This study investigated risk factors for re-attempts and suicide after an index suicide attempt using data from 1241 first-time suicide attempters in Spain over 5 years. The study found that suicide re-attempters were more likely to have cluster B personality disorders or alcohol use disorders. Several patients (1.2%) died by suicide, and those who did were more likely to be alcohol users and older. The study concluded that alcohol use, personality disorders, and younger age increase risk for re-attempts, while older age increases risk for suicide after an attempt.
1. Social and economic factors may have changed between the time periods studied, such as increases in unemployment, poverty, or family disruption, which could impact rates of psychiatric morbidity.
2. Changes may have occurred in how psychiatric disorders are diagnosed and classified between 1977 and 1985 that could influence prevalence findings.
3. Increased awareness, destigmatization of mental health issues, and expansion of treatment services between the periods may have impacted help-seeking behaviors and the proportion of cases identified.
Sex- and Age-specific Increases in Suicide Attempts by Self-Poisoning in the ...Δρ. Γιώργος K. Κασάπης
There was a more than twofold increase in the rate of suspected self-poisoning suicide cases between 2011 and 2018, according to a new study that looked at more than 1.6 million such cases.
Here’s what else you need to know:
•Overall trends: Cases of suicide attempts by self-poisoning doubled in those aged 10-18 between 2011 and 2018, rising from around 39,000 to more than 78,000.
•Gender: More girls than boys attempted suicide by self-poisoning. The rate of intentional attempts among girls 10-18 also steadily increased from 2011-2018.
•Outcomes: The number of serious outcomes — including death and hospitalizations — as a result of the poisoning increased 235% between 2000 and 2018, and more than 1,400 children died.
This study examined factors affecting adherence to Suboxone treatment among 50 African American patients through a retrospective chart review. The results showed significantly negative correlations between adherence and concurrent use of opioids, cocaine, and alcohol. Surprisingly, PTSD showed a positive correlation with adherence, contradicting other studies. No correlation was found between adherence and unemployment. The study concluded that while mental health issues and unemployment may impact adherence, the small sample size likely influenced the results. Larger studies are still needed to fully understand factors affecting Suboxone adherence in minority groups.
Introduction: Migraine is a chronic disease evolving through recurrent attack; it constitutes a frequent reason of consultation in
neurology. It has a signifi cant impact that can affect all spheres of life. Thus, it is one of the most disabling primary headaches.
Objective: To evaluate the impact of migraine in population of Brazzaville
This study assessed the predictive validity of the HCR-20V3 in predicting violence among 63 civil psychiatric patients within 3 weeks of hospital admission. Four raters completed the HCR-20V3 on each patient. Within the study period, 59% of patients were involved in at least one aggressive incident. The Case Prioritization and Severe Physical Harm ratings showed weak predictive validity and non-significant differences between risk groups. However, the Imminent Violence ratings showed moderate predictive validity that approached significance, with significant differences in aggression severity between risk groups. Overall, the results suggest the HCR-20V3 has limited accuracy in identifying violence risk in civil psychiatric patients within the short-term period examined.
This document discusses sampling distributions and their use in making statistical inferences from data. It begins by defining key aspects of sampling distributions, including the statistic of interest (e.g. mean, proportion), random selection of samples, sample size, and population. It then generates a sampling distribution using an example of calculating the mean number of months since patients' last medical examination across different samples. The document outlines important characteristics of sampling distributions and how the central limit theorem applies. It also discusses how to construct confidence intervals and conduct hypothesis testing using sampling distributions.
Burnout among Health Workers: Case of the Military Hospital of Ouakam, Senegalinventionjournals
This study assessed burnout among workers at the Military Hospital of Ouakam in Senegal. A survey was conducted using the Maslach Burnout Inventory tool, involving 66 hospital employees. The results found that 68.2% of workers showed signs of burnout, with 46.9% experiencing mild burnout and 21.2% moderate burnout. Emotional exhaustion was observed in 30.3% of participants, depersonalization in 21.2%, and reduced personal achievement in 36.3%. Burnout was more common among older workers and paramedics. The high prevalence of burnout indicates the need for measures to improve workers' social and professional environments.
1. Social and economic factors may have changed between the time periods studied, such as increases in unemployment, poverty, or family disruption, which could impact rates of psychiatric morbidity.
2. Changes may have occurred in how psychiatric disorders are diagnosed and classified between 1977 and 1985 that could influence prevalence findings.
3. Increased awareness, destigmatization of mental health issues, and expansion of treatment services between the periods may have impacted help-seeking behaviors and the proportion of cases identified.
Sex- and Age-specific Increases in Suicide Attempts by Self-Poisoning in the ...Δρ. Γιώργος K. Κασάπης
There was a more than twofold increase in the rate of suspected self-poisoning suicide cases between 2011 and 2018, according to a new study that looked at more than 1.6 million such cases.
Here’s what else you need to know:
•Overall trends: Cases of suicide attempts by self-poisoning doubled in those aged 10-18 between 2011 and 2018, rising from around 39,000 to more than 78,000.
•Gender: More girls than boys attempted suicide by self-poisoning. The rate of intentional attempts among girls 10-18 also steadily increased from 2011-2018.
•Outcomes: The number of serious outcomes — including death and hospitalizations — as a result of the poisoning increased 235% between 2000 and 2018, and more than 1,400 children died.
This study examined factors affecting adherence to Suboxone treatment among 50 African American patients through a retrospective chart review. The results showed significantly negative correlations between adherence and concurrent use of opioids, cocaine, and alcohol. Surprisingly, PTSD showed a positive correlation with adherence, contradicting other studies. No correlation was found between adherence and unemployment. The study concluded that while mental health issues and unemployment may impact adherence, the small sample size likely influenced the results. Larger studies are still needed to fully understand factors affecting Suboxone adherence in minority groups.
Introduction: Migraine is a chronic disease evolving through recurrent attack; it constitutes a frequent reason of consultation in
neurology. It has a signifi cant impact that can affect all spheres of life. Thus, it is one of the most disabling primary headaches.
Objective: To evaluate the impact of migraine in population of Brazzaville
This study assessed the predictive validity of the HCR-20V3 in predicting violence among 63 civil psychiatric patients within 3 weeks of hospital admission. Four raters completed the HCR-20V3 on each patient. Within the study period, 59% of patients were involved in at least one aggressive incident. The Case Prioritization and Severe Physical Harm ratings showed weak predictive validity and non-significant differences between risk groups. However, the Imminent Violence ratings showed moderate predictive validity that approached significance, with significant differences in aggression severity between risk groups. Overall, the results suggest the HCR-20V3 has limited accuracy in identifying violence risk in civil psychiatric patients within the short-term period examined.
This document discusses sampling distributions and their use in making statistical inferences from data. It begins by defining key aspects of sampling distributions, including the statistic of interest (e.g. mean, proportion), random selection of samples, sample size, and population. It then generates a sampling distribution using an example of calculating the mean number of months since patients' last medical examination across different samples. The document outlines important characteristics of sampling distributions and how the central limit theorem applies. It also discusses how to construct confidence intervals and conduct hypothesis testing using sampling distributions.
Burnout among Health Workers: Case of the Military Hospital of Ouakam, Senegalinventionjournals
This study assessed burnout among workers at the Military Hospital of Ouakam in Senegal. A survey was conducted using the Maslach Burnout Inventory tool, involving 66 hospital employees. The results found that 68.2% of workers showed signs of burnout, with 46.9% experiencing mild burnout and 21.2% moderate burnout. Emotional exhaustion was observed in 30.3% of participants, depersonalization in 21.2%, and reduced personal achievement in 36.3%. Burnout was more common among older workers and paramedics. The high prevalence of burnout indicates the need for measures to improve workers' social and professional environments.
This document summarizes a proposed study on the effects of medical marijuana on reducing symptoms of post-traumatic stress disorder (PTSD). The study would utilize a randomized, double-blind experimental design with 200 participants divided into a control group receiving placebo and an experimental group receiving medical marijuana capsules. Participants would be evaluated quarterly for one year using standardized PTSD assessment tools. The goal is to determine if medical marijuana can effectively reduce PTSD symptoms compared to a placebo by analyzing differences in assessment scores between the two groups over time. Limitations include not addressing effectiveness for long-term PTSD or those taking other medications. If significant results are found, it could provide evidence for medical marijuana as an approved PTSD treatment.
This document discusses chronic diseases and proposes a framework for early detection. It begins by defining chronic diseases and listing some common types like arthritis, cancer, stroke, and heart attack. Parkinson's disease is then discussed in more detail, including its causes, symptoms, increasing rates, and challenges around early detection. The importance of early detection for Parkinson's is explained. Recent research on potential biomarkers from cerebrospinal fluid and blood is mentioned. Research from India and abroad is summarized, including studies using smartphones to assess tremors, deep learning to analyze sensor data, and quantifying finger tremors. The document concludes by emphasizing the need for more research to enable earlier detection of Parkinson's disease.
prevalence and correlates bipolar spectrum disorder in the world mental healt...Priscila Navarro
This study examined the prevalence, clinical correlates, and treatment patterns of bipolar spectrum disorder in 61,392 participants across 11 countries. The key findings were:
1. The lifetime prevalence of bipolar I disorder was 0.6%, bipolar II was 0.4%, subthreshold bipolar disorder was 1.4%, and the total bipolar spectrum was 2.4%.
2. Across all countries, severity of symptoms, impairment, and suicidal behavior increased stepwise from subthreshold bipolar disorder to bipolar I disorder. Three-quarters of individuals with bipolar spectrum disorder also met criteria for another mental health condition, most commonly an anxiety disorder.
3. Less than half of individuals with a lifetime
The document discusses a study that explored the relationships between emotion processing, neuropsychiatric symptoms, and quality of life in stroke survivors. The study found that all three stages of emotion processing were affected after a stroke. It also found positive relationships between unprocessed emotions and several neuropsychiatric symptoms, as well as negative relationships between quality of life and some neuropsychiatric symptoms. The results suggest that diagnosis and treatment of neuropsychiatric symptoms could improve stroke survivors' quality of life by addressing difficulties with emotion processing.
This study examined 110 patients with substance abuse issues to determine if they also had attention-deficit/hyperactivity disorder (ADHD). The patients were assessed using the Wender Utah Rating Scale to evaluate childhood ADHD and the Conners' Adult ADHD Rating Scales to assess current ADHD symptoms. The results showed that 37.7-63.6% of patients in each substance abuse group (heroin, cannabis, opioids, polydrug, alcohol) likely had childhood ADHD based on the Wender Utah Rating Scale. Additionally, 33.3-46.6% of patients in each group showed symptoms of current ADHD based on the Conners' Adult ADHD Rating Scales. This suggests ADHD is
Lecture for Post and Undergraduate.
From the past two decades Non Communicable diseases are increasing in both developing and developed countries due to which developing are experiencing double burden of diseases.
This document discusses various study designs used in epidemiology, including measures of disease occurrence such as prevalence and incidence. It defines prevalence as the total number of cases of a disease at a specified time, while incidence refers to the number of new cases that occur over a period of time. Cohort studies are described as following groups over time to compare rates of an outcome between those exposed and unexposed to a factor. Case-control studies select groups based on having or not having an outcome and look back to compare exposures. Biases such as selection, information and confounding are also outlined.
This study assessed adherence to psychotropic and non-psychotropic medications in 88 patients with bipolar disorder. Adherence was defined as missing 20% or less of medications. Patients had high rates of medical comorbidities like hypertension, hyperlipidemia, obesity, and smoking. Adherence to psychotropic medications was worse than adherence to non-psychotropic medications, with over half missing foundational bipolar medications. Poor non-psychotropic adherence was related to greater psychiatric symptoms and hospitalizations. The results suggest mental health instability impacts one's ability to manage other medical treatments and that interventions should address adherence in a personalized way.
This document discusses health-related quality of life (HRQOL) and how it is measured. Some key points:
1. HRQOL assessments evaluate how medical treatments impact patients' overall well-being and ability to function, not just clinical outcomes like survival. It is a multidimensional concept.
2. Valid and reliable HRQOL instruments use standardized questions across domains to accurately capture patients' perceptions over time. Instruments must demonstrate properties like reliability, validity, and responsiveness to change.
3. Comparing HRQOL scores to appropriate comparison groups and clinically meaningful thresholds is important for interpreting results in research and clinical practice. Both general and disease-specific HRQOL instruments are used.
The document discusses a study examining self-efficacy, body image, and sexual adjustment in women with breast cancer. Key findings include:
1) Women with breast cancer had low self-efficacy and their former sexual adjustment and body image negatively affected their post-diagnosis sexual functions.
2) Women who underwent mastectomy or lacked partner support/sexuality education had lower scores on measures of self-efficacy and sexual/body image adjustment.
3) There was a positive correlation between self-efficacy in self-care and better sexual adjustment, sexual function, and body image. Support from oncology professionals is important for women's physical, social and emotional needs after a breast cancer diagnosis.
Epidemiology and Social demographics of Mental disorders.pptSonamManoj1
Epidemiology in teh context of mental disorders refers to the study of the distribution of mental conditions within specific populations. This ppt covers the data on India.
This research critique summarizes a study examining nurses' perceptions of violence in emergency departments in Nigeria. The study surveyed 81 nurses from 6 hospitals to understand the epidemiology of violence against nurses, their definitions of violence, and potential prevention strategies. Key findings included that ED nurses commonly experience both verbal and physical abuse. The critique provides recommendations to improve the study design and organization. It suggests making the objectives clearer, defining important terms, and considering a broader sample to generalize findings.
This study examined psychiatric comorbidities and treatment outcomes in 100 mentally ill prisoners referred to a tertiary psychiatric hospital in India. The most common primary diagnoses were substance use disorder (45%) and adjustment disorder (36%). 46% of prisoners had more than one psychiatric diagnosis, most commonly intellectual disabilities, personality disorders, and substance use disorders. 59% were treated with medication alone, 27% required inpatient admission, and outcomes were generally positive with patients responding well to treatment. The high rates of comorbidities suggest the need for integrated treatment approaches within prison psychiatric services.
Epidemiology has seven main uses:
1. Studying disease trends over time to understand rises and falls in disease and identify emerging health problems.
2. Diagnosing health issues in communities to prioritize disease prevention and control and evaluate health services.
3. Planning and evaluating health services and programs by using disease burden data to allocate resources effectively.
4. Assessing individual risk levels by calculating disease incidence and relative risks.
5. Identifying disease syndromes by observing common associated findings.
6. Furthering understanding of disease natural histories by studying patterns.
7. Searching for disease causes and risk factors through epidemiological investigations.
The document provides an overview of psycho-oncology. It discusses the mental health consequences of cancer at diagnosis, during active treatment, and for survivors. It covers common issues like maladaptation, mental disorders, suicide, and impact on quality of life and compliance. It also reviews psychiatric side effects of cancer treatments and management approaches.
Based on the information provided, the co-chairpersons of the study were:
- Jens D. Lundgren, M.D.
- Abdel G.Babiker, Ph.D.
- Fred Gordin, M.D.
They, along with other members of the INSIGHT START Study Group, assume responsibility for the overall content and integrity of the article.
This document discusses different epidemiological study designs used to study the distribution and determinants of health-related events in populations. It describes descriptive epidemiology which observes disease distribution and identifies associated characteristics. Descriptive studies define the population, disease, measure disease occurrence and describe patterns. Analytical epidemiology comprises observational case-control and cohort studies, which can determine associations between disease and suspected factors. Case-control studies compare exposure in cases vs controls, while cohort studies follow groups over time from exposure to disease. Their strengths and limitations are provided.
This document discusses various epidemiological study designs. It begins by defining descriptive studies, which involve systematically collecting and presenting data to describe a situation, and analytical studies, which attempt to establish causes or risk factors by comparing exposed and unexposed groups. The main types of descriptive studies covered are cross-sectional (examining a population at a single point in time), longitudinal (following a population over time), and ecological (examining population-level associations between exposures and outcomes). Advantages and disadvantages of each design are provided.
Assessment of suicide risk dr essam hassanEssamHassan32
This document provides an overview of suicide risk assessment. It begins with definitions of suicide and epidemiological data showing suicide is a leading cause of death. It then discusses risk factors like psychiatric disorders, previous attempts, and life stressors. Methods of suicide and self-harm are outlined. The assessment process involves understanding current suicidal thoughts, intent, plans and stressors, as well as protective factors. Tools like the TASR can aid evaluation. Management depends on the individual's risk level, mental state, and social support. Ongoing monitoring is important given risk can change over time.
This document summarizes a proposed study on the effects of medical marijuana on reducing symptoms of post-traumatic stress disorder (PTSD). The study would utilize a randomized, double-blind experimental design with 200 participants divided into a control group receiving placebo and an experimental group receiving medical marijuana capsules. Participants would be evaluated quarterly for one year using standardized PTSD assessment tools. The goal is to determine if medical marijuana can effectively reduce PTSD symptoms compared to a placebo by analyzing differences in assessment scores between the two groups over time. Limitations include not addressing effectiveness for long-term PTSD or those taking other medications. If significant results are found, it could provide evidence for medical marijuana as an approved PTSD treatment.
This document discusses chronic diseases and proposes a framework for early detection. It begins by defining chronic diseases and listing some common types like arthritis, cancer, stroke, and heart attack. Parkinson's disease is then discussed in more detail, including its causes, symptoms, increasing rates, and challenges around early detection. The importance of early detection for Parkinson's is explained. Recent research on potential biomarkers from cerebrospinal fluid and blood is mentioned. Research from India and abroad is summarized, including studies using smartphones to assess tremors, deep learning to analyze sensor data, and quantifying finger tremors. The document concludes by emphasizing the need for more research to enable earlier detection of Parkinson's disease.
prevalence and correlates bipolar spectrum disorder in the world mental healt...Priscila Navarro
This study examined the prevalence, clinical correlates, and treatment patterns of bipolar spectrum disorder in 61,392 participants across 11 countries. The key findings were:
1. The lifetime prevalence of bipolar I disorder was 0.6%, bipolar II was 0.4%, subthreshold bipolar disorder was 1.4%, and the total bipolar spectrum was 2.4%.
2. Across all countries, severity of symptoms, impairment, and suicidal behavior increased stepwise from subthreshold bipolar disorder to bipolar I disorder. Three-quarters of individuals with bipolar spectrum disorder also met criteria for another mental health condition, most commonly an anxiety disorder.
3. Less than half of individuals with a lifetime
The document discusses a study that explored the relationships between emotion processing, neuropsychiatric symptoms, and quality of life in stroke survivors. The study found that all three stages of emotion processing were affected after a stroke. It also found positive relationships between unprocessed emotions and several neuropsychiatric symptoms, as well as negative relationships between quality of life and some neuropsychiatric symptoms. The results suggest that diagnosis and treatment of neuropsychiatric symptoms could improve stroke survivors' quality of life by addressing difficulties with emotion processing.
This study examined 110 patients with substance abuse issues to determine if they also had attention-deficit/hyperactivity disorder (ADHD). The patients were assessed using the Wender Utah Rating Scale to evaluate childhood ADHD and the Conners' Adult ADHD Rating Scales to assess current ADHD symptoms. The results showed that 37.7-63.6% of patients in each substance abuse group (heroin, cannabis, opioids, polydrug, alcohol) likely had childhood ADHD based on the Wender Utah Rating Scale. Additionally, 33.3-46.6% of patients in each group showed symptoms of current ADHD based on the Conners' Adult ADHD Rating Scales. This suggests ADHD is
Lecture for Post and Undergraduate.
From the past two decades Non Communicable diseases are increasing in both developing and developed countries due to which developing are experiencing double burden of diseases.
This document discusses various study designs used in epidemiology, including measures of disease occurrence such as prevalence and incidence. It defines prevalence as the total number of cases of a disease at a specified time, while incidence refers to the number of new cases that occur over a period of time. Cohort studies are described as following groups over time to compare rates of an outcome between those exposed and unexposed to a factor. Case-control studies select groups based on having or not having an outcome and look back to compare exposures. Biases such as selection, information and confounding are also outlined.
This study assessed adherence to psychotropic and non-psychotropic medications in 88 patients with bipolar disorder. Adherence was defined as missing 20% or less of medications. Patients had high rates of medical comorbidities like hypertension, hyperlipidemia, obesity, and smoking. Adherence to psychotropic medications was worse than adherence to non-psychotropic medications, with over half missing foundational bipolar medications. Poor non-psychotropic adherence was related to greater psychiatric symptoms and hospitalizations. The results suggest mental health instability impacts one's ability to manage other medical treatments and that interventions should address adherence in a personalized way.
This document discusses health-related quality of life (HRQOL) and how it is measured. Some key points:
1. HRQOL assessments evaluate how medical treatments impact patients' overall well-being and ability to function, not just clinical outcomes like survival. It is a multidimensional concept.
2. Valid and reliable HRQOL instruments use standardized questions across domains to accurately capture patients' perceptions over time. Instruments must demonstrate properties like reliability, validity, and responsiveness to change.
3. Comparing HRQOL scores to appropriate comparison groups and clinically meaningful thresholds is important for interpreting results in research and clinical practice. Both general and disease-specific HRQOL instruments are used.
The document discusses a study examining self-efficacy, body image, and sexual adjustment in women with breast cancer. Key findings include:
1) Women with breast cancer had low self-efficacy and their former sexual adjustment and body image negatively affected their post-diagnosis sexual functions.
2) Women who underwent mastectomy or lacked partner support/sexuality education had lower scores on measures of self-efficacy and sexual/body image adjustment.
3) There was a positive correlation between self-efficacy in self-care and better sexual adjustment, sexual function, and body image. Support from oncology professionals is important for women's physical, social and emotional needs after a breast cancer diagnosis.
Epidemiology and Social demographics of Mental disorders.pptSonamManoj1
Epidemiology in teh context of mental disorders refers to the study of the distribution of mental conditions within specific populations. This ppt covers the data on India.
This research critique summarizes a study examining nurses' perceptions of violence in emergency departments in Nigeria. The study surveyed 81 nurses from 6 hospitals to understand the epidemiology of violence against nurses, their definitions of violence, and potential prevention strategies. Key findings included that ED nurses commonly experience both verbal and physical abuse. The critique provides recommendations to improve the study design and organization. It suggests making the objectives clearer, defining important terms, and considering a broader sample to generalize findings.
This study examined psychiatric comorbidities and treatment outcomes in 100 mentally ill prisoners referred to a tertiary psychiatric hospital in India. The most common primary diagnoses were substance use disorder (45%) and adjustment disorder (36%). 46% of prisoners had more than one psychiatric diagnosis, most commonly intellectual disabilities, personality disorders, and substance use disorders. 59% were treated with medication alone, 27% required inpatient admission, and outcomes were generally positive with patients responding well to treatment. The high rates of comorbidities suggest the need for integrated treatment approaches within prison psychiatric services.
Epidemiology has seven main uses:
1. Studying disease trends over time to understand rises and falls in disease and identify emerging health problems.
2. Diagnosing health issues in communities to prioritize disease prevention and control and evaluate health services.
3. Planning and evaluating health services and programs by using disease burden data to allocate resources effectively.
4. Assessing individual risk levels by calculating disease incidence and relative risks.
5. Identifying disease syndromes by observing common associated findings.
6. Furthering understanding of disease natural histories by studying patterns.
7. Searching for disease causes and risk factors through epidemiological investigations.
The document provides an overview of psycho-oncology. It discusses the mental health consequences of cancer at diagnosis, during active treatment, and for survivors. It covers common issues like maladaptation, mental disorders, suicide, and impact on quality of life and compliance. It also reviews psychiatric side effects of cancer treatments and management approaches.
Based on the information provided, the co-chairpersons of the study were:
- Jens D. Lundgren, M.D.
- Abdel G.Babiker, Ph.D.
- Fred Gordin, M.D.
They, along with other members of the INSIGHT START Study Group, assume responsibility for the overall content and integrity of the article.
This document discusses different epidemiological study designs used to study the distribution and determinants of health-related events in populations. It describes descriptive epidemiology which observes disease distribution and identifies associated characteristics. Descriptive studies define the population, disease, measure disease occurrence and describe patterns. Analytical epidemiology comprises observational case-control and cohort studies, which can determine associations between disease and suspected factors. Case-control studies compare exposure in cases vs controls, while cohort studies follow groups over time from exposure to disease. Their strengths and limitations are provided.
This document discusses various epidemiological study designs. It begins by defining descriptive studies, which involve systematically collecting and presenting data to describe a situation, and analytical studies, which attempt to establish causes or risk factors by comparing exposed and unexposed groups. The main types of descriptive studies covered are cross-sectional (examining a population at a single point in time), longitudinal (following a population over time), and ecological (examining population-level associations between exposures and outcomes). Advantages and disadvantages of each design are provided.
Assessment of suicide risk dr essam hassanEssamHassan32
This document provides an overview of suicide risk assessment. It begins with definitions of suicide and epidemiological data showing suicide is a leading cause of death. It then discusses risk factors like psychiatric disorders, previous attempts, and life stressors. Methods of suicide and self-harm are outlined. The assessment process involves understanding current suicidal thoughts, intent, plans and stressors, as well as protective factors. Tools like the TASR can aid evaluation. Management depends on the individual's risk level, mental state, and social support. Ongoing monitoring is important given risk can change over time.
This document summarizes suicide prevention efforts and data from Mersey Care NHS Trust and Henry Ford Health System. It shows suicide rates and numbers from 2005-2011 in Mersey Care, breakdowns by age, gender, diagnosis and method. Henry Ford achieved a 75% reduction in suicides through rapid investigations, clear risk assessment and interventions, and a culture shift toward pursuing perfection in depression care. Mersey Care's improvement plan aims to reduce suicides among its service users by 100% over 4 years through understanding evidence, treating depression effectively, enhancing safety pathways and staff skills, improving care transitions and engagement with carers.
Protective factors against suicidal acts in major depression:Reasons for living, Journal Club Presentation in the Dept of Psychiatric Nursing, Kothamangalam
Epidemiology is the study of the distribution and determinants of health-related states or events in populations and the application of this study to control health problems. The goals of epidemiology are to describe the magnitude of health problems, identify risk factors, and provide data to plan, implement, and evaluate health services. Epidemiologists use various tools like rates, ratios, and proportions to measure factors like mortality, morbidity, and environmental exposures. Descriptive epidemiology involves defining populations, diseases, and distributions by time, place, and person to form hypotheses about disease etiology, while analytical studies like case-control and cohort studies aim to determine associations between risk factors and diseases.
Definition, types, tools and uses of.pptxFeniksRetails
Epidemiology is defined as the study of the distribution and determinants of health-related states or events in populations and the application of this study to control health problems. There are two main types of epidemiological study: observational (descriptive and analytical) and experimental/interventional. Descriptive studies describe disease distribution by person, place, and time while analytical studies, including case-control and cohort designs, are used to identify risk factors. The main tools of epidemiology include rates, ratios, and proportions. Epidemiology is used to study disease trends over time, identify high-risk groups, inform healthcare planning and evaluation, and search for disease causes and risk factors.
Strategies to prevent death by suicide: meta-analysis of randomized controlle...Ahsan Aziz Sarkar
This meta-analysis reviewed randomized controlled trials comparing suicide prevention interventions to usual care. It found that the WHO's Brief Intervention and Contact intervention was associated with significantly lower odds of death by suicide. Cognitive behavioral therapy and lithium also showed fewer suicide deaths among intervention groups, but results were not statistically significant. Overall, most psychosocial interventions and pharmacotherapies did not show clear evidence of reducing suicide risk. The study highlights the need for further research on effective prevention strategies.
Caregivers’ perspective on non-fatal deliberate self harmiosrjce
This document summarizes a study examining caregivers' perspectives on non-fatal deliberate self-harm. Fifty patients who engaged in deliberate self-harm and were admitted to a hospital were evaluated. Caregivers of these patients were interviewed using a 15-item questionnaire to assess their attitudes. Common characteristics of the self-harm incidents were that they occurred when someone else was present and no suicide notes were left. The most common psychiatric diagnosis among patients was major depressive disorder. Most caregivers reported feeling shock, anger, and a need to overprotect the individual after the self-harm incident. A significant association was found between caregivers perceiving an unsympathetic family attitude and repetition of deliberate self-harm.
Suicide by Patient in health care organization occupies 2nd position In all 12 sentinel events reported to Joint commission on accreditation of health care organization (JCI).
How Hospital administrator should handle this Problem.
Suicide in a hospital is known risk factor and recognized as sentinel event by JCI &NABH. Health care provider should know what to do in a post suicdide scenario.
Similar to Risk of re attempts and suicide death after a suicide attempt- a survival analysis (20)
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
Pollock and Snow "DEIA in the Scholarly Landscape, Session One: Setting Expec...
Risk of re attempts and suicide death after a suicide attempt- a survival analysis
1. RISK OF RE-ATTEMPTS AND SUICIDE
DEATH AFTER A SUICIDE ATTEMPT:
A SURVIVAL ANALYSIS
Presented by Dr. Htein Lin
Parra-Uribe et al. BMC Psychiatry (2017) 17:163
DOI 10.1186/s12888-017-1317-z
2. ABSTRACT
• Background: Suicide is the primary cause of unnatural death in
Spain, and suicide re-attempts a major economic burden worldwide.
• The risk factors for re-attempt and suicide after an index suicide
attempt are different.
• This study aims to investigate risk factors for re-attempt and suicide
after an index suicide attempt.
3. METHODS
• This observational study is part of a one-year telephone management
program.
• included all first-time suicide attempters evaluated in the emergency
department at Parc Taulí-University Hospital (n = 1241) recruited
over a five-year period (January 2008 to December 2012).
• Suicide attempters were evaluated at baseline using standardized
instruments.
• Bivariate logistic regression models were used to identify risk factors.
4. • Kaplan-Meier curves were used to compare the time to re-attempt
between categorical variables. Comparisons were performed using
Log-Rank and Wilcoxon tests.
• Variables with a p-value lower than 0.2 were included in a
multivariate Cox regression model.
• Bivariate logistic regression models were considered to identify risk
factors for suicide.
• The significance level was set to 0.05.
5. RESULTS
• Suicide re-attempters were more likely diagnosed with cluster B
personality disorders (36.8% vs. 16. 6%; p < 0.001), and alcohol use
disorders (19.8 vs. 13.9; p = 0.02).
• Several [1.2% (15/1241)] of them died by suicide.
• Attempters who suicide were more likely alcohol users (33.3% vs.
17.2%; p = 0.047), and older (50. 9 ± 11.9 vs. 40.7 ± 16.0; p = 0.004).
6. CONCLUSIONS
• Alcohol use, personality disorders and younger age are risk factors
for re-attempting.
• Older age is a risk factor for suicide among suicide attempters.
• Current prevention programs of suicidal behaviour should be tailored
to the specific profile of each group.
7. BACKGROUND
• Suicide is a global health issue and since 2008
• the primary cause of unnatural death in Spain.
• A history of previous suicide attempt is the strongest predictor for
future suicidal ideation and behaviour (SIB), including suicide
ideation, suicide attempts, and suicide.
• in a 5 years follow-up of 302 individuals admitted to an inpatient
psychiatric unit for medically serious suicide attempts, 37% of them
made at least one further suicide attempt, and 6.7% eventually died
by suicide.
8. • most suicides occur in people with mental disorders, but most people
with mental disorders, even severe, never attempt suicide.
• In other words, this risk factor and many others have poor predictive
power.
• a better differentiation between suicide attempters who eventually
suicide and suicide attempters who will not is critical to developing
preventive plans.
9. • Neeleman estimated that individuals with antecedents of self-harm
were 25 times more likely to die by suicide than the general
population.
• Owens et al. concluded that the risk of another SIB ranged between
16% (first year) and 23% (follow-up of 4 years or longer), whereas
for suicide it ranged from 2% (first year) to 7% (follow-up of 9
years).
• Christiansen et al. estimated the risk of another SIB in a five-year
follow-up study at about 31%.
10. • These authors stressed that the risk of another SIB was higher during
the first two-years.
• Female gender and the presence of mental disorders are well-known
risk factors for repeated SIB.
• Other authors have stressed the role of personality disorders,
particularly borderline personality disorder, in future SIB.
• On the other hand, between 1 and 6% of individuals evaluated
because of a suicide attempt eventually suicide in the year following.
11. • The risk of suicide is higher in older patients and those individuals
with a higher number of lifetime suicide attempts,
• Counter to frequent attempters not being at risk for suicide because
they only engage in low risk SIB.
• recent studies have demonstrated that it is possible to reduce the risk
of re-attempt or even suicide in individuals at risk.
• previously reported that a one-year telephone intervention program
was effective in reducing an 8% the proportion of patients who
re-attempted suicide compared to the control population.
12. Aims of the study
• The main objective of the current study is to identify risk factors for
re-attempt and suicide using survival analysis.
13. METHOD
SAMPLES AND PROCEDURE
• This observational study is part of a one-year telephone management
program, which forms part of the European Alliance Against Depression
(EAAD) framework for the management of SIB.
• All first-time suicide attempters (index suicide attempt) evaluated in the
emergency department (ED) at Parc Taulí-University Hospital, Spain (n =
1241) between January 1st 2008 and December 31st 2012 were
approached to take part in a one-year telephone follow-up prevention
program that had the objective of reducing suicide attempts rate.
• This telephone management program was aimed at determining the
effectiveness over 1 year of a follow-up on patients discharged from the
ED after a suicide attempt.
14. • The one-year telephone intervention program reduced an 8% the
proportion of patients who reattempted suicide.
• This ED sees all medical emergencies for a catchment population of
474,778 inhabitants.
• On-call psychiatrists evaluated all suicide attempters.
• A suicide attempt was defined as a self-harming behaviour with clear
suicidal intent.
15. • All suicides (n = 142) in hospital’s catchment area were recorded
during this period of time, based on direct information from the
Institute of Forensic Medicine of Catalonia, charged with making
determinations about cause of death.
• The primary outcome measures were time to new suicide behaviour
(SB; either suicide attempt or suicide, only suicidal ideation was not
included), and the percentage of suicide attempters who re-attempted
suicide or suicide during the period of study.
• The information on re-attempts was extracted from the electronic
medical record.
16. • The Institute of Forensic Medicine of Catalonia provided information
on suicide deaths.
• All first-time suicide attempters recruited during the last year (1st
January 2012 to December 31st 2012) were equally offered the 1-
year telephone follow-up (up to December 31st 2013).
• Accordingly, the information on the main outcomes of our study (re-
attempts and suicides) ranges from 1 to 6 years.
17. • All first time suicide attempters provided information on
• sociodemographic factors (sex, age, marital status, place of birth, level
of education, employment status, and living arrangements),
• clinical factors (multiaxial psychiatric diagnosis according to DSM-IV-
TR criteria, previous medical follow-up),
• characteristics related to the suicide event (method used, date of the
attempt, consumption of drugs or alcohol at the time of the act, and
degree of lethality (mild: < 24 h in the ED for medical
observation/intervention; moderate: 24–48 h in the ED; severe: > 48 h
in the ED or surgical intervention or psychiatric inpatient
hospitalization), and
• type of medical follow-up prior to the SB.
18. • Data were obtained from inpatient clinical histories and from
emergency and primary care electronic reports.
• All first time suicide attempters discharged from the ED were
scheduled for a post-discharge visit with the referring psychiatrist
within a maximum of 10 days and verbally consented to participate in
a telephone follow-up during a year.
• The telephone follow-up was conducted by a nurse specialized in
mental health who had received specific training on the
administration of the program, detection of high risk for suicide and
management of patients with low and mild risk of suicide.
19. • The telephone follow-up was carried out at 1 week, 1 month and,
thereafter at 3, 6, 9 and 12 months after the index suicide attempt.
• all individuals were seen either in mental health center or in the
primary care center for at least 1 year after the end of study enrolment
(December 31st 2012).
• Whenever this information was not available, a phone call confirmed
that the individual was alive and did not change their place of
residence.
20.
21. Statistical analysis
• Descriptive statistics of socio-demographic characteristics at the
index suicide attempt are presented for re-attempters, non re-
attempters and globally (absolute and relative frequencies).
• Bivariate logistic regression models were used to identify risk factors
and odds ratios (OR) and 95% confidence intervals were calculated.
• Kaplan-Meier curves for all variables -sociodemographic and clinical
factors, and characteristics related to the suicide event- were used to
compare the time to re-attempt between re-attempters and non re-
attempters.
22. • Comparisons were performed using Log-Rank and Wilcoxon tests.
• Variables with a p-value lower than 0.2 were included in a
multivariate Cox regression model.
• Hazard ratios (HR) and 95% confidence intervals were calculated.
• Additionally, bivariate logistic regression models were constructed to
identify risk factors for suicide.
• Given the small number of suicides, we could not run multivariate
analyses in the case of suicides.
• The analysis was performed with software SAS v9.3 (SAS Institute
Inc., Cary, NC, USA).
• Alpha was set to 0.05.
23. RESULTS
Sociodemographics
• Suicide attempts represented 0.3% of all emergencies presenting to the ED
during the study period and 14.4% of psychiatric emergencies.
• The suicide rate in our catchment area was 8.3/100,000 inhabitants in
2008, 6.6/100,000 in 2009, 7.2/100,000 in 2010, 4.8/100,000 in 2011 and
7.2/ 100,000 in 2012.
• During the 5 years of recruitment, there were 2328 suicide attempts made
by 1627 patients evaluated at the Parc Taulí Sabadell-University Hospital.
24. • From that sample, selected first-time suicide attempters (n = 1241).
• Women represented 62.4% of our sample, and the mean age was 40.8
(±16.0).
• The most frequent method used in the index suicide attempt was drug
overdose (70.8%).
• Around 20% (20.5%) were hospitalized in the acute mental health
unit.
25. • Two hundred and forty-nine (20.1%) of first-time suicide attempters,
re-attempted suicide at least once, and 15 (1.2%) died by suicide
during follow-up (mean and median time of follow-up for re-attempts
and suicides were 298 and 177 days, respectively).
• it is important to stress that during this period, of the 142 suicides in
our catchment area, 127 [87.5%; n = 89 (70.1%) males, and n = 38
(29.9%) women] were not evaluated in the ED, even though 35
[24.6%; 18 women (12.6%) and 17 men (12%)] of them had a
previous suicide attempt.
• Of those 35 patients, 15 patients had previous suicide attempts
evaluated in the ED during the follow-up, and the remaining 20
patients had attempted suicide before the follow-up.
26. Timing of the survival curve for re-attempts and suicide
• Most (88%) re-attempts and suicides (93%) took place within the
first-2 years of follow-up
27. Risk factors for re-attempts
• As for the risk of re-attempts after the index suicide attempt, bivariate
survival analyses showed that age, alcohol use and personality
disorders presented differences in time to re-attempt.
• Compared with suicide attempters who re-attempt during follow-up,
attempters who didn’t re-attempt were older.
• being older than 60 years old was a protective factor.
• No statistically significant differences were observed in the rest of
socio-demographic variables.
28. • Compared with non re-attempters, suicide re-attempters were also
more likely diagnosed with cluster B personality disorders (36.8% vs.
16.6%; p < 0.001), and alcohol use disorders (19.8 vs. 13.9; p =
0.02).
• All risk factors in bivariate analyses –age, alcohol use, and
personality disorders- were entered into a multivariate model.
29.
30. Risk factors for suicide
• Fifteen (n = 15) or 1.2% (15/1241) of first time suicide attempters
evaluated eventually died by suicide.
• Ten (66.7%) were women.
• The index suicide attempt was mostly (80%) a drug overdose, the
medical lethality was mild in 73.3% of cases, and 73.3% of cases
were discharged after the index suicide attempt.
• The methods of suicide were jumping (n = 9), hanging (n = 5), and
suffocation (n = 1).
• Most were depressed (6/15) or had no Axis I diagnosis (4/15) at
baseline.
31. • Compared with suicide attempters who did not die by suicide, suicide
attempters who did were more likely alcohol dependent (33.3% vs.
17.2%; p = 0.047), and older (50.9 ± 11.9 vs. 40.7 ± 16.0; p = 0.004).
• Nearly 90% [86.7% (3/15)] of suicides were aged 40 to 59 when they
died.
• No other socio-demographic or clinical factors (either method used or
severity of the index suicide attempt, being hospitalized after the
index suicide attempt, or the presence of axis I or II diagnosis) were
related to the risk of suicide death.
32. • Of relevance, 86.7% (13/15) of the suicide attempters who eventually
died by suicide did not complete all telephone follow-ups.
• Of these, four patients had already died by suicide when
telephonically contacted for the first time, three of them during the
first week in the aftermath of their evaluation in the ED
• six patients were lost to follow-up, and three patients rejected the
follow-up because they were already being followed at a mental
health clinic.
• 51.6% of those who did not suicide were followed-up until month 12.
33. DISCUSSION
• In keeping with the literature younger age, and presence of
personality disorders and alcohol use disorder were risk factors for
re-attempting suicide in our sample of suicide attempters.
• Furthermore, alcohol use and older age were risk factors for suicide.
• As for the telephone management program, around 50% of suicide
attempters and 90% of those who died by suicide, respectively, did
not complete the telephone follow-up at month 12.
• Those who completed the telephone follow-up were less likely to die
by suicide.
34. • However, it was discouraging that most suicides (n = 127, nearly
90% of all suicides) were not evaluated in the ED during the study
period.
• Overall, there were more index suicide attempts for women than men
in our sample, which is consistent with literature , and might be
explained by the higher risk of depression among women.
• Twenty percent of suicide attempters re-attempted suicide during the
follow-up period.
• This is also in keeping with previous literature.
35. • In one study, 25% of the initial cohort of suicide attempters (n = 150;
38% had previous suicide attempts) re-attempted suicide during the
10-years follow-up.
• In a Danish register-based survival analysis of 2614 suicide
attempters matched with 39,210 non-attempters, 31.33% of suicide
attempters re-attempted suicide within the follow-up period –average
follow-up period was nearly 4 years.
• The authors stressed that the probability of suicide attempters
reattempting suicide was stronger during the first 2 years after the
index suicide attempt.
36. • In a 10-year follow-up study between 1993 and 2002, from the initial
3690 suicide attempters admitted to Christchurch Hospital, 28.1%
were readmitted for a further non-fatal suicide attempt.
• Again, risk of readmission and rates of mortality from suicide were
higher in the first 2 years after the index suicide attempt, but occurred
throughout the 10 years follow-up period.
• The findings from both studies perfectly match our results as 88% of
suicide attempters in our sample re-attempted within the first-2 years
of follow-up.
37. • Regarding risk factors for re-attempting suicide, we found three risk
factors: 1) younger age; 2) presence of personality disorders; and 3)
presence of alcohol use disorder, which is also in keeping with the
literature.
• In the Danish registry-based survival analysis mentioned above, both
younger age and alcohol abuse were risk factors for re-attempting suicide.
• Our results also match those reported by Osvath and colleagues when
comparing first-time suicide attempters (n = 549) with repeaters (n =
609): both alcohol abuse, and particularly, the presence of personality
disorders were associated with an increased risk of re-attempting suicide.
38. • In a study following a similar case-control design comparing 112
first-time attempters and 159 repeaters, alcohol misuse was again one
of the strongest factors associated with repetition of suicide attempts.
• In a 20-year follow-up of first-ever suicide attempters, alcohol
intoxication at index suicide attempt predicted repetition of suicide
attempt at 5 years.
• In the 10-year follow-up carried out by Gibb and colleagues, the
factors associated with repetition were female gender, younger age,
and use of a low-lethality suicide method.
• In a previous study of 446 suicide attempters, we also reported that
younger female attempters with severe personality disorders were
prone to repeat suicide attempts.
39. • On the other hand, 1.2% (15/1241) of suicide attempters evaluated died
by suicide within the follow-up period, which is in the lower range of
reported studies.
• in a follow-up of 11,563 patients who presented to hospital after
deliberate self-harming, 1.5% and 3% died by suicide after 5 and 15
years of follow-up, respectively.
• Also, in the 10-year follow-up mentioned above, of the initial 3690
suicide attempters admitted to Christchurch Hospital, 4.6% died by
suicide.
• In another cohort of 150 suicide attempters followed-up during 10 years
in Catalonia, 12% completed suicide, and the risk was highest during
the first 2 years after the index suicide attempt.
40. • We found that the risk factors for suicide among suicide attempters
followed-up in our study were: 1) being older; and 2) the presence of
an alcohol use disorder.
• These results are also in keeping with literature.
• Indeed, one of the most consistent findings in Suicidology is that
suicide rates are higher among adults aged 60 and older.
• Accordingly, suicide prevention programs should specifically be
designed for this population.
41. • On the other hand, alcohol use disorders not only increased the risk
for re-attempting suicide but for suicide.
• Our finding is also in keeping with previous literature.
• For instance, in a sample of 1018 unselected deliberate self-poisoning
patients followed-up 14 years, of the 22.7% who had suicided by the
end of the study, 85 (38.5%) showed clear evidence of long-term
alcohol misuse.
• These authors stressed that more attention should be paid to alcohol
use disorders in suicide attempters.
42. • However, our data cannot be generalized, as the most relevant and
discouraging aspect of our study was that most suicides (127 out of
142, 87.5%) took place in people who were not evaluated in the ED
during the study period.
• In other words, the 15 suicides among our sample of suicide
attempters are likely not representative of suicide completers in our
catchment area.
• For instance, most individuals who died by suicide in our study were
women with a history of previous suicide attempts.
43. • However, most suicides within our catchment area, but who were not
evaluated in the ED during the study period, were men (70.1%).
• Literature is clear in this respect: most suicides are male in most
countries.
• Our finding that most suicides in our catchment area were not
included in our sample might be explained by the fact that 60% of
suicides in our area died during the first attempt, and 92.3% of
suicides occurred during the first or second attempt.
44. • Furthermore, most individuals who suicide are not followed up in
mental health services, but rather in primary health services, thus
making it difficult to identify individuals at risk.
• Finally, 90% of those who eventually died by suicide, were not
followed-up at month 12.
• This finding, paired with the above mentioned data that most suicides
are followed up in primary health services, strongly suggests that, for
the prevention of suicide, it is critical to implement “multiple practice
improvements over several years”.
45. Strengths and limitations
• The major strength of our study is the sample size of suicide
attempters, which allowed us to extract some valuable information on
the risk of re-attempting suicide and suicide in suicide attempters.
• One limitation is that we did not individually follow-up our
population during the 5-year period of study, only during the first
year of telephone follow-up intervention, and instead relied on the
electronic medical record of all suicide attempts evaluated at the ED.
• This means that suicide attempts that did not require medical
intervention may have been missed.
46. • Nonetheless, it is likely we detected the medically severe suicide
attempts.
• Moreover, we cannot rule out the possibility that some suicide
attempts were evaluated in an ED at a different hospital during the
follow-up.
• However, this possibility is unlikely because all severe suicide
attempts are systematically referred to our hospital.
47. • Furthermore, the follow-up period (5 years) and the small number of
suicides within the initial sample of suicide attempters limited our
capacity to extrapolate the results to other populations of suicide.
• Finally, the most important limitation is that we could not explore the
effectiveness of our telephone program in preventing suicide.
• This is important because most telephone preventive programs have
been devoted to preventing re-attempts.
• The sparse literature available on preventing suicide is not definitive.
48. • For instance, in a study examining long-term effects of a telephone
helpline service, 18,641 services users were compared with a general
population group in Italy.
• They reported a reduction in suicide deaths among service users, but
there was a lack of benefit for elderly males.
49. • Furthermore, a recent meta-analysis on the potential use of letters,
green cards, telephone calls and postcards to preventing suicide did
not find a “significant reduction in the odds of suicide in intervention
compared with control”.
• Accordingly, the authors recommended “further assessment of
possible benefits in well-designed trials in clinical populations”
before these brief interventions could be recommended for
widespread clinical implementation.
50. CONCLUSIONS
• Younger age and the presence of either a personality disorder or an
alcohol use disorder are risk factors for re-attempt in suicide
attempters.
• Alcohol use and older age were risk factors for suicide.
• Most suicides within the period of study were not included in our
study.
• Thus, our study raises an important question: longitudinal, follow-up
studies are methodologically sound studies that allow drawing
etiological connections between risk factors and suicide.
51. • The problem is that, if previously published follow-up studies on
suicide had the same problem that we faced in our study –that most
suicides were not “detected”
• most literature published to date on follow-ups could be extrapolating
data from populations affected by a selection bias, thus not reflecting
the real predictive characteristics of suicide deaths.
• Furthermore, research is clear on this: most who die by suicide do not
even seek mental health services, and attempters and completes are
different, although partially overlapping, populations.
52. • Thus, until we are able to detect most individuals at risk, and bearing
always in mind that the prediction of suicide is impossible,
• probably the most intelligent interventions to decrease the daunting
suicide rate are
• reducing access to means and
• a population-based strategy directed to the prevention of depression in
the general population by using different measures at different levels of
the health system as recommended by the EAAD.
In a systematic review of 14 cohorts (n = 21,385), Neeleman estimated that individuals with antecedents of self-harm were 25 times more likely to die by suicide than the general population.
Owens et al. reviewed 80 observational and empirical studies and concluded that the risk of another SIB ranged between 16% (first year) and 23% (follow-up of 4 years or longer), whereas for suicide it ranged from 2% (first year) to 7% (follow-up of 9 years).