scholarly journals Suicide following presentation to emergency departments with suicidal ideation: a population-wide study

2019 ◽  
Vol 4 (3) ◽  
Author(s):  
Emma Ross ◽  
Aideen Maguire ◽  
Denise O'Hagan ◽  
Dermot O'Reilly
Keyword(s):  
Emergency Departments ◽  
Suicide Ideation ◽  
Cox Regression ◽  
Factors Associated ◽  
Risk Of Death ◽  
Emergency Department Staff ◽  
Completed Suicide ◽  
Target Prevention ◽  
Self Harm ◽  
The Uk

Background Little is known about the association between suicide ideation and completed suicide. As NI has the highest suicide rate in the UK and Ireland it is vital to understand who is most at risk in order to target prevention strategies effectively. Aim To explore the risk factors for completed suicide following presentation with suicide ideation. Methods The Northern Ireland Registry of Self-Harm and Suicide Ideation contains information on all presentations to all Emergency Departments in NI for self-harm and suicide ideation. Data from 2012-2015 were linked to centralised electronic data relating to primary care, prescribed medication and mortality records. Initial analyses were completed to explore the profile of those who present with suicide ideation, and logistic regression was utilised to examine the likelihood of mortality post presentation. Cox regression was utilised to examine the factors associated with completed suicide following presentation with ideation. Results The cohort consisted of 1,483,435 individuals born or resident in NI from 1st January 1970 until 31st December 2015 (maximum age in 2015, 45 years). Between 2012-2015, 4,975 (0.3%) individuals presented with suicide ideation and 583 (0.04%) individuals died by suicide. Ideation is more likely in men compared to women (OR=1.87, 95%CI 1.76,1.98), in those aged 18-24 years, and in more deprived individuals. Of those who presented with ideation, 66 (1.3%) subsequently died by suicide. In fully-adjusted models, those who presented with suicide ideation were 25 times more likely to die by suicide compared to those who did not (HR=25.0, 95%CI 19.3,32.5). Amongst suicide ideators, male gender (HR=2.67, 95% CI 1.39,5.10) and multiple presentations (HR=1.95, 95% CI 1.09,3.50) were associated with the greatest risk of death by suicide. Conclusion These findings could help emergency department staff identify individuals at greatest risk of suicide and could be utilised in the development of targeted intervention strategies.

scholarly journals What happens after self-harm? An exploration of self-harm and suicide using the Northern Ireland Registry of Self-Harm

2019 ◽  
Vol 4 (3) ◽  
Author(s):  
Aideen Maguire ◽  
Emma Ross ◽  
Foteini Tseliou ◽  
Denise O'Hagan ◽  
Dermot O'Reilly
Keyword(s):  
Northern Ireland ◽  
Suicide Ideation ◽  
Cox Regression ◽  
Health Concern ◽  
Prevention Strategies ◽  
Completed Suicide ◽  
Target Prevention ◽  
Self Harm ◽  
The Uk

Background Suicide is a major public health concern and Northern Ireland (NI) has the highest rate of both self-harm and suicide in the UK and Ireland. In order to target prevention strategies effectively, it is vital to understand who is most at risk. Aim To explore the risk factors for completed suicide following presentation with self-harm. Methods The Northern Ireland Registry of Self-Harm (NIRSH) collects information on all self-harm and suicide ideation presentations to all Emergency Departments in NI. NIRSH data from 2012-2015 was linked to centralised electronic data relating to primary care, prescribed medication and mortality records. Logistic regression was employed to quantify the likelihood of mortality with adjustment for factors associated with mental ill health and suicide risk, and Cox regression was used to explore which characteristics of those who self-harm are most associated with risk of suicide. Results The cohort consisted of all 1,483,435 individuals born or resident in NI from 1st January 1970 until 31st December 2015 (maximum age in 2015, 45 years). During the follow-up period, 12,327 (0.8%) individuals presented with self-harm and 892 (0.1%) died by suicide. Rates of self-harm were equivalent for males and females with highest rates observed in the 18-24 years age group, and more common in deprived than affluent areas (OR=3.42, 95%CI 3,21, 3.65). Most individuals self-harmed via self-poisoning with psychotropic medications (71.5%), followed by self-injury with a sharp object (21.7%). Although only 162 (1.3%) of those who presented with self-harm went on to die by suicide, those who presented with self-harm were 24 times more likely to die by suicide compared to those who did not present with self-harm after adjustment for age and sex (HR=24.3, 95%CI 20.46,28.76). Conclusion This constitutes the first population-wide study of self-harm in the UK and could be utilised to inform suicide prevention strategies.

scholarly journals Religious affiliation and the risk of COVID 19 related mortality; a retrospective analysis of variation in pre and post lockdown risk by religious group in England and Wales

2020 ◽  
Author(s):  
Charlotte Hannah Gaughan ◽  
Daniel Ayoubkhani ◽  
Vahe Nafilyan ◽  
Peter Goldblatt ◽  
Chris White ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Cox Regression ◽  
Religious Affiliation ◽  
Religious Groups ◽  
England And Wales ◽  
Risk Of Death ◽  
Before And After ◽  
The Difference ◽  
Behavioural Factors ◽  
The Uk

AbstractBackgroundCOVID 19 mortality risk is associated with demographic and behavioural factors; furthermore religious gatherings have been linked with the spread of COVID. We sought to understand the variation in the risk of COVID 19 related death across religious groups in the UK both before and after lockdown.MethodsWe conducted a retrospective cohort study of usual residents in England and Wales enumerated at the 2011 Census (n = 48,422,583), for risk of death involving COVID-19 using linked death certificates. Cox regression models were estimated to compare risks between religious groups. Time dependent religion coefficients were added to the model allowing hazard ratios (HRs) pre and post lockdown period to be estimated separately.ResultsCompared to Christians all religious groups had an elevated risk of death involving COVID-19; the largest age adjusted HRs were for Muslim and Jewish males at 2.5 (95% confidence interval 2.3-2.7) and 2.1 (1.9-2.5), respectively. The corresponding HRs for Muslim and Jewish females were 1.9 (1.7-2.1) and 1.5 (1.7-2.1). The difference in risk between groups contracted after lockdown. Those who affiliated with no religion had the lowest risk of COVID 19 related death before and after lockdown.ConclusionThe majority of the variation in COVID 19 mortality risk was explained by controlling for socio demographic and geographic determinants; however, Jews remained at a higher risk of death compared to all other groups. Lockdown measures were associated with reduced differences in COVID 19 mortality rates between religious groups, further research is required to understand the causal mechanisms.

Determinants of enhanced vulnerability to Covid-19 in U.K. cancer patients: Results from the OnCovid study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1574-1574
Author(s):  
David James Pinato ◽  
Lorenza Scotti ◽  
Alessandra Gennari ◽  
Emeline Colomba ◽  
Ailsa Sita-Lumsden ◽  
...  
Keyword(s):  
Cancer Therapy ◽  
Cancer Patients ◽  
Cox Regression ◽  
Risk Mitigation ◽  
Case Fatality ◽  
Patient Characteristics ◽  
Risk Groups ◽  
Risk Of Death ◽  
Anti Cancer ◽  
The Uk

1574 Background: Despite high contagiousness and rapid spread, SARS-Cov-2 has led to heterogeneous outcomes across affected nations. Within Europe, the United Kingdom is the most severely affected country, with a death toll in excess of 100.000 as of February 2021. We aimed to compare the national impact of Covid-19 on the risk of death in UK cancer patients versus those in continental Europe (EU). Methods: We performed a retrospective analysis of the OnCovid study database, a European registry of cancer patients consecutively diagnosed with Covid-19 in 27 centres from February 27 to September 10, 2020. We analysed case fatality rates and risk of death at 30 days and 6 months stratified by region of origin (UK versus EU). We compared patient characteristics at baseline, oncological and Covid-19 specific therapy across cohorts and tested these in multivariable Cox regression models to identify predictors of adverse outcome in UK versus EU patients. Results: Compared to EU patients (n = 924), UK patients (n = 468) were characterised by higher case fatality rates (40.38% versus 26.5%, p < 0.0001), higher risk of death at 30 days (hazard ratio, HR 1.64 [95%CI 1.36-1.99]) and 6 months after Covid-19 diagnosis (47.64% versus 33.33%, p < 0.0001, HR 1.59 [95%CI 1.33-1.88]). UK patients were more often males, of older age and more co-morbid than EU counterparts (p < 0.01). Receipt of anti-cancer therapy was lower in UK versus EU patients (p < 0.001). Despite equal proportions of complicated Covid-19, rates of intensive care admission and use of mechanical ventilation, UK cancer patients were less likely to receive anti-Covid-19 therapies including corticosteroids, anti-virals and interleukin-6 antagonists (p < 0.0001). Multivariable analyses adjusted for imbalanced prognostic factors confirmed the UK cohort to be characterised by worse risk of death at 30 days and 6 months, independent of patient’s age, gender, tumour stage and status, number of co-morbidities, Covid-19 severity, receipt of anti-cancer and anti-Covid-19 therapy. Rates of permanent cessation of anti-cancer therapy post Covid-19 were similar in UK versus EU. Conclusions: UK cancer patients have been more severely impacted by the unfolding of the Covid-19 pandemic despite societal risk mitigation factors and rapid deferral of anti-cancer therapy. The increased frailty of UK cancer patients highlights high-risk groups that should be prioritised for anti-SARS-Cov-2 vaccination. Continued evaluation of long-term outcomes is warranted.

scholarly journals Factors associated with rehoming and time until rehoming for horses listed with an equine charity

2019 ◽  
Vol 185 (12) ◽  
pp. 373-373 ◽  
Author(s):  
Sarah Rosanowski ◽  
Kristien Verheyen
Keyword(s):  
Median Time ◽  
Cox Regression ◽  
Factors Associated ◽  
The Uk

The number of unwanted horses in the UK has increased in recent years. It is therefore important to identify factors that indicate whether a horse can be rehomed and how long it takes to be rehomed. Data from 1 January 2013 until 30 March 2014 were extracted from an equine rehoming charity’s database. Exposure variables were examined using multivariable logistic and Cox regression. In total, 791 horses were included in the study and 410 (51.8%) were rehomed during the study period. Median time until rehomed was 39 days (IQR 24–75). Horses whose owner was prepared to transfer ownership were nearly three times more likely to be rehomed than those available for loan. Horses deemed suitable for beginner riders had higher odds of finding a new home, compared with those needing an advanced rider. Horses that were only suitable as unridden companions took longer to find a new home than rideable horses. A restricted rehoming radius (<50 miles) also resulted in longer time to rehoming. Findings from this study can be used to inform rehoming strategies but also to identify horses less likely to be rehomed, and thus where alternative options should be considered.

scholarly journals Referrals to liaison services for older adults with deliberate self harm during the SARS-CoV-2 national lockdown - a collaborative service evaluation using liaison referral data

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S33-S33
Author(s):  
Josie Jenkinson ◽  
Kehinde Junaid ◽  
Sara Ormerod ◽  
Sunita Sahu ◽  
Hugh Grant-Peterkin ◽  
...  
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Individual Case ◽  
Service Evaluation ◽  
Data Sets ◽  
Deliberate Self Harm ◽  
Completed Suicide ◽  
Time Period ◽  
Self Harm ◽  
The Uk

AimsSocial isolation and living alone have been associated with increased suicidality in older adults. During the SARS-CoV-2 pandemic, older adults were advised to keep isolated and maintain social distancing. Lockdown periods in England may have led to increased isolation and loneliness in older people, possibly resulting in an increased rates of DSH and suicide. This study aimed to explore whether numbers of older adults referred to liaison services with deliberate self harm changed during the SARS-CoV-2 pandemic.MethodReason for referral and total number of referrals to liaison services for older adults data were collected across 6 mental health trusts who had access to robust data sets. Data were collected prospectively for three months from the start of the UK national lockdown and for the corresponding 3 month period in 2019, via trust reporting systems. This study was registered as service evaluation within each of the participating mental health trusts.ResultOverall numbers of referrals to older adult liaison services went down, but the proportion of referrals for older adults with DSH increased. Across the six mental health trusts there there were a total of 2167 referrals over the first three month lockdown period in 2020, and 170 (7.84%) of these referrals were for deliberate self harm. During a corresponding time period in 2019, there were a total of 3416 referrals and 155 (4.54%) of these referrals were for deliberate self harmConclusionAlthough numbers of referrals for older adults with delberate self harm appeared to stay the same, the severity of these presentations is not clear. Outcomes of referrals and severity of self harm could be explored by examining individual case records. As there have been subsequent lockdowns the data collection period should also be extended to include these. Triangulation with national and local datasets on completed suicide is planned.

scholarly journals Mortality and survival of COVID-19

2020 ◽  
Vol 148 ◽  
Author(s):  
G. J. B. Sousa ◽  
T. S. Garces ◽  
V. R. F. Cestari ◽  
R. S. Florêncio ◽  
T. M. M. Moreira ◽  
...  
Keyword(s):  
Cox Regression ◽  
Neurological Diseases ◽  
Binary Variable ◽  
Historical Cohort ◽  
Factors Associated ◽  
Risk Of Death ◽  
Kaplan Meier ◽  
Main Factors ◽  
Brazilian Northeast ◽  
Robust Poisson Regression

Abstract This study aims to identify the risk factors associated with mortality and survival of COVID-19 cases in a state of the Brazilian Northeast. It is a historical cohort with a secondary database of 2070 people that presented flu-like symptoms, sought health assistance in the state and tested positive to COVID-19 until 14 April 2020, only moderate and severe cases were hospitalised. The main outcome was death as a binary variable (yes/no). It also investigated the main factors related to mortality and survival of the disease. Time since the beginning of symptoms until death/end of the survey (14 April 2020) was the time variable of this study. Mortality was analysed by robust Poisson regression, and survival by Kaplan–Meier and Cox regression. From the 2070 people that tested positive to COVID-19, 131 (6.3%) died and 1939 (93.7%) survived, the overall survival probability was 87.7% from the 24th day of infection. Mortality was enhanced by the variables: elderly (HR 3.6; 95% CI 2.3–5.8; P < 0.001), neurological diseases (HR 3.9; 95% CI 1.9–7.8; P < 0.001), pneumopathies (HR 2.6; 95% CI 1.4–4.7; P < 0.001) and cardiovascular diseases (HR 8.9; 95% CI 5.4–14.5; P < 0.001). In conclusion, mortality by COVID-19 in Ceará is similar to countries with a large number of cases of the disease, although deaths occur later. Elderly people and comorbidities presented a greater risk of death.

scholarly journals Self-harm induced somatic admission after discharge from psychiatric hospital – a prospective cohort study

2014 ◽  
Vol 29 (4) ◽  
pp. 246-252 ◽  
Author(s):  
L. Mellesdal ◽  
R.A. Kroken ◽  
O. Lutro ◽  
T. Wentzel-Larsen ◽  
E. Kjelby ◽  
...  
Keyword(s):  
Cohort Study ◽  
Suicide Ideation ◽  
Cox Regression ◽  
Psychiatric Patients ◽  
First Year ◽  
Recurrent Depression ◽  
Psychiatric Admission ◽  
Self Harm ◽  
Observation Period

AbstractBackground:Few studies have examined rate and predictors of self-harm in discharged psychiatric patients.Aims:To investigate the rate, coding, timing, predictors and characteristics of self-harm induced somatic admission after discharge from psychiatric acute admission.Method:Cohort study of 2827 unselected patients consecutively admitted to a psychiatric acute ward during three years. Mean observation period was 2.3 years. Combined register linkage and manual data examination. Cox regression was used to investigate covariates for time to somatic admission due to self-harm, with covariates changing during follow-up entered time dependently.Results:During the observation period, 10.5% of the patients had 792 somatic self-harm admissions. Strongest risk factors were psychiatric admission due to non-suicidal self-harm, suicide attempt and suicide ideation. The risk was increased throughout the first year of follow-up, during readmission, with increasing outpatient consultations and in patients diagnosed with recurrent depression, personality disorders, substance use disorders and anxiety/stress-related disorders. Only 49% of the somatic self-harm admissions were given hospital self-harm diagnosis.Conclusions:Self-harm induced somatic admissions were highly prevalent during the first year after discharge from acute psychiatric admission. Underdiagnosing of self-harm in relation to somatic self-harm admissions may cause incorrect follow-up treatments and unreliable register data.

scholarly journals Clinical characteristics and mortality associated with COVID-19 in Jakarta, Indonesia: a hospital-based retrospective cohort study

2020 ◽  
Author(s):  
Henry Surendra ◽  
Iqbal RF Elyazar ◽  
Bimandra A Djaafara ◽  
Lenny L Ekawati ◽  
Kartika Saraswati ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Clinical Characteristics ◽  
Cox Regression ◽  
Age Distribution ◽  
Factors Associated ◽  
Risk Of Death ◽  
Younger Age ◽  
Hospitalised Patients ◽  
Related Mortality ◽  
Overall Mortality

AbstractBackgroundData on COVID-19-related mortality and associated factors from low-resource settings are scarce. This study examined clinical characteristics and factors associated with in-hospital mortality of COVID-19 patients in Jakarta, Indonesia, from March 2 to July 31, 2020.MethodsThis retrospective cohort included all hospitalised patients with PCR-confirmed COVID-19 in 55 hospitals. We extracted demographic and clinical data, including hospital outcomes (discharge or death). We used Cox regression to examine factors associated with mortality.FindingsOf 4265 patients with a definitive outcome by July 31, 3768 (88%) were discharged and 497 (12%) died. The median age was 46 years (IQR 32–57), 5% were children, and 31% had at least one comorbidity. Age-specific mortalities were 11% (7/61) for <5 years; 4% (1/23) for 5-9; 2% (3/133) for 10-19; 2% (8/638) for 20-29; 3% (26/755) for 30-39; 7% (61/819) for 40-49; 17% (155/941) for 50-59; 22% (132/611) for 60-69; and 34% (96/284) for ≥70. Risk of death was associated with higher age; pre-existing hypertension, cardiac disease, chronic kidney disease or liver disease; clinical diagnosis of pneumonia; multiple (>3) symptoms; and shorter time from symptom onset to admission. Patients <50 years with >1 comorbidity had a nearly six-fold higher risk of death than those without (adjusted hazard ratio 5·50, 95% CI 2·72-11·13; 27% vs 3% mortality).InterpretationOverall mortality was lower than reported in high-income countries, probably due to younger age distribution and fewer comorbidities. However, deaths occurred across all ages, with >10% mortality among children <5 years and adults >50 years.

scholarly journals Living alone, loneliness and lack of emotional support as predictors of suicide and self-harm: seven-year follow up of the UK Biobank cohort

2019 ◽  
Author(s):  
Richard J. Shaw ◽  
Breda Cullen ◽  
Nicholas Graham ◽  
Donald M. Lyall ◽  
Daniel Mackay ◽  
...  
Keyword(s):  
Emotional Support ◽  
Living Arrangements ◽  
Hospital Admissions ◽  
Cox Regression ◽  
Living Alone ◽  
Uk Biobank ◽  
Self Harm ◽  
The Uk ◽  
The Relationship

AbstractBackgroundThe association between loneliness and suicide is complex, poorly understood, and there are no prior longitudinal studies. We aimed to investigate the relationship between living alone, loneliness and emotional support as predictors of death by suicide and self-harm.MethodsBetween 2006 and 2010 UK Biobank recruited over 0.5m people aged 37-73. This data was linked to prospective hospital admission and mortality records. Adjusted Cox regression models were used to investigate the relationship between self-reported measures of loneliness, emotional support and living arrangements and death by suicide and self-harm.ResultsFor women, there was no evidence that living arrangements, loneliness or lack of emotional support were associated with death by suicide. However, for men, both living alone (Hazard Ratio (HR) 2.19 95%CI 1.47-3.27) and with non-partners (HR 2.17 95%CI 1.28-3.69) were associated with death by suicide, independently of loneliness, which had a modest relationship with suicide in men (HR 1.45 95%CI 0.99-2.12). Associations between living alone and self-harm were explained by health for women, and by health, loneliness and emotional support for men. In fully adjusted models, loneliness was associated with hospital admissions for self-harm in both women (HR 1.90 95%CI 1.58-2.29) and men (HR 1.75 95%CI 1.41-2.18).ConclusionsFor men -but not for women- living alone or with a non-partner increased the risk of suicide, a finding not explained by loneliness. Loneliness may be more important as a risk factor for self-harm than for suicide, and appears to mitigate against any protective effect of cohabitation.

scholarly journals Tocilizumab in COVID-19: Factors Associated With Mortality Before and After Treatment

2021 ◽  
Vol 12 ◽  
Author(s):  
Luis Sarabia De Ardanaz ◽  
Jose M. Andreu-Ubero ◽  
Miriam Navidad-Fuentes ◽  
Miguel Ángel Ferrer-González ◽  
Victor Ruíz del Valle ◽  
...  
Keyword(s):  
Troponin I ◽  
Cox Regression ◽  
Laboratory Parameters ◽  
Time To Death ◽  
Factors Associated ◽  
Reactive Protein ◽  
Risk Of Death ◽  
Before And After ◽  
Discharged Patients ◽  
Mean Differences

Tocilizumab (TCZ) has been administered in SARS-CoV-2 pneumonia but the factors associated with mortality before and after treatment remain unclear. Cox regression models were used to estimate the predictors of time to death in a cohort of hospitalized patients with COVID-19 receiving TCZ. In addition, the mean differences between discharged and deceased patients in laboratory parameters measured before and 3, 6 and 9 days after TCZ administration were estimated with weighted generalized estimation equations. The variables associated with time to death were immunosuppression (Hazard Ratio-HR 3.15; 95% confidence interval-CI 1.17, 8.51), diabetes mellitus (HR 2.63; 95% CI 1.23–5.64), age (HR 1.05; 95% CI 1.02–1.09), days since diagnosis until TCZ administration (HR 1.05, 95% CI 1.00–1.09), and platelets (HR 0.27; 95% CI: 0.11, 0.69). In the post-TCZ analysis and compared to discharged patients, deceased patients had more lactate dehydrogenase (p = 0.013), troponin I (p = 0.013), C-reactive protein (p = 0.013), neutrophils (p = 0.024), and fewer platelets (p = 0.013) and lymphocytes (p = 0.013) as well as a lower average PaO2/FiO2 ratio. In conclusion, in COVID-19 diagnosed patients receiving TCZ, early treatment decreased the risk of death, while age, some comorbidities and baseline lower platelet counts increased that risk. After TCZ administration, lower platelet levels were again associated with mortality, together with other laboratory parameters.

Sign in / Sign up

Export Citation Format

Share Document