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1.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(9): 885-890, 2019 Sep 06.
Artículo en Chino | MEDLINE | ID: mdl-31474068

RESUMEN

Objective: To describe the epidemiological characteristics of suicide death and self-harm/suicide in China from 2006 to 2016. Methods: Data in this study are from the datasets of National Death Cause Surveillance from 2006 to 2016 and the National Injury Surveillance Dataset 2016. The age-standardized death rate based on the population census in 2000 was used to describe the trend of suicide over years. This study also described the epidemiological characteristics of suicide death and the demographic characteristics, suicide methods and severity of patients who sought medical help after committing suicide or self-inflicted injury in 2016. Results: Age-standardized suicide mortality had been declining from 9.23/100 000 in 2006 to 5.33/100 000 in 2016 by 42.25%. Suicide mortality increased with age. In 2016, the suicide mortality in China was 7.05/100 000, and among people over 85 years old was 49.49/100 000. In 2016, the dominant two suicide methods were poisoning (39.12%) and sharp injury (25.62%). The first leading method of suicide in rural population, urban population and young people aged 10-to 17-year-old was poisoning (65.13%), sharp injury (29.90%) and fall (25.47%), respectively. As age increased, the severity of suicide/self-inflicted injury increased. The proportions of serious cases among young people aged 10-to 17-year-old and older people aged 60 years old and above who sought medical help after committing suicide or self-inflicted injury were 4.88% and 26.86%, respectively. Conclusion: China's suicide mortality has been declining and special attention should be given to the suicide of old people.


Asunto(s)
Hospitales , Conducta Autodestructiva , Suicidio , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Causas de Muerte , Niño , China , Monitoreo Epidemiológico , Hospitales/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Conducta Autodestructiva/epidemiología , Conducta Autodestructiva/mortalidad , Suicidio/estadística & datos numéricos
2.
Plast Reconstr Surg ; 144(2): 415-422, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31348352

RESUMEN

BACKGROUND: Self-inflicted gunshot wounds involving the face are highly morbid. However, there is a paucity of objective estimates of mortality. This study aims to provide prognostic guidance to clinicians that encounter this uncommon injury. METHODS: A retrospective review of patients presenting to R Adams Cowley Shock Trauma Center (a Level I trauma center) with self-inflicted gunshot wounds to the face from 2007 to 2016. Isolated gunshot wounds to the calvaria or neck were excluded. The data were analyzed to determine predictors of survival. RESULTS: Of the 69 patients that met inclusion criteria, 90 percent were male and 80 percent were Caucasian, with an age range of 21 to 85 years. The most frequently seen injury patterns showed submental (57 percent), intraoral (22 percent), and temporal (12 percent) entry sites. Fewer than half (41 percent) of the cohort sustained penetrative brain injury. Overall, there were 18 deaths (overall mortality, 26 percent), 17 of which were secondary to brain injury. Independent predictors of death included penetrative brain injury (OR, 17; p < 0.0001) and age. Mortality was 17 percent among patients younger than 65 years, compared with 73 percent for those aged 65 years or older (p = 0.0001). Gastrostomy placement was independently associated with 25 percent reduction in length of hospitalization (p = 0.0003). CONCLUSIONS: Despite tremendous morbidity, the overwhelming majority of patients who present with facial self-inflicted gunshot wounds will survive, especially if they are young and have no penetrative brain injury. These findings should help guide clinical decisions for this devastating injury. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Asunto(s)
Traumatismos Faciales/mortalidad , Conducta Autodestructiva/mortalidad , Heridas por Arma de Fuego/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Traumatismos Faciales/cirugía , Femenino , Traumatismos Penetrantes de la Cabeza/mortalidad , Traumatismos Penetrantes de la Cabeza/cirugía , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Maryland/epidemiología , Persona de Mediana Edad , Estudios Retrospectivos , Conducta Autodestructiva/cirugía , Heridas por Arma de Fuego/cirugía , Adulto Joven
3.
Surgery ; 166(4): 580-586, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31320227

RESUMEN

BACKGROUND: Intentional self-inflicted injuries present unique challenges in treatment and prevention. We hypothesized intentional self-inflicted injuries would have higher in-hospital and postdischarge mortality than nonintentional self-inflicted injuries trauma. METHODS: Adult patients evaluated 2008 to 2012 were identified in our trauma registry and matched with mortality data from the National Death Index. Intentional self-inflicted injuries were identified using E-Codes. Readmissions were identified and analyzed. Intentional self-inflicted injuries patients who died in-hospital were compared with those surviving to discharge. Univariate analysis was performed using nonparametric tests. Kaplan-Meier curves were plotted to compare mortality ≤5 years postdischarge between intentional self-inflicted injuries and non-intentional self-inflicted injuries patients. RESULTS: In the study, 8,716 patient records were evaluated with 245 (2.8%) classified as intentional self-inflicted injuries. Eighteen (7.8%) patients with intentional self-inflicted injuries had multiple admissions, compared with 352 (4.4%) patients with nonintentional self-inflicted injuries with readmissions (P = .0210). In-hospital mortality was higher for intentional self-inflicted injuries compared with patients with non-intentional self-inflicted injuries (18.7% vs 4.9%, P < .0001). Survival analysis demonstrated that patients with intentional self-inflicted injuries had significantly lower postdischarge mortality at multiple time points. CONCLUSION: Patients with intentional self-inflicted injuries trauma have high in-hospital mortality, but low postdischarge mortality. We attribute this to high lethality mechanisms but appropriate psychiatric treatment and rehabilitation. However, the high intentional self-inflicted injuries readmission rate indicates further study of intentional self-inflicted injuries follow-up is warranted. Better prevention strategies are needed to identify and intervene in patients at-risk for intentional self-inflicted injuries.


Asunto(s)
Mortalidad Hospitalaria/tendencias , Readmisión del Paciente/estadística & datos numéricos , Sistema de Registros , Automutilación/mortalidad , Automutilación/psicología , Adulto , Distribución por Edad , Análisis de Varianza , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Conducta Autodestructiva/mortalidad , Conducta Autodestructiva/psicología , Conducta Autodestructiva/terapia , Distribución por Sexo , Análisis de Supervivencia , Centros Traumatológicos , Estados Unidos , Adulto Joven
4.
Nord J Psychiatry ; 73(6): 357-364, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31271336

RESUMEN

Background: Psychiatric disorders tend to be developmental, and longitudinal settings are required to examine predictors of psychiatric phenomena. Replicating and combining data and results from different birth cohorts, which are a source of reliable data, can make research even more valuable. The Finnish Psychiatric Birth Cohort Consortium (PSYCOHORTS) project combines birth cohorts in Finland. Aim: The aim of this paper is to introduce content, plans and perspectives of the PSYCOHORTS project that brings together researchers from Finland. In addition, we illustrate an example of data harmonization using available data on causes of death. Content: PSYCOHORTS includes eight Finnish birth cohorts. The project has several plans: to harmonize different data from birth cohorts, to incorporate biobanks into psychiatric birth cohort research, to apply multigenerational perspectives, to integrate longitudinal patterns of marginalization and inequality in mental health, and to utilize data in health economics research. Data on causes of death, originally obtained from Finnish Cause of Death register, were harmonized across the six birth cohorts using SAS macro facility. Results: Harmonization of the cause of death data resulted in a total of 21,993 observations from 1965 to 2015. For example, the percentage of deaths due to suicide and the sequelae of intentional self-harm was 14% and alcohol-related diseases, including accidental poisoning by alcohol, was 13%. Conclusions: PSYCOHORTS lays the foundation for complex examinations of psychiatric disorders that is based on compatible datasets, use of biobanks and multigenerational approach to risk factors, and extensive data on marginalization and inequality.


Asunto(s)
Trastornos Mentales/mortalidad , Adolescente , Adulto , Alcoholismo/mortalidad , Alcoholismo/psicología , Causas de Muerte , Estudios de Cohortes , Femenino , Finlandia/epidemiología , Humanos , Masculino , Trastornos Mentales/psicología , Persona de Mediana Edad , Factores de Riesgo , Conducta Autodestructiva/mortalidad , Conducta Autodestructiva/psicología , Factores Socioeconómicos , Suicidio/estadística & datos numéricos , Adulto Joven
5.
Aust N Z J Public Health ; 43(3): 248-253, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30786107

RESUMEN

OBJECTIVES: To compare demographic and psychosocial characteristics of completed suicide between younger and older adolescents, and by sex. METHODS: Data was collected from the Victorian Suicide Register, which contains information on suicides reported to the Coroners Court of Victoria. RESULTS: Between 2006 and 2015, there were 273 completed suicides aged 10-19 years, with none aged 10-12 years. There were 171 (63%) suicides in the older adolescent group (17-19 years), and 102 (37%) in the younger group (13-16 years). Males comprised 184 cases (67%) and females 89 (33%). A higher proportion of both younger and female adolescents had experienced abuse, peer conflict and bullying. There was also a higher incidence of previous self-harm in younger and female adolescents. Older adolescents were more likely to not be in formal education, employment or training. CONCLUSION: Suicide in younger adolescents and females appear to share characteristics, and differ from older and male adolescents. Negative interpersonal relationships and previous self-harm with possible co-existenting mental illness appear to be key differentiating features. Implications for public health: Understanding completed suicide is an important step towards prevention, and our results suggest a need for developmentally and sex-specific suicide prevention strategies.


Asunto(s)
Trastornos Mentales/mortalidad , Conducta Autodestructiva/mortalidad , Suicidio/estadística & datos numéricos , Adolescente , Conducta del Adolescente , Factores de Edad , Australia/epidemiología , Causalidad , Niño , Femenino , Humanos , Incidencia , Masculino , Estudios Retrospectivos , Factores Sexuales , Suicidio/clasificación , Suicidio/psicología , Victoria/epidemiología , Adulto Joven
8.
Early Interv Psychiatry ; 13(4): 902-907, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-29888512

RESUMEN

AIM: To investigate medication, rehospitalizations and mortality after first-episode hospital-treated psychosis. METHODS: A population-based nation-wide cohort (n = 2488) with a first hospitalization for psychosis at ages between 16 and 25 was identified. Cases were followed for up to 5 years after the first psychosis hospitalization with regard to mortality, hospitalizations and dispensations of antipsychotics and benzodiazepines. RESULTS: The proportion of patients dispensing antipsychotics decreased from 80% year 1 after first discharge to 55% year 5. The proportion of patients having episodes of inpatient care also decreased year by year from 46% year 1 to 27% year 5. Of 863 cases with 5 years of observation time 41% had dispensations of antipsychotics every year; 21% had no dispensation of antipsychotics or hospitalization after the first year. The cumulative 5-year mortality was 3.9%. Cumulative suicide mortality was 2.4%. Incidence of suicide was highest in the first year. Male gender, benzodiazepines, recent hospital-discharge and self-harm were identified as risk factors for suicide. CONCLUSIONS: The proportion of cases dispensing antipsychotics decreases year by year after first discharge. Mortality and rates of rehospitalization also decrease year by year from high levels the first year.


Asunto(s)
Antipsicóticos/uso terapéutico , Hospitalización , Trastornos Psicóticos/tratamiento farmacológico , Trastornos Psicóticos/mortalidad , Adolescente , Adulto , Causas de Muerte , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Factores de Riesgo , Conducta Autodestructiva/tratamiento farmacológico , Conducta Autodestructiva/mortalidad , Conducta Autodestructiva/psicología , Suicidio/psicología , Suicidio/estadística & datos numéricos , Suecia , Adulto Joven
9.
Cien Saude Colet ; 23(9): 2813-2820, 2018 Sep.
Artículo en Español, Inglés | MEDLINE | ID: mdl-30281720

RESUMEN

INTRODUCTION: Adolescence is considered a healthy stage of life and therefore little studied. This study described mortality over time in teenagers in Uruguay and analysed the burden of disease at this stage of life by the measure of Years of Life Lost by Premature Death in Uruguay and by comparison with rates in Latin America and the Caribbean by sex, cause and sub-region. METHODOLOGY: Secondary data sources used were the national registry of deaths in Uruguay, the first Global Burden of Disease study in Uruguay and the information on the data visualisation page of the Institute of Metrics and Health Evaluation. Data were extracted by the authors and displayed in tables and graphs. RESULTS: Teenager mortality held roughly stable between 1997 and 2015. More years were lost to premature death among Uruguayan men, the main causes being traffic accidents, self-inflicted injuries and violence. The same behaviour occurs throughout the region. CONCLUSIONS: The social determinants of health connected with poverty and inequality play a role in the development of depression, risky and violent behaviour, which possibly explain the loss of years due to premature death in adolescence.


Asunto(s)
Causas de Muerte/tendencias , Carga Global de Enfermedades/tendencias , Mortalidad Prematura/tendencias , Pobreza , Accidentes de Tránsito/mortalidad , Accidentes de Tránsito/estadística & datos numéricos , Adolescente , Región del Caribe/epidemiología , Femenino , Humanos , América Latina/epidemiología , Masculino , Sistema de Registros , Conducta Autodestructiva/epidemiología , Conducta Autodestructiva/mortalidad , Factores Socioeconómicos , Uruguay/epidemiología , Violencia/estadística & datos numéricos , Violencia/tendencias , Adulto Joven
10.
PLoS One ; 13(9): e0204670, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30261030

RESUMEN

BACKGROUND: Observational studies are suited to examining links between the routine hospital management of self-harm and future suicide and all-cause mortality due to their large scale. However, care must be taken when attempting to infer causal associations in non-experimental settings. METHODS: Data from the Multicentre Study of Self-Harm in England were used to examine associations between four types of hospital management (specialist psychosocial assessment, general hospital admission, psychiatric outpatient referral and psychiatric admission) following self-harm and risks of suicide and all-cause mortality in the subsequent 12 months. Missing data were handled by multiple imputation and propensity score (PS) methods were used to address observed differences between patients at baseline. Unadjusted, PS stratified and PS matched risk ratios (RRs) were calculated. RESULTS: The PSs balanced the majority of baseline differences between treatment groups. Unadjusted RRs showed that all four treatment types were associated with either increased risks or no change in risks of suicide and all-cause mortality within a year. None of the four types of hospital management were associated with lowered risks of suicide or all-cause mortality following propensity score stratification (psychosocial assessment and medical admission) and propensity score matching (psychiatric outpatient referral and psychiatric admission), though there was no longer an increased risk among people admitted to a psychiatric bed. Individuals who self-cut were at an increased risk of death from any cause following psychosocial assessment and medical admission. Medical admission appeared to be associated with reduced risk of suicide in individuals already receiving outpatient or GP treatment for a psychiatric disorder. CONCLUSIONS: More intensive forms of hospital management following self-harm appeared to be appropriately allocated to individuals with highest risks of suicide and all-cause mortality. PS adjustment appeared to attenuate only some of the observed increased risks, suggesting that either differences between treatment groups remained, or that some treatments had little impact on reducing subsequent suicide or all-cause mortality risk. These findings are in contrast to some previous studies that have suggested psychosocial assessment by a mental health specialist reduces risk of repeat self-harm. Future observational self-harm studies should consider increasing the number of potential confounding variables collected.


Asunto(s)
Hospitalización , Conducta Autodestructiva/mortalidad , Conducta Autodestructiva/terapia , Suicidio/prevención & control , Adolescente , Adulto , Anciano , Causas de Muerte , Estudios de Cohortes , Inglaterra/epidemiología , Femenino , Humanos , Masculino , Servicios de Salud Mental , Persona de Mediana Edad , Puntaje de Propensión , Sistemas de Apoyo Psicosocial , Psicoterapia , Conducta de Reducción del Riesgo , Resultado del Tratamiento , Adulto Joven
11.
Obes Surg ; 28(11): 3531-3537, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-29982972

RESUMEN

PURPOSE: The objective of this descriptive study was to identify clinical characteristics of Roux-en-Y gastric bypass (RYGB) patients who died from intentional self-harm or accidental overdose postoperatively. MATERIALS AND METHODS: This retrospective, descriptive study included RYGB patients from a large rural medical center that completed surgery between January 2004 and December 2014 and died from intentional self-harm or accidental overdose through December 2015. Specific causes of death were obtained from the National Death Index and clinical data from electronic health records. Clinical characteristics explored were age, sex, time to surgery, weight loss expectations, postoperative weight loss, medication, diagnoses, psychiatric histories (diagnoses, self-harm, suicidal ideation and behaviors, medications, substance use, preoperative Beck Depression Inventory-II scores), pain, social support, and reported life stressors. RESULTS: Overall, 22 patients of 146 total deceased patients died from intention self-harm (n = 6) or accidental overdose (n = 16) over the study period (77.3% female, mean age at time of surgery = 38.4 ± 9.1 years). Younger age (< 40 years), history of self-harm or depression, preoperative pain, and use of opioids at the time of surgery emerged as common characteristics in weight loss surgery patients who died from intentional self-harm or accidental overdose. No trends regarding social support, life stressors, or actual or expected weight loss were identified. CONCLUSION: Certain weight loss surgery patients may be at risk for death from self-harm or overdose and may benefit from greater surveillance postoperatively.


Asunto(s)
Sobredosis de Droga/mortalidad , Derivación Gástrica , Obesidad Mórbida , Complicaciones Posoperatorias/mortalidad , Conducta Autodestructiva/mortalidad , Adulto , Femenino , Derivación Gástrica/efectos adversos , Derivación Gástrica/mortalidad , Derivación Gástrica/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Obesidad Mórbida/epidemiología , Obesidad Mórbida/cirugía , Estudios Retrospectivos , Pérdida de Peso
12.
JAMA ; 319(10): 1013-1023, 2018 03 13.
Artículo en Inglés | MEDLINE | ID: mdl-29536097

RESUMEN

Importance: Substance use disorders, including alcohol use disorders and drug use disorders, and intentional injuries, including self-harm and interpersonal violence, are important causes of early death and disability in the United States. Objective: To estimate age-standardized mortality rates by county from alcohol use disorders, drug use disorders, self-harm, and interpersonal violence in the United States. Design and Setting: Validated small-area estimation models were applied to deidentified death records from the National Center for Health Statistics (NCHS) and population counts from the US Census Bureau, NCHS, and the Human Mortality Database to estimate county-level mortality rates from 1980 to 2014 for alcohol use disorders, drug use disorders, self-harm, and interpersonal violence. Exposures: County of residence. Main Outcomes and Measures: Age-standardized mortality rates by US county (N = 3110), year, sex, and cause. Results: Between 1980 and 2014, there were 2 848 768 deaths due to substance use disorders and intentional injuries recorded in the United States. Mortality rates from alcohol use disorders (n = 256 432), drug use disorders (n = 542 501), self-harm (n = 1 289 086), and interpersonal violence (n = 760 749) varied widely among counties. Mortality rates decreased for alcohol use disorders, self-harm, and interpersonal violence at the national level between 1980 and 2014; however, over the same period, the percentage of counties in which mortality rates increased for these causes was 65.4% for alcohol use disorders, 74.6% for self-harm, and 6.6% for interpersonal violence. Mortality rates from drug use disorders increased nationally and in every county between 1980 and 2014, but the relative increase varied from 8.2% to 8369.7%. Relative and absolute geographic inequalities in mortality, as measured by comparing the 90th and 10th percentile among counties, decreased for alcohol use disorders and interpersonal violence but increased substantially for drug use disorders and self-harm between 1980 and 2014. Conclusions and Relevance: Mortality due to alcohol use disorders, drug use disorders, self-harm, and interpersonal violence varied widely among US counties, both in terms of levels of mortality and trends. These estimates may be useful to inform efforts to target prevention, diagnosis, and treatment to improve health and reduce inequalities.


Asunto(s)
Conducta Autodestructiva/mortalidad , Trastornos Relacionados con Sustancias/mortalidad , Suicidio/estadística & datos numéricos , Violencia/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Trastornos Relacionados con Alcohol/mortalidad , Niño , Preescolar , Femenino , Humanos , Relaciones Interpersonales , Masculino , Persona de Mediana Edad , Estados Unidos/epidemiología , Adulto Joven
13.
J Trauma Acute Care Surg ; 85(4): 668-673, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-29462080

RESUMEN

BACKGROUND: Children suffering nonaccidental trauma (NAT) are at high risk of death. It is unclear whether markers of injury severity for trauma center/system benchmarking such as Injury Severity Score (ISS) adequately characterize this. Our objective was to evaluate mortality prediction of ISS in children with NAT compared with accidental trauma (AT). METHODS: Pediatric patients younger than 16 years from the Pennsylvania state trauma registry 2000 to 2013 were included. Logistic regression predicted mortality from ISS for NAT and AT patients. Multilevel logistic regression determined the association between mortality and ISS while adjusting for age, vital signs, and injury pattern in NAT and AT patients. Similar models were performed for head Abbreviated Injury Scale (AIS). Sensitivity analysis examined impaired functional independence at discharge as an alternate outcome. RESULTS: Fifty thousand five hundred seventy-nine patients were included with 1,866 (3.7%) NAT patients. Nonaccidental trauma patients had a similar rate of mortality at an ISS of 13 as an ISS of 25 for AT patients. Nonaccidental trauma patients also have higher mortality for a given head AIS level (range, 1.2-fold to 5.9-fold higher). Injury Severity Score was a significantly greater predictor of mortality in AT patients (adjusted odds rations [AOR], 1.14; 95% confidence interval [CI], 1.13-1.15; p < 0.01) than NAT patients (AOR, 1.09; 95% CI, 1.07-1.12; p < 0.01) per 1-point ISS increase, while head injury was a significantly greater predictor of mortality in NAT patients (AOR, 3.48; 95% CI, 1.54-8.32; p < 0.01) than AT patients (AOR, 1.21; 95% CI, 0.95-1.45; p = 0.12). Nonaccidental trauma patients had a higher rate of impaired functional independence at any given ISS or head AIS level than AT patients. CONCLUSION: Nonaccidental trauma patients have higher mortality and impaired function at a given ISS/head AIS than AT patients. Conventional ISS thresholds may underestimate risk and head injury is a more important predictor of mortality in the NAT population. These findings should be considered in system performance improvement and benchmarking efforts that rely on ISS for injury characterization. LEVEL OF EVIDENCE: Epidemiologic study, level III.


Asunto(s)
Escala Resumida de Traumatismos , Accidentes/mortalidad , Maltrato a los Niños/mortalidad , Puntaje de Gravedad del Traumatismo , Conducta Autodestructiva/mortalidad , Heridas y Traumatismos/mortalidad , Adolescente , Niño , Preescolar , Traumatismos Craneocerebrales/mortalidad , Femenino , Predicción , Humanos , Lactante , Recién Nacido , Masculino , Pennsylvania/epidemiología , Sistema de Registros
14.
Psychiatry Res ; 259: 333-339, 2018 01.
Artículo en Inglés | MEDLINE | ID: mdl-29120839

RESUMEN

Morbidity and mortality after deliberate self-harm (DSH) are high, so mental health care shortly after DSH is recommended. Using population-level health data we determined the association between a mental health visit and risk for repeat DSH with or without intensive care unit (ICU) admission or all-cause death. Over two years, 23,140 individuals had emergency department treatment for DSH. Within 30 days, 10.7% had a family physician mental health visit, 17.1% visited a psychiatrist, 3.6% visited both and 68.6% neither. Individuals who received mental health follow-up had more chronic and severe mental illness and higher acuity DSH. Over five years, repeat DSH occurred in 4792 (20.7%). Repeat DSH was more common in those who had a mental health visit within 30 days. Adjusting for baseline characteristics attenuated these differences. Similar results were found for DSH with ICU admission (5.0%) and death (7.6%). More frequent follow-up was not associated with better outcome. Timely access to mental health care after DSH was poor at 31%. Follow-up care had virtually no association with subsequent risk, so treatment as usual is insufficient. Post-DSH care augmented with evidence-based interventions is required.


Asunto(s)
Cuidados Posteriores/estadística & datos numéricos , Servicios de Salud Mental/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Psicoterapia/estadística & datos numéricos , Conducta Autodestructiva/terapia , Adolescente , Adulto , Cuidados Posteriores/métodos , Causas de Muerte , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Ontario , Psicoterapia/métodos , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Conducta Autodestructiva/mortalidad , Conducta Autodestructiva/psicología , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
15.
Int J Public Health ; 63(Suppl 1): 39-46, 2018 May.
Artículo en Inglés | MEDLINE | ID: mdl-28776251

RESUMEN

OBJECTIVES: We used GBD 2015 findings to measure the burden of intentional injuries in the Eastern Mediterranean Region (EMR) between 1990 and 2015. METHODS: The Global Burden of Disease (GBD) study defines intentional injuries as a combination of self-harm (including suicide), interpersonal violence, collective violence (war), and legal intervention. We estimated number of deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) for each type of intentional injuries. RESULTS: In 2015, 28,695 individuals (95% UI: 25,474-37,832) died from self-harm, 35,626 (95% UI: 20,947-41,857) from interpersonal violence, and 143,858 (95% UI: 63,554-223,092) from collective violence and legal interventions. In 2015, collective violence and legal intervention was the fifth-leading cause of DALYs in the EMR and the leading cause in Syria, Yemen, Iraq, Afghanistan, and Libya; they account for 49.7% of total DALYs in Syria. CONCLUSIONS: Our findings call for increased efforts to stabilize the region and assist in rebuilding the health systems, as well as increasing transparency and employing preventive strategies to reduce self-harm and interpersonal injuries.


Asunto(s)
Carga Global de Enfermedades/estadística & datos numéricos , Conducta Autodestructiva/economía , Conducta Autodestructiva/epidemiología , Violencia/economía , Violencia/estadística & datos numéricos , Adolescente , Adulto , Costo de Enfermedad , Femenino , Salud Global , Humanos , Masculino , Persona de Mediana Edad , Medio Oriente/epidemiología , Años de Vida Ajustados por Calidad de Vida , Conducta Autodestructiva/mortalidad , Suicidio/estadística & datos numéricos , Adulto Joven
16.
Health Inf Manag ; 47(1): 28-37, 2018 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-28537199

RESUMEN

BACKGROUND: Research has associated some chronic conditions with self-harm and suicide. Quantifying such a relationship in mortality data relies on accurate death records and adequate techniques for identifying these conditions. OBJECTIVE: This study aimed to quantify the impact of identification methods for co-morbid conditions on suicides in individuals aged 30 years and older in Australia and examined differences by gender. METHOD: A retrospective examination of mortality records in the National Coronial Information System (NCIS) was conducted. Two different methods for identifying co-morbidities were compared: International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) coded data, which are provided to the NCIS by the Australian Bureau of Statistics, and free-text searches of Medical Cause of Death fields. Descriptive statistics and χ2 tests were used to compare the methods for identifying co-morbidities and look at differences by gender. RESULTS: Results showed inconsistencies between ICD-10 coded and coronial reports in the identification of suicide and chronic conditions, particularly by type (physical or mental). There were also significant differences in the proportion of co-morbid conditions by gender. CONCLUSION: While ICD-10 coded mortality data more comprehensively identified co-morbidities, discrepancies in the identification of suicide and co-morbid conditions in both systems require further investigation to determine their nature (linkage errors, human subjectivity) and address them. Furthermore, due to the prescriptive coding procedures, the extent to which medico-legal databases may be used to explore potential and previously unrecognised associations between chronic conditions and self-harm deaths remains limited.


Asunto(s)
Comorbilidad , Conducta Autodestructiva/mortalidad , Suicidio , Adulto , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Causas de Muerte , Codificación Clínica , Bases de Datos Factuales , Certificado de Defunción , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
17.
Aust N Z J Psychiatry ; 52(3): 262-270, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-28675938

RESUMEN

OBJECTIVE: Prior and repeated self-harm hospitalisations are common risk factors for suicide. However, few studies have accounted for pre-existing comorbidities and prior hospital use when quantifying the burden of self-harm. The aim is to quantify hospitalisation in the 12 months preceding and re-hospitalisation and mortality risk in the 12 months post a self-harm hospitalisation. METHOD: A population-based matched cohort using linked hospital and mortality data for individuals ⩾18 years from four Australian jurisdictions. A non-injured comparison cohort was matched on age, gender and residential postcode. Twelve-month pre- and post-index self-harm hospitalisations and mortality were examined. RESULTS: The 11,597 individuals who were hospitalised following self-harm in 2009 experienced 21% higher health service use in the 12 months pre and post the index admission and a higher mortality rate (2.9% vs 0.3%) than their matched counterparts. There were 133 (39.0%) deaths within 2 weeks of hospital discharge and 342 deaths within 12 months of the index hospitalisation in the self-harm cohort. Adjusted rate ratios for hospital readmission were highest for females (2.86; 95% confidence interval: [2.33, 2.52]) and individuals aged 55-64 years (3.96; 95% confidence interval: [2.79, 5.64]). CONCLUSION: Improved quantification of the burden of self-harm-related hospital use can inform resource allocation for intervention and after-care services for individuals at risk of repeated self-harm. Better assessment of at-risk self-harm behaviour, appropriate referrals and improved post-discharge care, focusing on care continuity, are needed.


Asunto(s)
Readmisión del Paciente/estadística & datos numéricos , Conducta Autodestructiva/epidemiología , Conducta Autodestructiva/mortalidad , Adolescente , Adulto , Distribución por Edad , Anciano , Australia/epidemiología , Estudios de Cohortes , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Morbilidad , Alta del Paciente , Factores de Riesgo , Distribución por Sexo , Adulto Joven
18.
Ann Glob Health ; 83(5-6): 791-802, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29248096

RESUMEN

BACKGROUND: Adolescence is a distinct period of rapid and dramatic biological, cognitive, psychological, and social development. The burden of injuries among young people (aged 10-24) is both substantial and maldistributed across regions and levels of economic development. OBJECTIVES: Our objective was to compare sociodemographic correlates of injury cause, intentionality, and mortality between Kenya and Oman, 2 countries with different levels of economic development and position in the demographic and epidemiologic transitions. METHODS: Data on 566 patients in Oman and 5859 in Kenya between 10 and 24 years old were extracted from 2 separate multicenter trauma registries. Multivariable log binomial and Poisson regressions were used to evaluate social and demographic factors associated with injury cause, intentionality, and mortality. Literature on adolescent development was used to parameterize variables, and Akaike information criteria were used in the final model selections. FINDINGS: The trauma registry data indicated a substantial burden of adolescent and young adult injury in both Oman and Kenya, particularly among males. The data indicated significant differences between countries (P < .001) in age category, gender distributions, level of education, occupation, cause of injury, and place where injury occurred. Consistent with other literature, road traffic injuries emerged as the most common type of injury as well as the most severe and fatal, with interpersonal violence also resulting in severe injury across contexts. Both road traffic injuries and interpersonal violence were more common among older adolescents and young adults. Education and being in school were protective against injury, after controlling for gender, age category, occupation, and country. CONCLUSIONS: A rising burden of injuries among young people has been documented in every region of the world, irrespective on income status or level of development. Cost-effective injury control measures targeting this age group exist, including involvement in educational, vocational, and other prosocial activities; environmental alterations; and road safety measures.


Asunto(s)
Accidentes de Tránsito/estadística & datos numéricos , Países en Desarrollo , Desarrollo Económico , Sistema de Registros , Conducta Autodestructiva/epidemiología , Violencia/estadística & datos numéricos , Heridas y Traumatismos/epidemiología , Adolescente , Distribución por Edad , Niño , Escolaridad , Femenino , Humanos , Kenia/epidemiología , Masculino , Análisis Multivariante , Ocupaciones , Omán/epidemiología , Distribución de Poisson , Factores Protectores , Análisis de Regresión , Factores de Riesgo , Conducta Autodestructiva/mortalidad , Distribución por Sexo , Índices de Gravedad del Trauma , Heridas y Traumatismos/mortalidad , Adulto Joven
19.
BMJ ; 359: j4351, 2017 Oct 18.
Artículo en Inglés | MEDLINE | ID: mdl-29046278

RESUMEN

Objectives To examine temporal trends in sex and age specific incidence of self harm in children and adolescents, clinical management patterns, and risk of cause specific mortality following an index self harm episode at a young age.Design Population based cohort study.Setting UK Clinical Practice Research Datalink-electronic health records from 647 general practices, with practice level deprivation measured ecologically using the index of multiple deprivation. Patients from eligible English practices were linked to hospital episode statistics (HES) and Office for National Statistics (ONS) mortality records.Participants For the descriptive analytical phases we examined data pertaining to 16 912 patients aged 10-19 who harmed themselves during 2001-14. For analysis of cause specific mortality following self harm, 8638 patients eligible for HES and ONS linkage were matched by age, sex, and general practice with up to 20 unaffected children and adolescents (n=170 274).Main outcome measures In the first phase, temporal trends in sex and age specific annual incidence were examined. In the second phase, clinical management was assessed according to the likelihood of referral to mental health services and psychotropic drug prescribing. In the third phase, relative risks of all cause mortality, unnatural death (including suicide and accidental death), and fatal acute alcohol or drug poisoning were estimated as hazard ratios derived from stratified Cox proportional hazards models for the self harm cohort versus the matched unaffected comparison cohort.Results The annual incidence of self harm was observed to increase in girls (37.4 per 10 000) compared with boys (12.3 per 10 000), and a sharp 68% increase occurred among girls aged 13-16, from 45.9 per 10 000 in 2011 to 77.0 per 10 000 in 2014. Referrals within 12 months of the index self harm episode were 23% less likely for young patients registered at the most socially deprived practices, even though incidences were considerably higher in these localities. Children and adolescents who harmed themselves were approximately nine times more likely to die unnaturally during follow-up, with especially noticeable increases in risks of suicide (deprivation adjusted hazard ratio 17.5, 95% confidence interval 7.6 to 40.5) and fatal acute alcohol or drug poisoning (34.3, 10.2 to 115.7).Conclusions Gaining a better understanding of the mechanisms responsible for the recent apparent increase in the incidence of self harm among early-mid teenage girls, and coordinated initiatives to tackle health inequalities in the provision of services to distressed children and adolescents, represent urgent priorities for multiple public agencies.


Asunto(s)
Manejo de Atención al Paciente , Atención Primaria de Salud , Psicotrópicos/uso terapéutico , Conducta Autodestructiva , Suicidio/prevención & control , Adolescente , Niño , Bases de Datos Factuales , Femenino , Humanos , Incidencia , Masculino , Servicios de Salud Mental/estadística & datos numéricos , Manejo de Atención al Paciente/métodos , Manejo de Atención al Paciente/organización & administración , Manejo de Atención al Paciente/estadística & datos numéricos , Atención Primaria de Salud/métodos , Atención Primaria de Salud/estadística & datos numéricos , Modelos de Riesgos Proporcionales , Medición de Riesgo , Factores de Riesgo , Conducta Autodestructiva/diagnóstico , Conducta Autodestructiva/mortalidad , Conducta Autodestructiva/psicología , Conducta Autodestructiva/terapia , Factores Sexuales , Suicidio/estadística & datos numéricos , Reino Unido/epidemiología
20.
Cien Saude Colet ; 22(7): 2375-2382, 2017 Jul.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-28724019

RESUMEN

This paper aimed to compare the profile of mortality from external causes among Seventh-day Adventists and the general population of Espírito Santo from 2003 to 2009. A search of Adventists was performed in the nominal database of the Mortality Information System containing data on Adventists provided by the administrative offices of the institution. Deaths from external causes occurred during the study period were then divided into two groups: Adventists and the general population. Adventists had lower proportional mortality from external causes (10%) than the general population (19%), and males were the main reason for this difference. In both groups, deaths prevailed in the 20-29 years age group. Deaths from accidental causes were most significant among Adventists (68.08%), while deaths from intentional causes related to assault and self-inflicted injuries were more significant in the general population (53.67% of all deaths). The standardized mortality ratio for external causes was 41.3, thus, being Adventist reduced mortality by 58.7%. It is believed that the benefit of Adventists observed for mortality from external causes is related to this group's abstinence from alcohol consumption.


Asunto(s)
Accidentes/estadística & datos numéricos , Abstinencia de Alcohol/estadística & datos numéricos , Consumo de Bebidas Alcohólicas/epidemiología , Protestantismo , Accidentes/mortalidad , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Consumo de Bebidas Alcohólicas/mortalidad , Brasil/epidemiología , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Mortalidad/tendencias , Conducta Autodestructiva/epidemiología , Conducta Autodestructiva/mortalidad , Distribución por Sexo , Violencia/estadística & datos numéricos , Adulto Joven
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