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1.
Lancet Public Health ; 6(1): e39-e49, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33417845

RESUMEN

BACKGROUND: Suicide rates in young people have increased in England and Wales since 2010. There are a range of possible explanations for this increase, and problem gambling has been suggested as a potential risk factor. We aimed to examine the association between suicidality (suicidal thoughts and suicide attempts) and problem gambling specifically for young adults in Great Britain, where gambling has become more widely available and normalised in the past two decades. METHODS: We analysed data from the Emerging Adults Gambling Survey: a cross-sectional, online, non-probability sample survey of young adults aged 16-24 years living in Great Britain, who were selected from a YouGov online panel. Participants were eligible if they had not taken part in any other YouGov survey on gambling in the past year. We examined associations between problem gambling (defined as a score of 8 or higher on the Problem Gambling Severity Index [PGSI]) and suicidal thoughts and suicide attempts in the year before survey completion in a series of regression models, with and without adjustment for sociodemographic factors, alcohol use, video gaming, anxiety, loneliness, and impulsivity. FINDINGS: 3549 eligible participants completed the survey between June 25 and Aug 16, 2019. 24 (37·0% [95% CI 25·6-50·2]) of 62 men who had attempted suicide in the past year had survey scores that were indicative of problem gambling, compared with 38 (3·6% [2·6-5·0]) of 1077 men who had not attempted suicide or had suicidal thoughts in the past year. 13 (14·5% [8·5-23·6]) of 85 women who had attempted suicide in the past year had survey scores that were indicative of problem gambling, compared with 25 (2·0% [1·4-3·0]) of 1184 women who had not attempted suicide or had suicidal thoughts in the past year. The adjusted odds ratio for attempted suicide was 9·0 (4·1-19·7) in men with scores that indicated problem gambling and 4·9 (2·0-12·0) in women with scores that indicated problem gambling, compared with participants of the same gender with PGSI scores of 0. INTERPRETATION: Problem gambling appears to be associated with suicide attempts in both young men and young women. This association persisted after adjusting for anxiety, impulsivity, life satisfaction, and other factors, which suggests that other mechanisms, such as the severity and multiplicity of harms experienced, or gambling to cope with life stressors, might underpin this relationship. Young people with problem-gambling behaviours should be considered at risk for suicidality. FUNDING: Wellcome Trust.


Asunto(s)
Conducta Adictiva/psicología , Juego de Azar/psicología , Ideación Suicida , Intento de Suicidio/estadística & datos numéricos , Adolescente , Conducta Adictiva/epidemiología , Estudios Transversales , Femenino , Juego de Azar/epidemiología , Humanos , Masculino , Factores de Riesgo , Encuestas y Cuestionarios , Reino Unido/epidemiología , Adulto Joven
2.
Asian J Psychiatr ; 56: 102509, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33418284

RESUMEN

Coronavirus disease 2019 (COVID-19) was recently declared a pandemic by the WHO. This outbreak threatens not only physical health but also has significant repercussions on mental health. In recent world history, major infectious outbreaks were associated with severe mental health sequelae, including suicide. In this study, we systematically review the literature on suicidal outcomes during major international respiratory outbreaks, including COVID-19. We reviewed descriptive and analytic articles addressing suicide during major international respiratory outbreaks. We searched PubMed, Medline, Embase, Scopus, and PsycInfo databases and then utilized an independent method for study selection by a pair of reviewers. Two reviewers completed data abstraction and conducted a narrative summary of the findings. Our search generated 2,153 articles. Nine studies (three descriptive, five analytical, and one with mixed methodology) were eligible. The included studies were heterogeneous, divergent in methods, and with a low degree of evidence. Deducing an association between pandemics, suicide, and suicide-related outcomes remains thus poorly supported. Future research with better methodological characteristics, the use of longitudinal studies, and a focus on suicide as the primary outcome would allow for an in-depth understanding and formulation of the scope of this problem.


Asunto(s)
/epidemiología , Brotes de Enfermedades , Gripe Humana/epidemiología , Síndrome Respiratorio Agudo Grave/epidemiología , Ideación Suicida , Suicidio/estadística & datos numéricos , Infecciones por Coronavirus/epidemiología , Humanos , Intento de Suicidio/estadística & datos numéricos , Suicidio Completo/estadística & datos numéricos
3.
J Psychiatr Res ; 134: 32-38, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33360222

RESUMEN

Evidence suggests that the negative consequences of COVID-19 may extend far beyond its considerable death toll, having a significant impact on psychological well-being. Despite work highlighting the link between previous epidemics and elevated suicide rates, there is limited research on the relationship between the COVID-19 pandemic and suicidal thoughts and behaviors. Utilizing an online survey, the current study aimed to better understand the presence, and extent, of the association between COVID-19-related experiences and past-month suicidal thoughts and behaviors among adults in the United States recruited via Amazon Mechanical Turk (n = 907). Results support an association between several COVID-19-related experiences (i.e., general distress, fear of physical harm, effects of social distancing policies) and past-month suicidal ideation and suicide attempts. Further, a significant proportion of those with recent suicidal ideation explicitly link their suicidal thoughts to COVID-19. Exploratory analyses highlight a potential additional link between COVID-19 and suicidal behavior, suggesting that a portion of individuals may be intentionally exposing themselves to the virus with intent to kill themselves. These findings underscore the need for suicide risk screening and access to mental health services during the current pandemic. Particular attention should be paid to employing public health campaigns to disseminate information on such services to reduce the enormity of distress and emotional impairment associated with COVID-19 in the United States.


Asunto(s)
/psicología , Cuarentena/psicología , Ideación Suicida , Intento de Suicidio/psicología , Intento de Suicidio/estadística & datos numéricos , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Riesgo , Estados Unidos , Adulto Joven
6.
Epidemiol Psychiatr Sci ; 29: e175, 2020 Oct 19.
Artículo en Inglés | MEDLINE | ID: mdl-33070799

RESUMEN

AIMS: Previous studies regarding associations between depressive symptoms and suicidality (suicidal ideation, plans and attempts) have usually employed a variable-centred approach, without considering the individual variance in time-varying changes of depressive symptoms. Through 10-year follow-up of a large cohort of Chinese adolescents exposed to the 2008 Wenchuan earthquake, this study examined whether individual variance in depressive symptoms during the early phases post-earthquake could generate different suicidality outcomes in young adulthood. METHODS: A total of 1357 Chinese adolescents exposed to the Wenchuan earthquake were surveyed on depressive symptoms and other variables at 6, 18 and 30 months post-earthquake. In total, 799 participants responded to the 10-year follow-up and completed an online survey covering suicidality and other variables. The analytic sample was 744 participants who had valid data on depressive symptoms and suicidality. Data were analysed using logistic regressions. RESULTS: Prevalence estimates of past-year suicidal ideation, suicide plans and suicide attempts measured at 10 years post-earthquake were found to be 10.8%, 7.3% and 3.0%, respectively. Five trajectories of depressive symptoms were classified: resistance (54.4%), chronicity (13.3%), recovery (10.4%), delayed dysfunction (12.0%) and relapsing/remitting (10.0%). After controlling for covariates, whole-sample regressions revealed only the relapsing/remitting depressive trajectory remained significantly predictive of suicidality. Moreover, males not females in the chronic group were more likely to have suicide plans. CONCLUSIONS: The findings highlight the importance of detecting disaster survivors with different trajectories of mental status and providing with them individualised and effective mental health services, to decrease their risk of suicidality in the future.


Asunto(s)
Grupo de Ascendencia Continental Asiática/psicología , Terremotos , Trastornos por Estrés Postraumático/psicología , Ideación Suicida , Intento de Suicidio/estadística & datos numéricos , Adaptación Psicológica , Adolescente , Grupo de Ascendencia Continental Asiática/estadística & datos numéricos , Estudios de Cohortes , Depresión/diagnóstico , Depresión/etnología , Depresión/psicología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Prevalencia , Factores de Riesgo , Distribución por Sexo , Trastornos por Estrés Postraumático/etnología , Suicidio/psicología , Intento de Suicidio/psicología , Encuestas y Cuestionarios , Sobrevivientes
7.
Medicine (Baltimore) ; 99(40): e22514, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019453

RESUMEN

Despite the controversy surrounding electronic cigarette (e-cigarette) safety, global consumption has been rapidly increasing. We investigated the relationship between e-cigarette use and mental health conditions in adults of various ages.We conducted a secondary data analysis of adults aged 19 to 80 who participated in the first year of the 7th Korea National Health and Nutrition Examination Survey (2016). The total number of participants was 5469, including 3398 non-smokers, 1700 smokers who had never used e-cigarettes, and 371 smokers who had previously used e-cigarettes, selected based on self-report questionnaires. Mental health factors including stress status, depressive mood, suicide plan, and suicide attempt were assessed by self-reported questionnaire. The Patient Health Questionnaire (PHQ-9) was used to assess depressive mood, with a cut-off value of 10. The relationship between e-cigarette use and stress status with depressive mood were analyzed with adjustment for potential confounders.Both male and female smokers who previously used e-cigarettes showed higher levels of stress than non-smokers or smokers who had never used e-cigarettes. The average PHQ-9 score was higher among previous e-cigarette-using smokers relative to non-smokers and smokers who had never used e-cigarettes, regardless of gender. The number of participants with depressive mood was significantly higher in the group of smokers who previously used e-cigarettes. In multivariable-adjusted logistic regression analyses, there was a significantly higher odds ratio for higher stress in male smokers who had previously used e-cigarettes and for depressive mood in female smokers who had previously used e-cigarettes, compared with non-smokers.This study analyzed the association between adult e-cigarette use and mental health conditions, including stress and depressive mood, and showed that e-cigarette use was significantly related to both conditions in men and women.


Asunto(s)
Depresión/epidemiología , Sistemas Electrónicos de Liberación de Nicotina/estadística & datos numéricos , Salud Mental/estadística & datos numéricos , Estrés Psicológico/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , República de Corea/epidemiología , Intento de Suicidio/estadística & datos numéricos , Adulto Joven
8.
BMJ ; 370: m2984, 2020 09 02.
Artículo en Inglés | MEDLINE | ID: mdl-32878868

RESUMEN

OBJECTIVE: To analyse the relation between exposure to workplace sexual harassment and suicide, as well as suicide attempts. DESIGN: Prospective cohort study. SETTING: Sweden. PARTICIPANTS: 86 451 men and women of working age in paid work across different occupations responded to a self-report questionnaire including exposure to work related sexual harassment between 1995 and 2013. The analytical sample included 85 205 people with valid data on sexual harassment, follow-up time, and age. MAIN OUTCOME MEASURES: Suicide and suicide attempts ascertained from administrative registers (mean follow-up time 13 years). RESULTS: Among the people included in the respective analyses of suicide and suicide attempts, 125 (0.1%) died from suicide and 816 (1%) had a suicide attempt during follow-up (rate 0.1 and 0.8 cases per 1000 person years). Overall, 11 of 4095 participants exposed to workplace sexual harassment and 114 of 81 110 unexposed participants committed suicide, and 61/4043 exposed and 755/80 513 unexposed participants had a record of suicide attempt. In Cox regression analyses adjusted for a range of sociodemographic characteristics, workplace sexual harassment was associated with an excess risk of both suicide (hazard ratio 2.82, 95% confidence interval 1.49 to 5.34) and suicide attempts (1.59, 1.21 to 2.08), and risk estimates remained significantly increased after adjustment for baseline health and certain work characteristics. No obvious differences between men and women were found. CONCLUSIONS: The results support the hypothesis that workplace sexual harassment is prospectively associated with suicidal behaviour. This suggests that suicide prevention considering the social work environment may be useful. More research is, however, needed to determine causality, risk factors for workplace sexual harassment, and explanations for an association between work related sexual harassment and suicidal behaviour.


Asunto(s)
Acoso Sexual/psicología , Intento de Suicidio/prevención & control , Intento de Suicidio/psicología , Lugar de Trabajo/psicología , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Autoinforme , Acoso Sexual/estadística & datos numéricos , Ideación Suicida , Intento de Suicidio/estadística & datos numéricos , Encuestas y Cuestionarios , Suecia/epidemiología
9.
BMC Dermatol ; 20(1): 10, 2020 09 29.
Artículo en Inglés | MEDLINE | ID: mdl-32993599

RESUMEN

BACKGROUND: Chronic illnesses belong to suicide risk factors. The goal of the current study was to estimate the rate of suicide-related behaviors in patients with atopic dermatitis, psoriasis, or acne from a third-person perspective (namely, Austrian dermatologists). METHODS: A link to a questionnaire specially developed for this study was emailed to 450 self-employed dermatologists in Austria, from which a total of 45 participated. RESULTS: Three dermatologists reported more than five patients with atopic dermatitis, psoriasis, or acne who committed suicide in 2017. Seven doctors treated between 1 and 10 such patients suffering from suicidal ideation. These results are suggestive for a low rate of suicidal ideations in Austrian dermatology ordinations. The majority of dermatologists in the sample (82%) knew that these patients are at higher suicide risk. 60% of participants also believed that it rather would not be a problem for them to recognize suicidal ideation. When facing patients in a suicide crisis, reported intervention steps were: referring them to a specialist in psychiatry, or having a conversation about it. In the sample, most challenging about suicide was lack of time and lack of knowledge. Dermatologists were also interested in cooperating with mental health professionals and in the implementation of new prevention strategies (e.g., suicide-related training programs). Analysis revealed that private specialists, as compared with contract physicians, had fewer patients, but spent more time with them. Yet, these differences did not appear to influence the quality of treatment they provided. Treatment quality was defined as the extent to which doctors tell their patients that additional psychological treatments could be helpful and asking them about their emotional state. Female gender and a professional background in psychology impacted positively on treatment quality. CONCLUSIONS: Possible explanations for the low rate of suicidal ideations reported include the advanced Austrian health care system and dermatologists' underestimation of the problem. Implications of the study are to promote cooperation between dermatologists and mental health professionals and to address patient suicidality from a first-person perspective (i.e., the patients).


Asunto(s)
Dermatólogos , Conocimientos, Actitudes y Práctica en Salud , Enfermedades de la Piel/psicología , Ideación Suicida , Actitud del Personal de Salud , Austria , Enfermedad Crónica/psicología , Femenino , Humanos , Masculino , Prevalencia , Factores Sexuales , Estadísticas no Paramétricas , Suicidio/prevención & control , Suicidio/estadística & datos numéricos , Intento de Suicidio/estadística & datos numéricos , Encuestas y Cuestionarios
10.
Pediatrics ; 146(4)2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32958610

RESUMEN

BACKGROUND: Gender-incongruent (GI) youth have high rates of mental health problems. Although gender-affirming medical care (GAMC) provides psychological benefit, some GI youth present to care at older ages. Whether a relationship exists between age of presentation to GAMC and mental health difficulties warrants study. METHODS: A cross-sectional chart review of patients presenting to GAMC. Subjects were classified a priori as younger presenting youth (YPY) (<15 years of age at presentation) or older presenting youth (OPY) (≥15 years of age). Self-reported rates of mental health problems and medication use were compared between groups. Binary logistic regression analysis was used to identify determinants of mental health problems. Covariates included pubertal stage at presentation, social transition status, and assigned sex. RESULTS: Of 300 youth, there were 116 YPY and 184 OPY. After presentation, more OPY than YPY reported a diagnosis of depression (46% vs 30%), had self-harmed (40% vs 28%), had considered suicide (52% vs 40%), had attempted suicide (17% vs 9%), and required psychoactive medications (36% vs 23%), with all P < .05. After controlling for covariates, late puberty (Tanner stage 4 or 5) was associated with depressive disorders (odds ratio 5.49; 95% confidence interval [CI]: 1.14-26.32) and anxiety disorders (odds ratio 4.18 [95% CI: 1.22-14.49]), whereas older age remained associated only with psychoactive medication use (odd ratio 1.31 [95% CI: 1.05-1.63]). CONCLUSIONS: Late pubertal stage and older age are associated with worse mental health among GI youth presenting to GAMC, suggesting that this group may be particularly vulnerable and in need of appropriate care.


Asunto(s)
Factores de Edad , Disforia de Género/psicología , Disforia de Género/terapia , Trastornos Mentales/epidemiología , Transexualidad/psicología , Transexualidad/terapia , Adolescente , Antipsicóticos/uso terapéutico , Trastornos de Ansiedad/epidemiología , Niño , Estudios Transversales , Depresión/epidemiología , Trastorno Depresivo/epidemiología , Revelación , Humanos , Modelos Logísticos , Trastornos Mentales/tratamiento farmacológico , Salud Mental , Pubertad , Conducta Autodestructiva/epidemiología , Factores Sexuales , Ideación Suicida , Intento de Suicidio/estadística & datos numéricos
11.
Isr Med Assoc J ; 9(22): 481-485, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32954693

RESUMEN

BACKGROUND: Acetaminophen is the most common drug involved in pediatric poisonings, both intentionally and accidentally, and is the leading cause of acute liver failure among all age groups. OBJECTIVES: To define the characteristics of patients admitted to a pediatric emergency department (ED) where serum acetaminophen concentrations were measured, and to determine which variables are associated with significant risk of acetaminophen toxicity. METHODS: Acetaminophen serum concentrations were measured, in a retrospective case series, of patients younger than 18 years who had been admitted to the ED at Shamir Medical Center between 1 January 2008 and 31 December 2015. RESULTS: During the study period 180,174 children were admitted to the ED. Acetaminophen serum concentrations were measured in 209 (0.12%) patients. Mean age was 12.4 ± 5.9 years. Elevated liver enzymes were found in 12 patients, 5 of whom had documented acute liver injury. All five were older than 11years.Two cases of acute liver injury were attributable to acetaminophen ingestion. In both cases the cause was intentional overdose. Univariate analysis showed a significant (P < 0.05) correlation between detectable acetaminophen blood level and a positive history of drug or acetaminophen ingestion, and suicide attempt. Not all children with non-severe acetaminophen poisoning had been diagnosed during the study period. A positive history of acetaminophen ingestion was associated with a 28-fold higher risk for detectable acetaminophen blood level. CONCLUSIONS: In the absence of a positive history of acetaminophen ingestion and in young children with accidental intoxication, the risk of hepatotoxicity is relatively low.


Asunto(s)
Acetaminofén/envenenamiento , Analgésicos no Narcóticos/envenenamiento , Enfermedad Hepática Inducida por Sustancias y Drogas/epidemiología , Sobredosis de Droga/epidemiología , Servicio de Urgencia en Hospital , Acetaminofén/sangre , Adolescente , Analgésicos no Narcóticos/sangre , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Israel , Masculino , Estudios Retrospectivos , Intento de Suicidio/estadística & datos numéricos
12.
BMC Public Health ; 20(1): 1102, 2020 Aug 10.
Artículo en Inglés | MEDLINE | ID: mdl-32772922

RESUMEN

BACKGROUND: Understanding the burden and determinants of suicide during adolescence is key to achieving global health goals. We examined the prevalence and determinants of self-reported suicidal ideation and attempts among younger (13-15 years) and older adolescents (16-17 years). METHODS: Pooled prevalence estimates with 95% confidence interval, were calculated for suicide ideation and attempts for 118 surveys from 90 countries that administered the Global School-based Student Health Survey (GSHS) to adolescents (13-17 years of age) from 2003 to 2017. Indicators (including individual and social factors) associated with suicidal ideation and attempts were determined from multivariable linear regressions on key outcomes. RESULTS: The prevalence of suicidal ideation representing 397,299 adolescents (51.3% female) was significantly higher among girls than boys whereas attempts did not differ by age or sex. Being bullied, or having no close friends was associated with suicidal ideation among girls 13-15 years and 16-17 years, respectively. Among all boys, being in a fight and having no close friends was associated with suicidal ideation with the addition of serious injury for boys 13-15 years. Common to all younger adolescents was an association of suicide attempt with being bullied and having had a serious injury. Among young boys, having no close friends was an additional indicator for suicide attempt. Having no close friends was associated with suicide attempt in older adolescents with the addition to being bullied in older girls and serious injury in older boys. CONCLUSIONS: Building positive social relationships with peers and avoiding serious injury appear key to suicide prevention strategies for vulnerable adolescents. Targeted programs by age group and sex for such indicators could improve mental health during adolescence in low and middle-income countries, given the diverse risk profiles for suicidal ideation and attempts.


Asunto(s)
Salud Global/estadística & datos numéricos , Estudiantes/psicología , Ideación Suicida , Adolescente , Acoso Escolar/estadística & datos numéricos , Femenino , Amigos , Encuestas Epidemiológicas , Humanos , Relaciones Interpersonales , Masculino , Prevalencia , Factores de Riesgo , Instituciones Académicas , Estudiantes/estadística & datos numéricos , Intento de Suicidio/estadística & datos numéricos
13.
PLoS One ; 15(8): e0236880, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32764776

RESUMEN

Sexual minority (SM) youth are at high risk for intimate partner violence (IPV) and suicidal ideation/attempts compared to their heterosexual peers. We examined whether SM identity enhanced the relationship between experiences of IPV and suicidal ideation/attempts. Weighted logistic regression models were run using the 2017 Youth Risk Behavior Survey. All main effects were significant; each SM identity and both physical and sexual IPV were significantly associated with suicidal ideation and suicide attempts. The interaction between bisexual identity and physical IPV was significant for suicidal ideation; as physical IPV experiences increased, the difference between bisexual identity and heterosexual youth was non-significant. Findings suggest exploring trauma and suicidal ideation by aggregate groups and increasing support for SM youth in schools and communities.


Asunto(s)
Violencia de Pareja/estadística & datos numéricos , Minorías Sexuales y de Género/psicología , Minorías Sexuales y de Género/estadística & datos numéricos , Ideación Suicida , Intento de Suicidio/estadística & datos numéricos , Adolescente , Niño , Femenino , Humanos , Violencia de Pareja/psicología , Modelos Logísticos , Masculino , Factores de Riesgo , Intento de Suicidio/psicología
14.
Am J Psychiatry ; 177(10): 928-935, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-32854532

RESUMEN

OBJECTIVE: The authors aimed to clarify the sources of parent-child transmission for suicide attempt and death by suicide. METHODS: Three sources of parent-child resemblance (genes plus rearing, genes only, and rearing only) were examined in parents and offspring from four family types from Swedish national samples: intact nuclear families, families with a not-lived-with biological father, families with a stepfather, and adoptees and their biological and adoptive parents. Parent-child resemblance was assessed primarily by tetrachoric correlation. RESULTS: For suicide attempt to suicide attempt transmission, best-estimate tetrachoric correlations for genes plus rearing, genes only, and rearing only were 0.23 (95% CI=0.23, 0.24), 0.13 (95% CI=0.11, 0.15), and 0.14 (95% CI=0.11, 0.16), respectively. Suicide attempt was more strongly transmitted to male offspring compared with female offspring. Parental psychiatric disorders accounted for 40% of the genetic transmission but had no impact on rearing effects. For suicide death to suicide death transmission, best estimates of tetrachoric correlations for genes plus rearing, genes only, and rearing only were 0.16 (95% CI=0.15, 0.18), 0.07 (95% CI=0.02, 0.12), and -0.05 (95% CI=-0.17, 0.07), respectively. Although the suicide attempt-suicide death genetic correlation was high (0.84), the hypothesis that they reflect behaviors only differing in severity on the same continuum of genetic liability could be rejected. CONCLUSIONS: The transmission of suicide attempt across generations is moderately strong and arises equally from genetic and rearing effects. Parental psychiatric illness explains almost half of the genetic transmission of suicide attempt but none of the rearing effect. Suicide death is modestly transmitted across generations, probably via genetic effects, although rearing may play a role. While suicide attempt and suicide death share a substantial proportion of their hereditary risk, they do not, from a genetic perspective, simply reflect milder and more severe forms of the same diathesis.


Asunto(s)
Relaciones Padres-Hijo , Intento de Suicidio/estadística & datos numéricos , Suicidio Completo/estadística & datos numéricos , Adolescente , Adopción/psicología , Adulto , Niño , Crianza del Niño/psicología , Femenino , Predisposición Genética a la Enfermedad/epidemiología , Predisposición Genética a la Enfermedad/psicología , Humanos , Masculino , Persona de Mediana Edad , Sistema de Registros , Factores de Riesgo , Factores Sexuales , Suecia/epidemiología , Adulto Joven
15.
J Clin Psychiatry ; 81(5)2020 07 28.
Artículo en Inglés | MEDLINE | ID: mdl-32726001

RESUMEN

OBJECTIVE: The Affordable Care Act (ACA) of 2010 was fully implemented in 2014, expanding access to outpatient mental health services and potentially reducing reliance on emergency (ED) services. This study examined trends and correlates of ED visits for mental health conditions from 2007 to 2016, with attention to changes in ED use after 2014. METHODS: Nationally representative samples of ED visits in the United States were assessed using a repeated cross-sectional analysis of National Hospital Ambulatory Medical Care Survey data. This study used diagnoses associated with each ED visit to identify changes in proportions in mental health diagnostic categories (psychiatric diagnoses only, substance use-related diagnoses only, or both, based on ICD-9-CM or ICD-10-CM criteria). These trends were further examined by age, sex, race/ethnicity, and insurance status. The statistical significance of temporal patterns was evaluated with multivariate logistic regression analyses. RESULTS: Between 2007 and 2016, about 8.4 million (8.3%) of 100.9 million ED visits nationwide were for psychiatric or substance use-related diagnoses. Over the 10-year study period, the proportion of ED visits for mental health diagnoses increased from 6.6% to 10.9% (P < .001). Visits for alcohol and "other" substance use and psychiatric diagnoses classified as "other" accounted for an increasing portion of mental health-related ED visits during this time (P < .001). ED visits in which Medicaid was the primary source of insurance coverage showed the largest increase, nearly doubling from 27.2% in 2007-2008 to 42.8% in 2015-2016 (adjusted odds ratio for linear trends = 1.71; 95% CI, 1.36-2.15). CONCLUSIONS: ED utilization for mental health conditions-and especially substance use conditions-significantly increased in the last decade. The increasing use of EDs by patients with mental health conditions may indicate suboptimal delivery of effective or acceptable outpatient mental health care, particularly for substance use-related conditions.


Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Trastornos Mentales/terapia , Aceptación de la Atención de Salud/estadística & datos numéricos , Adulto , Factores de Edad , Anciano , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/terapia , Femenino , Humanos , Masculino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Trastornos del Humor/epidemiología , Trastornos del Humor/terapia , Trastornos Psicóticos/epidemiología , Trastornos Psicóticos/terapia , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/terapia , Intento de Suicidio/estadística & datos numéricos , Estados Unidos/epidemiología , Adulto Joven
16.
S Afr Med J ; 110(5): 400-402, 2020 Apr 29.
Artículo en Inglés | MEDLINE | ID: mdl-32657725

RESUMEN

BACKGROUND: Hanging is a common form of self-harm, and emergency care physicians will not infrequently be called upon to manage a survivor.Despite the relative frequency of the injury, there is a paucity of literature on the topic and the spectrum and incidence of associated injuries are poorly described. OBJECTIVES: To review experience with management of victims of hanging at a major trauma centre in South Africa. METHODS: All patients treated by the Pietermaritzburg Metropolitan Trauma Service following a hanging incident between December 2012 and December 2018 were identified from the Hybrid Electronic Medical Registry. Basic demographics were recorded, and the management and outcome of each patient were noted. RESULTS: During the 6-year period under review, a total of 154 patients were seen following a hanging incident. The mean age was 29.4 years. There were 24 females (15.6%) and 130 males (84.4%). The vast majority (n=150; 97.5%) had attempted suicide, and only 4 hangings (2.5%) were accidental. A total of 92 patients (60.9%) had consumed alcohol prior to the incident. There were 23 patients with a Glasgow Coma Score (GCS) <9 (severe traumatic brain injury (TBI)), 14 with a GCS of 9 - 12 (moderate TBI) and 117 with a GCS >12 (mild TBI). A total of 7 patients (4.5%) required intensive care unit admission, and 25 (16.2%) required intubation. The following extracranial injuries were documented on computed tomography scans: hyoid bone fractures (n=2), cervical spine fracture (n=10), mandible fracture (n=4) and oesophageal injury (n=1). Intracranial pathology was evident on 27.0% of scans, with the most common finding being global cerebral ischaemia. The mortality rate was 2.5% (4/154). CONCLUSIONS: Hanging is a common mechanism of self-harm. It is associated with significant injuries and mortality. The acute management of hanging should focus on airway protection followed by detailed imaging of the head and neck. Further work must attempt to include mortuary data on hanging.


Asunto(s)
Accidentes/estadística & datos numéricos , Asfixia/epidemiología , Traumatismos del Cuello/epidemiología , Intento de Suicidio/estadística & datos numéricos , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/epidemiología , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/lesiones , Esófago/diagnóstico por imagen , Esófago/lesiones , Femenino , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/epidemiología , Escala de Coma de Glasgow , Humanos , Hueso Hioides/diagnóstico por imagen , Hueso Hioides/lesiones , Unidades de Cuidados Intensivos/estadística & datos numéricos , Intubación Intratraqueal/estadística & datos numéricos , Masculino , Fracturas Mandibulares/diagnóstico por imagen , Fracturas Mandibulares/epidemiología , Estudios Retrospectivos , Distribución por Sexo , Sudáfrica/epidemiología , Tomografía Computarizada por Rayos X , Centros Traumatológicos
17.
Epidemiol Health ; 42: e2020052, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32660215

RESUMEN

OBJECTIVES: This study was performed to explore socioeconomic factors associated with suicidal ideation and suicidal attempts among the local community's resident elderly. METHODS: The subjects included 129,277 participants aged 65 years or above of the Korea Community Health Survey conducted in 2013 and 2017. Based on the questions for suicidal ideation and suicidal attempts, the subjects were divided into a no suicidal ideation group (n=111,344), a suicidal ideation group (n=17,487), and a suicidal attempt group (n=446). All analyses were stratified by gender, and a complex sample logistic regression analysis was performed to analyze associated factors. SAS version 9.4 was used for all analyses with a significance level of 0.05. RESULTS: Common factors associated with suicidal ideation in both genders included marital status, frequency of contact with friends, social activity, and average monthly household income. Economic activity was demonstrated as relevant only to the elderly men subjects. According to the analysis, factors associated with suicidal attempts were the recipients of the National Basic Living Security Act for the elderly men compared to age, frequency of contact with family, frequency of contact with friends, and average monthly household income for the elderly women. CONCLUSIONS: The study revealed that socioeconomic factors leading to suicidal ideation were similar in the elderly of both genders, while a difference was demonstrated for factors associated with suicidal attempts between the elderly of both genders. It is expected that the results of this study may be used as the basis for screening the local community's elderly with a high suicidal risk, and in the development of suicide prevention services.


Asunto(s)
Ideación Suicida , Intento de Suicidio/estadística & datos numéricos , Anciano , Femenino , Encuestas Epidemiológicas , Humanos , Vida Independiente , Masculino , República de Corea , Factores Sexuales , Factores Socioeconómicos
18.
Epidemiol Psychiatr Sci ; 29: e140, 2020 Jul 08.
Artículo en Inglés | MEDLINE | ID: mdl-32635966

RESUMEN

AIMS: Mental ill-health is a known risk factor for suicide mortality. However, the relationship between physical ill-health and suicide is less clear. This study examined the relationship between different aspects of physical ill-health and the risk of suicide death. METHODS: Data for 1 196 364 adults (aged 18 years and over) were identified from the 2011 Northern Ireland Census and linked to death registrations until the end of 2015. Multivariate logistic regression was used to construct models to test associations with likelihood ratio tests for interactions. RESULTS: Over one in eight individuals (13.7%) reported multimorbidity (⩾2 physical health conditions) and one in four (25.4%) identified having limitation of daily activities. During follow-up, 51 672 individuals died; 877 due to suicide. The gradient in suicide risk by number of physical conditions disappeared following adjustment for activity limitation. Individuals with a lot of activity limitation were over three times more likely to die by suicide (OR = 3.13, 95% CI 2.50-3.93) compared to those with no limitations though this was reduced to OR = 1.72 (95% CI 1.35-2.20) with adjustment for poor mental health. The relationship between activity limitation and suicide was most pronounced at younger ages (18-34 years). CONCLUSIONS: This study suggests that it is the effect that physical illness has on a person's life, in terms of disruption to daily activity, rather than the number of conditions that predicts suicide risk, especially at younger ages. Improved awareness and better management of mental wellbeing of individuals with physical health conditions may help to reduce suicides, especially in younger people.


Asunto(s)
Enfermedad Crónica/psicología , Calidad de Vida , Intento de Suicidio/estadística & datos numéricos , Suicidio/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Censos , Enfermedad Crónica/epidemiología , Femenino , Estudios de Seguimiento , Estado de Salud , Humanos , Irlanda/epidemiología , Masculino , Salud Mental , Persona de Mediana Edad , Mortalidad , Multimorbilidad , Factores de Riesgo , Suicidio/psicología , Intento de Suicidio/psicología , Adulto Joven
19.
PLoS One ; 15(7): e0235379, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32628722

RESUMEN

AIM: To estimate the pooled prevalence and incidence of suicidal ideation, attempts, and deaths in people with sleep apnea. METHOD: We will identify epidemiological studies reporting the prevalence or incidence rate of suicide in people with sleep apnea. We will search the following databases: PubMed (MEDLINE), Scopus, Cochrane Library, OVID (HEALTH STAR), OVID (MEDLINE) and Joana Briggs Institute EBF Database. No age, geographical location, study-design or language limits will be applied. This protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. Two reviewers (YY and YP) will independently screen citations, abstracts and will identify full-text articles for inclusion, extract data, and appraise the quality and bias of included studies. Discrepancies will be resolved by consulting with a third researcher (MC). Study quality will be assessed by the Newcastle-Ottawa Scale. The primary outcomes will be the overall prevalence or incidence of suicidal ideation, attempts and completion and the risk of suicide in people with sleep apnea. For pooling of the studies, we will use a random-effects model with a logit transformation. The DerSimonian and Laird (DL) random-effects method will be used to estimate the pooled inter-study variance. We will assess the between-study heterogeneity using I2 statistics, and Cochrane's Q statistic (significance level < 0.05). If the I2 is high (>75%), we will perform subgroup meta-analyses and conduct a meta-regression analysis to explore sources of study heterogeneity using study level median age, study-level proportions of race, gender, depression and quality scores. We will report effect estimates as suicide risk per 1000 individuals. Egger's test and funnel plots will be used to assess publication bias, and adjusted estimates using trim and fill methods will be reported if publication bias is suspected. ETHICS AND DISSEMINATION: No ethics clearance is required as no primary data will be collected. The results of this systematic review and meta-analysis will be presented at scientific conferences and published in a peer-review journal. The results may shed more light on the burden of suicide risk among individuals with sleep apnea and may guide future population-specific interventions. TRIAL REGISTRATION: PROSPERO registration number: CRD42020165404.


Asunto(s)
Proyectos de Investigación , Síndromes de la Apnea del Sueño/complicaciones , Ideación Suicida , Intento de Suicidio/estadística & datos numéricos , Suicidio Completo/estadística & datos numéricos , Humanos , Incidencia , Metaanálisis como Asunto , Prevalencia , Investigación Cualitativa , Síndromes de la Apnea del Sueño/psicología , Intento de Suicidio/psicología , Revisiones Sistemáticas como Asunto
20.
Lancet Psychiatry ; 7(8): 682-691, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32711709

RESUMEN

BACKGROUND: Self-harm is a leading cause of morbidity in prisoners. Although a wide range of risk factors for self-harm in prisoners has been identified, the strength and consistency of effect sizes is uncertain. We aimed to synthesise evidence and assess the risk factors associated with self-harm inside prison. METHODS: In this systematic review and meta-analysis, we searched four electronic databases (PubMed, Embase, Web of Science, and PsycINFO) for observational studies on risk factors for self-harm in prisoners published from database inception to Oct 31, 2019, supplemented through correspondence with authors of studies. We included primary studies involving adults sampled from general prison populations who self-harmed in prison and a comparison group without self-harm in prison. We excluded studies with qualitative or ecological designs, those that reported on lifetime measures of self-harm or on selected samples of prisoners, and those with a comparison group that was not appropriate or not based on general prison populations. Data were extracted from the articles and requested from study authors. Our primary outcome was the risk of self-harm for risk factors in prisoners. We pooled effect sizes as odds ratios (OR) using random effects models for each risk factor examined in at least three distinct samples. We assessed study quality on the basis of the Newcastle-Ottawa Scale and examined between-study heterogeneity. The study protocol was registered with PROSPERO, CRD42018087915. FINDINGS: We identified 35 independent studies from 20 countries comprising a total of 663 735 prisoners, of whom 24 978 (3·8%) had self-harmed in prison. Across the 40 risk factors examined, the strongest associations with self-harm in prison were found for suicide-related antecedents, including current or recent suicidal ideation (OR 13·8, 95% CI 8·6-22·1; I2=49%), lifetime history of suicidal ideation (8·9, 6·1-13·0; I2=56%), and previous self-harm (6·6, 5·3-8·3; I2=55%). Any current psychiatric diagnosis was also strongly associated with self-harm (8·1, 7·0-9·4; I2=0%), particularly major depression (9·3, 2·9-29·5; I2=91%) and borderline personality disorder (9·2, 3·7-22·5; I2=81%). Prison-specific environmental risk factors for self-harm included solitary confinement (5·6, 2·7-11·6; I2=98%), disciplinary infractions (3·5, 1·2-9·7; I2=99%), and experiencing sexual or physical victimisation while in prison (3·2, 2·1-4·8; I2=44%). Sociodemographic (OR range 1·5-2·5) and criminological (1·8-2·3) factors were only modestly associated with self-harm in prison. We did not find clear evidence of publication bias. INTERPRETATION: The wide range of risk factors across clinical and custody-related domains underscores the need for a comprehensive, prison-wide approach towards preventing self-harm in prison. This approach should incorporate both population and targeted strategies, with multiagency collaboration between the services for mental health, social care, and criminal justice having a key role. FUNDING: Wellcome Trust.


Asunto(s)
Prisioneros/psicología , Conducta Autodestructiva/psicología , Intento de Suicidio/prevención & control , Trastorno de Personalidad Limítrofe/psicología , Estudios de Casos y Controles , Víctimas de Crimen/psicología , Derecho Penal/organización & administración , Trastorno Depresivo Mayor/psicología , Estudios de Evaluación como Asunto , Femenino , Humanos , Masculino , Trastornos Mentales/epidemiología , Salud Mental/normas , Estudios Observacionales como Asunto , Prisioneros/estadística & datos numéricos , Factores de Riesgo , Conducta Autodestructiva/mortalidad , Ideación Suicida , Intento de Suicidio/estadística & datos numéricos
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