scholarly journals Children and young people who die by suicide: childhood-related antecedents, gender differences and service contact

BJPsych Open ◽  
2020 ◽  
Vol 6 (3) ◽  
Author(s):  
Cathryn Rodway ◽  
Su-Gwan Tham ◽  
Saied Ibrahim ◽  
Pauline Turnbull ◽  
Nav Kapur ◽  
...  
Keyword(s):  
Young People ◽  
Case Series ◽  
Third Sector ◽  
Drug Misuse ◽  
Mortality Data ◽  
Suicide Rates ◽  
National Mortality ◽  
Self Harm ◽  
The Uk ◽  
Witnessing Domestic Violence

Background Worldwide suicide is commonest in young people and in many countries, including the UK, suicide rates in young people are rising. Aims To investigate the stresses young people face before they take their lives, their contact with services that could be preventative and whether these differ in girls and boys. Method We identified a 3-year UK national consecutive case series of deaths by suicide in people aged 10–19, based on national mortality data. We extracted information on the antecedents of suicide from official investigations, primarily inquests. Results Between 2014 and 2016, there were 595 suicides by young people, almost 200 per year; 71% were male (n = 425). Suicide rates increased from the mid-teens, most deaths occurred in those aged 17–19 (443, 74%). We obtained data about the antecedents of suicide for 544 (91%). A number of previous and recent stresses were reported including witnessing domestic violence, bullying, self-harm, bereavement (including by suicide) and academic pressures. These experiences were generally more common in girls than boys, whereas drug misuse (odds ratio (OR) = 0.54, 95% CI 0.35–0.83, P = 0.006) and workplace problems (OR 0.52, 95% CI 0.28–0.96, P = 0.04) were less common in girls. A total of 329 (60%) had been in contact with specialist children's services, and this was more common in girls (OR 1.86, 95% CI 1.19–2.94, P = 0.007). Conclusions There are several antecedents to suicide in young people, particularly girls, which are important in a multiagency approach to prevention incorporating education, social care, health services and the third sector. Some of these may also have contributed to the recent rise.

Psychological autopsy study of suicides by people aged under 35

1999 ◽  
Vol 175 (2) ◽  
pp. 168-174 ◽  
Author(s):  
Louis Appleby ◽  
Jayne Cooper ◽  
Tim Amos ◽  
Brian Faragher
Keyword(s):  
Young People ◽  
Suicide Rate ◽  
Social Withdrawal ◽  
Drug Misuse ◽  
Psychological Autopsy ◽  
Autopsy Study ◽  
Chronic Disorder ◽  
Self Harm ◽  
And Gender ◽  
The Uk

BackgroundIn the past two decades the suicide rate in young people has risen in the UK and other countries.AimsTo identify the characteristics of people aged under 35 who commit suicide.MethodPsychological autopsy study with case–control design. Cases were 84 suicides and probable suicides (open verdicts). Controls were 64 age- and gender-matched non-suicides obtained through the general practices of the matched cases. Main variables: social, including employment status, marital status and living circumstances; life events and interpersonal difficulties; clinical, including current psychiatric disorder, alcohol and drug misuse, previous self-harm and personality disorder.ResultsA large number of highly significant social, interpersonal and clinical differences between suicides and controls was found. Factor analysis identified two groups of variables within each of the social, interpersonal and clinical domains which were independently linked to suicide, corresponding to: acute, severe mental disorder and chronic disorder of behaviour; rootlessness and social withdrawal; chronic and recent interpersonal problems.ConclusionsA broad prevention strategy is needed to reverse the recent rise in the suicide rate in young people.

scholarly journals Temporal trends in annual incidence rates for psychiatric disorders and self-harm among children and adolescents in the UK, 2003–2018

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lukasz Cybulski ◽  
Darren M. Ashcroft ◽  
Matthew J. Carr ◽  
Shruti Garg ◽  
Carolyn A. Chew-Graham ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Young People ◽  
Anxiety Disorders ◽  
Children And Adolescents ◽  
Autism Spectrum ◽  
Incidence Rates ◽  
Annual Incidence ◽  
Health Crisis ◽  
Self Harm ◽  
The Uk

Abstract Background There has been growing concern in the UK over recent years that a perceived mental health crisis is affecting children and adolescents, although published epidemiological evidence is limited. Methods Two population-based UK primary care cohorts were delineated in the Aurum and GOLD datasets of the Clinical Practice Research Datalink (CPRD). We included data from 9,133,246 individuals aged 1–20 who contributed 117,682,651 person-years of observation time. Sex- and age-stratified annual incidence rates were estimated for attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) (age groups: 1–5, 6–9, 10–12, 13–16, 17–19), depression, anxiety disorders (6–9, 10–12, 13–16, 17–19), eating disorders and self-harm (10–12, 13–16, 17–19) during 2003–2018. We fitted negative binomial regressions to estimate incidence rate ratios (IRRs) to examine change in incidence between the first (2003) and final year (2018) year of observation and to examine sex-specific incidence. Results The results indicated that the overall incidence has increased substantially in both boys and girls in between 2003 and 2018 for anxiety disorders (IRR 3.51 95% CI 3.18–3.89), depression (2.37; 2.03–2.77), ASD (2.36; 1.72–3.26), ADHD (2.3; 1.73–3.25), and self-harm (2.25; 1.82–2.79). The incidence for eating disorders also increased (IRR 1.3 95% CI 1.06–1.61), but less sharply. The incidence of anxiety disorders, depression, self-harm and eating disorders was in absolute terms higher in girls, whereas the opposite was true for the incidence of ADHD and ASD, which were higher among boys. The largest relative increases in incidence were observed for neurodevelopmental disorders, particularly among girls diagnosed with ADHD or ASD. However, in absolute terms, the incidence was much higher for depression and anxiety disorders. Conclusion The number of young people seeking help for psychological distress appears to have increased in recent years. Changes to diagnostic criteria, reduced stigma, and increased awareness may partly explain our results, but we cannot rule out true increases in incidence occurring in the population. Whatever the explanation, the marked rise in demand for healthcare services means that it may be more challenging for affected young people to promptly access the care and support that they need.

scholarly journals Clinical characteristics and care pathways of patients with personality disorder who died by suicide

BJPsych Open ◽  
2020 ◽  
Vol 6 (2) ◽  
Author(s):  
Sandra Flynn ◽  
Jane Graney ◽  
Thabiso Nyathi ◽  
Jessica Raphael ◽  
Seri Abraham ◽  
...  
Keyword(s):  
Personality Disorder ◽  
Clinical Care ◽  
Case Series ◽  
Drug Misuse ◽  
Care Pathways ◽  
Short Term ◽  
Psychological Therapies ◽  
Patient Admissions ◽  
History Of ◽  
The Uk

Background It is estimated that 1 in 10 people have a personality disorder. People with emotionally unstable personality disorder are at high risk of suicide. Despite being frequent users of mental health services, there is often no clear pathway for patients to access effective treatments. Aims To describe the characteristics of patients with personality disorder who died by suicide, examine clinical care pathways and explore whether the care adhered to National Institute for Health and Care Excellence guidance. Method National consecutive case series (1 January 2013 to 31 December 2013). The study examined the health records and serious incident reports of patients with personality disorder who died by suicide in the UK. Results The majority had a diagnosis of borderline/emotionally unstable or antisocial personality disorder. A high proportion of patients had a history of self-harm (n = 146, 95%) and alcohol (n = 101, 66%) or drug misuse (n = 79, 52%). We found an extensive pattern of service contact in the year before death, with no clear pathway for patients. Care was inconsistent and there were gaps in service provision. In 99 (70%) of the 141 patients with data, the last episode of care followed a crisis. Access to specialised psychological therapies was limited; short-term in-patient admissions was adhered to; however, guidance on short-term prescribing for comorbid conditions was not followed for two-thirds of patients. Conclusions Continuity and stability of care is required to prevent, rather than respond to individuals in crisis. A comprehensive audit of services for people with personality disorder across the UK is recommended to assess the quality of care provided.

scholarly journals Poisoning substances taken by young people: a population-based cohort study

2018 ◽  
Vol 68 (675) ◽  
pp. e703-e710 ◽  
Author(s):  
Edward G Tyrrell ◽  
Denise Kendrick ◽  
Kapil Sayal ◽  
Elizabeth Orton
Keyword(s):  
Cohort Study ◽  
Young People ◽  
Population Based ◽  
Incidence Rates ◽  
Practice Research ◽  
Mortality Data ◽  
Clinical Practice Research Datalink ◽  
Self Harm ◽  
Harm Prevention ◽  
Rate Ratios

BackgroundGlobally, poisonings account for most medically-attended self-harm. Recent data on poisoning substances are lacking, but are needed to inform self-harm prevention.AimTo assess poisoning substance patterns and trends among 10–24-year-olds across EnglandDesign and settingOpen cohort study of 1 736 527 young people, using linked Clinical Practice Research Datalink, Hospital Episode Statistics, and Office for National Statistics mortality data, from 1998 to 2014.MethodPoisoning substances were identified by ICD-10 or Read Codes. Incidence rates and adjusted incidence rate ratios (aIRR) were calculated for poisoning substances by age, sex, index of multiple deprivation, and calendar year.ResultsIn total, 40 333 poisoning episodes were identified, with 57.8% specifying the substances involved. The most common substances were paracetamol (39.8%), alcohol (32.7%), non-steroidal anti-inflammatory drugs (NSAIDs) (11.6%), antidepressants (10.2%), and opioids (7.6%). Poisoning rates were highest at ages 16–18 years for females and 19–24 years for males. Opioid poisonings increased fivefold from 1998–2014 (females: aIRR 5.30, 95% confidence interval (CI) = 4.08 to 6.89; males: aIRR 5.11, 95% CI = 3.37 to 7.76), antidepressant poisonings three-to fourfold (females: aIRR 3.91, 95% CI = 3.18 to 4.80, males: aIRR 2.70, 95% CI = 2.04 to 3.58), aspirin/NSAID poisonings threefold (females: aIRR 2.84, 95% CI = 2.40 to 3.36, males: aIRR 2.76, 95% CI = 2.05 to 3.72) and paracetamol poisonings threefold in females (aIRR 2.87, 95% CI = 2.58 to 3.20). Across all substances poisoning incidence was higher in more disadvantaged groups, with the strongest gradient for opioid poisonings among males (aIRR 3.46, 95% CI = 2.24 to 5.36).ConclusionIt is important that GPs raise awareness with families of the substances young people use to self-harm, especially the common use of over-the-counter medications. Quantities of medication prescribed to young people at risk of self-harm and their families should be limited, particularly analgesics and antidepressants.

Strategies for preventing suicide

1997 ◽  
Vol 171 (4) ◽  
pp. 351-354 ◽  
Author(s):  
Glyn Lewis ◽  
Keith Hawton ◽  
Peter Jones
Keyword(s):  
High Risk ◽  
Population Attributable Fraction ◽  
Population Based ◽  
Number Needed To Treat ◽  
Deliberate Self Harm ◽  
Suicide Rates ◽  
Population Attributable Fractions ◽  
Effective Interventions ◽  
Self Harm ◽  
The Uk

BackgroundThe Health of the Nation includes a target for reducing population suicide rates. We have examined and quantified various high-risk and population-based strategies for prevention based upon a number of stated assumptions and hypothetical interventions.MethodThe published literature was used to estimate the population attributable fractions for both high-risk and population-based strategies. The number needed to treat for the high-risk strategies was calculated, assuming an intervention that reduced suicide rates by 25%ResultsInterventions that would reduce rates of suicide by 25% would reduce population rates by about 2.6% for those recently discharged from hospital and by up to 5.8% for those presenting to general hospital with deliberate self-harm. The population attributable fraction for unemployment was 10.9%ConclusionsHigh-risk strategies will have only a modest effect on population suicide rates, even if effective interventions are developed. Evaluating interventions for deliberate self-harm patients seems worthwhile. The UK Government's target for suicide reduction is more likely to be achieved using population-based strategies. Reducing the availability of methods commonly used for committing suicide is the most practicable current policy, although more radical approaches, for example reducing unemployment, may also substantially reduce suicide rates.

scholarly journals Child Health Clinical Outcome Review Programme: The Mental Healthcare of Young People and Young Adults

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Sophie Wood ◽  
Sarah Rees ◽  
Ting Wang ◽  
Amanda Marchant ◽  
Ashley Akbari ◽  
...  
Keyword(s):  
Mental Health ◽  
Young Adults ◽  
Young People ◽  
Transitional Care ◽  
Healthcare Utilisation ◽  
Mental Health Disorders ◽  
Children And Young People ◽  
Self Harm ◽  
Health Disorders ◽  
The Uk

IntroductionThe diagnosis, management and services available for mental disorders are of growing concern and controversy in the UK. Transitional care between child and adult services and the interface between primary and secondary/ specialist services is often disjointed and thresholds for referral to Child and Adolescent Mental Health Services are high. Objectives and ApproachRoutinely collected healthcare datasets and data linkage were used to identify patterns of healthcare utilisation by young people and young adults with mental health disorders across the four UK Nations. We explored the extent to which routinely collected datasets can contribute to an assessment of the health needs and the quality of care that children and young people with mental health disorders receive. Data was requested from the national data providers in each country. A series of descriptive analyses were performed and methods were developed for cross- national comparisons to be made (e.g. Four Nation Person Spell). ResultsIt is feasible to explore healthcare utilisation across the four countries of the UK using routine data. However the recording, availability and access varied considerably between countries, making meaningful comparisons challenging. Descriptive analyses showed strong deprivation gradients in the diagnoses and care provided for young people and young adults with mental health disorders. Depression and anxiety were the most commonly recorded mental health conditions in primary care. In secondary care drug/alcohol disorders and self-harm were the most commonly recorded. Re-admissions to emergency departments were higher for those admitted for self-harm or psychiatric conditions. Conclusion/ImplicationsRoutine data has the potential to make a difference to care. However collection and access needs to be standardised in order to improve efficiency and effectiveness in improving the care for children and young people with mental health disorders. MQ has funded an Adolescent Data Platform to facilitate this.

scholarly journals Creative, participatory projects with young people: Reflections over five years

2017 ◽  
Vol 1 (2) ◽  
pp. 284-299 ◽  
Author(s):  
Valerie J Dunn ◽  
Tom Mellor
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Young People ◽  
Health Services ◽  
Participatory Research ◽  
Social Care ◽  
Third Sector ◽  
Animated Film ◽  
The Uk ◽  
Transition Preparation

Participatory research is collaborative and democratic, and may be particularly engaging for vulnerable or so-called hard-to-reach groups. In this paper, we describe three creative participatory projects carried out over five years with young people and NHS, social care and third sector partners. Working with young people in care we co-produced a trilogy of films, one of which won the young people a British Film Institute (BFI) award. The films are now used for training throughout the UK. With young people with experience of depression, we coproduced a short, animated film which aimed to offer support to other young people who may be depressed and not know where to turn. Finally, with young people attending or leaving NHS child and adolescent mental health services, we co-produced a transition preparation programme for those leaving the service at 17 or 18. For all the projects, the aim was to maximize involvement and give young people some ownership of the research. We outline our approach and describe some of the challenges and limitations.

scholarly journals Establishing a novel community-focussed lactation support service: a descriptive case series

2022 ◽  
Vol 17 (1) ◽  
Author(s):  
Samantha Griffin ◽  
Jo Watt ◽  
Sophie Wedekind ◽  
Solange Bramer ◽  
Yasmin Hazemi-Jebelli ◽  
...  
Keyword(s):  
Human Milk ◽  
Maternal Mental Health ◽  
Case Series ◽  
Third Sector ◽  
Support Service ◽  
Non Profit ◽  
Milk Bank ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
The Uk

Abstract Background Although breastfeeding is widely acknowledged as protecting both infant and maternal health postnatally, a partial or complete shortfall of maternal milk can occur for a range of reasons. In this eventuality, the currently available options for feeding infants are screened donor human milk (DHM), infant formula or unscreened shared human milk. In the UK, DHM has only been widely available in specific clinical contexts for the last 40 years, mainly to reduce the risk of necrotising enterocolitis in extremely preterm infants alongside optimal support for maternal lactation and breastfeeding. The Hearts Milk Bank (HMB) was established in 2017 as an independent, non-profit human milk bank that aimed to ensure equitable, assured access to screened DHM for neonatal units. As a result of the generosity of mothers, a surplus of DHM rapidly became available and together with lactation support, has since been provided to families with a healthcare referral. This programme has now been formalised for families facing lactational challenges, and DHM stocks are permanently maintained to meet their needs. Case series This case series describes the clinical paths of four families who accessed lactation support and DHM from the HMB, along with a description of the process for community provision. To date, the HMB has supported over 300 families. Working collaboratively with key stakeholders, the HMB team has developed a prioritisation strategy based on utilitarian ethical models, protocols that ensure safe handling and appropriateness of use, broader donor recruitment parameters that maintain safety with a pragmatic approach for full term healthy infants, and a process to ensure parents or carers have access to the knowledge needed to give informed consent and use DHM appropriately. Conclusions Stakeholders, including parents, healthcare professionals, and milk banks, will need to discuss priorities for both DHM use and research gaps that can underpin the equitable expansion of services, in partnership with National Health Service (NHS) teams and third-sector organisations that support breastfeeding and maternal mental health.

scholarly journals Trends in method-specific suicide in Brazil from 2000 to 2017

2021 ◽  
Author(s):  
Keltie McDonald ◽  
Daiane Borges Machado ◽  
Luís F. S. Castro-de-Araujo ◽  
Lígia Kiss ◽  
Alexis Palfreyman ◽  
...  
Keyword(s):  
Public Health ◽  
Suicide Prevention ◽  
State Level ◽  
Health Concern ◽  
Mortality Data ◽  
Suicide Rates ◽  
Undetermined Intent ◽  
National Mortality ◽  
Firearm Availability ◽  
High Place

Abstract Purpose Understanding long-term patterns of suicide methods can inform public health policy and prevention strategies. In Brazil, firearm-related policies may be one salient target for suicide prevention. This study describes trends in method-specific suicide at the national and state-levels in Brazil, with a particular focus on firearm-related suicides. Methods Brazilian mortality data for suicide and undetermined intent among people aged 10 years and older between 2000 and 2017 were obtained from the National Mortality Information System. We examined national and state-level trends in age-standardised suicide rates for hanging, self-poisoning, firearms, jumping from a high place, other, and unspecified methods. We also compared total rates of mortality from suicide and undetermined intent over the period. Applying Joinpoint regression, we tested changes in trends of firearm-specific suicide rates. Results The total suicide rate increased between 2000 and 2017. Rates of hanging, self-poisoning by drugs or alcohol and jumping from a high place showed the largest increases, while firearm-specific suicide rates decreased over the study period. Trends in methods of suicide varied by sex and state. Conclusion It is of public health concern that suicide rates in Brazil have risen this millennium. Restricting access to firearms might be an effective approach for reducing firearm-specific suicides, especially in states where firearm availability remains particularly high. Treatment and management of substance misuse may also be an important target for suicide prevention policies. More work is needed to understand the causes of rising suicide rates in Brazil and to improve the mental health of the population.

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