Psychiatric disorders are reported to be present in 80% to 90% of suicide deaths in high-income countries (HIC), but this association is less clear in low- and middle-income countries (LMIC). There ...has been no previous systematic review of this issue in LMIC. The current study aims to estimate the prevalence of psychiatric morbidity in individuals with suicidal behaviour in LMIC.
PubMed, PsycINFO, and EMBASE searches were conducted to identify quantitative research papers (any language) between 1990 and 2018 from LMIC that reported on the prevalence of psychiatric morbidity in suicidal behaviour. We used meta-analytic techniques to generate pooled estimates for any psychiatric disorder and specific diagnosis based on International classification of disease (ICD-10) criteria. A total of 112 studies (154 papers) from 26 LMIC (India: 25%, China: 15%, and other LMIC: 60%) were identified, including 18 non-English articles. They included 30,030 individuals with nonfatal suicidal behaviour and 4,996 individuals who had died by suicide. Of the 15 studies (5 LMIC) that scored highly on our quality assessment, prevalence estimates for psychiatric disorders ranged between 30% and 80% in suicide deaths and between 3% and 86% in those who engaged in nonfatal suicidal behaviour. There was substantial heterogeneity between study estimates. Fifty-eight percent (95% CI 46%-71%) of those who died by suicide and 45% (95% CI 30%-61%) of those who engaged in nonfatal suicidal behaviour had a psychiatric disorder. The most prevalent disorder in both fatal and nonfatal suicidal behaviour was mood disorder (25% and 21%, respectively). Schizophrenia and related disorders were identified in 8% (4%-12%) of those who died by suicide and 7% (3%-11%) of those who engaged in nonfatal suicidal behaviour. In nonfatal suicidal behaviour, anxiety disorders, and substance misuse were identified in 19% (1%-36%) and 11% (7%-16%) of individuals, respectively. This systematic review was limited by the low number of high-quality studies and restricting our searches to databases that mainly indexed English language journals.
Our findings suggest a possible lower prevalence of psychiatric disorders in suicidal behaviour in LMIC. We found very few high-quality studies and high levels of heterogeneity in pooled estimates of psychiatric disorder, which could reflect differing study methods or real differences. There is a clear need for more robust evidence in order for LMIC to strike the right balance between community-based and mental health focussed interventions.
Charcoal-burning suicide has recently been spreading to many Asian countries. There have also been several cases involving this new method of suicide in Western countries. Restricting access to ...suicide means is one of the few suicide-prevention measures that have been supported by empirical evidence. The current study aims to assess the effectiveness of a community intervention program that restricts access to charcoal to prevent suicide in Taiwan.
A quasi-experimental design is used to compare method-specific (charcoal-burning suicide, non-charcoal-burning suicide) and overall suicide rates in New Taipei City (the intervention site, with a population of 3.9 million) with two other cities (Taipei City and Kaohsiung City, the control sites, each with 2.7 million residents) before (Jan 1st 2009- April 30th 2012) and after (May 1st 2012-Dec. 31st 2013) the initiation of a charcoal-restriction program on May 1st 2012. The program mandates the removal of barbecue charcoal from open shelves to locked storage in major retail stores in New Taipei City. No such restriction measure was implemented in the two control sites. Generalized linear regression models incorporating secular trends were used to compare the changes in method-specific and overall suicide rates before and after the initiation of the restriction measure. A simulation approach was used to estimate the number of lives saved by the intervention. Compared with the pre-intervention period, the estimated rate reduction of charcoal-burning suicide in New Taipei City was 37% (95% CI: 17%, 50%) after the intervention. Taking secular trends into account, the reduction was 30% (95% CI: 14%, 44%). No compensatory rise in non-charcoal-burning suicide was observed in New Taipei City. No significant reduction in charcoal-burning suicide was observed in the other two control sites. The simulation approach estimated that 91 (95%CI 55, 128) lives in New Taipei City were saved during the 20 months of the intervention.
Our results demonstrate that the charcoal-restriction program reduced method-specific and overall suicides. This study provides strong empirical evidence that restricting the accessibility of common lethal methods of suicide can effectively reduce suicide rates.
To investigate the effect of 3-year phased bans of the pesticides dimethoate and fenthion in 2008-2010, and paraquat in 2009-2011, on suicide mortality in Sri Lanka.
Age-standardised overall, ...sex-specific, and method-specific suicide rates were calculated using Sri Lankan police data (1989-2015). Using negative binomial regression models, we estimated the change in the rate and number of suicide deaths in post-ban years (2011-15) compared to those expected based on pre-ban trends (2001-10).
Overall suicide mortality dropped by 21% between 2011 and 2015, from 18.3 to 14.3 per 100,000. The decline in pesticide suicides during this same period was larger than for overall suicides: from 8.5 to 4.2 per 100,000, a 50% reduction. This was accompanied by a smaller concurrent rise in non-pesticide suicide mortality with a 2% increase (9.9 to 10.1 per 100,000). In 2015, the ratio between the observed and expected pesticide suicide rates was 0.49 (95% confidence interval CI 0.40, 0.62), corresponding to an estimated 937 (95% CI 574, 1389) fewer pesticide suicides than expected from pre-ban suicide rates. Findings were similar in sensitivity analyses using 2008 or 2012 as commencement of the post intervention period.
Bans of paraquat, dimethoate and fenthion in Sri Lanka were associated with a reduction in pesticide suicide mortality and in overall suicide mortality despite a small rise in other methods. This study provides further evidence for the effectiveness of pesticide regulation in limiting the availability of highly hazardous pesticides and thereby reducing the number of global suicides.
Abstract Background Agricultural pesticide poisoning is a major contributor to the global burden of suicide. Over the last decade there has been a marked decrease in the incidence of suicide ...worldwide. It is unclear whether pesticide poisoning still plays a significant role in the global incidence of suicide. Methods WHO method-specific suicide data were supplemented by a systematic review of the literature between 2006 and 2015, including searches of thirteen electronic databases and Google, citation searching and a review of reference lists and personal collections. Our primary outcome was the proportion of total suicides due to pesticide poisoning. Weighted estimates were calculated for seven WHO regional and income strata. Results We identified data from 108 countries (102 from WHO data, 6 from the literature). A conservative estimate based on these data indicates that there were approximately 110,000 pesticide self-poisoning deaths each year from 2010 to 2014, comprising 13.7% of all global suicides. A sensitivity analysis accounting for under-reporting of suicides in India resulted in an increased estimate of 168,000 pesticide self-poisoning deaths annually, that is, 19.7% of global suicides. The proportion of suicides due to pesticide self-poisoning varies considerably between regions, from 0.9% in low- and middle-income countries in the European region to 48.3% in low- and middle-income countries in the Western Pacific region. Limitations High quality method-specific suicide data were unavailable for a number of the most populous countries, particularly in the African and Eastern Mediterranean regions. It is likely we have underestimated incidence in these regions. Conclusion There appears to have been a substantial decline in fatal pesticide self-poisoning in recent years, largely driven by a reduction in overall suicide rates in China. Nonetheless, pesticide self-poisoning remains a major public health challenge, accounting for at least one-in-seven suicides globally.
Means restriction for suicide prevention Yip, Paul SF, Prof; Caine, Eric, Prof; Yousuf, Saman, FCPS ...
The Lancet,
06/2012, Letnik:
379, Številka:
9834
Journal Article
Recenzirano
Odprti dostop
Limitation of access to lethal methods used for suicide—so-called means restriction—is an important population strategy for suicide prevention. Many empirical studies have shown that such means ...restriction is effective. Although some individuals might seek other methods, many do not; when they do, the means chosen are less lethal and are associated with fewer deaths than when more dangerous ones are available. We examine how the spread of information about suicide methods through formal and informal media potentially affects the choices that people make when attempting to kill themselves. We also discuss the challenges associated with implementation of means restriction and whether numbers of deaths by suicide are reduced.
ABSTRACT
Background and Aims
Given the growing concerns that international trade agreements may increase the supply of health‐harming commodities, including alcohol, this study aimed to investigate ...the changes in alcoholic beverage preference and consumption after Taiwan's accession to the World Trade Organization (WTO).
Design
A before‐and‐after comparison analysis using data from two waves (1993–1996 and 2005–2008) of the Nutrition and Health Survey in Taiwan (NAHSIT), before and after Taiwan's accession to the WTO in 2002.
Setting
Taiwan.
Participants
A total of 5031 and 2910 participants aged 19 years or older in NAHSIT 1993–1996 and 2005–2008, respectively.
Measurements
Alcohol measures included beverage‐specific preference, mean daily ethanol consumption, and heavy drinking. Logistic regression was used to estimate the prevalence rate ratios and rate differences of beverage preferences between the two waves and the risk ratios of heavy drinking associated with different beverage preferences.
Findings
A reduced prevalence rate of drinkers who preferred rice spirits (prevalence rate ratio PRR = 0.47; 95% confidence interval CI = 0.24, 0.91) and Asian wine (PRR = 0.11; 95% CI = 0.04, 0.29) was found in contrast to an increase in the preference for fruit wine (PRR = 2.90; 95% CI = 1.75, 4.79); the preference for Asian spirits showed a non‐significant increase (PRR = 1.63; 95% CI = 0.88, 3.02). Similarly, the mean daily ethanol consumption decreased for Asian wine and increased for Asian spirits. Compared with beer, an increased risk of heavy drinking was associated with rice spirits (adjusted risk ratio aRR = 3.30; 95% CI = 1.68, 6.47) and Asian spirits (aRR = 2.64; 95% CI = 1.38, 5.01).
Conclusions
After Taiwan became a member of the World Trade Organization and abolished its alcohol monopoly in 2002, the pattern of alcoholic beverage preference changed markedly, including a decrease in drinkers who preferred rice spirits and Asian wine (53% and 89% decrease, respectively) and an increase in drinkers who preferred fruit wine and Asian spirits (2.9‐fold and 1.6‐fold increase, respectively).
Previous investigations of geographic concentration of urban poverty indicate the contribution of a variety of factors, such as economic restructuring and class-based segregation, racial segregation, ...demographic structure, and public policy. However, the models used by most past research do not consider the possibility that poverty concentration may take different forms in different locations across a city, and most studies have been conducted in Western settings. We investigated the spatial patterning of neighborhood poverty and its correlates in Hong Kong, which is amongst cities with the highest GDP in the region, using the city-wide ordinary least square (OLS) regression model and the local-specific geographically weighted regression (GWR) model. We found substantial geographic variations in small-area poverty rates and identified several poverty clusters in the territory. Factors found to contribute to urban poverty in Western cities, such as socioeconomic factors, ethnicity, and public housing, were also mostly associated with local poverty rates in Hong Kong. Our results also suggest some heterogeneity in the associations of poverty with specific correlates (e.g. access to hospitals) that would be masked in the city-wide OLS model. Policy aimed to alleviate poverty should consider both city-wide and local-specific factors.
Aims
We aimed to investigate the trajectories of absolute and relative risks of cause‐specific mortality among patients discharged from inpatient psychiatric services.
Methods
We conducted a national ...matched cohort study (2002–2013) using data from the Taiwan National Health Insurance database linked to national cause‐of‐death data files. Patients discharged from inpatient psychiatric care without prior psychiatric hospitalizations were individually matched to 20 comparison individuals based on sex and age. The rates, rate differences, and relative risks (hazard ratios, HRs) of cause‐specific mortality were calculated at six follow‐up periods post‐discharge. Cumulative mortality incidence was assessed at 5 years of follow‐up.
Results
The mortality risks of all causes were increased among patients (n = 158 065) relative to comparison individuals (n = 3 161 300). Mortality rate differences were greater for natural causes, while relative risks (HRs) were higher for unnatural causes. Suicide was the leading cause of death within the first year of discharge, while circulatory and respiratory diseases were the leading causes of death from the second year. The mortality rates and HRs for all causes of death (except homicide) were highest during the first 3 months. The elevated risk of unnatural‐cause mortality declined rapidly after discharge but remained high in the long term; in contrast, risk elevation for natural‐cause mortality was more stable over time. Approximately one‐eighth of patients (12.9%, 95% confidence interval 12.7–13.7%) died within 5 years of follow‐up.
Conclusions
Integrated physical and mental health care is needed to reduce excess mortality, particularly during the first 3 months post‐discharge, among psychiatric patients.
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