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Background: The prevalence of major depressive disorder (MDD) in women is up to 50% higher as compared to men. However, little is known about discrepancies in health care utilization between depressed female and male patients. Consequently, the aim of the present study was to elucidate gender differences regarding the frequency of hospital admissions and the length of inpatient treatment for MDD across the lifespan. Methods: This nationwide, registry-based study analyzed all inpatient admissions in psychiatric hospitals due to recurrent/non-recurrent MDD episodes according to ICD-10 (moderate (F32/33.1), severe (F32/33.2), severe with psychotic features (F32/33.3)) in Austria across 14 years. We calculated weekly admission rates per 100,000 patients by directly age-standardized rates. Results: Across 232,289 admissions (63.2% female) the population based admission rates in MDD were significantly higher in women (p < 0.001). Female to male ratios across subgroups were 1.65 (F32/33.1), 1.58 (F32/33.2), 1.73 (F32/33.3), and peaked around 65 years (ratio ≥ 2 for all subgroups). Length of hospital stay for women was significantly longer in all depression subtypes (p < 0.001). Conclusions: Elevated rates of inpatient treatment in women cannot solely be explained by a higher MDD prevalence and are dependent on age and type of depressive episode. Irrespective of the type and severity of the mood episode, women exhibit longer hospitalisation times. [ABSTRACT FROM AUTHOR]

Methods of suicide have received considerable attention in suicide research. The common approach to differentiate methods of suicide is the classification into "violent" versus "non-violent" method. Interestingly, since the proposition of this dichotomous differentiation, no further efforts have been made to question the validity of such a classification of suicides. This study aimed to challenge the traditional separation into "violent" and "non-violent" suicides by generating a cluster analysis with a data-driven, machine learning approach. In a retrospective analysis, data on all officially confirmed suicides (N = 77,894) in Austria between 1970 and 2016 were assessed. Based on a defined distance metric between distributions of suicides over age group and month of the year, a standard hierarchical clustering method was performed with the five most frequent suicide methods. In cluster analysis, poisoning emerged as distinct from all other methods – both in the entire sample as well as in the male subsample. Violent suicides could be further divided into sub-clusters: hanging, shooting, and drowning on the one hand and jumping on the other hand. In the female sample, two different clusters were revealed – hanging and drowning on the one hand and jumping, poisoning, and shooting on the other. Our data-driven results in this large epidemiological study confirmed the traditional dichotomization of suicide methods into "violent" and "non-violent" methods, but on closer inspection "violent methods" can be further divided into sub-clusters and a different cluster pattern could be identified for women, requiring further research to support these refined suicide phenotypes. [ABSTRACT FROM AUTHOR]

Background Restriction of access to suicide methods has been shown to effectively reduce suicide mortality rates. Aims To examine how the global economic crisis of 2008 and the firearm legislation reform of 1997 affected suicide and homicide mortality rate within Austria. Methods Official data for the years 1985–2016 for firearm certificates, suicide, homicide, unemployment rates and alcohol consumption were examined using auto regressive error and Poisson regression models. Results Firearm certificates, total suicide mortality rate, suicide and homicides by firearms, and the fraction of firearm suicides/homicides among all suicides/homicides decreased after the firearm legislation reform in 1997. However, significant trend changes can be observed after 2008. The availability of firearm certificates significantly increased and was accompanied by significant changes in trends of firearm suicide and homicide rates. Concurrently, the total suicide mortality rate in 2008, for the first time since 1985, stopped its decreasing trend. While the total homicide rate further decreased, the fraction of firearm homicides among all homicides significantly increased. Conclusion The initially preventative effect of the firearm legislation reform in Austria in 1997 seems to have been counteracted by the global economic downturn of 2008. Increased firearm availability was associated with corresponding increases in both firearm suicide and firearm homicide mortality. Restrictive firearm legislation should be an imperative part of a country’s suicide prevention programme. Although firearm legislation reform may have long-lasting effects, societal changes may facilitate compensatory firearm acquisitions and thus counteract preventive efforts, calling in turn again for adapted counter-measures. [ABSTRACT FROM AUTHOR]

Background: Mood episodes in bipolar disorder (BD) are reported to exhibit a seasonal pattern (SP). However, it is unclear whether this pattern is influenced by a patient's sex and age.Methods: In this nationwide registry study, we examined all inpatient treatments due to a manic (F31.0-2), depressive (F31.3-5) or mixed (F31.6) BD-episode in Austria for 2001-2014. Calculations were based on directly age-standardized rates and seasonality was analyzed on a monthly basis.Results: The database comprised 60,607 admissions (35.8% men). SP were shown for women during manic (summer-autumn), depressive (winter) and mixed (summer) episodes, for men only during manic (summer) episodes. However, no significant sex differences (manic p = 0.101, depressive p = 0.295, mixed p = 0.622 episode) were found. Women at young age (15-35 years) seemed to be more vulnerable to a SP in manic and mixed episodes.Limitations: Only aggregated patient data of inpatient treatments and no single case histories were available.Conclusions: In this nationwide registry study, a distinct SP could be shown for manic episodes in men and women, as well as a SP for depressive and mixed episodes in women. As no significant difference in any BD-subgroup could be observed, the effect of sex on the SP seems to be small, if existing at all. However, when taking age into account, we observed a higher likelihood for a SP in young women. Single case studies with information on possible further influencing factors (e.g. medication use) might help to clarify the impact of sex and age on SP in more detail. [ABSTRACT FROM AUTHOR]

Background: Aside from the concept of seasonal affective disorder, the evidence for a seasonal pattern (SP) of major depressive disorder (MDD) is controversial. Furthermore, the effect of sex and age is still unclear.Methods: This is a nationwide, registry-based study assessing all inpatient admissions in mental health hospitals due to MDD episodes according to ICD-10 (moderate (F32/33.1), severe (F32/33.2) and severe with psychotic features (F32/33.3)) in Austria across 14 years. Calculations were based on deviations from expected monthly admissions.Results: The sample comprised 231,824 hospitalisations (36.8% men) for MDD. A significant SP (p=0.001) in moderate and severe depressive episodes in both women and men with decreased admission rates in the summer months and December was detected. In psychotic depression a significant SP was only evidenced in women (p = 0.002, men: p = 0.291). Patients older than 55 years had a reduced SP compared to those being younger.Limitations: Only anonymised admission data of inpatient treatments were available. Hospitalization rates cannot fully be equated to the occurrence of MDD.Conclusions: The current study indicates a seasonal variation in MDD symptoms that may go beyond seasonal affective disorder. Knowledge about the predictability of depressive symptoms in patients should encourage preventive strategies. [ABSTRACT FROM AUTHOR]

• Between 2004 and 2017 we found 10 suicides of pregnant/postpartal women in Austria. • The comparably low number of found suicides is arguably attributable to methodological issues in identifying perinatal suicides. • A more comprehensive inquiry into perinatal deaths and further improvements in perinatal mental health care are called for. Suicide is one of the leading causes of maternal death during pregnancy and the first postpartum year. This retrospective investigation aimed at characterizing suicides in Austria during pregnancy and the first postpartum year between 2004 and 2017. We identified 10 suicides of pregnant/ postpartal women in that period, all of whom used violent methods, resulting in a maternal suicide rate of 0.89 per 100,000 birth events. The comparably low number of found suicides is arguably attributable to methodological issues in identifying perinatal suicides. Hence, a more comprehensive inquiry into perinatal deaths and further improvements in perinatal mental health care are called for. [ABSTRACT FROM AUTHOR]

Background: Alcohol use disorder (AUD) is associated with a high prevalence rate and causes a significant burden on health systems globally. The most severe condition associated with AUD is end-stage alcohol-related liver disease (ARLD), for which liver transplantation (LTX) is the only curative therapy. However, the determination of key epidemiologic figures of both conditions is limited by several difficulties and challenges. Therefore, the goal of this paper is to discuss different epidemiological models to estimate AUD and ARLD prevalence, and compare the results of these models with LTX data., Methods: A literature search for epidemiological models estimating the prevalence of AUD and associated secondary diseases was conducted. Identified approaches are discussed and recalculated, applying the newest available data for Austria. The thus estimated numbers were, in a further step, set in relation to the national LTX statistics., Results: Besides health survey-based estimations and models based on economic data, estimations based on the mortality of ARLD (Jellinek formula) were identified. Depending on the prediction scenario, the calculated rates of prevalence of AUD ranged between 4.1% and 10.1% for the population aged older than 15 years. Furthermore, while the prevalence of secondary diseases due to AUD is high, only a marginal proportion (about 4%) of end-stage ARLD patients receive a new organ., Conclusion: These results suggest that the prevalence of AUD and associated diseases remain underestimated. Furthermore, a pronounced discrepancy between the number of ARLD deaths and the number of LTXs due to ARLD, and distinct regional differences in the supply of LTXs, were found.

Purpose: The purpose of this study is to compare the prevalence of depression among different types of hospital departments. Furthermore, it compares different methods for assessment of its recognition by non-psychiatric physicians., Methods: 993 inpatients of internal, surgical, gynecological and physical rehabilitation wards of community hospitals were interviewed by research psychiatrists using the Clinical Interview Schedule. Ward physicians were asked to fill in a short questionnaire in order to assess whether they could correctly identify patients with mental illnesses. In addition, routine discharge diagnoses were assessed., Results: Of the total sample, 13.3 % suffered from depression. Depression was most frequent on physical rehabilitation units (24.2 %), followed by surgical (9.8 %) and internal (9.5 %) wards. On gynecological wards, prevalence of depression was lowest (8.7 %). Of those suffering from depression, 45.7 % were identified as mentally ill by non-psychiatric ward physicians when using questionnaire data. Only 21.0 % of the depressed received a psychiatric discharge diagnosis, which equals less than half of those identified by questionnaire., Results: Of the total sample, 13.3 % of patients suffered from depression. Depression was most frequent in physical rehabilitation units (24.2 %), followed by surgical (9.8 %) and internal (9.5 %) wards. In gynecological wards, the prevalence of depression was the lowest (8.7 %). Of those suffering from depression, 45.7 % were identified as mentally ill by non-psychiatric ward physicians when using questionnaire data. Only 21.0 % of the depressed received a psychiatric discharge diagnosis, less than half of those identified by the questionnaire., Conclusions: Depression is very common among inpatients of physical hospital departments. Unfortunately, depression is frequently overlooked in everyday clinical work. Routine discharge diagnoses give only very limited information about how often ward physicians recognize mental disorders. Furthermore, hospital discharge diagnoses should not be used for planning mental health services.