Gambling-related suicide in Victoria, Australia: a population-based cross-sectional study.

Background: Gambling is associated with serious harms to health, including suicide. Yet public health systems for recording the role of gambling in suicide deaths are relatively underdeveloped. This study contributes to the understanding of this relationship. Methods: A population-based cross-sectional study of suicides reported to the Coroners Court of Victoria between 2009 and 2016 was performed to identify the incidence and characteristics of gambling-related suicides (GRS). Findings: From 2009 to 2016 there were 4788 suicide deaths in Victoria. Of these, 184 were identified as direct GRS and a further 17 were GRS by 'affected others'. Together, these GRS comprise 4.2% of all suicides in Victoria over this eight-year period. Direct GRS account for an annual average rate of 5.13 GRS per million Victorian adults. GRS were significantly more likely to be male (n = 153, 83%), than the Victorian population of total suicide deaths and significantly more likely to occur among those most disadvantaged. Family members and friends were more likely than clinicians to know about the deceased gambling. Interpretation: Given that gambling is not routinely investigated by coroners and may be hidden from family, friends, and health professionals, this is an underestimate of the true scale of the GRS in Victoria. A range of measures should be introduced to prevent, screen, support, and treat gambling harm. Family members and friends should also be provided with help services. Preventing gambling-related harm through public health measures could significantly reduce suicidality and suicide, both in Australia and globally. Funding: Federation University Australia, Coroners Court of Victoria, Suicide Prevention Australia.

Understanding the Context of Suicides by Older Men Compared With Younger Old Men and Women.

Background: The rate of suicide among men aged 85 years or older is the highest of any age or gender group in many countries, but little is known about their pathways to suicide. Aims: This study aimed to determine the context of suicide by men aged 85 years or older. Method: Data were extracted from the Victorian Suicide Register regarding suicide deaths between 2009 and 2015. Chi-squared test or Fisher's exact test was used to compare old men (65-84 years old) and older men (85 years or more), and old women and old men (both 65 years or more). Results: The context of suicide by older men differed significantly from that of old men, as did that of old men compared with old women, on variables related to suicidal behavior and intention, mental illness, mental health treatment, and life stressors. Limitations: The study is limited by the small numbers of deaths by suicide in this age group in Victoria. Conclusion: The context of suicide by older and old men is different from that of old men and old women, respectively. More research is needed to understand the pathways to suicide by older men.

Patterns of Suicide in the Context of COVID-19: Evidence From Three Australian States.

Aims: We aimed to determine whether there has been a change in the number of suicides occurring in three Australian states overall, and in age and sex subgroups, since the COVID-19 pandemic began, and to see if certain risk factors for suicide have become more prominent as likely underlying contributing factors for suicide. Method: Using real-time data from three state-based suicide registers, we ran multiple unadjusted and adjusted interrupted time series analyses to see if trends in monthly suicide counts changed after the pandemic began and whether there had been an increase in suicides where relationship breakdown, financial stressors, unemployment and homelessness were recorded. Results: Compared with the period before COVID-19, during the COVID-19 period there was no change in the number of suicides overall, or in any stratum-specific estimates except one. The exception was an increase in the number of young males who died by suicide in the COVID-19 period (adjusted RR 1.89 [95% CI 1.11-3.23]). The unadjusted analysis showed significant differences in suicide in the context of unemployment and relationship breakdown during the COVID-19 compared to the pre-COVID-19 period. Analysis showed an increase in the number of suicides occurring in the context of unemployment in the COVID-19 period (unadjusted RR 1.53 [95% CI 1.18-1.96]). In contrast, there was a decrease in the number of suicides occurring in the context of relationship breakdown in the COVID-19 period (unadjusted RR 0.82 [95% CI 0.67-0.99]). However, no significant changes were identified when the models were adjusted for possible over-dispersion, seasonality and non-linear trend. Conclusion: Although our analysis found no evidence of an overall increase in suicides after the pandemic began, the picture is complex. The identified increase in suicide in young men indicates that the impact of the pandemic is likely unevenly distributed across populations. The increase in suicides in the context of unemployment reinforces the vital need for mitigation measures during COVID-19, and for ongoing monitoring of suicide as the pandemic continues.

COVID-19 as a context in suicide: early insights from Victoria, Australia.

OBJECTIVE: To examine how the coronavirus (COVID-19) pandemic and its consequences may have influenced suicide in Victoria, Australia. METHODS: A mixed methods study of consecutive Victorian suicide cases spanning 1 January 2015 to 31 January 2021. Interrupted time series analysis examined whether suicide frequency changed following the pandemic onset. Thematic analysis was undertaken of police reports in suicides linked with COVID-19 to try to understand how COVID-19 acted as a stressor. RESULTS: The frequency of Victorian suicides did not change following the onset of COVID-19. Sixty COVID-linked suicides were identified, featuring three recurring themes: COVID-19 as a disturbance in the self, in relationships with others and institutions. CONCLUSIONS: While COVID-19 has not led to an increase in Victorian suicide frequency to date, it is an important background stressor that can erode one's wellbeing, sense of agency and connectedness to others. Implications for public health: Clinical interventions that serve to reconnect people with a sense of agency and seek to re-establish contact with significant others are indicated. Clinicians should ensure they are familiar with pathways for their patients to access government social and economic supports. A better understanding of how government interventions may be lessening psychological distress is needed.

Sociodemographic characteristics associated with hospital contact in the year prior to suicide: A data linkage cohort study in Victoria, Australia.

AIMS: The aims of this study were to examine the prevalence of hospital contact in the year prior to suicide in Victoria, Australia, and to compare characteristics among those who did and did not have contact in the year prior to suicide. METHODS: The study was a data linkage cohort study of 4348 Victorians who died by suicide over the period 2011-2017. Data from the Victorian Suicide Register (VSR) was linked with hospital separations and Emergency Department (ED) presentations datasets by the Centre for Victorian Data Linkages (CVDL). The main outcomes were: (1) hospital contact for any reason, (2) hospital contact for mental-health-related reasons, and (3) hospital contact for intentional self-harm. Unadjusted and adjusted odds ratios were calculated as the measures of association. RESULTS: In the year prior to suicide, half of the decedents (50.0%) had hospital contact for any reason (n = 2172), 28.6% had mental-health-related hospital contact (n = 1244) and 9.9% had hospital contact for intentional self-harm (n = 432). In the year prior to suicide, when compared with males aged 25-49 years (the reference group):males aged 75+ years and females of all ages were significantly more likely to have hospital contact for any reasonfemales aged 10-24 years and 25-49 years were significantly more likely to have mental-health-related hospital contactfemales aged 10-24 years and 25-49 years had 3.5 times and 2.4 times the odds of having hospital contact for intentional self-harm. CONCLUSIONS: The comparatively high proportion of female decedents with mental-health related hospital contact in the year prior to suicide suggests improving the quality of care for those seeking help is an essential prevention initiative; this could be explored through programs such as the assertive outreach trials currently being implemented in Victoria and elsewhere in Australia. However, the sizeable proportion of males who do not have contact in the year prior to suicide was a consistent finding and represents a challenge for suicide prevention. Programs to identify males at risk in the community and engage them in the health care system are essential. In addition, promising universal and selective interventions to reduce suicide in the cohort who do not have hospital contact, include restricting access to lethal means and other public health interventions are also needed.

Improving efficiency of a regional stand alone bone bank.

The introduction of a stand-alone Bone Bank in our Regional Orthopaedic Hospital has improved the availability of femoral head allograft. Benninger et al. (Bone Joint J 96-B:1307-1311, 2014), demonstrated their institutions bank to be cost effective despite a 30 % discard rate for harvested allograft. We sought to audit our own discard rates and subsequent cost-effectiveness of our bone bank. Donor recruitment. Before approaching a potential donor, our establishment's nurse specialists review their clinical notes and biochemical laboratory results, available on a regional Electronic Care Records. They view femoral head architecture on radiographs against set criteria, Patient Archive and Communication system (SECTRA, Sweden). In total 1383 femoral heads were harvested, 247 were discarded giving an overall rate of 17.9 %. The most common reasons for discard of harvested graft was a positive microbiology/bacteriology result, n = 96 (38.9 %). After a rise in discard rates in 2007, we have steadily reduced our discard rates since 2006/2007 (28.2 %), 2008/2009 (17 %), 2010/2011 (14.8 %), and finally to 10.3 % in 2012/2013. In the current financial year, our cost to harvest, test, store and release a femoral head is £ 610. With a structured donor recruitment process and unique pre-operative radiographic analysis we have successfully reduced our discard rates bi-annually making our bone bank increasingly cost-effective.