Search

Objective To determine the risk of non-fatal self harm in the 12 months after discharge from psychiatric inpatient care. Design Cohort study based on national hospital episode statistics. Setting England. Population Patients aged 16-64 years discharged from psychiatric inpatient care between 1 April 2004 and 31 March 2005 and followed up for one year. Results 75 401 people were discharged from psychiatric inpatient care overthe study period, 4935 (6.5%) of whom were admitted at least once for self harm in the following 12 months. Risk of self harm was greatest in the four weeks after discharge; one third (32%, n=1578) of admissions for self harm occurred in this period. The strongest risk factor for self harm after discharge was admission forself harm in the previous 12 months (hazard ratio 4.9, 95% confidence interval 4.6 to 5.2). The risk of self harm was also higher in females, younger people, those with diagnoses of depression, personality disorders, and substance misuse, and those with short lengths of stay. Conclusion More than 6% of patients discharged from psychiatric inpatient care are readmitted for an episode of self harm within 12 months, with one third of these episodes occurring in the month after discharge. Self harm after discharge from hospital shares many of the features of suicide after discharge. Interventions should be developed to reduce risk in this period. [ABSTRACT FROM AUTHOR]

Objective To investigate the population impact on the incidence of suicide and non-fatal self harm of regulatory action in 2003 to restrict the use of selective serotonin reuptake inhibitors (SSRIs) in under 18s. Design Ecological time series study. Setting United Kingdom. Populations Young people in the UK aged 12-19 years (prescribing trends), in England and Wales aged 12-17 years (mortality), and in England aged 12-17 years (hospital admissions). Main outcome measures Deaths from suicide and hospital admissions for self harm. Results Antidepressant prescribing doubled between 1999 and 2003 but fell to the 1999 level between 2004 and 2005. These large changes in prescribing did not seem to be associated with temporal trends in suicide or self harm. In the years 1993 to 2005 the annual percentage reduction for suicide among 12-17 year olds was -3.9% (95% confidence interval -6.2% to -1.5%) in males and -3.0% (-6.6% to 0.6%) in females, with no indication of a substantial change in this rate of decrease during that period. Similarly, hospital admission rates for self harm in the years 1999 to 2005 indicated an annual percentage increase for males of 1.1% (-0.5% to 2.7%) and for females of 5.7% (3.6% to 7.8%), again with no statistical evidence of a change in rate after the regulatory action. Conclusions The noticeable reduction in prescribing of antidepressants since regulatory action in 2003 to restrict the use of SSRIs in under 18s does not seem to have been associated with changes in suicidal behaviour in young people. Specifically, these data for England do not indicate that reductions in antidepressant use have led to an increase in suicidal behaviour. [ABSTRACT FROM AUTHOR]

Objective To investigate whether selective serotonin reuptake inhibitor (SSRI) antidepressants are associated with an increased risk of suicide related outcomes in adults. Design Meta-analysis of randomised controlled trials of SSRIs compared with placebo in adults submitted by pharmaceutical companies to the safety review of the Medicines and Healthcare products Regulatory Agency (MHRA). Participants Over 40 000 individuals participating in 477 randomised controlled trials. Main outcome measures Suicide, non-fatal self harm, and suicidal thoughts. Results An estimated 16 suicides, 172 episodes of non-fatal self harm, and 177 episodes of suicidal thoughts were reported. We found no evidence that SSRIs increased the risk of suicide, but important protective or hazardous effects cannot be excluded (odds ratio 0.85, 95% credible interval 0.20 to 3.40). We found weak evidence of an increased risk of self harm (1.57, 0.99 to 2.55). Risk estimates for suicidal thoughts were compatible with a modest protective or adverse effect (0.77, 0.37 to 1.55). The relative frequency of reported self harm and suicidal thoughts in the trials compared with suicide indicates non-fatal end points were under-recorded.Conclusion Increased risks of suicide and self harm caused by SSRIs cannot be ruled out, but larger trials with longer follow up are required to assess the balance of risks and benefits fully. Any such risks should be balanced against the effectiveness of SSRIs in treating depression. When prescribing SSRIs, clinicians should warn patients of the possible risk of suicidal behaviour and monitor patients closely in the early stages of treatment. [ABSTRACT FROM AUTHOR]

Presents a clinical review to evaluate the risk of suicide in patients taking antidepressant agents. Concern that serotonin reuptake inhibitors may precipitate suicidal behavior; Report that the rates of prescribing antidepressant drugs have increased in Great Britain while rates of suicide have decreased; Need for long term studies to assess the risks and benefits to population health of the rise in antidepressant prescribing.

Explores a study which investigated the association between suicide and area based measures of deprivation and social fragmentation. Association between deprivation and mortality; Application of the least squares regression; Limitations of ecological studies.

Focuses on prevention of suicidal incidents in Great Britain. Identification of causes of suicides and parasuicides; Conduction of general practitioner education programme on depression management; Evaluation of lithium and antidepressants marketing.

Examines the relationship between childhood nutrition and adult mortality from cancer. Methodology of the study; Brief account on the use of height as a determinant for childhood nutrition; Comparison of the study to animal studies; Discussion of results; Conclusions.

Examines the relation between parasuicide, suicide, psychiatric inpatient admissions and socioeconomic deprivation. Association between socioeconomic deprivation and psychiatric morbidity and mortality; Ecological association between suicide and parasuicide; Effectiveness of social policy changes aimed at reducing socioeconomic deprivation. INSET: Key messages..

Presents a letter to the editor regarding a previously published article which discussed the link between selective serotonin reuptake inhibitors (SSRI) and the increased risk of suicide.

Presents an observational study of variations in the hospital management of self harm in adults in England. Importance of the management of self harm in adults for the prevention of suicide; Presentation of a medical audit of the processes of medical care in hospitals in England; Variation across hospitals in levels of psychosocial assessment; Variation in the proportion of attendances leading to hospital admission of to a psychiatric bed.

Editorial. Focuses on epidemiological evidence for the association of insulin-like growth factor-1 and cancer risk. Physiological effect of high concentrations of insulin-like growth factor-1; Association of anthropometric markers of growth factor activity with cancer incidence; Potential mechanisms of the growth factor; Outlook for further study.

Focuses on the effects of media coverage on patterns of suicide. Increase suicide incidents following reporting of real life suicide coverage; Association of imitation effect on the increase suicide incidents; Social responsibility of media for the promotion of mental health.

Presents a a reply from Olive Bennewith and colleagues to a letter to the editor about their article "Variations in the hospital management of self harm in adults in England: observational study, " in the May 8, 2004 issue.

Offers the author's thoughts on the correlation between suicidal tendencies and income brackets for the mentally ill. Evidence from person based and ecological studies that relative poverty is associated with an increased risk of suicide; Suggestion that such a tendency could be the result of a greater stigma associated with mental illness among rich people.

Objectives: To investigate the national distribution of prolonged waiting for elective day case and inpatient surgery, and to examine associations of prolonged waiting with markers of NHS capacity, activity in the independent sector, and need. Setting: NHS hospital trusts in England. Population: People waiting for elective treatment in the specialties of general surgery; ear, nose and throat surgery; ophthalmic surgery; and trauma and orthopaedic surgery. Main outcome measure: Numbers of people waiting six months or longer (prolonged waiting). Characteristics of trusts with large numbers waiting six months or longer were examined by using logistic regression. Results: The distribution of numbers of people waiting for day case or elective surgery in all the specialties examined was highly positively skewed. Between 52% and 83% of patients waiting longer than six months in the specialties studied were found in one quarter of trusts, which in turn contributed 23-45% of the national throughput specific to the specialty. In general, there was little evidence to show that capacity (measured by numbers of operating theatres, dedicated day case theatres, available beds, and bed occupancy rate) or independent sector activity were associated with prolonged waiting, although exceptions were noted for individual specialties. There was consistent evidence showing an increase in prolonged waiting, with increased numbers of anaesthetists across all specialties and with increased bed occupancy rates for ear, nose, and throat surgery. Markers of greater need for health care, such as deprivation score and rate of limiting long term illness, were inversely associated with prolonged waiting. Conclusion: In most instances, substantial numbers of patients waiting unacceptably long periods for elective surgery were limited to a small number of hospitals. Little and inconsistent support was found for associations of prolonged waiting with markers of capacity, independent sector... [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To evaluate the impact of an intervention based in general practice on the incidence of repeat episodes of deliberate self harm. Design: Cluster randomised controlled trial in which 98 general practices were assigned in equal numbers to an intervention or a control group. The intervention comprised a letter from the general practitioner inviting the patient to consult, and guidelines on assessment and management of deliberate self harm for the general practitioner to use in consultations. Control patients received usual general practitioner care. Setting: General practices within Avon, Wiltshire, and Somerset Health Authorities, whose patients lived within the catchment area of four general hospitals in Bristol and Bath. Participants: 1932 patients registered with the study practices who had attended accident and emergency departments at one of the four hospitals after an episode of deliberate self harm. Main outcome measures: Primary outcome was occurrence of a repeat episode of deliberate self harm in the 12 months after the index episode. Secondary outcomes were number of repeat episodes and time to first repeat. Results: The incidence of repeat episodes of deliberate self harm was not significantly different for patients in the intervention group compared with the control group (odds ratio 1.2, 95% confidence interval 0.9 to 1.5). Similar findings were obtained for the number of repeat episodes and time to first repeat. Subgroup analyses indicated that there was no differential effect of the intervention according to patient's sex (P = 0.51) or method used to cause deliberate self harm (P = 0.64). The treatment seemed to be beneficial for people with a history of deliberate self harm, but it was associated with an adverse effect in people for whom the index episode was their first episode (interaction P = 0.017). Conclusions: An invitation to consult, sent by the general practitioner of patients who have deliberately harmed themselves,... [ABSTRACT FROM AUTHOR]

Compares the effectiveness and acceptability of early discharge to a hospital at home scheme to that of routine discharge from acute hospital. Details on some of the alternatives to inpatient hospital care; Methods used to identify patients suitable for early discharge; Types of patients who are allocated hospital at home schemes. INSETS: Hospital at home scheme: Patient suitability, remit, and...;Key messages.

A letter to the editor is presented in the article "Selective serotonin reuptake inhibitors and suicide in adults: meta-analysis of drug company data from placebo controlled, randomized controlled trials submitted to the MHRA's safety review," by D. Gunnell.

Objectives To explore trends in suicide in young people to investigate the recent observation that after year on year rises in the 1970s, 1980s, and early 1990s, rates in young men are now declining. Design Time trend analysis. Setting England and Wales, 1968-2005. Population Men and women aged 15-34 years. Results Since the 1990s, rates of suicide in young men have declined steadily and by 2005 they were at their lowest level for almost 30 years. This decline is partly because of a reduction in poisoning with car exhaust gas as an increased number of cars have catalytic converters; but there have been declines in suicides from all common methods, including hanging, suggesting a more pervasive effect. Other risk factors for suicide, such as unemployment and divorce, have also decreased. Possible recent reductions in alcohol use among young men and increases in prescribing of antidepressants do not seem to be temporally related to the decline in suicide. Conclusions Suicide rates in young men have declined markedly in the past 10 years in England and Wales. Reductions in key risk factors for suicide, such as unemployment, might be contributing to lower rates. [ABSTRACT FROM AUTHOR]

Objective To compare the risk of non-fatal self harm and suicide in patients taking selective serotonin reuptake inhibitors (SSRIs) with that of patients taking tricyclic antidepressants, as well as between different SSRIs and different tricyclic antidepressants. Design Nested case-control study. Setting Primary care in the United Kingdom. Participants 146 095 individuals with a first prescription of an antidepressant for depression. Main outcome measures Suicide and non-fatal self harm. Results 1968 cases of non-fatal self harm and 69 suicides occurred. The overall adjusted odds ratio of non-fatal self harm was 0.99 (95% confidence interval 0.86 to 1.14) and that of suicide 0.57 (0.26 to 1.25) in people prescribed SSRIs compared with those prescribed tricyclic antidepressants. We found little evidence that associations differed over time since starting or stopping treatment. We found some evidence that risks of non-fatal self harm in people prescribed SSRIs compared with those prescribed tricyclic antidepressants differed by age group (interaction P = 0.02). The adjusted odds ratio of non-fatal self harm for people prescribed SSRIs compared with users of tricylic antidepressants for those aged 18 or younger was 1.59 (1.01 to 2.50), but no association was apparent in other age groups. No suicides occurred in those aged 18 or younger currently or recently prescribed tricyclic antidepressants or SSRIs. Conclusion We found no evidence that the risk of suicide or non-fatal self harm in adults prescribed SSRIs was greater than in those prescribed tricyclic antidepressants. We found some weak evidence of an increased risk of non-fatal self harm for current SSRI use among those aged 18 or younger. However, preferential prescribing of SSRIs to patients at higher risk of suicidal behaviour cannot be ruled out. [ABSTRACT FROM AUTHOR]

Objective To investigate the association of paternal age at conception with the risk of offspring developing schizophrenia. Design A population based cohort study. Setting Sweden. Subjects 754 330 people born in Sweden between 1973 and 1980 and still alive and resident in Sweden at age 16 years. Main outcome measures Hospital admission with schizophrenia or non-schizophrenic, non-affective psychosis. Results After adjustment for birth related exposures, socioeconomic factors, family history of psychosis, and early parental death the overall hazard ratio for each 10 year increase in paternal age was 1.47 (95% confidence interval 1.23 to 1.76) for schizophrenia and 1.12 (0.98 to 1.29) for non-schizophrenic non-affective psychosis. This association between paternal age and schizophrenia was present in those with no family history of the disorder (hazard ratio for each 10 year increase in paternal age 1.60, 1.32 to 1.92), but not in those with a family history (0.91, 0.44 to 1.89) (P = 0.04 for interaction). Conclusions Advancing paternal age is an important independent risk factor for schizophrenia. The stronger association between paternal age and schizophrenia in people without a family history provides further evidence that accumulation of de novo mutations in paternal sperm contributes to the overall risk of schizophrenia. [ABSTRACT FROM AUTHOR]

Conclusion: Legislation restricting pack sizes of paracetamol and salicylates in the United Kingdom has had substantial beneficial effects on mortality and morbidity associated with self poisoning using these drugs. [ABSTRACT FROM AUTHOR]

Focuses on a study that was conducted to identify and synthesize the findings from all randomized controlled trials that have examined the effectiveness of treatments of patients who have deliberately harmed themselves. How the study was conducted; Findings in relation to repetition of self harm; Evidence which suggest that there remains considerable uncertainty about which form of psychosocial and physical treatments help these patients. INSET: Key messages.

Compares the costs associated with early discharge to a hospital at home scheme and those associated with continued care in an acute hospital, while offering the views of the National Health Service (NHS) and social services in Great Britain. Advantages associated with hospital at home schemes; Provision of an economic evaluation of continued care; Methods used to determine the effectiveness of the two processes. INSET: Key messages.

The article presents an overview of Internet websites which promote, offer deterrents to or give information about suicide. The content of the pro suicide websites, including popular and effective suicide methods, and the content of the suicide deterrent web sites, is discussed. A discussion of mass media's perpetual interest in suicide, and of a global increase in suicide in younger people which has been seen and could be related to the influence of Internet suicide sites and Internet chat rooms, is presented. INSETS: TOP 10 RETRIEVED SITES;DATA RETRIEVAL AND ANALYSIS.

Studies the opportunity cost in the rise of antidepressant prescribing in the NHS by evaluating it in terms of the effective treatment, cognitive behavior therapy. Use of the British Department of Health data to quantify changes between 1991 and 2002; Factors contributing to increased antidepressant prescribing; Other alternatives to antidepressants and cognitive behavior therapy; Indication more research is needed to establish a balance between drugs and non-pharmacological treatment for depression.