Treatment for opioid dependence and suicide prevention

Abstract Background Unemployment and being not in the labour force (NILF) are risk factors for suicide, but their association with self-harm is unclear, and there is continuing debate about the role of confounding by prior mental health conditions. We examine associations between employment status and self-harm and suicide in a prospective cohort, taking into account prior mental-health-related factors. Methods We used linked data from the New Zealand Integrated Data Infrastructure. The outcomes were chosen to be hospital presentation for self-harm and death by suicide. The exposure was employment status, defined as employed, unemployed, or NILF, measured at the 2013 Census. Confounders included demographic factors and mental health history (use of antidepressant medication, use of mental health services, and prior self-harm). Logistic regression was used to model effects. Analyses were stratified by gender. Results For males, unemployment was associated with an increased risk of suicide [odds ratio (OR): 1.48, 95% confidence interval (CI): 1.20–1.84] and self-harm (OR: 1.55, 95% CI: 1.45–1.68) after full adjustment for confounders. NILF was associated with an increased risk of self-harm (OR: 1.43, 95% CI: 1.32–1.55), but less of an association was seen with suicide (OR: 1.19, 95% CI: 0.94–1.49). For females, unemployment was associated with an increased risk of suicide (OR: 1.30, 95% CI: 0.93–1.80) and of self-harm (OR: 1.52, 95% CI: 1.43–1.62), and NILF was associated with a similar increase in risk for suicide (OR: 1.31, 95% CI: 0.98–1.75) and self-harm (OR: 1.32, 95% CI: 1.26–1.40). Discussion Exclusion from employment is associated with a considerably heightened risk of suicide and self-harm for both men and women, even among those without prior mental health problems.

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Association of source country gender inequality with experiencing assault and poor mental health among young female immigrants to Ontario, Canada

BMC Public Health ◽

10.1186/s12889-021-10720-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Michael Lebenbaum ◽

Therese A. Stukel ◽

Natasha Ruth Saunders ◽

Hong Lu ◽

Marcelo Urquia ◽

...

Keyword(s):

Mental Health ◽

Violence Against Women ◽

Gender Inequality ◽

Poor Mental Health ◽

Sub Saharan Africa ◽

Source Country ◽

Community Based Research ◽

Increased Risk ◽

Female Immigrants ◽

Self Harm

Abstract Background Gender inequality varies across countries and is associated with poor outcomes including violence against women and depression. Little is known about the relationship of source county gender inequality and poor health outcomes in female immigrants. Methods We used administrative databases to conduct a cohort study of 299,228 female immigrants ages 6–29 years becoming permanent residence in Ontario, Canada between 2003 and 2017 and followed up to March 31, 2020 for severe presentations of suffering assault, and selected mental health disorders (mood or anxiety, self-harm) as measured by hospital visits or death. Poisson regression examined the influence of source-country Gender Inequality Index (GII) quartile (Q) accounting for individual and country level characteristics. Results Immigrants from countries with the highest gender inequality (GII Q4) accounted for 40% of the sample, of whom 83% were from South Asia (SA) or Sub-Saharan Africa (SSA). The overall rate of assault was 10.9/10,000 person years (PY) while the rate of the poor mental health outcome was 77.5/10,000 PY. Both GII Q2 (Incident Rate Ratio (IRR): 1.48, 95% Confidence Interval (CI): 1.08, 2.01) and GII Q4 (IRR: 1.58, 95%CI: 1.08, 2.31) were significantly associated with experiencing assault but not with poor mental health. For females from countries with the highest gender inequality, there were significant regional differences in rates of assault, with SSA migrants experiencing high rates compared with those from SA. Relative to economic immigrants, refugees were at increased risk of sustaining assaults (IRR: 2.96, 95%CI: 2.32, 3.76) and poor mental health (IRR: 1.73, 95%CI: 1.50, 2.01). Higher educational attainment (bachelor’s degree or higher) at immigration was protective (assaults IRR: 0.64, 95%CI: 0.51, 0.80; poor mental health IRR: 0.69, 95% CI: 0.60, 0.80). Conclusion Source country gender inequality is not consistently associated with post-migration violence against women or severe depression, anxiety and self-harm in Ontario, Canada. Community-based research and intervention to address the documented socio-demographic disparities in outcomes of female immigrants is needed.

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Repetition of deliberate self-harm and subsequent suicide risk: Long-term follow-up study of 11 583 patients

The British Journal of Psychiatry ◽

10.1192/bjp.185.1.70 ◽

2004 ◽

Vol 185 (1) ◽

pp. 70-75 ◽

Cited By ~ 264

Author(s):

Daniel Louis Zahl ◽

Keith Hawton

Keyword(s):

Relative Risk ◽

Suicide Risk ◽

Single Episode ◽

Deliberate Self Harm ◽

Young Females ◽

Follow Up Study ◽

Increased Risk ◽

Self Harm

BackgroundRepetition of deliberate self-harm (DSH) is a risk factor for suicide. Little information is available on the risk for specific groups of people who deliberately harm themselves repeatedly.AimsTo investigate the long-term risk of suicide associated with repetition of DSH by gender, age and frequency of repetition.MethodA mortality follow-up study to the year 2000 was conducted on 11583 people who presented to the general hospital in Oxford between 1978 and 1997. Repetition of DSH was determined from reported episodes prior to the index episode and episodes presenting to the same hospital during the follow-up period. Deaths were identified through national registers.ResultsThirty-nine percent of patients repeated the DSH. They were at greater relative risk of suicide than the single-episode DSH group (2.24; 95% CI 1.77–2.84). The relative risk of suicide in the repeated DSH group compared with the single-episode DSH group was greater in females (3.5; 95% C11.3–2.4) than males (1.8; 95% C1 2.3–5.3) and was inversely related to age (up to 54 years). Suicide risk increased further with multiple repeat episodes of DSH in females.ConclusionsRepetition of DSH is associated with an increased risk of suicide in males and females. Repetition may be a better indicator of risk in females, especially young females.

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Depression and Deliberate Self-Harm Among Rural Adolescents of Sichuan Province in Western China: A 2-Year Longitudinal Study

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.605785 ◽

2021 ◽

Vol 12 ◽

Author(s):

Shimin Lai ◽

Chang Su ◽

Shasha Song ◽

Mingxia Yan ◽

Chengmeng Tang ◽

...

Keyword(s):

Social Support ◽

Influencing Factors ◽

Rating Scale ◽

Self Esteem ◽

Sichuan Province ◽

Western China ◽

Rural Adolescents ◽

Deliberate Self Harm ◽

Increased Risk ◽

Self Harm

Objective: To explore the change in the prevalence and association of depression and deliberate self-harm and their common and independent influencing factors among western Chinese rural adolescents.Methods: A total of 2,744 junior and senior high school students from two rural schools in Sichuan Province, China, participated in the baseline survey and were invited to participate in two follow-up surveys. The Center for Epidemiologic Studies-Depression Scale, a deliberate self-harm item, the Social Support Rating Scale, the Rosenberg Self-esteem Scale and the Connor-Davidson Resilience Scale were administered. A bivariate four-level logistic regression model was used for analysis.Results: The prevalence of depression and deliberate self-harm were 39.6 and 21.2%, respectively. Regular physical exercise, a good relationship with parents, high resilience, and high self-esteem were common protective factors for both depression and deliberate self-harm. Feeling disliked by teachers was a common risk factor for both. Being female, having a mother who emigrated as a migrant worker before the student was 3 years old, feeling disliked by classmates and having a poor family economic status were associated only with an increased risk of depression. Participants with medium social support were less likely to report deliberate self-harm than those with low or high support. Depression and deliberate self-harm were clustered at the class level.Conclusions: The comorbidity of depression and deliberate self-harm in rural adolescents should be given ample attention. Interventions should consider the class clustering of depression and deliberate self-harm and their common and unique influencing factors.

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Self-harm and suicidal behaviour in Ghana: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2021-053144 ◽

2021 ◽

Vol 11 (12) ◽

pp. e053144

Author(s):

Emmanuel Nii-Boye Quarshie ◽

Kwaku Oppong Asante ◽

Johnny Andoh-Arthur

Keyword(s):

Mental Health ◽

Systematic Review ◽

Global Health ◽

Protective Factors ◽

Suicide Prevention ◽

Suicidal Behaviour ◽

Observational Studies ◽

Risk And Protective Factors ◽

Prevalence Estimates ◽

Self Harm

IntroductionSelf-harm and suicidal behaviour represent major global health problems, which account for significant proportions of the disease burden in low-income and middle-income countries, including Ghana. This review aims to synthesise the available and accessible evidence on prevalence estimates, correlates, risk and protective factors, the commonly reported methods and reasons for self-harm and suicidal behaviour in Ghana.Methods and analysisWe will conduct a systematic review reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (2009) recommendations. Regional and global electronic databases (African Journals OnLine, African Index Medicus, APA PsycINFO, Global Health, MEDLINE and PubMed) will be searched systematically up to December 2021 for observational studies and qualitative studies that have reported prevalence estimates, correlates, risk and protective factors, methods and reasons for self-harm and suicidal behaviour in Ghana. The electronic database searches will be supplemented with reference harvesting and grey literature searching in Google Scholar and ProQuest Dissertations & Theses Global for postgraduate dissertations. Only records in English will be included. The Mixed Methods Appraisal Tool (2018) will be used to assess the methodological quality of included studies. Meta-analysis or narrative synthesis or both will be used, contingent on the extent of heterogeneity across eligible observational studies.Ethics and disseminationConsidering that this is a systematic review of accessible and available literature, we will not seek ethical approval. On completion, this review will be submitted to a peer-reviewed journal, be disseminated publicly at (mental) health conferences with focus on self-harm and suicide prevention. The important findings would also be shared with key national stakeholder groups in Ghana: Ghana Association for Suicide Prevention, Ghana Mental Health Authority, Ghana Psychological Association, Centre for Suicide and Violence Research, Accra and the Parliamentary Select Committee on Health.Prospero registration numberCRD42021234622.

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Social services Interventions and the Mental Health and Mortality of care leavers: a population based data linkage study in Northern Ireland and Finland

International Journal for Population Data Science ◽

10.23889/ijpds.v4i3.1252 ◽

2019 ◽

Vol 4 (3) ◽

Author(s):

Aideen Maguire ◽

Anne Kouvonen ◽

Dermot O'Reilly ◽

Hanna Remes ◽

Joonas Pitkänen ◽

...

Keyword(s):

Mental Health ◽

Northern Ireland ◽

Health Outcomes ◽

Social Services ◽

Psychiatric Hospital ◽

Poor Mental Health ◽

Mental Health Outcomes ◽

Care Intervention ◽

Increased Risk ◽

Self Harm

BackgroundResearch has highlighted the poor mental health of looked after children compared to those never in care. However, little is known on what becomes of these children and their mental health trajectories after they leave the care of social services. In addition, previous studies are limited in their ability to differentiate between type of social care intervention received; kinship care, foster care or residential care. AimTo utilise nationwide social services data from two countries (Northern Ireland (NI) and Finland), with similar populations but different intervention policies, linked to a range of demographic and health datasets to examine the mental health outcomes of young adults in the years following leaving care. MethodsData from both countries on children born 1991-2000 were linked to social services data, hospital admissions, prescribed medication data and death records. Mental health outcomes were defined after the age of 18years (when statutory care provision ends) examined by care intervention and included admissions to psychiatric hospital, for self-harm and death by suicide. ResultsThe gender split in care in Finland is reflective of the population but more males are in care in NI. Initial results from Finnish data suggest those exposed to care in childhood have an increased risk of self-harm, psychiatric hospital admission and suicide after the age of 18years compared to those never in care. After adjusting for gender, age of entry to care and deprivation at birth those exposed to any care intervention had 3 times the risk of suicide (HR=3.06, 95% CI 1.18,7.98). Risk increased with duration in care but was equivalent across care intervention types. Analysis on the NI data is underway. ConclusionFull results will be available December 2019 and will explore which care pathways are most associated with poor mental health outcomes informing discussion around intervention opportunities and policy.

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Life, lifestyle and location: examining the complexities of psychological distress in young adult Indigenous and non-Indigenous Australians

Journal of Developmental Origins of Health and Disease ◽

10.1017/s2040174417000162 ◽

2017 ◽

Vol 8 (5) ◽

pp. 541-549 ◽

Cited By ~ 6

Author(s):

B. Davison ◽

T. Nagel ◽

G. R. Singh

Keyword(s):

Mental Health ◽

Young Adults ◽

Psychological Distress ◽

Suicidal Ideation ◽

Emotional Health ◽

Well Being ◽

Indigenous Australians ◽

Physical And Mental Health ◽

Increased Risk ◽

Self Harm

Mental health is fundamental to an individual’s health and well-being. Mental health disorders affect a substantial portion of the Australian population, with the most vulnerable time in adolescence and young adulthood. Indigenous Australians fare worse than other Australians on almost every measure of physical and mental health. Cross-sectional data from young adults (21–27 years) participating in the Life Course Program, Northern Territory, Australia, is presented. Rates of psychological distress were high in remote and urban residing Indigenous and urban non-Indigenous young adults. This rate was more pronounced in young women, particularly in Indigenous remote and urban residing women. Young adults with high psychological distress also had lower levels of positive well-being, higher perceived stress levels, experienced a higher number of major life events and were at an increased risk of suicidal ideation and/or self-harm. This study supports the need for a continued focus on early screening and treatment at this vulnerable age. The significant association seen between psychological distress and other markers of emotional well-being, particularly risk of suicidal ideation and/or self-harm, highlights the need for a holistic approach to mental health assessment and treatment. A concerted focus on improving the environs of young adults by lowering levels of stress, improving access to adequate housing, educational and employment opportunity, will assist in improving the emotional health of young adults.

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Health care utilization and overall costs based on opioid dependence in patients undergoing surgery for degenerative spondylolisthesis

Neurosurgical FOCUS ◽

10.3171/2018.2.focus17764 ◽

2018 ◽

Vol 44 (5) ◽

pp. E14 ◽

Cited By ~ 5

Author(s):

Mayur Sharma ◽

Beatrice Ugiliweneza ◽

Zaid Aljuboori ◽

Maxwell Boakye

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Opioid Dependence ◽

Degenerative Spondylolisthesis ◽

Opioid Use Disorder ◽

Hospital Length Of Stay ◽

Care Utilization ◽

Opioid Use ◽

Opioid Dependency ◽

Linear Contrasts

OBJECTIVEOpioid abuse is highly prevalent in patients with back pain. The aim of this study was to identify health care utilization and overall costs associated with opioid dependence in patients undergoing surgery for degenerative spondylolisthesis (DS).METHODSThe authors queried the MarketScan database using ICD-9 and CPT-4 codes from 2000 to 2012. Opioid dependency was defined as having a diagnosis of opioid use disorder, having a prescription for opioid use disorder, or having 10 or more opioid prescriptions. Opioid dependency was evaluated in 12-month period leading to surgery and in the period 3–15 months following the procedure. Patients were segregated into 4 groups based on opioid dependence before and after surgery: group NDND (prior nondependent who remain nondependent), group NDD (prior nondependent who become dependent), group DND (prior dependent who become nondependent), and group DD (prior dependent who remain dependent). The outcomes of interest were discharge disposition, hospital length of stay (LOS), complications, and health care resource costs. The 4 groups were compared using the Kruskal-Wallis test and linear contrasts built from generalized regression models.RESULTSA total of 10,708 patients were identified, with 81.57%, 3.58%, 8.54%, and 6.32% of patients in groups NDND, NDD, DND, and DD, respectively. In group DD, 96.31% of patients had decompression with fusion, compared with 93.59% in group NDND. Patients in group NDD, DND, and DD had longer hospital LOS compared with those in group NDND. Patients in group DD were less likely to be discharged home compared with those in group NDND (odds ratio 0.639, 95% confidence interval 0.52–0.785). At 3–15 months postdischarge, patients in group DD incurred 21% higher hospital readmission costs compared with those in group NDND. However, patients in groups NDD and DD were likely to incur 2.8 times the overall costs compared with patients in group NDND (p < 0.001) at 3–15 months after surgery (median overall payments: group NDD $20,033 and group DD $19,654, vs group NDND $7994).CONCLUSIONSPatients who continued to be opioid dependent or became opioid dependent following surgery for DS incurred significantly higher health care utilization and costs within 3 months and in the period 3–15 months after discharge from surgery.

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Deliberate Self-Harm Patients Who Discharge Themselves from the General Hospital Without Adequate Psychosocial Assessment

Crisis ◽

10.1027/0227-5910.25.4.183 ◽

2004 ◽

Vol 25 (4) ◽

pp. 183-186 ◽

Cited By ~ 6

Author(s):

Rachel Crowder ◽

Rohan Van Der Putt ◽

Ceri-Anne Ashby ◽

Andrew Blewett

Keyword(s):

General Hospital ◽

Care Pathway ◽

Alcohol Intoxication ◽

Psychosocial Assessment ◽

Hospital Environment ◽

Control Group ◽

Deliberate Self Harm ◽

Increased Risk ◽

Self Harm ◽

Integrated Care Pathway

Abstract: Deliberate self-harm patients who leave the acute hospital environment before the completion of psychiatric assessment have an increased risk of subsequent self-harm. We considered the available data on 50 premature self-discharges identified prospectively in a general hospital with a well-developed integrated-care pathway for self-harm patients, and compared them to a control group. The self-discharge group was found to be more likely to have attempted self-poisoning without alcohol intoxication or other forms or combinations of self-harm, and an absence of identifiable previous self-harm or prior contact with local specialist psychiatric services. The two groups showed no difference in age, sex, or area of residence based on community mental health team sectors. It is proposed that these findings indicate hypotheses for further studies of why people leave the hospital without adequate assessment, and how service design could be improved in order to help them.

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Suicide and Self-inflicted Injury in Diabetes: A Balancing Act

Journal of Diabetes Science and Technology ◽

10.1177/1932296819891136 ◽

2019 ◽

Vol 14 (6) ◽

pp. 1010-1016 ◽

Cited By ~ 2

Author(s):

Katharine D. Barnard-Kelly ◽

Diana Naranjo ◽

Shideh Majidi ◽

Halis K. Akturk ◽

Marc Breton ◽

...

Keyword(s):

Glycemic Control ◽

General Population ◽

Complication Rates ◽

Psychological Burden ◽

The United Kingdom ◽

Use Of Technology ◽

Diabetes Technology ◽

Increased Risk ◽

Control And Prevention ◽

Self Harm

Glycemic control in type 1 diabetes mellitus (T1DM) remains a challenge for many, despite the availability of modern diabetes technology. While technologies have proven glycemic benefits and may reduce excess mortality in some populations, both mortality and complication rates remain significantly higher in T1DM than the general population. Diabetes technology can reduce some burdens of diabetes self-management, however, it may also increase anxiety, stress, and diabetes-related distress. Additional workload associated with diabetes technologies and the dominant focus on metabolic control may be at the expense of quality-of-life. Diabetes is associated with significantly increased risk of suicidal ideation, self-harm, and suicide. The risk increases for those with diabetes and comorbid mood disorder. For example, the prevalence of depression is significantly higher in people with diabetes than the general population, and thus, people with diabetes are at even higher risk of suicide. The Center for Disease Control and Prevention reported a 24% rise in US national suicide rates between 1999 and 2014, the highest in 30 years. In the United Kingdom, 6000 suicides occur annually. Rates of preventable self-injury mortality stand at 29.1 per 100 000 population. Individuals with diabetes have an increased risk of suicide, being three to four times more likely to attempt suicide than the general population. Furthermore, adolescents aged 15 to 19 are most likely to present at emergency departments for self-inflicted injuries (9.6 per 1000 visits), with accidents, alcohol-related injuries, and self-harm being the strongest risk factors for suicide, the second leading cause of death among 10 to 24 year olds. While we have developed tools to improve glycemic control, we must be cognizant that the psychological burden of chronic disease is a significant problem for this vulnerable population. It is crucial to determine the psychosocial and behavioral predictors to uptake and continued use of technology in order to aid the identification of those individuals most likely to realize benefits of any intervention as well as those individuals who may require more support to succeed with technology.

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