The COVID-19 pandemic is having profound mental health consequences for many people. Concerns have been expressed that, at their most extreme, these consequences could manifest as increased suicide ...rates. We aimed to assess the early effect of the COVID-19 pandemic on suicide rates around the world.
We sourced real-time suicide data from countries or areas within countries through a systematic internet search and recourse to our networks and the published literature. Between Sept 1 and Nov 1, 2020, we searched the official websites of these countries' ministries of health, police agencies, and government-run statistics agencies or equivalents, using the translated search terms "suicide" and "cause of death", before broadening the search in an attempt to identify data through other public sources. Data were included from a given country or area if they came from an official government source and were available at a monthly level from at least Jan 1, 2019, to July 31, 2020. Our internet searches were restricted to countries with more than 3 million residents for pragmatic reasons, but we relaxed this rule for countries identified through the literature and our networks. Areas within countries could also be included with populations of less than 3 million. We used an interrupted time-series analysis to model the trend in monthly suicides before COVID-19 (from at least Jan 1, 2019, to March 31, 2020) in each country or area within a country, comparing the expected number of suicides derived from the model with the observed number of suicides in the early months of the pandemic (from April 1 to July 31, 2020, in the primary analysis).
We sourced data from 21 countries (16 high-income and five upper-middle-income countries), including whole-country data in ten countries and data for various areas in 11 countries). Rate ratios (RRs) and 95% CIs based on the observed versus expected numbers of suicides showed no evidence of a significant increase in risk of suicide since the pandemic began in any country or area. There was statistical evidence of a decrease in suicide compared with the expected number in 12 countries or areas: New South Wales, Australia (RR 0·81 95% CI 0·72-0·91); Alberta, Canada (0·80 0·68-0·93); British Columbia, Canada (0·76 0·66-0·87); Chile (0·85 0·78-0·94); Leipzig, Germany (0·49 0·32-0·74); Japan (0·94 0·91-0·96); New Zealand (0·79 0·68-0·91); South Korea (0·94 0·92-0·97); California, USA (0·90 0·85-0·95); Illinois (Cook County), USA (0·79 0·67-0·93); Texas (four counties), USA (0·82 0·68-0·98); and Ecuador (0·74 0·67-0·82).
This is the first study to examine suicides occurring in the context of the COVID-19 pandemic in multiple countries. In high-income and upper-middle-income countries, suicide numbers have remained largely unchanged or declined in the early months of the pandemic compared with the expected levels based on the pre-pandemic period. We need to remain vigilant and be poised to respond if the situation changes as the longer-term mental health and economic effects of the pandemic unfold.
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•Drop in psychiatric hospitalizations during pandemic relates to epidemiological measures, with added burden to acute units.•Increase in emergency psychiatric visits is expected and can persist after ...normalization of regular outpatient services•Month-by-month dynamic is more informative than yearly trends in analyzing services utilization during the pandemic.•Specific psychiatric services bear added burden during pandemic, requiring compensation through early shift in resources.
With the significant impact of COVID-19 pandemic on the health, and the functioning of health care system, it has become increasingly important to understand changes in the ways health services were utilized and the factors influencing it. Drop in psychiatric admissions was seen during the pandemic, but also an increase in acute hospitalizations and emergency visits. Our aim was to analyze changes in out- and in-patient services utilization in the largest Croatian psychiatric institution during the first year of the pandemic, observed through the lens of the stringency index, and compare it to the pre-pandemic year. Along with an overall drop in hospitalizations, but a unit-specific rise in hospitalization, we have observed a non-significant overall drop in regular outpatient visits, and a significant drop coinciding with strictest epidemiological measures. There was also a significant increase in emergency visits coinciding with epidemiological measures that failed to return to pre-pandemic values, pointing to an expected significant and prolonged burden on emergency services. Simultaneous analysis of changing dynamics of mental health care service utilization during the pandemic helps us identify specific points of increased burden, and help us plan for early and flexible resources shift in order to adequately respond to evolving challenges.
Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We ...aimed to provide a timely, granular picture of the pandemic's impact on suicides globally.
We identified suicide data from official public-sector sources for countries/areas-within-countries, searching websites and academic literature and contacting data custodians and authors as necessary. We sent our first data request on 22nd June 2021 and stopped collecting data on 31st October 2021. We used interrupted time series (ITS) analyses to model the association between the pandemic's emergence and total suicides and suicides by sex-, age- and sex-by-age in each country/area-within-country. We compared the observed and expected numbers of suicides in the pandemic's first nine and first 10-15 months and used meta-regression to explore sources of variation.
We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries’ COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries’ income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well.
Although there are some countries/areas-within-countries where overall suicide numbers and numbers for certain sex- and age-based groups are greater-than-expected, these countries/areas-within-countries are in the minority. Any upward movement in suicide numbers in any place or group is concerning, and we need to remain alert to and respond to changes as the pandemic and its mental health and economic consequences continue.
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Plasminogen activator inhibitor-1 (PAI-1) has a significant role in fibrinolysis, atherogenesis, cellular senescence, and chronic inflammation. OSA (obstructive sleep apnea) leads to increased PAI-1 ...levels and the development of cardiovascular disease (CVD). The aim of this study was to determine the effects of CPAP therapy on coagulation parameters and PAI-1 in patients with severe OSA. This prospective, controlled study enrolled 57 patients who were newly diagnosed with severe OSA, 37 of whom had had good CPAP adherence after 6 months of therapy (usage of the device for at least 4 h per night), and their data were analyzed. The analysis showed a statistically significant increase in D-dimer values before CPAP therapy (415 (316.5–537.5)) vs. after therapy (499 (327–652)), p = 0.0282, and a decrease in fibrinogen values (3.665 ± 0.752 before CPAP therapy vs. 3.365 ± 0.771 after therapy, p = 0.0075)). PAI-1 concentration values before and after CPAP therapy did not differ significantly (17.35 ± 7.01 ng/mL before CPAP therapy vs. 17.42 ± 6.99 ng/mL after therapy, p = 0.9367). This study shows a tendency for fibrinolytic capacity to improve in patients with OSA after CPAP therapy, although PAI-1 levels did not differ significantly.
We reviewed the pleiotropic beneficial effects of the stable gastric pentadecapeptide BPC 157, three very recent demonstrations that may be essential in the gut-brain and brain-gut axis operation, ...and therapy application in the central nervous system disorders, in particular. Firstly, given in the reperfusion, BPC 157 counteracted bilateral clamping of the common carotid arteries-induced stroke, sustained brain neuronal damages were resolved in rats as well as disturbed memory, locomotion, and coordination. This therapy effect supports particular gene expression in hippocampal tissues that appeared in BPC 157-treated rats. Secondly, there are L-NG-nitro arginine methyl ester (L-NAME)- and haloperidol-induced catalepsy as well as the rat acute and chronic models of 'positive-like' schizophrenia symptoms, that BPC 157 counteracted, and resolved the complex relationship of the nitric oxide-system with amphetamine and apomorphine (dopamine agents application), MK-801 (non-competitive antagonist of the N-methyl-D-aspartate receptor) and chronic methamphetamine administration (to induce sensitivity). Thirdly, after rat spinal cord compression, there were advanced healing and functional recovery (counteracted tail paralysis). Likewise, in BPC 157 therapy, there is specific support for each of these topics: counteracted encephalopathies; alleviated vascular occlusion disturbances (stroke); counteracted dopamine disturbances (dopamine receptors blockade, receptors super sensitivity development, or receptor activation, over-release, nigrostriatal damage, vesicles depletion), and nitric oxide-system disturbances ("L-NAME non-responsive, L-arginine responsive," and "L-NAME responsive, L-arginine responsive") (schizophrenia therapy); inflammation reduction, nerve recovery in addition to alleviated hemostasis and vessels function after compression (spinal cord injury therapy). Thus, these disturbances may be all resolved within the same agent's beneficial activity, i.e., the stable gastric pentadecapeptide BPC 157.
Bolnički dio sustava skrbi za psihičko zdravlje izložen je svim izazovima sigurnosti kao i drugi dijelovi bolničkoga zdravstvenog sustava, no mimo njih izložen je i dodatnim, jedinstvenim izazovima ...sigurnosti, od kojih je jedan svakako povezan s pružanjem skrbi za suicidalne bolesnike. Kao krajnja pojavnost kontinuuma suicidalnosti – samoubojstvo, posebice u bolničkom sustavu skrbi, može predstavljati valjani pokazatelj sigurnosti pružene skrbi. To prepoznaje i pravni okvir u Republici Hrvatskoj koji pokušaj samoubojstva i samoubojstvo razvrstava u neočekivani neželjeni događaj. Međutim, nastojanje sprječavanja (prevencije) samoubojstava i pokušaja samoubojstava bremenito je mnogobrojnim izazovima, a koje u ovom preglednom radu prikazujemo kroz nekoliko međusobno isprepletenih (pod)cjelina: procjenu i predviđanje suicidalnosti (to jest, opasnost od samoubojstva), prijam na bolničko liječenje, liječenje i nadzor tijekom bolničkog liječenja, otpust s bolničkog liječenja te daljnje praćenje po otpustu. Unatoč svim izazovima, sprječavanje samoubojstava je središnji izazov sigurnosti bolesnika u bolničkom sustavu skrbi za psihičko zdravlje.
Depression is a growing public health problem still under-recognised in primary care settings. By focusing primarily on somatic complaints and diseases, general practitioners often fail to identify ...an underlying mental disorder. The aim of this study was to assess the prevalence of patients with unrecognised depression symptoms in general practice and identify associated socio-demographic factors.
The study included 769 patients without previous psychiatric disorder who attended their primary care physicians in the Health Centre Zagreb - Zapad in January 2011. Data on patients' age, sex, level of education, marital and employment status were collected. All participants completed The Zung Self-Rating Depression Scale.
Among the 25.5% of participants whose Zung score was outside the normal range, 19.38% were mildly, 4.64% moderately, and 0.91% severely depressed. Statistically significant differences were observed among groups defined according to level of education, employment and marital status (p<0.001). Lower Zung scores were found in individuals with a higher level of education, who were unmarried, employed or still undergoing education. Multivariate logistic regression model revealed that older age (p<0.001), unemployment (p=0.001) or unmarried status (p=0.025) were significant predictors of depression symptoms.
The study revealed a high prevalence of depression symptoms among primary care patients who had not been previously suspected to have any psychiatric co-morbidity. Awareness of depression symptoms and disorders should be raised among general practitioners, focusing on older, unemployed and unmarried people.
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