.000 entre no-indígena. CONCLUSIÓN: hubo especificidades étnico-raciales en la mortalidad por suicidio; entre los indígenas, las tasas fueron más altas, predominaron las edades más jóvenes y las muertes se concentran en pocos municipios, comparado con no-indígenas.

Abstract OBJECTIVE: to describe suicide characteristics and mortality rates among indigenous and non-indigenous people in Roraima, Brazil. METHODS: descriptive study using data from the Mortality Information System (SIM) about the suicides in individuals over 10 years old, recorded in the period from 2009 to 2013; suicide mortality rates were adjusted by sex and age. RESULTS: 170 suicide cases were reported, being 17.1% among indigenous people; median ages were 24 years among indigenous and 29 among non-indigenous people; four municipalities concentrated 25/29 of the suicides among indigenous people; the 141 suicides among non-indigenous people were distributed in 13/15 municipalities in the state; suicide mortality rates were 15.0/100,000 among indigenous people and 8.6/100,000 among non-indigenous people. CONCLUSION: ethnic-racial peculiarities stood out in suicide mortality; among the indigenous people, rates were higher, younger ages prevailed and deaths were concentrated in a smaller number of municipalities, when compared to non-indigenous people.

Caracterización del suicidio en adolescentes del Departamento de Quindío. Colombia, 1989-2013 / Characterization of suicide in adolescents in the Quindio Department, Colombia, 1989-2013

Introducción: El suicidio es considerado como un serio problema de salud pública, que cobra un importante número de vidas alrededor del mundo. El objetivo de la presente investigación fue caracterizar el suicidio en adolescentes residentes en el Departamento de Quindío, Colombia, entre los años 1989-2013. Material y Métodos: Se realizó una investigación de tipo observacional descriptiva con los registros de defunción que elabora el Departamento Administrativo Nacional de Estadística (DANE) de la República de Colombia. Se calcularon proporciones para las variables de persona, tiempo y lugar. Para establecer la tasa de mortalidad se recurrió a las proyecciones poblacionales del DANE. Resultados: En el período comprendido entre 1989-2013 se presentaron 158 suicidios en adolescentes del Departamento de Quindío. El 67,7 por ciento corresponden a hombres, 82,9 eran solteros, 39,9 por ciento utilizó el ahorcamiento y 13,3 por ciento de los casos ocurrieron en diciembre. La tasa de suicidio se ubicó en 6,7 por cada cien mil adolescentes -9,0 para hombres y 4,3 para mujeres-. El quinquenio que registró la mayor tasa fue 1999-2003 con 10,0 suicidios por cada cien mil adolescentes. Por municipios, el mayor riesgo se registró en Quimbaya y Pijao con 30,8 y 23,4 suicidios por cada cien mil adolescentes, respectivamente. Conclusiones: Se encontraron mayores prevalencias de suicidio en: hombres, solteros, área urbana, el mes de diciembre, en el hogar y el mecanismo más utilizado fue el ahorcamiento. Por quinquenios, las mayores tasas se registraron entre 1999-2003, período en que tuvo lugar un terremoto en la zona. A nivel municipal las tasas más altas se encontraron en Quimbaya y Pijao, lo que plantea la necesidad de mayor investigación e intervención(AU)

Introduction: Suicide is considered a serious public health problem, which claims an important number of lives all over the world. Objective: To characterize suicide in adolescents living in the Quindio Department of Colombia, from 1989 to 2013. Material and methods: An observational descriptive research was conducted, using data from death certificates compiled by the National Administrative Department of Statistics commonly referred to as DANE in the Republic of Colombia. Proportions were calculated for person, time and place variables. Population projections for DANE were used to establish mortality rates. Results: 158 suicides in adolescents occurred during the time period from 1989-2013 in the Quindio Department. The 67, 7 percent of the persons that committed suicide were male, 82,9 of them were single, the 39,9 percent of them used hanging as the method of suicide, and the 13,3 percent of the cases occurred in December. The suicide rate was 6,7 for every 100,000 inhabitants (9,0 for men, and 4,3 for women). 1999-2003 was the five year's time that registered the highest rates with 10,0 suicides for every 100,000 adolescents. In municipalities, he highest risk was registered in Quimbaya and Pijao with 30,8 and 23,4 suicides for every 100,000 adolescents, respectively. Conclusions:The highest prevalence of suicide was found in single men from the urban area, at home, in December, and hanging was the most common method used for suicide. In five year times, the highest rates were registered from 1999-2003, period in which an earthquake occurred in the zone. At a municipal level, the highest rates were found in Quimbaya and Pijao, which suggests the need of a greater intervention and investigation(AU)

Race/Ethnicity and the Pharmacogenetics of Reported Suicidality With Efavirenz Among Clinical Trials Participants.

Background: We examined associations between suicidality and genotypes that predict plasma efavirenz exposure among AIDS Clinical Trials Group study participants in the United States. Methods: Four clinical trials randomly assigned treatment-naive participants to efavirenz-containing regimens; suicidality was defined as reported suicidal ideation or attempted or completed suicide. Genotypes that predict plasma efavirenz exposure were defined by CYP2B6 and CYP2A6 polymorphisms. Associations were evaluated with weighted Cox proportional hazards models stratified by race/ethnicity. Additional analyses adjusted for genetic ancestry and selected covariates. Results: Among 1833 participants, suicidality was documented in 41 in exposed analyses, and 34 in on-treatment analyses. In unadjusted analyses based on 12 genotype levels, suicidality increased per level in exposed (hazard ratio, 1.11; 95% confidence interval, .96-1.27) and on-treatment 1.16; 1.01-1.34) analyses. In the on-treatment analysis, the association was strongest among white but nearly null among black participants. Considering 3 metabolizer levels (extensive, intermediate and slow), slow metabolizers were at increased risk. Results were similar after baseline covariate-adjustment for genetic ancestry, sex, age, weight, injection drug use history, and psychiatric history or recent psychoactive medication. Conclusions: Genotypes that predict higher plasma efavirenz exposure were associated with increased risk of suicidality. Strength of association varied by race/ethnicity.

The Role of Stigma and Denormalization in Suicide-Prevention Laws in East Asia: A Sociocultural, Historical, and Ethical Perspective.

In many Western countries, the criminalization and stigmatization of suicide has given way to a biomedical approach aimed at destigmatizing suicide and treating underlying mental illness. By contrast, in many East Asian countries, suicide has never historically been criminalized or stigmatized. High rates of suicide in Japan, South Korea, and Taiwan have recently led policy makers in those countries to pursue innovative suicide-prevention strategies. The intentional denormalization of harmful behaviors has been discussed in the public health and ethics literatures, particularly with regard to smoking cessation, and could represent a novel mechanism for preventing suicides in East Asia. Using examples from the sociocultural, historical, and legal discourses surrounding suicide in Western and East Asian contexts, we suggest that denormalization can be a justified, culturally relevant suicide-prevention strategy, but that care must be taken to avoid shaming or stigmatizing suicidal individuals. Specifically, we propose the term weak denormalization to refer to an ethically permissible strategy at the mildest end of a spectrum of denormalizing approaches-milder than the reintegrative shaming described in the criminal justice literature, and diametrically opposed to outright stigmatization, which is generally considered ethically impermissible. Given the severe stigma of mental illness in East Asia, adopting the dominant Western view of suicide as solely a psychiatric concern would not be justified. Weak denormalization strategies in East Asia should be culturally tailored and rigorously tested on a small scale. They should include social supports, praise for the bravery of those of who seek help, and strategies to reduce shame regarding perceived social failure.

Suicide risk among prisoners in French Guiana: prevalence and predictive factors.

BACKGROUND: Suicide rates in prison are high and their risk factors are incompletely understood. The objective of the present study is to measure the risk of suicide and its predictors in the only prison of multicultural French Guiana. METHODS: All new prisoners arriving between September 2013 and December 2014 were included. The Mini International Neuropsychiatric Interview (MINI) was used and socio-demographic data was collected. In order to identify the predictors of suicide risk multivariate logistic regression was used. RESULTS: Of the 707 prisoners included 13.2% had a suicidal risk, 14.0% of whom had a high risk, 15.1% a moderate risk and 41.9% a low risk. Predictive factors were depression (OR 7.44, 95% CI: 3.50-15.87), dysthymia (OR 4.22, 95% CI: 1.34-13.36), panic disorder (OR 3.47, 95% CI: 1.33-8.99), general anxiety disorder (GAD) (OR 2.19, 95% CI: 1.13-4.22), men having been abused during childhood (OR 21.01, 95%, CI: 3.26-135.48), having been sentenced for sexual assault (OR 7.12, 95% CI: 1.98-25.99) and smoking (OR 2.93, 95%, CI 1.30-6.63). CONCLUSION: The suicide risk was lower than in mainland France, possibly reflecting the differences in the social stigma attached to incarceration because of migrant populations and the importance and trivialization of drug trafficking among detainees. However, there were no differences between nationalities. The results reemphasize the importance of promptly identifying and treating psychiatric disorders, which were the main suicide risk factors.

Spatial-temporal trends and risk of suicide in Central Brazil: an ecological study contrasting indigenous and non-indigenous populations

Objective: To examine spatial-temporal distribution and risk of suicide, as well as trends in suicide mortality rates, in the indigenous and non-indigenous population of the state of Mato Grosso do Sul, Brazil. Methods: Data were obtained from the Information Department of the Brazilian Unified Health System. Deaths recorded as voluntary self-inflicted injuries (ICD-10 codes X60.0 to X84.9) were considered suicide. Suicide rates were estimated and adjusted by age in the population > 9 years of age. Kernel analysis was used to assess the spatial distribution of suicide cases, while trend analysis was carried out using a non-parametric test (Mann-Kendall). Results: The suicide risk among the indigenous population was 8.1 (95%CI 7.2-9.0) times higher than in the non-indigenous population. For indigenous residents in the 15-24 age group, the risk was 18.5 (95%CI 17.5-19.6) times higher than in the non-indigenous population. The majority of indigenous cases were concentrated in a few villages in reservation areas, mainly occupied by Guarani-Kaiowá and Guarani-Ñandeva groups. Rate patterns remained stable over time in both groups. Conclusion: Suicide is a serious public health problem in Mato Grosso do Sul, and has had an alarming and disproportionate impact on the indigenous population for more than a decade.

Acculturation and Health Behaviors of African Immigrants Living in the United States: An Integrative Review.

This research was conducted to identify the acculturation and health behaviors in the African Immigrant population, which is presently living in the United States. Ten studies met the criteria and included health behaviors of status, access to health care, psychiatric services, prostate cancer, morbidity and mortality, HIV knowledge and beliefs, perceptions of suicide, smoking, and obesity. Acculturation was measured using the most common social constructs that influenced the health behaviors of nativity, English (language proficiency), age at immigration, education and socioeconomic status, religion, age at immigration, and length of stay in the U.S. More research is needed to assist in prioritizing the health conditions that need intervention in serving this particular population.

Trends in Disparity by Sex and Race/Ethnicity for the Leading Causes of Death in the United States-1999-2010.

CONTEXT: Temporal trends in disparities in the leading causes of death within and between US demographic subgroups indicate the need for and success of interventions to prevent premature death in vulnerable populations. Studies that report recent trends are limited and outdated. OBJECTIVE: To describe temporal trends in disparities in death rates by sex and race/ethnicity for the 10 leading causes of death in the United States during 1999-2010. DESIGN: We used underlying cause of death data and population estimates from the National Vital Statistics System to calculate age-adjusted death rates for the 10 leading causes of death during 1999-2010. We measured absolute and relative disparities by sex and race/ethnicity for each cause and year of death; we used weighted linear regression to test for significance of trends over time. RESULTS: Of the 10 leading causes of death, age-adjusted death rates by sex and race/ethnicity declined during 1999-2010 for 6 causes and increased for 4 causes. But sex and racial/ethnic disparities between groups persisted for each year and cause of death. In the US population, the decreasing trend during 1999-2010 was greatest for cerebrovascular disease (-36.5%) and the increasing trend was greatest for Alzheimer disease (52.4%). For each sex and year, the disparity in death rates between Asian/Pacific Islanders (API) and other groups varied significantly by cause of death. In 2010, the API-non-Hispanic black disparity was largest for heart disease, malignant neoplasms, cerebrovascular diseases, and nephritis; the API-American Indian/Alaska Native disparity was largest for unintentional injury, diabetes mellitus, influenza and pneumonia, and suicide; and the API-non-Hispanic white disparity was largest for chronic lower respiratory diseases and Alzheimer disease. CONCLUSIONS: Public health practitioners can use these findings to improve policies and practices and to evaluate progress in eliminating disparities and their social determinants in vulnerable populations.

Overview of community-based studies of depression screening interventions among the elderly population in Japan.

OBJECTIVES: In most Western and Asian countries, a higher risk of suicide is found among elderly people than those in other age groups. However, the treatment needs of elderly people who are at risk of committing suicide are not well understood. We conducted an overview of studies that assessed the impact of suicide prevention interventions on suicide rates in elderly people in Japan. We interpreted the results of these studies, as well as prominent findings associated with other successful interventions, within a framework of the suicidal process and preventive strategies. METHOD: We assessed six quasi-experimental studies of community-based interventions providing universal depression screening, subsequent care, and education to elderly people in Japan, and performed a combined analysis of outcome data. RESULTS: Screening interventions were associated with lower suicide rates. We also found a gender difference in the response to subsequent psychiatric or primary care. Two types of interventions decreased the rate of suicide among elderly people: crisis helplines and screening interventions. These interventions featured a close link between universal, selective, and indicated prevention strategies, which reflect different approaches tailored to the size and risk profile of the target individuals. CONCLUSION: Successful interventions appear to hinge on systematic links between multi-level prevention interventions. Multi-level interventions for depression screening may result in lower suicide rates among elderly individuals in communities, although primary care interventions alone appear to be insufficient in men. The benefit of linked multi-level prevention interventions may highlight the importance of the multiple steps and components of the suicidal process.

Season of birth is different in Inuit suicide victims born into Traditional than into Modern Lifestyle: a register study from Greenland.

BACKGROUND: There is growing evidence that living conditions at birth play a role in medical conditions later in life. Population-based studies from the Northern Hemisphere have shown that persons born in the spring or summer are at greater risk of committing suicide. A statistical correlation with light availability at birth has been observed in past research, but the cause remains unknown. Greenland is one of the most extreme of natural human habitats with regard to seasonal changes in light. The combination of rapid social changes and reliable population statistics offers a unique opportunity to make comparisons between persons born into a Traditional Lifestyle and those born into a Modern Lifestyle. The aim of this work was to assess whether season of birth differed between suicide victims born into an old or into a modern lifestyle. METHODS: Official population and mortality registers were used. Suicide victims born (1903-1950) into the Traditional Lifestyle were compared with those born into the Modern Lifestyle (1961-1980). Rayleigh's test for circular distributions was used to assess the season of birth in suicide victims. Data regarding season of birth in the general population were collected. RESULTS: Persons born in March-June in the Traditional Lifestyle were much less likely to commit suicide than those born during other periods of the year. This is contrary to the findings of other studies. The seasonal differences had disappeared for those born into the Modern Lifestyle. The suicide rate increased from very low rates to about 140 suicides/100 000 person-years in the 1980s. CONCLUSIONS: The reason behind a variation in season of birth in suicide victims born into the old lifestyle is unknown. It is also unknown why the seasonal difference had disappeared with modern lifestyle. Possible influence of artificial light, nutrition, microbiota and seasonal infections are discussed. The underlying causes behind suicides may be different in traditional and modern Greenland.

Prevalence of suicidality among Hispanic and African American veterans following surgery.

OBJECTIVES: We evaluated factors associated with suicidal behavior and ideation (SBI) during 3 years of follow-up among 89,995 Veterans Health Administration (VHA) patients who underwent major surgery from October 2005 to September 2006. METHODS: We analyzed administrative data using Cox proportional hazards models. SBI was ascertained by International Classification of Disease, 9th Revision codes. RESULTS: African Americans (18% of sample; 16,252) were at an increased risk for SBI (hazard ratio [HR] = 1.21; 95% confidence interval [CI] = 1.10, 1.32), whereas Hispanics were not (HR = 1.10; 95% CI = 0.95, 1.28). Other risk factors included schizophrenia, bipolar disorder, depression, posttraumatic stress disorder, pain disorders, postoperative new-onset depression, and postoperative complications; female gender and married status were protective against SBI. CONCLUSIONS: The postoperative period might be a time of heightened risk for SBI among minority patients in the VHA. Tailored monitoring and postoperative management by minority status might be required to achieve care equity.

Stressful psychosocial school environment and suicidal ideation in Chinese adolescents.

PURPOSE: Suicide is one of the leading causes of death during adolescence worldwide. This study, using a sample of Chinese adolescents, examines associations of a stressful psychosocial school environment with suicidal ideation, which were rarely investigated so far. METHODS: A total of 1,004 Chinese students (468 boys and 536 girls) from Grade 7-12 were recruited into our questionnaire survey. Psychosocial school environment was measured by the effort-reward imbalance questionnaire adapted to the school setting, and suicidal ideation was assessed by a standardized question. Multivariate logistic regression was applied, adjusting odds ratios for age, gender, grade, smoking, alcohol drinking, physical activity, family wealth, and self-rated health. RESULTS: In school settings, 10.86% students reported suicidal ideation during the last 6 months, which was found to be significantly related to both effort and reward. Remarkably, effort-reward imbalance was associated with elevated risk of suicidal ideation (odds ratio = 1.77, 95% confidence interval = 1.34-2.35). CONCLUSIONS: This study finds significant associations between a stressful psychosocial school environment in terms of effort-reward imbalance and suicidal ideation in Chinese adolescents. Preventive actions aiming at reducing this imbalance may define a promising approach towards a healthy psychosocial school environment.