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BJGP Open Jun 2024Evidence is sparse regarding service usage and the clinical management of people recently discharged from inpatient psychiatric care who die by suicide.
BACKGROUND
Evidence is sparse regarding service usage and the clinical management of people recently discharged from inpatient psychiatric care who die by suicide.
AIM
To improve understanding of how people discharged from inpatient mental health care are supported by primary care during this high-risk transition.
DESIGN & SETTING
A nested case-control study utilising interlinked primary and secondary care records in England for people who died within a year of discharge between 2001 and 2019, matched on age, sex, practice-level deprivation and region with up to 20 living discharged people.
METHOD
We described patterns of consultation, prescription of psychotropic medication and continuity of care for people who died by suicide and those who survived. Mutually adjusted relative risk estimates were generated for a range of primary care and clinical variables.
RESULTS
Over 40% of patients who died within 2 weeks and 80% who died later had at least one primary care consultation. Evidence of discharge communication from hospital was infrequent. Within-practice continuity of care was relatively high. Those who died by suicide were less likely to consult within two weeks of discharge, AOR 0.61 (0.42-0.89), more likely to consult in the week before death, AOR 1.71 (1.36-2.15), to be prescribed multiple types of psychotropic medication, (AOR 1.73, 1.28-2.33), to experience readmission and have a diagnosis outside of the 'Severe Mental Illness' definition.
CONCLUSION
Primary care clinicians have opportunities to intervene and should prioritise patients experiencing transition from inpatient care. Clear communication and liaison between services is essential to provide timely support.
PubMed: 38866405
DOI: 10.3399/BJGPO.2023.0165 -
JAMA Network Open Jun 2024Extreme risk protection orders (ERPOs)-also known as red flag, risk warrant, and gun violence restraining orders-authorize law enforcement, family members, and sometimes...
IMPORTANCE
Extreme risk protection orders (ERPOs)-also known as red flag, risk warrant, and gun violence restraining orders-authorize law enforcement, family members, and sometimes others to petition a court to remove firearms from and prevent the acquisition of new firearms by a person judged to pose an immediate danger to themselves or others. Previous estimates suggest that 1 suicide is prevented for every 10 ERPOs issued, a number needed to treat that depends critically on the counterfactual estimate of the proportion of suicidal acts by ERPO respondents that would have involved firearms in the absence of ERPOs.
OBJECTIVE
To empirically inform updated estimates of the number of ERPOs needed to prevent 1 suicide.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study used data from California for method-specific suicides by handgun ownership (October 18, 2004, to December 31, 2015). Handgun-owning suicide decedents in California were identified using individual-level registry data about lawful handgun ownership linked to cause-specific mortality for a cohort of more than 25 million adults. The study also used data from Connecticut for method-specific suicides among ERPO respondents who died by suicide, extracted from published data (October 1999 to June 2013). Data analysis was performed in December 2023.
EXPOSURE
Handgun ownership.
MAIN OUTCOMES AND MEASURES
The primary outcomes were the number and distribution of suicidal acts by handgun owners in California, estimated using method-specific suicide mortality data and published case fatality ratios, and the counterfactual number and distribution of suicidal acts and deaths among ERPO respondents in Connecticut had no ERPOs been issued.
RESULTS
A total of 1216 handgun owners (mean [SD] age, 50 [18] years; 1019 male [83.8%]) died by suicide during the study period. Among male handgun owners in California, 28% of suicidal acts involved firearms, 54% involved drug poisoning, 9% involved cutting or piercing, 3% involved hanging or suffocation, 2% involved poisoning with solids and/or liquids, and the remaining 4% involved other methods. Assuming this distribution approximates the counterfactual distribution among ERPO respondents in Connecticut in the absence of ERPOs, 1 suicide death was prevented for every 22 ERPOs issued.
CONCLUSIONS AND RELEVANCE
The estimates produced by this cohort study of California handgun owners suggest that ERPOs can play an important role in averting deaths among high-risk individuals.
Topics: Humans; Firearms; Suicide Prevention; California; Male; Female; Adult; Suicide; Middle Aged; Cohort Studies; Gun Violence; Ownership; Aged; Law Enforcement
PubMed: 38865130
DOI: 10.1001/jamanetworkopen.2024.14864 -
EClinicalMedicine Jul 2024Autistic people are a high-risk group for self-harm and suicide. There are no evidence-based suicide prevention interventions developed specifically for autistic people....
BACKGROUND
Autistic people are a high-risk group for self-harm and suicide. There are no evidence-based suicide prevention interventions developed specifically for autistic people. We undertook a pilot feasibility randomised controlled trial of autism adapted safety plans (AASP) to reduce self-harm and suicide for autistic people.
METHODS
This study took place in the United Kingdom and followed a randomised, two-arm, controlled design. Autistic adults (n = 53, mean age = 39, gender = 49% female, 29% not male or female) were recruited via third sector organisations and self-referral between 11.8.21 and 19.10.22. Participants were randomised without stratification to usual care with or without AASP. The AASP was completed by the autistic adults together with someone trained to support them. Research staff who completed follow-up assessments were blind to participant allocation. Primary outcomes were feasibility and acceptability. Participants were assessed at baseline, 1 and 6 months. Primary data were analysed under the intention to treat principle. Study protocol is published. The trial is closed to new participants. This study is registered with the ISRCTN registry, ISRCTN70594445.
FINDINGS
53 participants consented, 49 were randomised to either AASP with usual care (n = 25) or usual care (n = 24). 68% of participants in the AASP arm were satisfied with the AASP and 41% rated it as useable. Feedback on the AASP and research methods were positive with suggested adaptations to some outcome measures. Retention and completion of outcomes measures in both arms was excellent, as was fidelity of delivery of the AASP.
INTERPRETATION
Study progression criteria were met, suggesting that the parameters of a future definitive trial of clinical and cost effectiveness of AASP to reduce self-harm and suicide in autistic adults are achievable, with minor recommended adaptions to outcome measures and AASP. Future research should explore the use of AASP in routine clinical practice.
FUNDING
This study is funded by the NIHR [Public Health Research Programme (NIHR129196)].
PubMed: 38864075
DOI: 10.1016/j.eclinm.2024.102662 -
Health Science Reports Jun 2024Borderline personality disorder (BPD) is a common psychiatric disorder associated with a high risk of suicide attempts, death by suicide, and non-suicidal self-injury...
The relationship between borderline personality disorder and self-injurious/suicidal behaviors in adolescents and young adults: A protocol for systematic review and meta-analysis.
BACKGROUND & AIMS
Borderline personality disorder (BPD) is a common psychiatric disorder associated with a high risk of suicide attempts, death by suicide, and non-suicidal self-injury (NSSI). A systematic and comprehensive understanding of the link between BPD and suicide and self-injury in adolescents and young adults is crucial for effective public health prevention strategies. This protocol outlines our approach to summarize the evidence on the association between BPD diagnosis and self-injurious/suicidal behaviors including death by suicide, nonfatal suicide attempts, NSSI, and self-harm behavior through a systematic review and meta-analysis.
METHODS
The protocol is registered (PROSPERO: CRD42022363329) and developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P)-2015 statement. We will conduct a comprehensive literature search using electronic databases including MEDLINE, EMBASE, SCOPUS, Web of Science, CINHAL, and PsycINFO. The review will include studies that meet the specific inclusion criteria and will be searched using multiple databases A meta-analysis will be conducted using a fixed-effects or random-effects approach based on the level of heterogeneity. Subgroup analysis and meta-regression will be performed if necessary.
CONCLUSION
This study is unique, as it is the first of its kind to systematically review and analyze the existing literature on this topic. The results of this study will provide important evidence on the magnitude of this relationship overall and in different subgroups, which can be used to inform the development of effective prevention and treatment strategies.
PubMed: 38863733
DOI: 10.1002/hsr2.2143 -
Frontiers in Psychiatry 2024The concept of entrapment has been highlighted as a transdiagnostic element that manifests itself in disorders such as depression, anxiety, and suicidal ideation....
BACKGROUND
The concept of entrapment has been highlighted as a transdiagnostic element that manifests itself in disorders such as depression, anxiety, and suicidal ideation. Although research has been conducted in different contexts independently, a comprehensive multi-country study to assess gender differences in entrapment through network analysis has not yet been carried out. The objective of this study was to evaluate the entrapment network in men and women at the multinational level.
METHODS
A sample of 2,949 participants, ranging in age from 18 to 73 years from six countries (Germany, Iran, Spain, Slovakia, El Salvador, and Peru), was considered. They completed the entrapment scale. A network analysis was performed for both men and women to identify the connectivity between indicators and the formation of clusters and domains, in addition to the centrality assessment in both sex groups.
RESULTS
The study findings revealed the presence of a third domain focused on external interpersonal entrapment in the network of men and women. However, in relation to the interconnectivity between domains, variations were evidenced in both networks, as well as in centrality, it was reported that men present a greater generalized entrapment in various aspects of life, while women tend to experience a more focused entrapment in expressions of intense emotional charge.
CONCLUSION
The multinational study identified variations in the structure of entrapment between genders, with three domains (internal, external, and external-interpersonal) and differences in the interaction of indicators and groupings, as well as discrepancies in centrality.
PubMed: 38863617
DOI: 10.3389/fpsyt.2024.1321207 -
Frontiers in Psychiatry 2024Suicide is a serious cause of mortality that affects families, communities, and the entire country. Because of a lack of national systematic reporting for cause-specific...
BACKGROUND
Suicide is a serious cause of mortality that affects families, communities, and the entire country. Because of a lack of national systematic reporting for cause-specific mortality, a high level of stigma, and religious non-acceptance, suicidal behavior is an under-reported and concealed cause of death in the majority of low- and middle-income countries.
OBJECTIVE
The aim of this study was to assess the prevalence of suicidal behavior and associated factors among holy water users at the Andassa Saint George Monastery, 2023.
METHODS
An institution-based cross-sectional study was conducted at the Andassa Saint George Monastery from 5 April to 5 May 2023. A systematic random sampling method was utilized to select 423 study participants and the Suicidal Behaviors Questionnaire-Revised was used to assess suicidal behavior. The data were gathered using the epicollect5 software with a face-to-face interview method then exported to SPSS-25 for analysis. A binary logistic regression model was used and all variables in a bivariate analysis with a -value of less than 0.25 were entered into a multivariable logistic regression model, and statistical significance was declared at a -value of less than 0.05.
RESULTS
The prevalence of suicidal behavior among holy water users was 9.7% (95% CI: 7.1-12.4). Being female [2.632 (1.206-5.748)], living alone [2.52 (1.06-5.97)], and having depression [3.03 (1.32-6.99)], epilepsy [3.82 (1.28-11.40)], and diabetes mellitus [3.37 (1.229-9.25)] were significantly associated with suicidal behavior.
CONCLUSION
In this study, almost 1 in 10 had engaged in suicidal behavior in their lifetime. Several risk factors for suicidal behavior were identified, including being female, living alone, and having diabetes mellitus, epilepsy, and depression.
PubMed: 38863616
DOI: 10.3389/fpsyt.2024.1398363 -
Frontiers in Psychiatry 2024Early detection of depression is important for preventing depression-related suicides and reducing the risk of recurrence. This study explored the association between...
INTRODUCTION
Early detection of depression is important for preventing depression-related suicides and reducing the risk of recurrence. This study explored the association between depression and intestinal microbiota and developed a depression risk-estimation method based on this.
METHODS
The intestinal microbiota of Japanese patients with depression (33 males and 35 females) and disease-free controls (246 males and 384 females) in their 20's to 60's were compared by sex using 16S rRNA gene amplicon sequencing. A depression-risk estimation method was developed using structural equation modeling.
RESULTS
Intestinal bacteria taxa that differed between depression and control groups were identified based on effect size (absolute value greater than 0.2). was more abundant, while , , _XlVb, and were less abundant in the male depression group compared to the male control group. In the female depression group, , , and were more abundant, whereas and were less abundant compared to the female control group. Several of the intestinal bacterial taxa that were less abundant in depression were associated with butyrate or hydrogen production. Using these depression-associated intestinal bacteria as indicators, risk-estimation models using structural equation modeling for depression were developed. In the risk-estimation models for males and females, the areas under the receiver operating characteristic curve were 0.72 and 0.70, respectively, indicating that these models can distinguish between individuals with and without depression.
CONCLUSIONS
This study provides insights into depression etiology and aids in its early detection and treatment.
PubMed: 38863614
DOI: 10.3389/fpsyt.2024.1382175 -
Frontiers in Psychiatry 2024Depression is a primary cause of illness and disability among teenagers, and the incidence of depression and the number of untreated young people have increased in...
BACKGROUND
Depression is a primary cause of illness and disability among teenagers, and the incidence of depression and the number of untreated young people have increased in recent years. Effective intervention for those youths could decrease the disease burden and suicide or self-harm risk during preadolescence and adolescence.
OBJECTIVE
To verify the short efficacy of the systemic couple group therapy (SCGT) on youths' depression changes and families with depressed adolescents.
METHODS
The study was a self-control trial; only within-group changes were evaluated. Participants were couples with a depressed child who was resistant to psychotherapy; they were recruited non-randomly through convenient sampling. The paired-sample -test and Wilcoxon signed-rank test were used to compare differences before and after interventions. The effect sizes were also estimated using Cohen's d. Spearman's correlation analysis was used to examine associations between changes.
RESULTS
A downward trend was seen in depressive symptoms after treatment, and Cohen's d was 0.33 ( = 0.258). The adolescents perceived fewer interparental conflicts, and the effect sizes were medium for perceived conflict frequency (0.66, = 0.043), conflict intensity (0.73, = 0.028), conflict solutions (0.75, = 0.025), coping efficacy (0.68, = 0.038), and perceived threat (0.57, = 0.072). For parents, global communication quality, constructive communication patterns, and subjective marital satisfaction significantly improved after interventions, with large effect sizes (1.11, 0.85, and 1.03, respectively; all 0.001). Other destructive communication patterns such as demand/withdraw ( = 0.003) and mutual avoidance ( = 0.018) and communication strategies like verbal aggression ( = 0.012), stonewalling ( = 0.002), avoidance-capitulation ( = 0.036), and child involvement ( = 0.001) also reduced, with medium effect sizes (0.69, 0.52, 0.55, 0.71, 0.46, and 0.79, respectively). Meanwhile, the associations between depression changes and changes in interparental conflicts ( 0.001) and marital satisfaction ( = 0.001) were significant.
CONCLUSIONS AND CLINICAL RELEVANCE
The SCGT offers the possibility for the treatment of families with depressed children who are unwilling to seek treatment. Helping parents improve communication and marital quality may have benefits on children's depressive symptoms.
PubMed: 38863609
DOI: 10.3389/fpsyt.2024.1283519 -
BMC Public Health Jun 2024Rates of self-harm and suicide are rising for young people globally and many implicate social media in this problem. To address this concern and to increase the...
BACKGROUND
Rates of self-harm and suicide are rising for young people globally and many implicate social media in this problem. To address this concern and to increase the confidence of adults to communicate safely about suicide and social media with young people, the #chatsafe Guide for Parents and Carers was developed in Australia. With significant uptake of the resource among Australian adults, the aim of the current study was to update and contextualise the #chatsafe Guide for Parents and Carers for audiences in 15 countries globally. To improve the relevance of this resource for parents and carers in these countries, the present study sought to understand the concerns held by parents, carers and suicide prevention professionals around the world about these topics and to explore the extent to which a resource such as #chatsafe would be helpful within their communities.
METHODS
Seven focus groups were conducted via Zoom with parents, carers and suicide prevention professionals (n = 40) from 15 countries. Transcribed data were coded and thematically analysed using both inductive and deductive processes.
RESULTS
Six themes are reported: (1) Two scary 'S' words; (2) Country and culture impact who talks (or is silent) about self-harm and suicide; (3) The need for a protective social ecosystem; (4) #chatsafe is a tool that can help parents, carers and young people worldwide; (5) #chatsafe should consider local context and end users to improve its relevance for parents and carers worldwide; and (6) A range of marketing and dissemination strategies are needed to reach adults with #chatsafe information. Findings of this study informed the update and contextualisation of the #chatsafe Guide for Parents and Carers for adult audiences in 15 countries.
CONCLUSIONS
The findings from this study underscore a universal need for psychoeducation initiatives that provide adults with the skills and knowledge to support the mental health of young people, both online and offline, and that resources like #chastafe can play an important role in providing reliable information about these topics to adults across a range of cultures and contexts.
Topics: Humans; Parents; Caregivers; Focus Groups; Qualitative Research; Adult; Male; Female; Australia; Social Media; Self-Injurious Behavior; Suicide Prevention; Middle Aged; Adolescent; Young Adult; Social Support; Suicide
PubMed: 38862974
DOI: 10.1186/s12889-024-19040-5 -
Scientific Reports Jun 2024We aimed to evaluate the association of unmet health-related need with suicidal behaviors among Korean adults. We included 26,219 adults (13,937 men and 17,788 women)...
We aimed to evaluate the association of unmet health-related need with suicidal behaviors among Korean adults. We included 26,219 adults (13,937 men and 17,788 women) aged ≥ 19 years from the Korea National Health and Nutrition Examination Survey (2015-2020). Suicidal behavior included suicidal plan and attempt. We analyzed the odds ratios and 95% confidence intervals of suicidal behaviors according to unmet health-related need via multivariable logistic regression analysis and performed stratified analyses according to sex, age, income, education, and type of insurance. Of the participants, 9.6% had unmet health-related need. Suicidal plans and attempts had 1.3% and 0.5% of the participants, respectively. The prevalence of suicidal plans and attempts was 0.9% and 0.4% among participants without unmet health-related need and 3.1% and 1.0% among those with such need, respectively. The odd ratios of suicidal plans and attempts increased significantly among participants with unmet health-related need compared to those without. In subgroup analysis, most subgroups showed similar results, except for suicidal plan and attempt in the 45-64 age group, high education, and medical care and suicidal attempt in 19-44 age group, low-income, and unmarried. Unmet health-related need was independently associated with suicidal plan and attempt. A policy alternative is needed for these associations.
Topics: Humans; Male; Adult; Female; Republic of Korea; Middle Aged; Retrospective Studies; Suicide, Attempted; Suicidal Ideation; Young Adult; Aged; Prevalence; Health Services Needs and Demand; Nutrition Surveys; Odds Ratio
PubMed: 38862658
DOI: 10.1038/s41598-024-63200-x