More than Suicide: Mortality after Emergency Psychiatric Care and Implications for Practice

Author(s):  
Scott A. Simpson ◽  
Bradley D. Shy ◽  
Ryan M. Loh
2021 ◽  
Vol 162 (32) ◽  
pp. 1283-1296
Author(s):  
Attila Németh ◽  
Péter Döme ◽  
Gergely Drótos ◽  
Zoltán Rihmer

Összefoglaló. Bevezetés: Az öngyilkosság régóta jelentős probléma hazánkban. Célkitűzés: Az elmúlt 20 év során elkövetett, befejezett öngyilkosságok elemzése három időintervallumban (2000–2006, 2006–2010, 2010–2019) nemek, korcsoportok, az elkövetési mód, a családi állapot és a munkanélküliség szempontjából. További célunk volt a pszichiátriai ellátást negatívan érintő, 2007. évi egészségügyi reform suicid halálozással való összefüggéseinek vizsgálata. Módszer: A suicid halálozást a Központi Statisztikai Hivatal adatainak felhasználásával elemeztük. Az évenkénti suicid rátát 100 000 lakosra adtuk meg. Az adatok statisztikai feldolgozásához az Excel 2011-es, az SPSS 23-as és az amerikai NIH Jointpoint programjának 4.8.0.1-as verzióját használtuk. Eredmények: 2000 és 2019 között 51,4%-kal csökkent a suicid halálozás (nők: 15,57 vs. 7,69/100 000 fő; férfiak: 51,5 vs. 24,73/100 000 fő, összlakosság: 32,61 vs. 15,85/100 000 fő). A legnagyobb mértékben a férfiak és a középkorúak körében csökkent a mortalitási ráta, a legkevésbé a fiatal, egyedülálló nőknél. A leggyakoribb elkövetési mód változatlanul az akasztás (58,4%). A 20 évig tartó rátacsökkenés 2006 után több évre megtorpant, és egészen 2010-ig nagyjából konstans maradt (24,43 vs. 24,88/100 000 fő). Azt feltételezzük, hogy ennek hátterében jelentős részben a pszichiátriai ellátórendszert negatívan érintő, 2007-ben bevezetett egészségügyi reform állt. Ez a megtörés kimutatható volt szinte minden korcsoportnál, a leggyakoribb elkövetési módoknál, és egyaránt érintette a hajadonokat/nőtleneket, a házasokat, az özvegyeket és az elváltakat. Csak 2010 után kezdődött újra a suicid mortalitás szignifikáns csökkenése. Az utolsó 10 év alatt 36,3%-kal csökkent a suicid mortalitás (24,88 vs. 15,85/100 000 fő), ami kiemelkedő eredmény az európai országok körében. Következtetés: Egy elhibázott, a pszichiátriai ellátórendszert sújtó egészségügyi reform következményeként az addig egyenletesen csökkenő suicid halálozás üteme 2006 után megtört, és néhány évig stagnált. Több évig tartott, mire bizonyos mértékig rendeződött a pszichiátriai ellátórendszer, és ennek köszönhetően 2010 után ismét folyamatosan és szignifikánsan csökkent a suicid mortalitás. Orv Hetil. 2021; 162(32): 1283–1296. Summary. Introduction: In Hungary, suicide has been a major public health issue for a long time. Objective: Our objective was to examine data on completed suicide cases in Hungary from a 20-year period divided into three intervals (2000–2006; 2006–2010; 2010–2019) grouped by sex, age, methods of commitment, marital and employment statuses. An auxiliary aim was to assess the associations between the healthcare reform in 2007 (with unfavourable impacts on the psychiatric care system) and suicide mortality. Method: Data on suicide were provided by the Hungarian Central Statistical Office. In all cases, the yearly suicide rates were given for 100 000 inhabitants. For statistical calculations, we used Excel 2011, SPSS v. 23 and NIH Joinpoint Regression Program v. 4.8.0.1. Results: Between 2000 and 2019, there was a 51.4% reduction in the suicide mortality (females: 15.57 vs. 7.69/100 000; males: 51.5 vs. 24.73/100 000; total population: 32.61 vs. 15.85/100 000). The greatest declines occurred among males and middle-aged. At the same time, the rate of young single females declined only slightly. The most common method of commitment remained hanging (58.4%). During the 20-year-long period investigated, there was a temporary halt between 2006 (24.43/100 000) and 2010 (24.88/100 000) in the otherwise steadily declining trend of the rate. One of the major underlying causes of this plateau is presumed to be the healthcare reform commenced in 2007 with negative impacts on psychiatric services. This plateau was observable in almost all subpopulations irrespective of their age, marital status and the suicide method they used. The decline of the rate restarted only after 2010. In the last 10 years, suicide mortality has decreased by 36.3% (from 24.88 to 15.85/100 000) in Hungary, which is a very good result in a European comparison. Conclusion: Due to an unsound health reform threatening the psychiatric care, the previously experienced declining trend of the suicide rate halted in 2006 and has remained almost unchanged for a few years during which psychiatric services could be restored in some degree. From 2010, as a consequence of this restoration, the marked decline of the suicide rate restarted and has been remained stable. Orv Hetil. 2021; 162(32): 1283–1296.


2005 ◽  
Vol 187 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Vincent Lorant ◽  
Anton E. Kunst ◽  
Martijn Huisman ◽  
Giuseppe Costa ◽  
Johan Mackenbach

BackgroundSocial factors have been shown to be predictors of suicide. It is not known whether these factors vary between countries.AimsTo present a first European overview of socio-economic inequalities in suicide mortality among men and women.MethodWe used a prospective follow-up of censuses matched with vital statistics in ten European populations. Directly standardised rates of suicide were computed for each country.ResultsIn men, a low level of educational attainment was a risk factor for suicide in eight out often countries. Suicide inequalities were smaller and less consistent in women. In most countries, the greater the socio-economic disadvantage, the higher is the risk of suicide. The population of Turin evidenced no socio-economic inequalities.ConclusionsSocio-economic inequalities in suicide are a generalised phenomenon in western Europe, but the pattern and magnitude of these inequalities vary between countries. These inequalities call for improved access to psychiatric care for lower socio-economic groups.


2008 ◽  
Vol 1 (3) ◽  
pp. 18-19
Author(s):  
ROBERT T. LONDON
Keyword(s):  

Crisis ◽  
2012 ◽  
Vol 33 (5) ◽  
pp. 249-253 ◽  
Author(s):  
José Manoel Bertolote ◽  
Diego De Leo

Crisis ◽  
1997 ◽  
Vol 18 (1) ◽  
pp. 35-47 ◽  
Author(s):  
Ilkka Henrik Mäkinen

This article describes suicide-related penal legislation in contemporary Europe, and analyzes and relates the results to cultural attitudes towards suicide and to national suicide rates. Data were obtained from 42 legal entities. Of these, 34 have penal regulations which - according to definition - chiefly and directly deal with suicide. There are three main types of act: aiding suicide, abetting suicide, and driving to suicide. The laws vary considerably with regard to which acts are sanctioned, how severely they are punished, and whether any special circumstances such as the motive, the result, or the object can make the crime more serious. Various ideologies have inspired legislation: religions, the euthanasia movement, and suicide prevention have all left their mark. There are some cases in which neighboring legal systems have clearly influenced laws on the topic. However, the process seems mostly to have been a national affair, resulting in surprisingly large discrepancies between European legal systems. The laws seem to reflect public opinions: countries which punish the crimes harder have significantly less permissive cultural attitudes towards suicide. Likewise, suicide rates were significantly higher in countries with a narrow scope of criminalization and milder punishments for suicide-related crimes. The cultural and normative elements of society are connected with its suicide mortality.


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