Self-Reported Suicide Ideation & Attempts & Medical Care for Intentional Self-Harm in Lesbians, Gays & Bisexuals in Sweden

BACKGROUND:

Minority sexual orientation is a robust risk indicator for self-reported suicidal ideation and attempts. However, little is known about patterns of medical care for intentional self-harm in this vulnerable population. We investigate sexual orientation-related differences in self-reported lifetime suicide symptoms and medical care for intentional self-harm between 1969 and 2010, including age at initial treatment and recurrence.

METHODS:

We used data from the Stockholm Public Health Cohort, a population-based sample of 874 lesbians/gays, 841 bisexuals and 67 980 heterosexuals, whose self-administered surveys have been linked to nationwide registers. Estimates of risk for medical care were calculated as incidence rate ratios (IRR) with 95% CIs.

RESULTS:

Both suicidal ideation and attempts were more commonly reported by lesbian/gay and bisexual (LGB) individuals. Adjusting for risk-time and confounding, lesbians (IRR 3.8, 95% CI 2.7 to 5.4) and bisexual women (IRR 5.4, 95% CI 4.4 to 6.6) experienced elevated risk for medical care for intentional self-harm, as compared to heterosexual women. Gay men evidenced higher risk (IRR 2.1, 95% CI 1.3 to 3.4) as compared to heterosexual men. Recurrent medical care was more frequent in LGB individuals, especially in bisexual women and gay men. Lesbian and bisexual women were also younger than heterosexual women when they first received medical care for intentional self-harm.

CONCLUSIONS:

Positive histories of suicidal ideation, attempts and medical care for intentional self-harm, including higher levels of recurrence, are more prevalent among LGB individuals in contrast to heterosexuals. Lesbian/bisexual women evidence an earlier age of onset of treatment. Tailored prevention efforts are urgently needed.

Purchase full article at:   http://goo.gl/oSg4Eo

By:  Björkenstam C1, Kosidou K2, Björkenstam E3, Dalman C2, Andersson G4, Cochran S5.

• 1Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden Department of Sociology, Stockholm University, Stockholm, Sweden.
• 2Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
• 3Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden Department of Community Health Sciences, Fielding School of Public Health and California Center for Population Research, University of California Los Angeles, Los Angeles, USA.
• 4Department of Sociology, Stockholm University, Stockholm, Sweden.
• 5Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA. 
• J Epidemiol Community Health. 2016 Mar 4. pii: jech-2015-206884. doi: 10.1136/jech-2015-206884.

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Sociodemographic Characteristics of Persons Committing Suicide in Durban, South Africa: 2006–2007

Background

Suicidal behaviour is a leading contributor to the burden of disease worldwide and varies widely between countries. South African figures are amongst the highest in the world, with recent trends indicating a disturbing rise, especially amongst the younger age groups, across all races.

Aim

This study analysed sociodemographic characteristics and trends relating to suicides committed in Durban, South Africa during the period of 2006–2007.

Method

A retrospective analysis of suicidal deaths (during 2006–2007), extracted from autopsy registers at all three government-run mortuaries in Durban, was conducted.

Results

The total number of suicides in Durban increased by 6.68% from 2006 to 2007. Suicide accounted for an average of 8.8% of all non-natural deaths per year of the study. The overall suicide rates of 14.53 (2006) and 15.53 (2007) per 100 000 population are comparable with national and global figures. The majority of suicides occurred in single unemployed persons, men and younger age groups. The largest number of suicides per year was recorded in black people, followed by Indian, white and mixed-race people. Hanging was the preferred method in the majority of victims, followed by self-poisoning, shooting and jumping.

Conclusions

The findings indicate a disturbingly high suicide rate amongst the various population and age groups in Durban. The dominant methods used may be influenced by ease of access. The reported trends may worsen unless there is a swift and decisive public health response and cohesive community-based programmes which include a supportive multidisciplinary network.

Below:  Suicide frequency by month and year

Below:  Number of suicides by race

Below:  Most common suicide methods in (a)2006 and (b) 2007

Full article at:  http://goo.gl/ygZCCs

By:  Soornarain S. Naidoo¹ and Lourens Schlebusch²

¹Department of Family Medicine, University of KwaZulu-Natal, South Africa

²Department of Behavioural Medicine, University of KwaZulu-Natal, South Africa

Corresponding author.

Correspondence to: Soornarain Naidoo, Email:Email: az.ca.nzku@97soodian, Postal address: Department of Family Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013

How to cite this article: Naidoo SS, Schlebusch L. Sociodemographic characteristics of persons committing suicide in Durban, South Africa: 2006–2007. Afr J Prm Health Care Fam Med. 2014;6(1), Art. #568, 7 pages. http://dx.doi.org/10.4102/phcfm.v6i1.568

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The Interrelations Between Internalized Homophobia, Depressive Symptoms, and Suicidal Ideation among Australian Gay Men, Lesbians, and Bisexual Women

Internalized homophobia has been linked to depression among gay men, lesbians, and bisexuals. Relatively little research has investigated the link between internalized homophobia and suicidal thoughts and behaviors. 

The current research investigated the interrelations among internalized homophobia, depressive symptoms, and suicidal ideation by testing additive, mediation, and moderation models. Self-identified Australian gay men (n = 360), lesbians (n = 444), and bisexual women (n = 114) completed the Internalized Homophobia Scale, the Center for Epidemiological Studies Depression Scale, and the suicide subscale of the General Health Questionnaire. 

Results supported the additive and partial mediation models for gay men and the mediation and moderation models for lesbians. 

None of the models were supported for bisexual women. 

The findings imply that clinicians should focus on reducing internalized homophobia and depressive symptoms among gay men and lesbians, and depressive symptoms among bisexual women, to reduce suicidal ideation.

Below:  The interaction effect of internalized homophobia × depressive symptoms on suicidal ideation among lesbians

Full article at:   http://goo.gl/xj9tC6

By:  McLaren S1.

• 1 School of Health Sciences and Psychology (http://goo.gl/p1o546), Federation University Australia , Ballarat , Australia. 

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School-Based Strategies to Reduce Suicidal Ideation, Suicide Attempts, and Discrimination among Sexual Minority and Heterosexual Adolescents in Western Canada

This study explored the relationships between the existence of and length of time since implementation of school-based Gay-Straight Alliances (GSAs) and explicit anti-homophobic bullying policies in secondary schools across British Columbia, Canada, with experiences of anti-gay discrimination, suicidal ideation and attempts among lesbian, gay, bisexual (LGB), mostly heterosexual, and exclusively heterosexual students. 

Analyses of the province-wide random cluster-stratified 2008 B.C. Adolescent Health Survey (n =21,70 8) compared students in schools with GSAs or policies implemented at least 3 years, and less than 3 years, with those in schools without GSAs or anti-homophobia policies, using multinomial logistic regression, separately by gender. LGB students had lower odds of past year discrimination, suicidal thoughts and attempts, mostly when policies and GSAs had been in place for 3+ years; policies had a less consistent effect than GSAs. Heterosexual boys, but not girls, also had lower odds of suicidal ideation and attempts in schools with longer-established anti-homophobic bullying policies and GSAs. 

Given consistently higher documented risk for suicidal ideation and attempts among LGB and mostly heterosexual adolescents, prevention efforts should be a priority, and school-level interventions, such as GSAs, may be an effective approach to reducing this risk, while also offering prevention benefits for heterosexual boys.

Full article at:   http://goo.gl/B75Fpi

By:  Elizabeth M. Saewyc, Ph.D, RN, FSAHM, FCAHS, Chiaki Konishi, Ph.D., Hilary A. Rose, Ph.D., and Yuko Homma, Ph.D.

Elizabeth M. Saewyc, Professor of Nursing and Adolescent Medicine, and Director of the Stigma and Resilience Among Vulnerable Youth Centre (http://www.saravyc.ubc.ca/), at the University of British Columbia School of Nursing, T201-2211 Wesbrook Mall, Vancouver, B.C., Canada, V6T 2B5. Office Telephone: (604) 822 -7505. Fax: (604) 822-7466;

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Suicide Attempts and Childhood Maltreatment among Street Youth

BACKGROUND:

Although suicide is a known leading cause of death among street youth, few prospective studies have explored childhood experiences as risk factors for future suicide attempt in this population. We examined the risk of attempted suicide in relation to childhood maltreatment among street youth.

METHODS:

From September 2005 to November 2013, data were collected from the At Risk Youth Study (ARYS), a prospective cohort of street youth in Vancouver, Canada. Inclusion criteria were age 14 to 26 years, past-month illicit drug use, and street involvement. Participants completed the Childhood Trauma Questionnaire, an instrument measuring self-reported sexual, physical, and emotional abuse and physical and emotional neglect. Suicide attempts were assessed semiannually. Using Cox regression, we examined the association between the 5 types of maltreatment and suicide attempts.

RESULTS:

Of 660 participants, 68.2% were male and 24.6% were Aboriginal. Median age was 21.5 years. The prevalence of moderate to extreme childhood maltreatment ranged from 16.8% (sexual abuse) to 45.2% (emotional abuse). Participants contributed 1841 person-years, with suicide attempts reported by 35 (5.3%) individuals (crude incidence density: 1.9 per 100 person-years; 95% confidence interval [CI]: 1.4-2.6 per 100 person-years). In adjusted analyses, types of maltreatment associated with suicide attempts included physical abuse (adjusted hazard ratio [HR]: 4.47; 95% CI: 2.12-9.42), emotional abuse (adjusted HR: 4.92; 95% CI: 2.11-11.5), and emotional neglect (adjusted HR: 3.08; 95% CI: 1.05-9.03).

CONCLUSIONS:

Childhood maltreatment is associated with subsequent risk of suicidal behavior among street youth. Suicide prevention efforts should be targeted toward this marginalized population and delivered from a trauma-informed perspective.

Below:  Associations of Childhood Maltreatment With Suicide Attempts During Follow-up: ARYS (Vancouver, British Columbia; 2005–2013)

Full article at:   http://goo.gl/roaQzI

By:   Hadland SE1, Wood E2, Dong H3, Marshall BD4, Kerr T2, Montaner JS2, DeBeck K5.

• 1Division of Adolescent/Young Adult Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;
• 2British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada;
• 3British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada;
• 4Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island; and.
• 5British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada; School of Public Policy, Simon Fraser University, Vancouver, British Columbia, Canada uhri-kd@cfenet.ubc.ca. 

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To What Extent Can Adolescent Suicide Attempts Be Attributed to Violence Exposure? A Population-Based Study from Western Canada

Suicide is the second leading cause of death among adolescents in Canada and globally. The purpose of our study was to calculate what proportion of adolescent suicide attempts could be prevented in the absence of verbal, physical and sexual violence. Using the province-wide 2008 British Columbia Adolescent Health Survey (N=29,315) we calculated population-attributable fractions for each type of violence, as well as exposure to any violence, separately by gender, among adolescents age 12–19. We found violence victimization is implicated in the majority of suicide attempts. Focusing on violence prevention may be an important strategy for reducing suicide among young people.

… This study of adolescent students in British Columbia shows that violence exposure is not only linked to suicide attempt, it is strongly implicated among the majority of adolescents in school who attempt suicide. For both boys and girls, whether that violence is verbal harassment and taunting, physical assaults and abuse, or sexual assaults, we can partially attribute to violence exposure between one-third to two-thirds of those youth who attempt suicide. We also considered the exposure to any form of violence as compared to no violence at all, and that comparison offers an even more sobering finding: the majority of the prevalence of suicide attempts could be attributed, in part, to experiencing some form of violence.

Our results are similar to rates found by one large-scale study of suicide attempts and various childhood adverse events among adults (Dube et al., 2001), but much higher than those reported in the other adult studies. However, since the attributable fraction is a function of the prevalence of various types of violence, as well as the strength of the relationship between the violence exposure and suicide attempt, it is possible that underreporting of both violence exposure and prior suicide attempts due to recall bias among older adults, or the limited types of violence included (usually limited to more severe forms of violence exposure) may help explain differences between our results and those among adults in other countries. The high prevalence of any violence victimization in our study was similar to that found in a study of peer-to-peer violence in one school district in the same region (Trach, et al., 2010), and is much higher than the rates of violence retrospectively reported by adults in other countries, when the questions did not also include exposure to bullying in school or sexual harassment. At the same time, several studies have documented the link between bullying at school and suicidal ideation and attempts, so it is clear these forms of violence should be included in considering global exposures to violence as a contributor to suicide among adolescents.

Exposure to violence victimization, whether in school, at home, or in the community, is an important social determinant of health for adolescents, even in a country like Canada, which is not experiencing armed conflicts at home, and where firearms and similar weapons are not easily accessible to the general population. This suggests that violence prevention initiatives may have further value as a strategy for suicide prevention for adolescents, especially as primary prevention. This perspective, however, does not appear to be widely considered by public health policy makers and others involved in suicide prevention initiatives. International reviews of suicide prevention strategies suggest most strategies are focused on secondary or tertiary prevention, i.e., improving screening to identify those at higher risk for suicide, means restriction for who are actively suicidal, reducing stigma and promoting help-seeking behaviours among those who are depressed, or pharmacological and therapeutic treatments for those who have already experienced a suicide attempt (Mann, et al., 2005; Buus Florentine & Crane, 2010; Cusimamo & Sameem, 2011). While these may be important strategies for suicide prevention when they are effective, they are downstream approaches, and many are not population-based strategies. At the same time, many population-based suicide prevention strategies have focused on social media campaigns or psycho-educational approaches designed to raise awareness of signs of depression and suicidality, sources of help for those at risk, and occasionally problem coping skills; such strategies have been targeted to the general population (Mann et al.,), or to students in schools (Buus Florentine & Crane; Miller, Eckert & Mazza, 2009). Unfortunately, these population-based prevention strategies offer limited to no evidence of effective prevention of suicidal behaviour, primarily documenting changes in awareness, attitudes, and knowledge of sources for referral and help-seeking (Buus Florentine & Crane; Miller, et al.), or offering some promising results but weak evaluation methods. None of them focus on preventing upstream risk factors for suicide.

Full article at:   http://goo.gl/IEZUd6

By:   Elizabeth M. Saewyc, PhD, RN, FSAHM and Weihong Chen, PhD

University of British Columbia School of Nursing, Vancouver, British Columbia

Author Contact: Dr. Elizabeth M. Saewyc, UBC School of Nursing, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Tel: 604-822-7505, Fax: 604-822-7466, Email: ac.cbu.gnisrun@cyweas.htebazile

  

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Health Correlates of Criminal Justice Involvement in 4,793 Transgender Veterans

Purpose: Transgender (TG) persons are overrepresented in prison settings and in the U.S. veteran population. Health disparities studies of large populations of transgender people involved with the criminal justice system have not been published to date.

Methods: We studied a large cohort of TG veterans who received care in Veterans Health Administration (VHA) facilities during 2007–2013 (n = 4,793) and a 3:1 matched control group of veterans without known TG identification (n = 13,625). Three hundred twenty six (n = 138 TG, 188 non-TG) had received VHA services in programs designed to address the needs of justice involved (JI) veterans. We linked patients in each of the three groups to their medical and administrative data.

Results: TG veterans were more likely to be justice involved than controls (2.88% vs. 1.38%; P < .0001). Compared to non-TG JI veterans, TG JI veterans were more likely to have a history of homelessness (80% vs. 67%; P < .05) and to have reported sexual trauma while serving in the military (23% vs. 12%; P < .01). Significant health disparities were noted for TG JI veterans for depression, hypertension, obesity, posttraumatic stress disorder, serious mental illness, and suicidal ideation/attempts.

Conclusion: These data suggest that TG veterans experience a number of health risks compared to non-TG veterans, including an increased likelihood of justice involvement. TG veterans involved with the criminal justice system are a particularly vulnerable group and services designed to address the health care needs of this population, both while incarcerated and when in the community, should take these findings into account in the development of health screenings and treatment plans.

Purchase full article at:   http://goo.gl/aWuf4l

By: George R. Brown, MD^1,2 and Kenneth T. Jones, PhD

¹Mountain Home Veterans Affairs Medical Center, Psychiatry Service, Johnson City, Tennessee.

²Department of Psychiatry and Behavioral Sciences, East Tennessee State University, Quillen College of Medicine, Johnson City, Tennessee.

³Office of Health Equity, Veterans Health Administration, Washington, D.C.

Address correspondence to:

George R. Brown, MD

549 Miller Hollow Road

Bluff City, TN 37618

E-mail: george.brown@va.gov

 

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Problem Gambling among Ontario Students: Associations with Substance Abuse, Mental Health Problems, Suicide Attempts, and Delinquent Behaviours

This paper describes gambling problems among Ontario students in 2009 and examines the relationship between gambling problems and substance use problems, mental health problem indicators, and delinquent behaviors. 

Data were derived from the Ontario Student Drug Use and Health Survey of Ontario students in grades 7-12. Gambling problems were measured as 2 or more of 6 indicators of problem gambling. In total 2.8 % of the students surveyed endorsed two or more of the problem gambling items. The odds of problem gamblers reporting mental distress was 4.2 times higher than the rest of the sample and the odds of problem gamblers reporting a suicide attempt were 17.8 times greater than the rest of the sample. 

In addition compared to the rest of the students, delinquent behaviors were also more common among problem gamblers, including theft (OR = 14.5), selling marijuana (OR = 19.6), gang fights (OR = 11.3) and carrying a handgun (OR = 11.2). 

In a multivariate analysis, substance-use problems, mental health problems, and the participation in a variety of delinquent behaviors remained significantly associated with youth problem gambling behavior. Students who report problem gambling behaviors show increased substance abuse, mental health, and delinquency/criminal problems that are similar to those seen among adult problem gamblers. 

The association between these problems suggests that these problems could be addressed in a unified manner.

Purchase full article at:  http://goo.gl/BtQxWP

By:  Cook S1, Turner NE2,3, Ballon B4,5, Paglia-Boak A6, Murray R7, Adlaf EM8,9, Ilie G10, den Dunnen W11, Mann RE12,13.

• 1Department of Sociology, University of Toronto, Toronto, ON, Canada. steven.cook10@me.com.
• 2Centre for Addiction and Mental Health, 33 Russell Street, Rm. T524, Toronto, ON, M5S 2S1, Canada. Nigel_Turner@camh.net.
• 3Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. Nigel_Turner@camh.net.
• 4Centre for Addiction and Mental Health, 33 Russell Street, Rm. T524, Toronto, ON, M5S 2S1, Canada. Bruce.Ballon@camh.ca.
• 5Department of Psychiatry, University of Toronto, Toronto, ON, Canada. Bruce.Ballon@camh.ca.
• 6Centre for Addiction and Mental Health, 33 Russell Street, Rm. T524, Toronto, ON, M5S 2S1, Canada. Angela.Boak@camh.ca.
• 7Centre for Addiction and Mental Health, 33 Russell Street, Rm. T524, Toronto, ON, M5S 2S1, Canada. Robert.Murray@camh.ca.
• 8Centre for Addiction and Mental Health, 33 Russell Street, Rm. T524, Toronto, ON, M5S 2S1, Canada. eadlaf@sympatico.ca.
• 9Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. eadlaf@sympatico.ca.
• 10St. Michael's Hospital, Toronto, ON, Canada.
• 11Department of Psychology, University of Ottawa, Ottawa, ON, Canada.
• 12Centre for Addiction and Mental Health, 33 Russell Street, Rm. T524, Toronto, ON, M5S 2S1, Canada. Robert.Mann@camh.ca.
• 13Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. Robert.Mann@camh.ca. 

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