scholarly journals Comparison of suicide risk and other outcomes among boys and girls who self-harm

2020 ◽  
Vol 29 (12) ◽  
pp. 1741-1746 ◽  
Author(s):  
Anna Ohlis ◽  
Johan Bjureberg ◽  
Paul Lichtenstein ◽  
Brian M. D’Onofrio ◽  
Alan E. Fruzzetti ◽  
...  
Keyword(s):  
Sex Differences ◽  
Suicide Attempts ◽  
Psychiatric Hospitalization ◽  
Economic Status ◽  
Adverse Outcomes ◽  
Hazard Ratios ◽  
Self Harm ◽  
Males And Females ◽  
Drug Use Disorder

Abstract Little is known about sex differences in outcomes of self-harm, and there are inconclusive results concerning the association between sex, self-harm, and suicide attempts. The aim of this study was to explore sex differences in outcomes of self-harm in adolescence. In this cohort study, all individuals (0–17 years) enrolled at the child- and adolescent mental health services (CAMHS) in Stockholm between 2001 and 2015 (N = 110,072) were followed in national registers from their last contact with the CAMHS, until end of 2015. Exposure was self-harm as reason for contact, outcome measures were: alcohol-/substance use disorder, psychiatric hospitalization, non-violent or violent crime, and suicide. Differences in outcomes rates between exposed versus unexposed males, and exposed versus unexposed females, were examined using Cox regressions, expressed as hazard ratios (HR) with 95% confidence intervals (CI). Median follow-up time was 5.8 years (Q1: 2.3 years; Q3: 9.7 years). Self-harm was documented in 2.2% (N = 1241) males and 8.7% (4716) females. Exposed individuals had higher HR for all outcomes as compared with unexposed individuals of their own sex. Exposed females had more pronounced risk for drug use disorder (HR 11.2; 95% CI 9.9–12.7) compared with exposed males (HR 6.5, 95% 5.2–8.0). Both males and females who had engaged in self-harm had elevated risks for future suicide. Adjusting for socio-economic status and age at start of follow-up only marginally affected the associations. Females and males with self-harm had similarly elevated risk for suicide, and self-harm was also an important risk marker for other adverse outcomes within both sexes.

scholarly journals Sex differences in outcomes after arthroscopic bankart repair

2020 ◽  
Vol 6 (1) ◽  
pp. e000965
Author(s):  
Natalie A Lowenstein ◽  
Peter J Ostergaard ◽  
Daniel B Haber ◽  
Kirsten D Garvey ◽  
Elizabeth G Matzkin
Keyword(s):  
Mental Health ◽  
Sex Differences ◽  
Patient Reported Outcomes ◽  
Strength Function ◽  
Bankart Repair ◽  
Level Of Evidence ◽  
Arthroscopic Bankart Repair ◽  
Patient Reported ◽  
Males And Females

ObjectivesRisk factors for anterior shoulder dislocation include young age, contact activities and male sex. The influence of sex on patient-reported outcomes of arthroscopic Bankart repair (ABR) is unclear, with few studies reporting potential differences. This study’s purpose was to compare patient-reported outcomes of males and females following ABR.MethodsProspectively collected data was analysed for 281 patients (males: 206, females: 75) after ABR with preoperative, 1-year and 2-year follow-up responses. The Wilcoxon signed-rank and χ2 tests, preoperative, 1 year and 2 year follow-up results were examined to determine differences of scores in males versus females.ResultsNo statistically significant sex differences were observed in Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES), Visual Analogue Scale (VAS) or Single Assessment Numerical Evaluation (SANE) Scores at 1-year or 2-year follow-up. Females had lower Veterans RAND 12-item health survey (VR-12) mental health subscores at 2-year follow-up (females: 52.3±9.0, males: 55.8±7.6, p=0.0016). Females were more likely to report that treatment had ‘exceeded expectations’ at 2-year follow-up regarding motion, strength, function and normal sports activities.ConclusionResults of study demonstrate that ABR has similar outcomes for both males and females. There were no statistically significant sex-related differences in SST, ASES, VAS or SANE scores following ABR. VR-12 mental health subscores showed a minimal difference at 2-year follow-up, with lower scores in females.Level of evidenceRetrospective cohort study; level II.

scholarly journals S135. EXPOSURE TO COMMON INFECTIONS AND RISK OF SUICIDE AND SELF-HARM – A LONGITUDINAL GENERAL POPULATION STUDY

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S86-S87
Author(s):  
Maija Lindgren ◽  
Minna Holm ◽  
Niina Markkula ◽  
Tommi Härkänen ◽  
Faith Dickerson ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Regression Models ◽  
Suicide Attempts ◽  
Herpes Viruses ◽  
Suicidal Thoughts ◽  
Self Harm ◽  
Antibody Levels ◽  
Common Infections ◽  
Hsv 1

Abstract Background Common infectious agents, such as Toxoplasma gondii (T. gondii) and several human herpes viruses, have been linked to increased risk of self-harm. As the infections may be prevented and treated, information on the possible association on common infections and suicidal outcomes may help prevent self-harm. We aimed to investigate the associations between self-harm and seropositivity to T. gondii, Epstein-Barr virus (EBV), Herpes Simplex virus Type 1 (HSV-1), and Cytomegalovirus (CMV). As depression is a major risk factor for suicidality, we also investigated whether being seropositive to the studied herpes viruses was associated with depressive symptoms. Methods IgM and IgG antibodies to T. gondii, EBV, HSV-1, and CMV were measured in a large Finnish population survey, the Health 2000 project, in year 2000. The 6250 participants were followed for 15 years via health care register and causes of death register. In addition, lifetime suicidal ideation and suicide attempts were assessed in a smaller subsample of 694 participants, based on systematically-evaluated self-report, medical records, and register data. The participants in the subsample were screened for possible psychotic symptoms or were controls; we controlled for this screen status in the regression models. Results We found no significant cross-sectional associations between baseline depressive symptom and the herpes infections, when controlling for background variables related to infection seropositivity. During the follow-up, 18 of the 6250 participants (0.3%) had either died by suicide or had a self-harm diagnosis. In Cox regression models, serological evidence of lifetime or acute infections was not found to be associated with these suicidal outcomes. In the subsample, 31% had had suicidal thoughts and 13% had attempted suicide. There were no significant associations between suicidal thoughts and infection seropositivity / antibody levels. However, those seropositive for IgG class antibodies for CMV, measuring latent infection, had fewer suicide attempts compared to those seronegative in multinomial logistic regression models adjusting for gender, age, education, childhood family size, regional residence, and screen status (OR for multiple attempts compared to no attempts =0.45, 95% confidence interval 0.22‒0.91, p=.026). Genders were investigated separately in post-hoc analyses and there were significant associations only in males: suicide attempts were associated negatively with CMV and positively with EBV. Looking separately at diagnosis groups, the CMV association was significant among those with a mood disorder and not among those with a psychotic disorder. C-reactive protein (CRP) measuring inflammation seemed to explain some but not all of the associations. Discussion In a large sample nationally representative of the whole Finnish adult population, antibodies to CMV, EBV, or HSV-1 were not associated with depressive symptoms. Seropositivity or antibody levels of T. gondii or herpes viruses were not associated with risk of subsequent death by suicide or intentional self-harm diagnoses at a 15 year follow-up. In the subsample consisting mostly of participants with severe mental disorders, in males, EBV antibody level was associated with a history of a suicide attempt and none of the other infection variables were associated with a heightened risk for suicidal thoughts or acts. We found a heightened risk for multiple suicide attempts in persons belonging to the CMV seronegative minority. This “protective effect” of being infected with CMV calls for further research.

scholarly journals S210. COMPARATIVE EFFECTIVENESS OF ANTIPSYCHOTICS FOR RISK OF ATTEMPTED OR COMPLETED SUICIDE AMONG PERSONS WITH SCHIZOPHRENIA

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S118-S119
Author(s):  
Heidi Taipale ◽  
Markku Lähteenvuo ◽  
Antti Tanskanen ◽  
Ellenor Mittendorfer-Rutz ◽  
Jari Tiihonen
Keyword(s):  
Drug Use ◽  
Comparative Effectiveness ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
Antipsychotic Therapy ◽  
Completed Suicide ◽  
Hazard Ratios ◽  
Persons With Schizophrenia ◽  
Swedish Cohort

Abstract Background Suicidal attempts and suicide are rather common phenomena in persons with schizophrenia whom are 6–14 times more likely to die due to suicide than the general population. Very little is known on effectiveness of antipsychotics in preventing suicide attempts and completed suicides among patients with schizophrenia. Whether all antipsychotics are effective in preventing attempted or completed suicides also remains unclear. The objective of our study was to investigate comparative effectiveness of antipsychotics for risk of attempted or completed suicide among all patients with schizophrenia in Finland and Sweden. Methods Two nationwide register-based cohort studies were conducted including all individuals with schizophrenia in Finland (N=61889) and Sweden (N=29823). The Finnish cohort included all persons treated for schizophrenia in inpatient care (1972–2014), with follow-up for drug use and outcomes during 1996–2017. The Swedish cohort included all persons with treatment contact due to schizophrenia in inpatient or specialized outpatient care, sickness absence, or disability pension (2006–2013), with follow-up for drug use and outcomes during 2006–2016. The main exposure included the ten most commonly used antipsychotic monotherapies, and also adjunctive pharmacotherapies (antidepressants, mood stabilizers, lithium, benzodiazepines and related drugs were investigated). The main outcome measure was attempted or completed suicide which was analyzed with within-individual models by comparing use and non-use periods in the same individual. Sensitivity analyses were conducted by between-individual models, with attempted suicide (hospitalization only) as an outcome, and by censoring first 30 days from each exposure. Results are reported as hazard ratios (HRs) with 95 % confidence intervals (95% CI). Results Compared with no use of antipsychotics, clozapine was the only antipsychotic therapy consistently associated with a decreased risk of suicidal outcomes. Hazard ratios (HRs) and 95% CI for attempted or completed suicide were 0.64 (95% CI 0.49–0.84) in the Finnish cohort, and 0.66 (0.43–0.99) in the Swedish cohort, and for attempted suicide 0.60 (0.46–0.79) in the Finnish cohort and 0.62 (0.40–0.95) in the Swedish cohort. No other antipsychotic was associated with a reduced risk of attempted and/or completed suicide than clozapine. Regarding adjunctive pharmacotherapies, benzodiazepines and Z-drugs were associated with an increased risk of suicide attempts or deaths (HRs for benzodiazepines 1.29–1.30 and 1.33–1.62 for Z-drugs, not reaching statistical significance in the Swedish cohort). Discussion The results from two large nationwide cohorts provide the first evidence on comparative real-world effectiveness of specific antipsychotics in the prevention of severe suicidal behavior. Clozapine was the only pharmacological treatment associated with a substantially decreased risk of attempted or completed suicide and should be considered as a first-line treatment for patients with suicidal ideation or behavior.

scholarly journals Predictors of Psychiatric Aftercare among Formerly Hospitalized Adolescents

2012 ◽  
Vol 57 (11) ◽  
pp. 666-676 ◽  
Author(s):  
Corine E Carlisle ◽  
Muhammad Mamdani ◽  
Russell Schachar ◽  
Teresa To
Keyword(s):  
Rural Areas ◽  
Psychotic Disorders ◽  
Suicide Attempts ◽  
Psychiatric Hospitalization ◽  
Psychiatric Treatment ◽  
Population Based ◽  
Care Physician ◽  
Administrative Databases ◽  
Timely Access ◽  
Self Harm

Objective: Timely aftercare can be viewed as a patient safety imperative. In the context of decreasing inpatient length of stay (LOS) and known child psychiatry human resource challenges, we investigated time to aftercare for adolescents following psychiatric hospitalization. Method: We conducted a population-based cohort study of adolescents aged 15 to 19 years with psychiatric discharge between April 1, 2002, and March 1, 2004, in Ontario, using encrypted identifiers across health administrative databases to determine time to first psychiatric aftercare with a primary care physician (PCP) or a psychiatrist within 395 days of discharge. Results: Among the 7111 adolescents discharged in the study period, 24% had aftercare with a PCP or a psychiatrist within 7 days and 49% within 30 days. High socioeconomic status (adjusted hazard ratio [AHR] 1.31; 95% CI 1.21 to 1.43, P < 0.001) and psychotic disorders (AHR 1.24; 95% CI 1.12 to 1.36, P < 0.001) were associated with greater likelihood of aftercare. Youth in the northern part of the province (AHR 0.48; 95% CI 0.32 to 0.71, P < 0.001), rural areas (AHR 0.82; 95% CI 0.76 to 0.89, P < 0.001), and with self-harm or suicide attempts (AHR 0.58; 95% CI 0.53 to 0.64, P < 0.001) and substance use disorders (AHR 0.50; 95% CI 0.44 to 0.56, P < 0.001) were less likely to receive aftercare. Conclusions: Hospitalization is our most intensive, intrusive, and expensive psychiatric treatment setting, yet in our cohort of formerly hospitalized adolescents fewer than 50% received psychiatry-related aftercare in the month postdischarge. Innovations are necessary to address geographic inequities and improve timely access to mental health aftercare for all youth.

scholarly journals Influencing Factors of Multiple Adverse Outcomes Among Schizophrenia Patients Using Count Regression Models: A Cross-Sectional Study

2021 ◽  
Author(s):  
Lichang Chen ◽  
Wenyan Tan ◽  
Xiao Lin ◽  
Haicheng Lin ◽  
Junyan Xi ◽  
...  
Keyword(s):  
Risk Factor ◽  
Influencing Factors ◽  
Violent Crime ◽  
Regression Models ◽  
Negative Binomial ◽  
Suicide Attempts ◽  
Adverse Outcomes ◽  
Different Types ◽  
History Of ◽  
Self Harm

Abstract Background: Schizophrenia patients have increased risks of several adverse outcomes, including violent crime, aggressiveness and suicide. However, studies of different adverse outcomes in the same population are rare and the influencing factors for these outcomes need clarification by appropriate models. This study aimed to identify influencing factors of these adverse outcomes by examining and comparing different count regression models.Methods: This study included schizophrenia patients who had at least once follow-up record in the Guangdong Mental Health Center Network Medical System during 2020. Three types of adverse outcomes including a) aggressiveness with police dispatch or violence crime, b) aggressiveness without police dispatch, and c) self-harm or suicide attempts. First, we investigated the incidence of these adverse outcomes in each type. Second, the Poisson, negative binomial (NB), zero-inflated Poisson (ZIP), and zero-inflated negative binomial (ZINB) regression models were fitted and compared for their intensity. Finally, We analysed associations between these adverse outcomes intensity and sociodemographic, clinical factors with the best model. Results: A total of 130474 schizophrenia patients were selected. Each type of adverse outcomes was reported by less than 1% of schizophrenia patients in 2020. NB regression model is the best model for fitting the number of aggressiveness without police dispatch because of the best goodness of fit and relatively simple interpretation, whereas ZINB models for the other two outcomes. Age, sex, and history of adverse outcomes were influencing factors shared across these adverse outcomes. Higher educational level, employment were protective factors shared between aggressiveness with police dispatch or violent crime , and aggressiveness without police dispatch. Aggressiveness without police dispatch , and self-harm or suicide attempts shared older onset age (≥18 years) as a risk factor. Family history of mental disease was a risk factor of self-harm or suicide attempts individually.Conclusions: NB and ZINB models were selected for fitting the number of adverse outcomes in our studies. Influencing factors for adverse outcomes intensity included both those shared across different types and those individual to specific types. Therefore, combined and customized tools in risk assessment and intervention for different types of these outcomes might be necessary.

scholarly journals Understanding the Differing Impacts of On-Call Work for Males and Females: Results from an Online Survey

2019 ◽  
Vol 16 (3) ◽  
pp. 370 ◽  
Author(s):  
Bernadette Roberts ◽  
Grace Vincent ◽  
Sally Ferguson ◽  
Amy Reynolds ◽  
Sarah Jay
Keyword(s):  
Sex Differences ◽  
Coping Strategies ◽  
Online Survey ◽  
Coping Styles ◽  
Leisure Activities ◽  
Adverse Outcomes ◽  
Valuable Insight ◽  
Physical And Mental Health ◽  
Males And Females ◽  
And Coping

On-call work is prevalent worldwide and is associated with adverse outcomes, including disrupted sleep, impaired leisure time, and difficulties in mentally detaching from work. Limited studies specifically explored whether men and women experience on-call differently; therefore, our aim was to investigate whether sex differences exist in terms of both the impacts of and coping strategies to deal with on-call work. On-call workers (n = 228) participated in an online survey to investigate how on-call work impacts domestic, non-domestic, and leisure activities, and coping strategies. Pearson chi-squared analyses were used to determine sex differences for each construct of interest. Results indicated that female respondents were more likely to be responsible for running their household, and reported that being on call disturbed leisure, domestic, and non-domestic activities “a lot/very much”. While both males and females adopted engaged coping styles, a greater proportion of males used “problem solving” and a greater proportion of females “talked about their feelings” when managing on-call work. These findings provide valuable insight into how males and females are differentially impacted and cope with on-call work. Further research is required to better understand these impacts, particularly over time, and should include measures such as of quality of life, relationship satisfaction, and physical and mental health outcomes.

Prevalence and Predictors of Physically Self-Destructive Acts over Time

2018 ◽  
pp. 87-98
Author(s):  
Mary C. Zanarini
Keyword(s):  
Major Depression ◽  
Help Seeking ◽  
Suicide Attempts ◽  
Survival Strategies ◽  
Affective States ◽  
Self Mutilation ◽  
Suicide Threats ◽  
Self Harm ◽  
Over Time

Self-mutilation and help-seeking suicide threats and attempts are among the few almost pathognomonic symptoms of BPD. This chapter assesses predictors of self-harm and reasons for self-harm over time. It also assesses predictors of suicide threats and attempts over the years of prospective follow-up. Each outcome has a different set of multivariate predictors, but some appear in several multivariate models. More specifically, sexual adversity in childhood and adulthood, major depression, and severity of dissociation are predictors of self-mutilation; and sexual adversity in adulthood, major depression, and severity of dissociation are predictors of suicide attempts. However, these factors do not play a role in predicting suicide threats. Instead, two dysphoric affective states and two outmoded interpersonal survival strategies are the best set of predictors of suicide threats.

scholarly journals Prevalence of comorbid mental and physical illnesses and risks for self-harm and premature death among primary care patients diagnosed with fatigue syndromes

2019 ◽  
Vol 50 (7) ◽  
pp. 1156-1163
Author(s):  
Matthew J. Carr ◽  
Darren M. Ashcroft ◽  
Peter D. White ◽  
Nav Kapur ◽  
Roger T. Webb
Keyword(s):  
Cox Regression ◽  
Premature Mortality ◽  
Premature Death ◽  
Epidemiological Studies ◽  
Adverse Outcomes ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Hazard Ratios ◽  
History Of ◽  
Self Harm

AbstractBackgroundFatigue syndromes (FSs) affect large numbers of individuals, yet evidence from epidemiological studies on adverse outcomes, such as premature death, is limited.MethodsCohort study involving 385 general practices in England that contributed to the Clinical Practice Research Datalink (CPRD) with linked inpatient Hospital Episode Statistics (HES) and Office for National Statistics (ONS) cause of death information. A total of 10 477 patients aged 15 years and above, diagnosed with a FS during 2000–2014, were individually matched with up to 20 comparator patients without a history of having a FS. Prevalence ratios (PRs) were estimated to compare the FS and comparison cohorts on clinical characteristics. Adjusted hazard ratios (HRs) for subsequent adverse outcomes were estimated from stratified Cox regression models.ResultsAmong patients diagnosed with FSs, we found elevated baseline prevalence of: any psychiatric illness (PR 1.77; 95% CI 1.72–1.82), anxiety disorders (PR 1.92; 1.85–1.99), depression (PR 1.89; 1.83–1.96), psychotropic prescriptions (PR 1.68; 1.64–1.72) and comorbid physical illness (PR 1.28; 1.23–1.32). We found no significant differences in risks for: all-cause mortality (HR 0.99; 0.91–1.09), natural death (HR 0.99; 0.90–1.09), unnatural death (HR 1.00; 0.59–1.72) or suicide (HR 1.68; 0.78–3.63). We did, however, observe a significantly elevated non-fatal self-harm risk: HR 1.83; 1.56–2.15.ConclusionsThe absence of elevated premature mortality risk is reassuring. The raised prevalence of mental illness and increased non-fatal self-harm risk indicate a need for enhanced assessment and management of psychopathology associated with fatigue syndromes.

Adverse outcomes of sick leave due to mental disorders: A prospective study of discordant twin pairs

2017 ◽  
Vol 47 (2) ◽  
pp. 127-136 ◽  
Author(s):  
Lisa Mather ◽  
Victoria Blom ◽  
Gunnar Bergström ◽  
Pia Svedberg
Keyword(s):  
Mental Disorders ◽  
Sick Leave ◽  
Disability Pension ◽  
Cox Proportional Hazards ◽  
Adverse Outcomes ◽  
Shared Environment ◽  
Hazard Ratios ◽  
Time Varying Covariates ◽  
Discordant Twin

Aims: The aim of this study was to investigate whether sick leave due to different mental disorders increased the risk of reoccurring sick-leave, disability pension and unemployment, taking genetics and shared environment into account. Methods: This register-based cohort study contains 2202 discordant twin pairs 18–64 years old, where one twin had sick leave due to a mental disorder 2005–2006. The end of the sick-leave spell was the start of follow-up for both twins. The twins were followed up for reoccurring sick-leave, disability pension and unemployment (> 180 days in a year), until December 2012. Analyses were censored for disability pension, death, emigration and old-age pension. Cox proportional hazards models with time-varying covariates were used to calculate hazard ratios with 95% confidence intervals (CI). Results: Those with sick leave due to mental disorders had a 3.64 (CI: 3.24–4.08) times higher risk of reoccurring sick-leave within the first two years; after that, hazard ratios were attenuated and explained by genetic factors. The first year, they had 12.24 (CI: 8.11–18.46) times the risk of disability pension. The risk was attenuated but remained at 2.75 (CI: 2.07–3.65) after one year. The risk of unemployment was 1.99 (CI: 1.72–2.31) during the whole follow-up period. The risk of unemployment and disability pension was lower for those with stress-related than other mental disorders, this was less clear for recurrent reoccuring sick-leave. Conclusions: Sick leave due to mental disorders increased the risk of reoccurring sick-leave within two years, disability pension and unemployment, independent of genetics and shared environment.

scholarly journals Association of heart rate trajectories with the risk of adverse outcomes in a community-based cohort in Taiwan

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e8987
Author(s):  
Cheng-Chun Wei ◽  
Pei-Chun Chen ◽  
Hsiu-Ching Hsu ◽  
Ta-Chen Su ◽  
Hung-Ju Lin ◽  
...  
Keyword(s):  
Heart Rate ◽  
Adverse Outcomes ◽  
Secondary Outcome ◽  
Hazard Ratios ◽  
All Cause Mortality ◽  
Trajectory Pattern ◽  
Secondary Outcomes ◽  
Artery Disease ◽  
Stable Trajectory

Heart rate trajectory patterns integrate information regarding multiple heart rate measurements and their changes with time. Different heart rate patterns may exist in one population, and these are associated with different outcomes. Our study investigated the association of adverse outcomes with heart rate trajectory patterns. This was a prospective cohort study based on the Chin-Shan Community Cardiovascular Cohort in Taiwan. A total of 3,015 Chinese community residents aged > 35 years were enrolled in a prospective investigation of cardiovascular risk factors and outcomes from 1990 to 2013.The primary outcome was all-cause mortality, and the secondary outcome was a composite of coronary artery disease and cerebrovascular accidents. The following trajectory patterns were identified: stable, 61%; decreased, 5%; mildly increased, 32%; and markedly increased, 2%. During follow-up (median, 13.9 years), 557 participants died and 217 experienced secondary outcomes. The adjusted hazard ratios of primary and secondary outcomes for participants with a markedly increased trajectory pattern were 1.80 (95% CI [1.18–2.76]) and 1.45 (95% CI [0.67–3.12]), respectively, compared to those for participants with a stable trajectory pattern. A markedly increased heart rate trajectory pattern may be associated with all-cause mortality risks. Heart rate trajectory patterns demonstrated the utility of repeated heart rate measurements for risk assessment.

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