Search

Purpose: There is growing interest in the concept of 'deaths of despair' (DoD)—defined as deaths from three causes: suicide, drug poisoning, and alcohol-related conditions—as a more comprehensive indicator of the impact of psychological distress on mortality. The purpose of this study is to investigate the degree of commonality in trends and geographic patterning of deaths from these causes in England and Wales. Methods: WHO mortality data were used to calculate age-standardised, sex-specific temporal trends in DoD mortality and in mortality from suicide, drug poisonings, and alcohol-related conditions in England and Wales, 2001–2016. Three-year average crude rates were calculated for English local authorities for 2016–2018 and associations between rates were assessed using Spearman's rank correlation. Results: Between 2001 and 2016, the DoD mortality rate increased by 21·6% (males) and 16·9% (females). The increase was largely due to a rise in drug poisoning deaths, with limited tracking between trends in mortality by each cause. DoD mortality risk was highest in middle-aged people; there were rises in all age groups except 15–24 year old males and 65 + females. There were strong positive correlations (r = 0.66(males) and 0.60(females)) between local authority-area drug poisoning and alcohol-specific mortality rates in 2016–2018. Correlations of these outcomes with suicide were weaker (r = 0.29–0.54). Conclusions: DoD mortality is increasing in England and Wales but there is limited evidence of commonality in the epidemiology of cause-specific mortality from the component causes of DoD (suicide, drug poisoning and alcohol-related conditions), indicating the need for tailored prevention for each outcome. [ABSTRACT FROM AUTHOR]

Purpose: Internet use is common among people with suicidal feelings and a considerable amount of suicide help material is available online. Despite attempts to promote formal help sites (e.g. governmental and charity sector) in internet search results, users' evaluation of these sites is lacking. This study, therefore, aimed to explore distressed users' perceptions of formal online help and their experiences of using this in times of crisis. Methods: In-depth interview study of 53 adults reporting suicide-related internet use. Results: While highly valued in relation to general mental health problems, formal sites were not perceived to meet the different needs of those experiencing suicidal thoughts, and did not engage individuals in crisis. Sites were criticised for being impersonal, dispassionate, too focused on information-giving, and lacking solutions that were novel or sensitive to reasons why an individual may choose to seek help online. Most participants criticised the tendency for sites to signpost to offline services as their primary response. Participants desired immediacy and responsive online help incorporating 'live chat', self-help tools, opportunities to interact with others and lived-experience content. Positive accounts of seeking online help described sites incorporating these features. Conclusions: Formal online help services should be reappraised to ensure they meet users' needs for immediacy and responsive help to capitalise upon the opportunity available for suicide prevention. [ABSTRACT FROM AUTHOR]

Purpose: Socioeconomic deprivation is associated with increased rates of self-harm but its association with levels of clinical care has not previously been explored. The aim of the current study was to investigate socioeconomic differences in the clinical management of people who self-harm.Methods: Cross-sectional analysis of 3607 people presenting to a large inner-city hospital following self-harm.Results: People living in the least deprived quintile were more likely to receive a psychosocial assessment (most vs. least deprived: 63.51 vs. 70.14%). This effect persisted in our fully adjusted model (OR 1.45, CI 1.15-1.82, p = 0.002). Mediation analysis suggested this association was in large part explained by higher rates of self-discharge in people presenting from areas of higher deprivation.Conclusions: Compared to those from more deprived areas, people from less deprived areas are more likely to receive a psychosocial assessment when presenting to hospital following self-harm. The occurrence of higher rates of self-discharge from emergency departments among those from more deprived areas may explain the association. [ABSTRACT FROM AUTHOR]

Purpose: The number of antidepressants prescribed in the UK has been increasing over the last 25 years; however, the reasons for this are not clear. This study examined trends in antidepressant prescribing in the UK between 1995 and 2011 according to age, sex, and drug class, and investigated reasons for the increase in prescribing over this period.Methods: This is a retrospective analysis of antidepressant prescribing data from the Clinical Practice Research Datalink: a large, anonymised, primary care database in the UK. The dataset used in this study included 138 practices, at which a total of 1,524,201 eligible patients were registered across the 17-year period. The proportion of patients who received at least one antidepressant prescription and the number of patients who started a course of antidepressants were calculated for each year of the study. We used person years (PY) at risk as the denominator. The duration of treatment for those starting antidepressants was also examined.Results: 23% of patients were prescribed an antidepressant on at least one occasion over the 17-year study period. Antidepressant prescriptions rose from 61.9 per 1000 PY in 1995 to 129.9 per 1000 PY in 2011. This was largely driven by an increase in prescribing of selective serotonin reuptake inhibitors and 'other' antidepressants. In contrast, incidence rates of those starting antidepressants remained relatively stable (1995: 21.3 per 1000 PY; 2011: 17.9 per 1000 PY). The duration of treatment increased with later starting years, with an increasing proportion of long-term use, and decrease in short-term use.Conclusion: The increase in antidepressant prescribing over the study period appears to be driven by an increase in long-term use of these medications. [ABSTRACT FROM AUTHOR]

Purpose: Whilst psychotic experiences are associated with suicidal behaviour in a number of studies the value of psychotic experiences for the prediction of suicidal behaviour and the role of depressive symptoms in this relationship is not clear. We examined the association between psychotic experiences and subsequent suicidal behaviour and examine the role of depressive symptoms in this relationship.Methods: Psychotic experiences and depressive symptoms at age 12 and 16 years, and suicidal behaviour at age 16 years were assessed in participants (prospective analysis n = 3171; cross-sectional analysis n = 3952) from a population-based cohort.Results: Psychotic experiences (OR 1.75 95 % CI 1.20, 2.54) and depression (OR 3.97 95 % CI 2.56, 6.15) at 12 years were independently associated with suicidal behaviour at 16 years after adjustment for confounding. There was no evidence that the relationship between psychotic experiences and suicidal behaviour was stronger in participants who were also depressive. A ROC analysis showed that adding information on psychotic experiences to measures of depressive symptoms had hardly any effect on improving prediction of suicidal behaviour (AUC increased from 0.64 to 0.65). Whereas adding a measure of depressive symptoms to the measure of psychotic experiences improved prediction substantially (AUC 0.56-0.65).Conclusions: Psychotic experiences and depression are independently associated with suicidal behaviour although the association with depression is substantially stronger. Psychotic experiences alone are not a strong predictor of later suicidal behaviour and add little to predicting the risk of suicidal behaviour over and above the information provided by depressive symptoms. [ABSTRACT FROM AUTHOR]

Purpose: In the late 1990s, an epidemic rise in suicides by carbon monoxide poisoning from burning barbecue charcoal began in Hong Kong and Taiwan. This study investigates the diffusion of this new method of suicide. Method: Official mortality data for 1998-2010 in Taiwan and 1998-2009 in Hong Kong were collected; overall and method-specific suicide rates in different socio-demographic subgroups over the study period were compared. Multiple logistic regression analyses were conducted to assess the socio-demographic risk factors for charcoal-burning vs. non-charcoal-burning suicide. Results: In Hong Kong, the incidence of charcoal-burning suicide increased steeply within 1 year of the first reported cases, but its use has declined from 24.2 % of all suicides during the peak period (2002-2004) to 17.1 % (2007-2009); in Taiwan, the pace of diffusion was slower in onset, but it remains a popular method accounting for 31.0 % of all suicides in 2008-2010. The early adopters in both places tended to be young- and middle-aged men. As the epidemic progressed, the method has also been gradually adopted by older age groups and women, particularly in Taiwan, but in 2009/10, the method still accounted for <8 % of suicides in those aged >60 years in both areas. Conclusions: Common features of the epidemic in both places were the greater levels of early uptake by the young- and middle-aged males. The different course of the charcoal-burning suicide epidemic may reflect social, geographic and media reporting differences. Surveillance to identify the emergence of new suicide methods is crucial in suicide prevention. [ABSTRACT FROM AUTHOR]

Purpose: Studies carried out in the West indicate that the incidence of self-harm (SH) is particularly high amongst adolescents, but few studies have investigated its incidence and aetiology in low-income countries. The purpose of this study was to investigate risk factors associated with new onset episodes of SH, amongst Chilean adolescents from low socio-economic backgrounds. Methods: Prospective cohort study nested within a cluster randomised controlled trial. A 6-month follow-up for 2,042 adolescents, median age 14 years, from socio-economically deprived areas of Santiago, Chile. Results: The lifetime prevalence of SH was 23 %. The incidence rate of SH at 6 months was 14 % amongst those reporting no SH at baseline. In multivariable analyses, risk factors for incident SH include depressive symptoms, suicidal thoughts, poor problem-solving skills and cannabis misuse. Conclusions: The prevalence and incidence of SH in this socio-economically deprived sample differed highly according to gender. Poor problem-solving skills, suicidal thoughts, and cannabis misuse were associated with onset of SH. [ABSTRACT FROM AUTHOR]

Purpose: Socio-economic position (SEP) during childhood and parental social mobility have been associated with subsequent health outcomes in adolescence and adulthood. This study investigates whether parental SEP during childhood is associated with subsequent self-harm in adolescence. Methods: This study uses data from a prospective birth-cohort study (the Avon Longitudinal Study of Parents and Children) which followed 14,610 births in 1991-1992 to age 16-18 years ( n = 4,810). The association of parental SEP recorded pre-birth and throughout childhood with self-harm was investigated using logistic regression models, with analyses conducted separately for those reporting self-harm (a) with and (b) without suicidal intent. The impact of missing data was investigated using multiple imputation methods. Results: Lower parental SEP was associated with increased risk of offspring self-harm with suicidal intent, with less consistent associations evident for self-harm without suicidal intent. Associations were somewhat stronger in relation to measures of SEP in later childhood. Depressive symptoms appeared to partially mediate the associations. Adolescents of parents reporting consistently low income levels during childhood were approximately 1.5 times more likely to engage in SH than those never to report low income. Conclusions: Lower SEP during childhood is associated with the subsequent risk of self-harm with suicidal intent in adolescence. This association is stronger in those experiencing consistently lower SEP. [ABSTRACT FROM AUTHOR]

Background: Sleep problems may lead to, or be symptomatic of, depression and other mental illnesses yet few studies have investigated their association with suicide risk. Design: Prospective cohort study. Setting: Taiwan. Participants: 393,983 men and women aged 20 or above participating in the MJ health check-up programme. Results: There were 335 suicides over a mean of 7.4 years follow-up. There was a reverse J-shaped association between sleep duration and suicide risk. When compared with those sleeping 6-8 h per night the adjusted hazard ratios (95 % confidence intervals) for suicide associated with 0-4, 4-6 and >8 h sleep were 3.5 (2.0-6.1), 1.5 (1.1-1.9) and 1.5 (1.1-2.0), respectively. People requiring sleeping pills to get to sleep (1.2 % participants) were at over 11-fold increased risk; difficulty falling asleep (11.5 % participants), frequent dreaming (16.7 %) and being easily awoken (30.6 %) were associated with a 2.0-, 1.6- and 1.3-fold increased risk of suicide, respectively. Conclusions: Less than 6 h sleep duration, sleep disturbances and reported use of sleep medicines are markers of suicide risk. Sleep problems should be assessed when evaluating suicide risk. [ABSTRACT FROM AUTHOR]

Purpose: Many young people with psychological problems do not seek help. Recognition of problems and knowledge of appropriate sources of help may increase the likelihood of help seeking. This study aimed to explore whether young adults recognised depressive symptoms in a vignette, and how they thought a young person might respond to these symptoms. Methods: A postal survey was sent to 3,004 young people aged 16-24 in SW England. The survey included a two-part vignette; the first part depicted mild depressive symptoms, and the second part depicted severe depressive symptoms. Open-ended questions exploring symptom recognition and illness behaviour were answered by 1,125 respondents. Results: Severe depressive symptoms were recognised by 61.4% of respondents. Young men, particularly those from deprived backgrounds were less likely than women to recognise a mental health problem. Men were also less likely to suggest seeing a doctor than women. 64.7% of the respondents who recognised a mental health problem suggested seeing a doctor, however, only 16.4% thought a severely depressed person actually would see a doctor. Conclusions: Whilst the majority of young people recognised symptoms of severe depression, the gap between perceived options for help and proposed help seeking behaviour is clinically relevant. The sociodemographic groups at greatest risk of suicide are the least likely to recognise depression, highlighting a need to develop interventions targeting men, particularly those from deprived backgrounds. [ABSTRACT FROM AUTHOR]

Background: One of the most important components of suicide prevention strategies is to target people who repeat self-harm as they are a high risk group. However, there is some evidence that the incidence of repeat self-harm is lower in Asia than in the West. The objective of this study was to investigate the prevalence of previous self-harm among a consecutive series of self-harm patients presenting to hospitals in rural Sri Lanka. Method: Six hundred and ninety-eight self-poisoning patients presenting to medical wards at two hospitals in Sri Lanka were interviewed about their previous episodes of self-harm. Results: Sixty-one (8.7%, 95% CI 6.7-11%) patients reported at least one previous episode of self-harm [37 (10.7%) male, 24 (6.8%) female]; only 19 (2.7%, 95% CI 1.6-4.2%) patients had made more than one previous attempt. Conclusion: The low prevalence of previous self-harm is consistent with previous Asian research and is considerably lower than that seen in the West. Explanations for these low levels of repeat self-harm require investigation. Our data indicate that a focus on the aftercare of those who attempt suicide in Sri Lanka may have a smaller impact on suicide incidence than may be possible in the West. [ABSTRACT FROM AUTHOR]

Objective: To identify cause-of-death categories in which suicides might be misclassified in Taiwan.Methods: We plotted secular trends (1971-2007) in sex- and method-specific rates of deaths classified as suicide, undetermined intent and accident for the Taiwanese population aged 15+ and compared the sex, age and marital status profiles of deaths in these three categories by method of death.Results: The demographic profiles of registered suicides generally resembled those for deaths of undetermined intent and accidents by pesticide poisoning/suffocation but differed from those for accidents from non-pesticide poisoning/drowning/falling/poisoning by non-domestic gas. For the period 1990-2007, suicide rates based on suicides alone (14.8 per 100,000) would increase by 23, 7 and 1%, respectively, when including deaths of undetermined intent, accidental pesticide poisonings and accidental suffocations.Conclusions: Suicide rates may be underestimated by more than 30% in Taiwan because some suicides are 'hidden' amongst deaths certified as due to other causes. [ABSTRACT FROM AUTHOR]

To identify cause-of-death categories in which suicides might be misclassified in Taiwan. We plotted secular trends (1971–2007) in sex- and method-specific rates of deaths classified as suicide, undetermined intent and accident for the Taiwanese population aged 15+ and compared the sex, age and marital status profiles of deaths in these three categories by method of death. The demographic profiles of registered suicides generally resembled those for deaths of undetermined intent and accidents by pesticide poisoning/suffocation but differed from those for accidents from non-pesticide poisoning/drowning/falling/poisoning by non-domestic gas. For the period 1990–2007, suicide rates based on suicides alone (14.8 per 100,000) would increase by 23, 7 and 1%, respectively, when including deaths of undetermined intent, accidental pesticide poisonings and accidental suffocations. Suicide rates may be underestimated by more than 30% in Taiwan because some suicides are ‘hidden’ amongst deaths certified as due to other causes. [ABSTRACT FROM AUTHOR]

Studies in young male conscripts suggest that low IQ scores are associated with an increased risk of suicide. Mechanisms underlying this association are unclear. To investigate the association of IQ, as indexed by the national adult reading test (NART), with the incidence of, and recovery from, suicidal thoughts. An 18-month follow-up of 2,278 of the adults who took part in the Britain’s second national psychiatric morbidity survey who completed the NART at baseline. There was no evidence that poor performance on the NART was associated with an increased incidence of suicidal thoughts over the 18 month follow-up (adjusted odds ratio per 10 unit increase in NART-IQ 1.08 (95% CI 0.86–1.36). However, amongst the 155 subjects with suicidal thoughts at baseline, those with low NART-IQ were least likely to recover from them: the adjusted odds of recovery per 10 unit increase in NART-IQ was 1.42 (95% CI 0.96–2.10). The association between low IQ and an increased risk of suicide may be because people with low IQ experience suicidal thoughts for more prolonged periods than those with high IQ or because low IQ increase the likelihood that people experiencing suicidal thoughts act upon them. [ABSTRACT FROM AUTHOR]

Knowledge concerning the epidemiology of suicide in Sri Lanka is limited despite its suicide rates being amongst the highest in the world. To examine the characteristics of a large sample of Sri Lankan suicides to inform approaches to prevention. Psychological autopsy study of suicides occurring in three rural districts of Sri Lanka during August–October 1997. Interviews were conducted with contacts of 372 (74%) of the 499 suicides that occurred over the study period. Males accounted for 79% of the deaths. Twenty-one percent of male and 57% of female suicides were aged <25 years of age. Pesticide self-poisoning accounted for 259 (70%) of the deaths. Almost two-thirds (62%) of the deaths occurred in hospital and 95 (26%) had made previous suicidal gestures. 138 (37%) were moderately or severely depressed and 144 (49%) of male suicides, but only 2 (2.5%) of the females, were alcohol dependent. Illegally brewed alcohol (kasippu) was the main product used by two thirds (62%) of problem drinkers. There was a family history of suicide in 20% of cases. Pesticide self-poisoning accounts for over two thirds of suicides in rural Sri Lanka. Suicide prevention efforts in Sri Lanka should focus on restricting access to pesticides, improving the medical management of pesticide poisoning, reducing alcohol misuse—particularly targeting the supply of illegal alcohol—and improving the identification and aftercare of people who self-harm. [ABSTRACT FROM AUTHOR]

There is increasing evidence of an association between low dietary intake of essential n-3 long chain polyunsaturated fatty acids (n-3 EFAs) and depressed mood. This study aimed to evaluate this association in a large population-based sample of UK individuals. N-3 EFA intake (intake from fish alone, and from all sources (fish and supplements)), depressed mood (assessed using the short-form Depression, Anxiety and Stress Scales) and demographic variables (sex, age, Index of Multiple Deprivation (IMD) based on postal code, and date of questionnaire completion) were obtained simultaneously by self-report questionnaire (N = 2982). Using polynomial regression, a non-linear relationship between depressed mood and n-3 EFA intake from fish was found, with the incremental decrease in depressed mood diminishing as n-3 EFA intake increased. However, this relationship was attenuated by adjustment for age and IMD. No relationship between depression and n-3 EFA intake from all sources was found. These findings suggest that higher levels of n-3 EFA intake from fish are associated with lower levels of depressed mood, but the association disappears after adjustment for age and social deprivation, and after inclusion of n-3 EFA intake from supplements. This study does have a number of limitations, but the findings available suggest that the apparent associations between depressed mood and n-3 EFA intake from fish may simply reflect a wider association between depressed mood and lifestyle. [ABSTRACT FROM AUTHOR]

Objective: To examine the association of variables from survey data on well-being with suicide rates and other markers of population mental health in Europe.Design: Ecological study correlating (Spearman's rank correlation) life satisfaction and happiness (European Values Survey 1999/2000) in 32 countries with suicide rates (WHO Mortality Database), rates of hospital discharge for mental and behavioural disorders and prevalence of mental disorders based on registered mental patients (WHO Regional Office for Europe) and Mental Health Index (MHI)-5 survey data (European Opinion Research Group).Results: An inverse association exists between suicide rates and life satisfaction (r=-0.44; 95% CI: -0.68, -0.11) and happiness (r=-0.42; 95% CI: -0.67, -0.08). Similar though weaker associations were seen with hospital discharge data and MHI-5 data but not with the prevalence of mental disorders. The association between suicide rates and life satisfaction was weaker amongst 15-44 year olds (r=-0.31; 95% CI: -0.59, 0.04) than amongst 45-64 year olds (r=-0.47; 95% CI: -0.70, -0.14). It was strongest in the 65+ age group (r=-0.54; 95% CI: -0.75, -0.23). A similar pattern was observed for the association with happiness. In a subgroup analysis, the association between suicide and life satisfaction in Eastern Europe was similar to that in the whole dataset (r=-0.35) but a positive association was seen in Western Europe (r=0.47).Conclusions: Life satisfaction and happiness were modestly associated with other indicators of population mental health. Since all such markers have their limitations, surveys of well-being may be useful indicators of population mental health. [ABSTRACT FROM AUTHOR]

Rural suicide rates have been shown to be disproportionately high in several countries. This study compares suicide rates in Cornwall with the rest of England and Wales over a 90-year period (1911-2001). Age and sex standardised mortality ratios were calculated for suicide and undetermined death for Cornwall standardised to England and Wales. From 1911 until the start of the Second World War, suicide rates were lower in Cornwall than England and Wales. Since the 1960s suicide rates in Cornwall have risen significantly above England and Wales. We have shown that the suicide rate in a poor, rural area has increased disproportionately compared to England and Wales over the last 35 years. This change has occurred in both sexes. Prior to this period the suicide rate was lower or about the same as that in England and Wales. [ABSTRACT FROM AUTHOR]

Background: Gunshot suicides account for 2.5% of suicides in England and Wales. This amounts to more than 100 deaths per year. Information about such deaths may assist in the development of suicide prevention strategies.Method: We have examined coroners' inquest records for all gunshot suicides between 1st January 2000 and 31st December 2001 in 24 coroners' jurisdictions in England.Results: Fifty-eight gunshot suicides were identified, including one homicide-suicide. Ninety-three per cent of cases were male. Sport or occupational usage was the main reason for owning the gun. Ten per cent were farmers or farm-workers. In 20% of cases the gun did not belong to the individual who used it for suicide. This was more likely in younger suicides. Seven (12.1%) individuals used illegally owned handguns. Large amounts of alcohol had been consumed before the act in nine cases. Nearly three-quarters (72.9%) of individuals with diagnostic information had a probable diagnosis of depression. However, only 22.4% had ever had contact with psychiatric services. Two shotgun certificate holders were under the care of psychiatric services at the time of their death and two others had a history of previous self-harm.Conclusions: Strategies to reduce the number of gunshot suicides need to focus on limiting access to guns. These include restricting access to guns by non-certificate holders and those who may be at increased risk of suicide, and holding regular gun amnesties. [ABSTRACT FROM AUTHOR]

Geographic patterns of suicide are associated with area levels of social fragmentation. It is unknown whether this reflects higher levels of severe mental illness in socially fragmented areas. Psychiatric hospital admission rates were higher in areas with high levels of socioeconomic deprivation than in areas with high levels of social fragmentation. In contrast, associations with suicide were stronger in relation to social fragmentation than socioeconomic deprivation. Association of suicide with social fragmentation was only moderately attenuated in models controlling for psychiatric admission rate and socio-economic deprivation, RR 1.23 (95% C.I. 1.09–1.38) per quartile increase in social fragmentation, compared to 1.29 (95% C.I. 1.16­1.44) before adjustment. The association between social fragmentation and suicide is not explained by socioeconomic deprivation or the prevalence of severe mental illness within socially fragmented areas as measured by psychiatric admission rate. [ABSTRACT FROM AUTHOR]

Background:. There is growing evidence that areas characterised by high levels of social fragmentation have higher suicide rates. Previous ecological studies have focused on relatively large geographic areas and/or examined associations in all age groups combined. Methods:. Negative binominal regression was used to assess age- and sex-specific suicide rate ratios for a range of census-derived indicators of the social, health and economic characteristics of small areas (mean population aged ≥ 15: 4500) in England and Wales. Results:. Indicators of social fragmentation (e. g. proportion of people living alone or population mobility) were most consistently associated with suicide risk. For example, across quartiles of wards ranked according to increasing proportions of single-person households, age- and sex-adjusted suicide rate ratios were: 1.00, 1.05 (1.00, 1.11), 1.14 (1.08, 1.19) and 1.42 (1.36, 1.49). Associations were strongest in 15 to 44 and 45 to 64 year-olds. Associations with social fragmentation persisted after controlling for the effect of other area characteristics. Conclusions:. Targeted mental health promotion and social policy initiatives to reduce area-health inequalities in suicide might usefully focus on areas with high levels of social fragmentation. [ABSTRACT FROM AUTHOR]