Personality disorders and health problems distinguish suicide attempters from completers in a direct comparison

Background

Whether suicide attempters and completers represent the same population evaluated at different points along a progression towards suicide death, overlapping populations, or completely different populations is a problem still unresolved.

Methods

446 Adult suicide attempters and knowledgeable collateral informants for 190 adult suicide probands were interviewed. Sociodemographic and clinical data was collected for both groups using semi-structured interviews and structured assessments. Univariate analyses and logistic regression models were conducted to explore the similarities and differences between suicide attempters and completers.

Results

Univariate analyses yielded significant differences in sociodemographics, recent life events, impulsivity, suicide intent, and distribution of Axis I and II disorders. A logistic regression model aimed at distinguishing suicide completers from attempters properly classified 90% of subjects. The most significant variables that distinguished suicide from attempted suicide were the presence of narcissistic personality disorder (OR=21.4; 95% CI=6.8–67.7), health problems (OR=20.6; 95% CI=5.6–75.9), male sex (OR=9.6; 95% CI=4.42–20.9), and alcohol abuse (OR=5.5; 95% CI=2.3–14.2).

Limitations

Our study shares the limitations of studies comparing suicide attempters and completers, namely that information from attempters can be obtained from the subject himself, whereas the assessment of completers depends on information from close family or friends. Furthermore, different semi-structured instruments assessed Axis I and Axis II disorders in suicide attempters and completers. Finally, we have no data on inter-rater reliability data.

Conclusions

Suicide completers are more likely to be male and suffer from alcohol abuse, health problems (e.g. somatic illness), and narcissistic personality disorder. The findings emphasize the importance of implementing suicide prevention programs tailored to suicide attempters and completers.     

Cigarette smoking and completed suicide: Results from 3 prospective cohorts of American adults

Background

Prior reports have indicated a potential dose–response relationship between smoking and suicide. However, this relationship is controversial.

Methods

This study evaluated the association between smoking and risk of death from suicide in three large-scale cohorts of U.S. men and women (n=253,033). Suicides were identified from death certificates among 43,816 men enrolled in the Health Professionals Follow-up Study (HPFS) between 1986 and 2008, 116,566 women in the Nurses’ Health Study (NHS) between 1976 and 2008, and 92,651 women in the NHS II between 1989 and 2007. Information on smoking was obtained at baseline and updated every 2 years. Relative risks (RRs) of suicide were estimated using Cox proportional hazards regression models. Cohort specific RRs were pooled using random-effects models. Suicide deaths were determined by physician review of death certificates.

Results

A total of 457 deaths from suicide were documented. Compared to never smokers, the pooled multivariate RR (95% confidence interval [CI]) of suicide was 1.15 (0.91–1.45) for former smokers and 2.69 (2.11–3.42) for current smokers. A nonmonotonic dose–response relationship was noted between the number of cigarettes smoked per day (CPD) and suicide risk (P_trend<0.001). Compared to never smokers, the pooled multivariate RR (95% CI) was 2.59 (1.77–3.79) for those with 1–14 CPD, 2.03 (1.39–2.94) for those with 15–24 CPD, and 4.13 (2.96–5.78) for those with ≥25 CPD.

Limitations

Smoking was self-reported and had some degree of measurement error. Participants were not a representative sample of the U.S. population.

Conclusions

Results from three large cohorts suggest a nonmonotonic dose–response association between smoking and suicide risk.     

Psychiatric disorders in patients presenting to hospital following self-harm: A systematic review

Background

Psychiatric disorders occur in approximately 90% of individuals dying by suicide. The prevalence of psychiatric disorders in people who engage in non-fatal self-harm has received less attention.

Method

Systematic review using electronic databases (Embase, PsychINFO and Medline) for English language publications of studies in which psychiatric disorders have been assessed using research or clinical diagnostic schedules in self-harm patients of all ages presenting to general hospitals, followed by meta-analyses using random effects methods.

Results

A total of 50 studies from 24 countries were identified. Psychiatric (Axis I) disorders were identified in 83.9% (95% CI 74.7–91.3%) of adults and 81.2% (95% CI 60.9–95.5%) of adolescents and young persons. The most frequent disorders were depression, anxiety and alcohol misuse, and additionally attention deficit hyperactivity disorder (ADHD) and conduct disorder in younger patients. Personality (Axis II) disorders were found in 27.5% (95% CI 17.6–38.7%) of adult patients. Psychiatric disorders were somewhat more common in patients in Western (89.6%, 95% CI 83.0–94.7%) than non-Western countries (70.6%, 95% CI 50.1–87.6%).

Limitations

Heterogeneity between study results was generally high. There were differences between studies in identification of study participants and diagnostic procedures.

Conclusions

Most self-harm patients have psychiatric disorders, as found in people dying by suicide. Depression and anxiety disorders are particularly common, together with ADHD and conduct disorder in adolescents. Psychosocial assessment and aftercare of self-harm patients should include careful screening for such disorders and appropriate therapeutic interventions. Longitudinal studies of the progress of these disorders are required.

Declaration of interests

None.     

Suicidal behaviours in South East London: Prevalence,risk factors and the role of socio-economic status

Background

Low socio-economic status (SES) is an established risk factor of suicidal behaviours, but it is unknown to what extent its association is direct, indirect or confounded, given its strong association to mental health. We aimed to (I) estimate the prevalence of suicidal behaviours; (II) describe relevant risk factors; and (III) investigate direct and indirect effects of SES on suicidal behaviours.

Methods

We used cross-sectional community survey data of adults from randomly selected South East London households (SELCoH). Suicidal outcome measures replicated the 2007 Adult Psychiatric Morbidity Survey in England (APMS). Lifetime prevalence was described by socio-demographics, SES, mental health indicators, and life events. Structured symptom screens and a drug use questionnaire measured mental health. Structural equation models estimated direct and indirect effects of a latent SES variable on suicidal ideation and suicide attempts, adjusting for covariates.

Results

20.5% (95% CI: 18.4–22.7) reported suicidal ideation and 8.1% (95% CI: 6.8–9.7) reported suicide attempts (higher than APMS estimates: 13.7%, 4.8%, respectively). Unadjusted risk factors included poor mental health, low SES, and non-married/non-cohabitating relationship status. Black African ethnicity was protective, and women reported more suicide attempts. SES was directly associated to suicide attempts, but not suicidal ideation. SES had indirect effects on suicidal outcomes via mental health and life events.

Limitations

The cross-sectional design and application of measures for different time periods did not allow for causal inferences.

Conclusions

Suicidal behaviours were more prevalent than in the general UK population. Interventions targeting low SES individuals may prove effective in preventing suicide attempts.     

National study of suicide method in violent criminal offenders

Background

Gaining a greater knowledge of the mechanisms and means by which violent offenders die by suicide can inform tailored preventive strategies.

Methods

Using interlinked national Danish registry data we constructed a nested case-control study dataset of all adult suicides during 1994–2006: N=9708 cases and N=188,134 age and gender matched living controls. Completely ascertained International Classification of Diseases 10th revision cause-specific mortality codes were examined, with all criminal charges since 1980, and covariate information on psychiatric treatment and socio-demographics. Self-poisonings were classified as ‘nonviolent’ suicide and all other methods as being ‘violent’ ones.

Results

Compared with the general population, risk among male and female violent offenders was strongly and significantly elevated for suicide by either a violent or a nonviolent method, although the relative risk was greater for nonviolent suicide. These patterns were also observed among nonviolent offenders, albeit with smaller effect sizes. Risk was especially raised for self-poisoning with narcotics & hallucinogens. We could only examine the full range of suicide methods in male violent offenders. In these men, hanging was the most frequently used method, although risk was markedly and significantly elevated virtually across the entire range of regularly used suicide methods.

Limitations

We lacked sufficient statistical power for undertaking a detailed profiling of specific suicide methods among female violent offenders.

Conclusions

Our findings indicate that comprehensive and broadly-based preventive approaches are needed for tackling the markedly raised risk of suicide by both violent and nonviolent means in this population. Their high relative risk for self-poisoning by illicit or illegal drugs underlines the importance of access to means and of prevailing subculture.     

Differentiating army suicide attempters from psychologically treated and untreated soldiers: A demographic,psychological and stress-reaction characterization

Background

Suicide is the leading cause of death in most armies during peace-time. The recent dramatic rise in suicides in the US Army further focuses attention on the causes of suicidal behavior in the military.

Methods

This study investigated demographic characteristics, psychological profile and stress-related risk factors associated with suicide attempts in Israelis aged 18–21 years, who served in the Army in 2009. Soldiers who attempted suicide (N=60) were compared to soldiers treated by a mental health professional, but reported no suicidal behavior (N=58), and to controls (N=50).

Results

Suicide attempters had lower socioeconomic status and less cognitive ability compared with treated soldiers and untreated control soldiers. Only 25% of the suicide attempters had received mental healthcare prior to the attempt. The majority of the attempts were non-lethal (86.2%), and only 5.2% used firearms. Attempters had more previous suicide attempts (37.9%) and deliberate selfharm incidents (19.3%), compared to almost no such behaviors in the other two groups. Following the suicide attempt, 77% were diagnosed with moderate to severe mental disorders, 44.8% personality disorders and 8.6% mood disorders. Attempters reported higher levels of general stress compared to their peers in the other two groups. Being away from home and obeying authority were especially more stressful in attempters.

Conclusions

Young soldiers are less prone to seek mental health assistance, despite suffering from higher levels of stress. Screening is required to detect soldiers at risk for suicidal behavior and preventive intervention will require active outreach.     

Psychosocial factors associated with suicidal ideation in clinical patients with depression

Background

Depression is a major risk factor for suicide, but few studies have examined psychosocial risk factors for suicide in clinical patients with depression. The purpose of this study was to investigate psychosocial factors which could be associated with suicidal ideation in clinical patients with depression including: sick-leave, help-seeking behavior, and reluctance to admit mental health problems.

Methods

A multi-center cross-sectional survey using self-report questionnaire was conducted at 54 outpatient psychiatric clinics in Tokyo in 2012. Adult outpatients who were diagnosed by psychiatrists as mood disorders (F30–F39) in the International Classification of Diseases-10 (ICD-10) were included in the study. Those who met the criteria for current hypomanic or manic episode were excluded from the study.

Results

A total of 189 patients with depression participated in the survey. Multivariable logistic regression analysis showed that taking sick-leave and having sought help from family were associated with decreased odds of current suicidal ideation. Moderate or more severe depression was associated with increased odds of suicidal ideation, and reluctance to admit own mental health problem tended to increase odds of suicidal ideation.

Limitations

Living status and suicidal ideation before consultation with psychiatrist were not investigated. Severity of suicidal ideation and comorbid psychiatric disorders were not assessed.

Conclusions

Importance of treatment of more severe depression for suicide prevention was confirmed. Industrial health staffs should consider the possibility of positive effect of taking sick-leave when they see employees with depression. Promoting help-seeking for family and reducing stigma of mental illness may be effective for suicide prevention.     

Comparison of the clinical features of suicide attempters by jumping from a height and those by self-stabbing in Japan

Background

A history of psychiatric disorders is a high risk for suicide. The present study compared the clinical features of psychiatric patients in Japan who attempted suicide by jumping from a height and those who attempted suicide by self-stabbing.

Methods

We compared two groups of suicide attempters who were hospitalized for both physical and psychiatric treatment (n=202). We compared the psychiatric diagnoses and clinical features between those who attempted suicide by jumping from a height (N=147) and those who did so by self-stabbing (N=55).

Results

The self-stabbing group (mean age 52.3 years) was significantly older compared to the jumping group (mean age 37.9 years). A significantly higher proportion of females were found in the jumping group. Jumping from a height was significantly associated with schizophrenia spectrum disorders, whereas self-stabbing was significantly associated with mood disorders.

Limitations

The results were drawn from data from a single hospital in a large urban city, and the study population did not include subjects who completed their suicide attempts.

Conclusions

Our findings show that differences in suicide methods (here, between jumping from a height and self-stabbing) may be related to suicide attempters' psychiatric diagnosis, gender and age. It is thus important to obtain a more detailed background information about a patient's suicide attempt and to create suicide prevention plans in accord with individuals' psychiatric diagnosis, age and gender, especially among those who have attempted suicide by jumping from a height or self-stabbing.     

BDNF promoter methylation and suicidal behavior in depressive patients

Introduction

Suicide is a major health problem, and depression is a major psychiatric cause of suicide. Suicide is influenced by the multifactorial interaction of many risk factors. Therefore, epigenetic research may lead to understandings that are applicable to suicide. This study investigated whether epigenetic changes are associated with suicidal behavior and evaluated the treatment outcome of suicidal ideation in depressive patients.

Methods

In 108 patients with major depression, the promoter methylation of the gene encoding brain-derived neurotrophic factor (BDNF) was measured. Sociodemographic and clinical characteristics including a history of previous depressive episodes, age at onset, duration of illnesses, family history of depression, and number of stressful life events as well as subjective perception of stress and assessment scales for depression (HAMD), anxiety (HAMA), function (SOFAS), disability (WHODAS-12), and quality of life (WHOQOL-BREF) were evaluated at baseline. Suicidal behavior was ascertained using a semistructured clinical interview with questions about severity and intent. Beck Scale for Suicide Ideation (BSS) was administered during 12 weeks of treatment with antidepressants.

Results

A higher BDNF promoter methylation status was significantly associated with a previous suicidal attempt history, suicidal ideation during treatment, and suicidal ideation at last evaluation as well as with higher BSS scores and poor treatment outcomes for suicidal ideation.

Limitations

Methylation status was investigated with limited area of the BDNF gene and sample size was relatively small.

Conclusions

BDNF methylation status could be a proxy marker for previous suicidal attempts and a clinical biomarker for poor treatment outcomes of suicidal ideation in depression.     

Patterns of benzodiazepine and antidepressant use among middle-aged adults. The Brazilian longitudinal study of adult health (ELSA-Brasil)

Background

Antidepressant and benzodiazepine medicines are widely prescribed in high-income countries. Our aim was to investigate and describe clinical and demographic characteristics of their use in a large cohort from a middle-income country.

Methods

Participants (n=15,105) from the Brazilian Health Longitudinal Study (ELSA-Brasil), a civil servant cohort from six different sites in Brazil were asked about antidepressant and benzodiazepine use. The Clinical Interview Schedule-Revised was used for psychiatric assessment. Sociodemographic and clinical data were also collected.

Results

Current use of antidepressant and benzodiazepine medicines was respectively reported by 6.87% and 3.88% of participants. These numbers were higher in major depression—MDD (16.5% and 13.9%), generalized anxiety disorder—GAD (14% and 9.5%) and any mental disorder (11.7% and 7.8%). The use of antidepressant and benzodiazepine was directly associated with clinical comorbidities and psychiatry diagnosis. In addition, older age was associated with benzodiazepine use and more years of schooling, with antidepressant use. Finally, the use of these medicines was strongly associated (odds ratio=8.48, p<0.001).

Limitations

Our cohort does not include younger adults (18–34 years), although it includes older (65–75 years) participants.

Discussion

Antidepressant and benzodiazepine use in Brazil is lower than in high-income countries. We found that factors such as age and education level were associated with the use of these medicines, whereas MDD and GAD were poor predictors of psychopharmacotherapy use, suggesting misuse/overuse of psychopharmacotherapy among individuals without psychiatric illness and underuse among those with psychiatric conditions in Brazil.     

TNF-alpha −308G>A polymorphism is associated with suicide attempts in major depressive disorder

Background

Despite the substantial role of the cytokine network in depression and suicide, few studies have investigated the role of genetic polymorphisms of pro- and anti-inflammatory cytokines in suicide in major depressive disorder (MDD). The aim of this study was to investigate whether tumor necrosis factor-alpha (TNF-alpha) −308G>A, interferon-gamma (IFN-gamma) +874A>T, and interleukin-10 (IL-10) −1082A>G are associated with increased risk for suicide attempts in MDD.

Methods

Among patients with MDD, 204 patients who had attempted suicide and 97 control patients who had not attempted suicide were recruited. A chi-square test was used to identify a possible risk genotype or allele type for suicide. A subsequent multivariate logistic regression analysis was conducted to investigate the influence of a risk genotype or allele type adjusted for other environmental factors. The lethality of the suicide attempt was also tested between genotype and allele types among suicidal patients with MDD.

Results

The GG genotype of the TNF-alpha −308G>A polymorphism was found to significantly increase risk for suicide attempt (adjusted OR=2.630, 95% CI=1.206 to 5.734). IFN-gamma +874A>T and IL-10 −1082A>G were not associated with risk for suicide. Lethality of the suicide attempt was not associated with any of the three cytokine genotypes or allele types.

Limitations

Limitations include a relatively small sample size and a cross-sectional design.

Conclusions

TNF-alpha −308G>A polymorphism is an independent risk factor for suicide attempts in MDD. Future studies should clarify the neural mechanisms by which the GG genotype of TNF-alpha −308G>A influences suicide in MDD.     

Social support as a protective factor in suicide: Findings from two nationally representative samples

Background

Suicide is a problem of worldwide concern and research on possible protective factors is needed. We explored the role of social support as one such factor. Specifically, we hypothesized that increased social support would be associated with decreased likelihood of a lifetime suicide attempt in two nationally representative samples as well as a high-risk subsample.

Methods

We analyzed the relationship between social support and lifetime history of a suicide attempt, controlling for a variety of related psychopathology and demographic variables, in the National Comorbidity Study Replication (NCS-R), a United States sample and the Adult Psychiatric Morbidity Study (APMS), an English sample.

Results

Results indicate that social support is associated with decreased likelihood of a lifetime suicide attempt controlling for a variety of related predictors in both the full US sample (OR=0.68, p<.001) and the full English sample (OR=0.93, p<.01).

Limitations

The cross-sectional data do not allow true cause and effect analyses.

Conclusions

Our findings suggest social support is associated with decreased likelihood of a lifetime suicide attempt. Social support is a highly modifiable factor that can be used to improve existing suicide prevention programs worldwide.     

The prevalence of suicidal ideation and attempts among individuals attending an adult psychiatry out-patient clinic in Gondar, Ethiopia

Background

Suicide is a common problem worldwide and the magnitude is high especially in countries where mental illnesses are prevalent and psychiatric services are poor.

Objective

To determine the prevalence of suicidal ideation and attempts among patients who attended the Psychiatry clinic of Gondar University Hospital.

Methods

A cross sectional study was conducted from March–December 2006 involving a total of 474 patients. Data was collected using a pre tested structured questionnaire containing basic socio-demographic variables, psychiatric diagnosis, suicidal ideation, suicidal attempt, the methods of suicide attempt and ways of survival from the attempted suicide. It was administered by psychiatry nurses working in the clinic. The data was analyzed anonymously using SPSS software.

Results

The commonest mental illness was Major Depressive Disorder (51.3%) followed by Psychosis (38%). Ninety one (19.2 %) patients attempted suicide at least once after the onset of the current mental illness and 307(64.8%) have suicidal ideation. The common method of suicidal attempt was hanging (45.1%) and 69.2% were at home. An association was found between suicidal ideation and attempt (OR=33.7; CI=8.2–138.8, p-value <0.01).

Conclusion

Suicidal ideation was common in psychiatric patients. It was also associated with suicidal attempt.     

Population attributable risk of modifiable risk factors associated with invasive breast cancer in women aged 45–69 years in Queensland,Australia

Objectives

To quantify the population attributable risk of key modifiable risk factors associated with breast cancer incidence in Queensland, Australia.

Study design

Population attributable fractions (PAFs) for high body mass index (BMI), use of hormone replacement therapy (HRT), alcohol consumption and inadequate physical activity were calculated, using prevalence data from a representative survey of women attending mammographic screening at BreastScreen Queensland in 2008 and relative risk estimates sourced from published literature. Attributable cancers were calculated using ‘underlying’ breast cancer incidence data for 2008 based on Poisson regression models, adjusting for the inflation of incidence due to the effects of mammographic screening.

Main outcome measures

Attributable burden of breast cancer due to high body mass index (BMI), use of hormone replacement therapy (HRT), alcohol consumption and inadequate physical activity.

Results

In Queensland women aged 45–69 years, an estimated 12.1% (95% CI: 11.6–12.5%) of invasive breast cancers were attributable to high BMI in post-menopausal women who have never used HRT; 2.8% (95% CI: 2.7–2.9%) to alcohol consumption; 7.6% (95% CI: 7.4–7.9%) to inadequate physical activity in post-menopausal women and 6.2% (95% CI: 5.5–7.0%) to current use of HRT after stratification by BMI and type of HRT used. Combined, just over one quarter (26.0%; 95% CI: 25.4–26.6%) of all invasive breast cancers in Queensland women aged 45–69 years in 2008 were attributable to these modifiable risk factors.

Conclusions

There is benefit in targeting prevention strategies to modify lifestyle behaviours around BMI, physical activity, HRT use and alcohol consumption, as a reduction in these risk factors could decrease invasive breast cancer incidence in the Queensland population.     

Depression and suicide ideation in late adolescence and early adulthood are an outcome of child hunger

Background

Child hunger represents an adverse experience that could contribute to mental health problems in later life. The objectives of this study were to: (1) examine the long-term effects of the reported experience of child hunger on late adolescence and young adult mental health outcomes; and (2) model the independent contribution of the child hunger experience to these long-term mental health outcomes in consideration of other experiences of child disadvantage.

Methods

Using logistic regression, we analyzed data from the Canadian National Longitudinal Survey of Children and Youth covering 1994 through 2008/2009, with data on hunger and other exposures drawn from NLSCY Cycle 1 (1994) through Cycle 7 (2006/2007) and mental health data drawn from Cycle 8 (2008/2009). Our main mental health outcome was a composite measure of depression and suicidal ideation.

Results

The prevalence of child hunger was 5.7% (95% CI 5.0–6.4). Child hunger was a robust predictor of depression and suicidal ideation [crude OR=2.9 (95% CI 1.4–5.8)] even after adjustment for potential confounding variables, OR=2.3 (95% CI 1.2–4.3).

Limitations

A single question was used to assess child hunger, which itself is a rare extreme manifestation of food insecurity; thus, the spectrum of child food insecurity was not examined, and the rarity of hunger constrained statistical power.

Conclusions

Child hunger appears to be a modifiable risk factor for depression and related suicide ideation in late adolescence and early adulthood, therefore prevention through the detection of such children and remedy of their circumstances may be an avenue to improve adult mental health.     

Functional health literacy mediates the relationship between socio-economic status,perceptions and lifestyle behaviors related to cancer risk in an Australian population

Objective

To determine if functional health literacy (FHL) mediates the relationship between socio-economic status, and perception of the risk of lifestyle behaviors for cancer.

Methods

Cross-sectional, random population survey, 2824 people aged ≥15 years, September–October 2008, included newest vital sign measure of FHL.

Results

Less than adequate FHL occurred in 45.1%. People who perceived behavioral factors (smoking, diet, obesity, alcohol, physical activity) to be not important, or did not know if they were important cancer risks, were more likely to have inadequate FHL. In a logistic regression model adjusted for age, gender, education, income, occupation, country of birth and area of residence, inadequate FHL was associated with 2–3 (OR = 1.9; 95% CI: 1.2–3.0) and 4 or more self-reported lifestyle risk factors (OR = 2.8; 95% CI: 1.6–5.0). In a structural equation model of the relationship of socio-economic status, perceptions of risk and behaviors there was significant mediation effect of FHL on the path from SES to health perceptions, estimated 29.4% of the total effect.

Conclusion

A specific focus on the literacy demands made on individuals from health promotion and materials with a view to improving health communication is indicated.

Practice implications

Health literacy is important for health promotion.     

Menopause could be involved in the pathogenesis of muscle and joint aches in mid-aged women

Background

Muscle and joint aches (MJA) are frequently observed among menopausal women. They impair quality of life and are a burden to the healthcare system.

Objective

To analyze the relation between MJA and several variables related to the menopause.

Methods

In this cross-sectional study, 8373 healthy women aged 40–59 years, accompanying patients to healthcare centers in 18 cities of 12 Latin American countries, were asked to fill out the Menopause Rating Scale (MRS) and a questionnaire containing personal data.

Results

Mean age of the whole sample was 49.1 ± 5.7 years, 48.6% were postmenopausal and 14.7% used hormone therapy (HT). A 63.0% of them presented MJA, with a 15.6% being scored as severe to very severe according to the MRS (scores 3 or 4). Logistic regression model determined that vasomotor symptoms (OR: 6.16; 95% CI, 5.25–7.24), premature menopause (OR: 1.58; 95% CI, 1.02–2.45), postmenopausal status (OR: 1.43; 95% CI, 1.20–1.69), psychiatric consultation (OR: 1.93; 95% CI, 1.60–2.32) and the use of psychotropic drugs (OR: 1.35; 95% CI, 1.08–1.69) were significantly related to the presence of severe-very severe MJA. Other significant variables included: age, tobacco consumption and lower education. Self perception of healthiness (OR: 0.49; 95% CI, 0.41–0.59), private healthcare access (OR: 0.77; 95% CI, 0.67–0.88) and HT use (OR: 0.75; 95% CI, 0.62–0.91) were significantly related to a lower risk for the presence of severe-very severe MJA.

Conclusion

In this large mid-aged sample the prevalence of MJA was high, which was significantly associated to menopausal variables, especially vasomotor symptoms. This association may suggest a potential role of mid-life female hormonal changes in the pathogenesis of MJA.     

Age-related macular degeneration and 5-year incidence of impaired activities of daily living

Objectives

We aimed to assess the prospective association between age-related macular degeneration (AMD) and impaired activities of daily living (ADL) among a large cohort of older adults.

Study design

Functional status was determined by the Older Americans Resources and Services ADL scale from 2002–2004 to 2007–2009 among 761 participants aged 60+ years. AMD was assessed from retinal photographs.

Results

After adjusting for age, sex, living status, self-rated poor health, smoking, body mass index, visual impairment, hypertension, diabetes, hospital admissions in the past year, walking disability, probable depression, mini-mental state examination scores, having any AMD or late AMD increased the risk of incident impaired total ADL 5 years later, odds ratio, OR 2.87 (95% confidence intervals, CI 1.44–5.71) and OR 12.95 (95% CI 3.78–44.35), respectively. Having any AMD increased the risk of developing instrumental ADL disability over the 5 years, multivariable-adjusted OR 2.06 (95% CI 1.11–3.83).

Conclusions

This study shows that the presence of AMD could independently signal an increased risk of functional disability, particularly in performing instrumental ADL tasks.     

Food insecurity and its association with co-occurring postnatal depression,hazardous drinking,and suicidality among women in peri-urban South Africa

Background

Although the public health impacts of food insecurity and depression on both maternal and child health are extensive, no studies have investigated the associations between food insecurity and postnatal depression or suicidality.

Methods

We interviewed 249 women three months after they had given birth and assessed food insecurity, postnatal depression symptom severity, suicide risk, and hazardous drinking. Multivariable Poisson regression models with robust standard errors were used to estimate the impact of food insecurity on psychosocial outcomes.

Results

Food insecurity, probable depression, and hazardous drinking were highly prevalent and co-occurring. More than half of the women (149 [59.8%]) were severely food insecure, 79 (31.7%) women met screening criteria for probable depression, and 39 (15.7%) women met screening criteria for hazardous drinking. Nineteen (7.6%) women had significant suicidality, of whom 7 (2.8%) were classified as high risk. Each additional point on the food insecurity scale was associated with increased risks of probable depression (adjusted risk ratio [ARR], 1.05; 95% CI, 1.02–1.07), hazardous drinking (ARR, 1.04; 95% CI, 1.00–1.09), and suicidality (ARR, 1.12; 95% CI, 1.02–1.23). Evaluated at the means of the covariates, these estimated associations were large in magnitude.

Limitations

The study is limited by lack of data on formal DSM-IV diagnoses of major depressive disorder, potential sample selection bias, and inability to assess the causal impact of food insecurity.

Conclusion

Food insecurity is strongly associated with postnatal depression, hazardous drinking, and suicidality. Programmes promoting food security for new may enhance overall psychological well-being in addition to improving nutritional status.     

Suicidal behaviors in elderly Koreans: One-month-point prevalence and factors related to suicidality

Background

Suicide prevention in the elderly is a major public health priority worldwide and in Korea in particular. We investigated the one-month-point prevalence and factors related to suicidality for suicidal behaviors in elderly Koreans.

Methods

A simple random sample (N=1588) was drawn from the residential roster of 14,051 Koreans aged 60 years or older who were residents of Osan in February 2010. All subjects were invited to participate in the survey through door-to-door home visits, and the response rate was 59.8%.

Results

The age- and gender-standardized prevalence rates of lifetime suicide attempts, current suicidal ideation without a plan or attempt, and current suicidal ideation with a plan or attempt were estimated at 9.2%, 19.6%, and 2.24%. The prevalence of suicidal ideation without a plan or attempt was higher in women and less-educated individuals and increased with advancing age, whereas the prevalence of suicidal ideation with a plan or attempt was higher in more-educated individuals, was not differentiated by gender, increased until age 70, and then decreased thereafter. The factors related to suicidal ideation differed by the presence of a suicide plan or attempt.

Conclusions

Depressive elders in their 70s who have recently developed suicidal ideation would be a prime target for suicide intervention programs.

Limitations

The sample was regional, although the suicide rate in Osan was comparable to the average suicide rate in Korea.