David Gunnell
Suicide and Self-Harm Studies
University of Bristol
About
Research focus
Suicide and Self-Harm Studies
Impact
806 pubs · 100,020 cites · h-index 125
Affiliations
Publications
Systematic Review
FEB 2025RubboPLOS Global Public Health
Preventing suicide by restricting access to Highly Hazardous Pesticides (HHPs): A systematic review of international evidence since 2017
Suicide is a leading cause of death worldwide. A previous systematic review showed that regulations limiting access to highly hazardous pesticides (HHPs) were successful in preventing suicides. As the WHO strongly supports regulation of pesticides, we aimed to update and strengthen the evidence on the effectiveness of HHP bans. We conducted a systematic review by searching MEDLINE, Embase, and PsycINFO databases in March 2024 for manuscripts published since 2017 that investigated the effects of regulatory changes limiting access to HHPs on pesticide suicide, at the population level. Two reviewers independently screened titles and abstracts, and extracted data using a standardized form, defined a priori. The study protocol was registered in PROSPERO (CRD42023441247). All nine studies in six Asian countries showed reductions in pesticide suicide rates following HHP bans (range 28.0% to 91.9%), of which six applied time series analyses to account for trends prior to the intervention (reductions in pesticide suicide rates ranged 28.0% to 60.5%). Only five studies assessed overall suicides; of those, four reported decreases in overall suicide rates following the intervention, of which three used time series analysis (range 7.0% to 45.1%). Only one study had a low risk of bias in all domains, with five studies having high risk of bias in at least one of the domains. Restricting access to HHPs leads to declines in both pesticide and overall suicide rates. Findings from this and the previous systematic review provide strong evidence to governments and public health officials that are considering implementing bans on HHPs in order to reduce suicides. However, this review only covered studies published since 2017 and there is a need for data from other regions to investigate the generalisability of this approach.
Systematic Review
JAN 2025SchölinHealth Promotion International
Mapping commercial practices of the pesticide industry to shape science and policymaking: a scoping review
There is a growing body of evidence for how health harming industries (HHIs) engage in similar practices to influence science and policymaking. However, limited attention has been paid to the pesticide industry within the commercial determinants of health (CDOH) field. We conducted a scoping review to map practices adopted by the pesticide industry to influence science and policymaking and to assess the breadth and focus of the associated literature. We included 31 documents and categorized the extracted data using a typology of commercial practices. The documents described how major pesticide companies, and their trade bodies, have acted to influence science and maintain favourable regulatory environments while undermining the credibility of researchers and agencies that publish findings threatening to their commercial interests. A large proportion of the literature consists of historical analyses, narrative reviews, commentaries/perspective pieces, and investigative reports published in the grey literature, predominantly informed by analysis of internal industry documents and freedom of information requests. Most studies focus on high-income settings. There were a limited number of primary peer-reviewed empirical studies that explicitly aimed to study the practices of the pesticide industry from a CDOH perspective. However, our findings show that major pesticide companies adopt political and scientific practices highly similar to other HHIs. The review shows a critical need for research on the pesticide industry's current practices in low- and middle-income countries where the negative impacts of its activities on health and the environment are likely to be more marked.
Original Research
MAY 2024SpittalCrisis
Evaluating Population-Level Interventions and Exposures for Suicide Prevention
Evaluations of interventions targeting the population level are an essential component of the policy development cycle. Pre-post designs are widespread in suicide prevention research but have several significant limitations. To inform future evaluations, our aim is to explore the three most frequently used approaches for assessing the association between population-level interventions or exposures and suicide - the pre-post design, the difference-in-difference design, and Poisson regression approaches. The pre-post design and the difference-in-difference design will only produce unbiased estimates of an association if there are no underlying time trends in the data and there is no additional confounding from other sources. Poisson regression approaches with covariates for time can control for underlying time trends as well as the effects of other confounding factors. Our recommendation is that the default position should be to model the effects of population-level interventions or exposures using regression methods that account for time effects. The other designs should be seen as fall-back positions when insufficient data are available to use methods that control for time effects.
Original Research
MAY 2024BennettBJPsych Open
Investigating changes in student mental health and help-seeking behaviour after the introduction of new well-being support services at a UK university
Background Growing numbers of students now seek mental health support from their higher education providers. In response, a number of universities have invested in non-clinical well-being services, but there have been few evaluations of these. This research addresses a critical gap in the existing literature. Aims This study examined the impact of introducing non-clinical well-being advisers on student mental health and help-seeking behaviour at a large UK university. Method Survey data collected pre–post service introduction in 2018 ( n = 5562) and 2019 ( n = 2637) measured prevalence of depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7), and low mental well-being (Warwick–Edinburgh Mental Wellbeing Scale), alongside student support-seeking behaviour. Logistic regression models investigated changes in outcome measures. Administrative data (2014–2020) were used to investigate corresponding trends in antidepressant prescribing at the onsite health service, student counselling referrals and course withdrawal rates. Results Adjusted models suggested reductions in students’ levels of anxiety (odds ratio 0.86, 95% CI 0.77–0.96) and low well-being (odds ratio 0.84, 95% CI 0.75–0.94) in 2019, but not depression symptoms (odds ratio 1.05, 95% CI 0.93–1.17). Statistical evidence showed reduced student counselling referrals, with antidepressant prescribing and course withdrawal rates levelling off. Student perception of the availability and accessibility of university support improved. Conclusions Our findings suggest a non-clinical well-being service model may improve student perception of support, influence overall levels of anxiety and low well-being, and reduce clinical need. The current study was only able to examine changes over the short term, and a longer follow-up is needed.
Clinical Trial
APR 2024MartinJAMA
Prostate-Specific Antigen Screening and 15-Year Prostate Cancer Mortality
Importance The Cluster Randomized Trial of PSA Testing for Prostate Cancer (CAP) reported no effect of prostate-specific antigen (PSA) screening on prostate cancer mortality at a median 10-year follow-up (primary outcome), but the long-term effects of PSA screening on prostate cancer mortality remain unclear. Objective To evaluate the effect of a single invitation for PSA screening on prostate cancer–specific mortality at a median 15-year follow-up compared with no invitation for screening. Design, Setting, and Participants This secondary analysis of the CAP randomized clinical trial included men aged 50 to 69 years identified at 573 primary care practices in England and Wales. Primary care practices were randomized between September 25, 2001, and August 24, 2007, and men were enrolled between January 8, 2002, and January 20, 2009. Follow-up was completed on March 31, 2021. Intervention Men received a single invitation for a PSA screening test with subsequent diagnostic tests if the PSA level was 3.0 ng/mL or higher. The control group received standard practice (no invitation). Main Outcomes and Measures The primary outcome was reported previously. Of 8 prespecified secondary outcomes, results of 4 were reported previously. The 4 remaining prespecified secondary outcomes at 15-year follow-up were prostate cancer–specific mortality, all-cause mortality, and prostate cancer stage and Gleason grade at diagnosis. Results Of 415 357 eligible men (mean [SD] age, 59.0 [5.6] years), 98% were included in these analyses. Overall, 12 013 and 12 958 men with a prostate cancer diagnosis were in the intervention and control groups, respectively (15-year cumulative risk, 7.08% [95% CI, 6.95%-7.21%] and 6.94% [95% CI, 6.82%-7.06%], respectively). At a median 15-year follow-up, 1199 men in the intervention group (0.69% [95% CI, 0.65%-0.73%]) and 1451 men in the control group (0.78% [95% CI, 0.73%-0.82%]) died of prostate cancer (rate ratio [RR], 0.92 [95% CI, 0.85-0.99]; P = .03). Compared with the control, the PSA screening intervention increased detection of low-grade (Gleason score [GS] ≤6: 2.2% vs 1.6%; P < .001) and localized (T1/T2: 3.6% vs 3.1%; P < .001) disease but not intermediate (GS of 7), high-grade (GS ≥8), locally advanced (T3), or distally advanced (T4/N1/M1) tumors. There were 45 084 all-cause deaths in the intervention group (23.2% [95% CI, 23.0%-23.4%]) and 50 336 deaths in the control group (23.3% [95% CI, 23.1%-23.5%]) (RR, 0.97 [95% CI, 0.94-1.01]; P = .11). Eight of the prostate cancer deaths in the intervention group (0.7%) and 7 deaths in the control group (0.5%) were related to a diagnostic biopsy or prostate cancer treatment. Conclusions and Relevance In this secondary analysis of a randomized clinical trial, a single invitation for PSA screening compared with standard practice without routine screening reduced prostate cancer deaths at a median follow-up of 15 years. However, the absolute reduction in deaths was small. Trial Registration isrctn.org Identifier: ISRCTN92187251
Original Research
MAR 2024BennettJournal of Further and Higher Education
Student mental health support: A qualitative evaluation of new well-being services at a UK university
Increasing numbers of UK students now seek mental health support while at university. Clear evidence for the best configuration of student support services is lacking. Most service evaluations have focused on counselling – with little evaluation of low-intensity support services such as non-clinical mental health and well-being teams or student accommodation welfare support. This qualitative study addresses that gap, examining student and staff experiences of new well-being advisers in academic departments and halls of residence at one UK university in 2018, marking a step-change in welfare support delivery. Using reflexive thematic analysis with data collected in 40 focus groups and interviews approximately 18 months after service launch, five themes were identified: Trusted Friend; Joined Up Approach; Proactive versus Reactive; Belonging; and My University Cares. The well-being advisers offered timely, low-intensity support as an accessible, approachable addition to academic, clinical and online provision. However, evidence showed operational challenges such as data-sharing between academic, professional and support service staff. The volume of students seeking support also appeared to compromise resource intended for preventative and community-building work, particularly in student accommodation. Concerns remained for students who do not seek help, with findings underlining the importance of issues of belonging, connection and representation in relation to well-being support. Notably, this highly visible well-being investment appeared to shift a negative cultural narrative which was undermining student and staff confidence to one of greater reassurance of support. Our conclusions have implications for student support service configuration and emphasise the importance of a whole university well-being approach.
Original Research
FEB 2024LiangCrisis
Travel Distance to Hospital Is Associated With Self-Harm Hospital Presentation But Not Suicide
Travel distance to hospital emergency departments (EDs) may be a more influential factor in the spatial variation in hospital-presenting self-harm than for suicide deaths.
Guideline
DEC 2023CullyBMC Psychiatry
Evaluation of a national clinical programme for the management of self-harm in hospital emergency departments: impact on patient outcomes and the provision of care
BACKGROUND: Emergency departments are important points of intervention, to reduce the risk of further self-harm and suicide. A national programme to standardise the management of people presenting to the emergency department with self-harm and suicidal ideation (NCPSHI) was introduced in Ireland in 2014. The aim of this study was to evaluate the impact of the NCPSHI on patient outcomes and provision of care. METHODS: Data on self-harm presentations were obtained from the National Self-Harm Registry Ireland from 2012 to 2017. The impacts of the NCPSHI on study outcomes (3-month self-harm repetition, biopsychosocial assessment provision, admission, post-discharge referral, and self-discharge) were examined at an individual and aggregate (hospital) level, using a before and after study design and interrupted time series analyses, respectively. The 15 hospitals that implemented the programme by January 2015 (of a total of 24 between 2015 and 2017) were included in the analyses. RESULTS: There were 31,970 self-harm presentations during the study period. In hospitals with no service for self-harm (n = 4), risk of patients not being assessed reduced from 31.8 to 24.7% following the introduction of the NCPSHI. Mental health referral in this hospital group increased from 42.2 to 59.0% and medical admission decreased from 27.5 to 24.3%. Signs of a reduction in self-harm repetition were observed for this hospital group, from 35.1 to 30.4% among individuals with a history of self-harm, but statistical evidence was weak. In hospitals with a pre-existing liaison psychiatry service (n = 7), risk of self-discharge was lower post-NCPSHI (17.8% vs. 14.8%). In hospitals with liaison nurse(s) pre-NCPSHI (n = 4), medical admission reduced (27.5% vs. 24.3%) and there was an increase in self-harm repetition (from 5.2 to 7.8%. for those without a self-harm history). CONCLUSION: The NCPSHI was associated with improvements in the provision of care across hospital groups, particularly those with no prior service for self-harm, highlighting the need to consider pre-existing context in implementation planning. Our evaluation emphasises the need for proper resourcing to support the implementation of clinical guidelines on the provision of care for people presenting to hospital with self-harm.
Original Research
OCT 2023LeeCrisis
Understanding Suicide Clusters Through Exploring Self-Harm Behaviors
Background: There is little information about characteristics and long-term outcomes of individuals who self-harm during a suicide cluster. Aims: To compare characteristics of individuals who self-harmed during a suicide cluster in South Wales (∼10 deaths between December 2007 and March 2008) with others who self-harmed prior to the cluster and to evaluate 10-year self-harm and mortality outcomes. Method: Using records from the hospital serving the catchment area of the suicide cluster, enhanced by national routinely collected linked data, we created the following two groups: individuals who self-harmed (a) during the suicide cluster and (b) 1 year before. We compared individuals’ characteristics and performed logistic regression to compute odds ratios of 10-year self-harm and mortality outcomes. Results: Individuals who self-harmed during the cluster were less likely to be hospitalized or have a mental health history than those who self-harmed prior to the cluster. No significant group differences were found for 10-year self-harm outcomes, but all-cause mortality was higher for males. Limitations: Sample size was small, and data were lacking on psychological and social proximity to individuals who died during the suicide cluster. Conclusion: Our findings highlight the importance of long-term healthcare follow-up of those who self-harm during a suicide cluster, particularly males.
Original Research
OCT 2023WeerasingheTropical Medicine & International Health
Differences in the characteristics of people who purchase pesticides from shops for self‐harm versus those who use pesticides available in the domestic environment in Sri Lanka
OBJECTIVE: Data from South Asia indicate that for 15%-20% of suicide attempts, pesticides are purchased from shops; otherwise, pesticides are obtained from an individual's house or nearby environment. We aimed to investigate the difference between individuals who directly purchase pesticides from shops for suicide attempts and suicide deaths versus those related to accessing the pesticides from an individual's house or nearby environment. METHODS: We conducted two comparative studies in rural Sri Lanka: (1) non-fatal shop cases (n = 50) were survivors of self-poisoning with pesticides who ingested the pesticides after purchasing them from a shop; non-fatal domestic cases (n = 192) were survivors who accessed pesticides from their house or nearby environment. (2) fatal shop cases (n = 50) were individuals who died after ingesting pesticides they purchased for the act; fatal domestic cases (n = 102) were patients who died after ingesting pesticides they accessed at house or nearby environment. Logistic regression analysis was used to assess the characteristics which distinguished between the shop and domestic cases. RESULTS: Data indicate that 20.7% and 32.9% of individuals who used pesticides for suicide attempts and suicide deaths had purchased them from shops, respectively. Being a non-farmer was the main distinguishing characteristic of shop cases: adjusted odds ratios (AOR) 8.9, 95% confidence intervals (CI) 3.2-24.4 for non-fatal shop cases, and AOR 4.0, 95% CI 1.5-10.6 for fatal shop cases. Non-fatal shop cases also had higher suicide intent (AOR 3.0, CI 1.0-8.9), and ingesting an insecticide (AOR 4.8, CI 1.8-1.0-8.9) than non-fatal domestic cases. CONCLUSION: A high suicide intent of individuals who purchase pesticides for the event explains the high proportion of such fatal cases. Such high suicide intent makes the prevention implications difficult to spell out for those individuals who purchase pesticides for self-poisoning. However, our findings are valuable for clinicians to assess pesticide poisoning cases in hospitals.
Original Research
SEP 2023HeuvelmanHealth Technology Assessment
Antidepressants in pregnancy: applying causal epidemiological methods to understand service-use outcomes in women and long-term neurodevelopmental outcomes in exposed children
Background Antidepressants are commonly prescribed during pregnancy, despite a lack of evidence from randomised trials on the benefits or risks. Some studies have reported associations of antidepressants during pregnancy with adverse offspring neurodevelopment, but whether or not such associations are causal is unclear. Objectives To study the associations of antidepressants for depression in pregnancy with outcomes using multiple methods to strengthen causal inference. Design This was an observational cohort design using multiple methods to strengthen causal inference, including multivariable regression, propensity score matching, instrumental variable analysis, negative control exposures, comparison across indications and exposure discordant pregnancies analysis. Setting This took place in UK general practice. Participants Participants were pregnant women with depression. Interventions The interventions were initiation of antidepressants in pregnancy compared with no initiation, and continuation of antidepressants in pregnancy compared with discontinuation. Main outcome measures The maternal outcome measures were the use of primary care and secondary mental health services during pregnancy, and during four 6-month follow-up periods up to 24 months after pregnancy, and antidepressant prescription status 24 months following pregnancy. The child outcome measures were diagnosis of autism, diagnosis of attention deficit hyperactivity disorder and intellectual disability. Data sources UK Clinical Practice Research Datalink. Results Data on 80,103 pregnancies were used to study maternal primary care outcomes and were linked to 34,274 children with at least 4-year follow-up for neurodevelopmental outcomes. Women who initiated or continued antidepressants during pregnancy were more likely to have contact with primary and secondary health-care services during and after pregnancy and more likely to be prescribed an antidepressant 2 years following the end of pregnancy than women who did not initiate or continue antidepressants during pregnancy (odds ratio initiation 2.16, 95% confidence interval 1.95 to 2.39; odds ratio continuation 2.40, 95% confidence interval 2.27 to 2.53). There was little evidence for any substantial association with autism (odds ratio multivariableregression 1.10, 95% confidence interval 0.90 to 1.35; odds ratio propensityscore 1.06, 95% confidence interval 0.84 to 1.32), attention deficit hyperactivity disorder (odds ratio multivariableregression 1.02, 95% confidence interval 0.80 to 1.29; odds ratio propensityscore 0.97, 95% confidence interval 0.75 to 1.25) or intellectual disability (odds ratio multivariableregression 0.81, 95% confidence interval 0.55 to 1.19; odds ratio propensityscore 0.89, 95% confidence interval 0.61 to 1.31) in children of women who continued antidepressants compared with those who discontinued antidepressants. There was inconsistent evidence of an association between initiation of antidepressants in pregnancy and diagnosis of autism in offspring (odds ratio multivariableregression 1.23, 95% confidence interval 0.85 to 1.78; odds ratio propensityscore 1.64, 95% confidence interval 1.01 to 2.66) but not attention deficit hyperactivity disorder or intellectual disability; however, but results were imprecise owing to smaller numbers. Limitations Several causal-inference analyses lacked precision owing to limited numbers. In addition, adherence to the prescribed treatment was not measured. Conclusions Women prescribed antidepressants during pregnancy had greater service use during and after pregnancy than those not prescribed antidepressants. The evidence against any substantial association with autism, attention deficit hyperactivity disorder or intellectual disability in the children of women who continued compared with those who discontinued antidepressants in pregnancy is reassuring. Potential association of initiation of antidepressants during pregnancy with offspring autism needs further investigation. Future work Further research on larger samples could increase the robustness and precision of these findings. These methods applied could be a template for future pharmaco-epidemiological investigation of other pregnancy-related prescribing safety concerns. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (15/80/19) and will be published in full in Health Technology Assessment ; Vol. 27, No. 15. See the NIHR Journals Library website for further project information.
Original Research
MAR 2023PirkisCrisis
A Public Health, Whole-of-Government Approach to National Suicide Prevention Strategies
Many countries have national suicide prevention strategies, all of which aim to reduce suicide and many of which also address self-harm more generally (World Health Organization, 2018).In this editorial, we argue that national strategies could be strengthened through an increased focus on the social determinants associated with suicide and self-harm.We present a public health model that articulates how these social determinants might operate and how they might interact with individual-level risk factors.We then describe how these social determinants might be addressed by a whole-of-government approach involving cross-sectoral action and genuine social participation and empowerment of people with lived experience of suicide and self-harm.
Cohort Study
FEB 2023ChenPsychosomatic Medicine
All-Cause and Cause-Specific Mortality in Parents After the Death of a Child in Taiwan: A Population-Based Cohort Study
OBJECTIVE: Research from Western countries suggests that there is an increase in mortality in parents bereaved by the death of a child. Few studies have investigated this issue in a non-Western context. We explored the impact of the death of a child on parental mortality in Taiwan. METHOD: By linking population-based national registers, we followed the 2004-2014 birth cohort ( N = 2,083,972) up until 2016. A total of 11,755 child deaths were identified. For each deceased child, four living children matched on age and sex were randomly selected; their parents were the comparison group. We used Cox proportional hazards regression models to compare the mortality risk of bereaved parents with the comparison group up until 2017. RESULTS: Overall mortality risk was increased in parents who experienced the death of a child; the risk was higher in bereaved mothers (adjusted hazard ratio = 4.91, 95% confidence interval = 3.96-6.09) than fathers (adjusted hazard ratio = 1.82, 95% confidence interval = 1.55-2.13). The risk did not differ according to the sex of the child, but parents whose children died of unexpected causes (i.e., suicide/accidents/violence) were at greater risk than those dying of other causes. Risk was higher when the child was older than 1 year at the time of death than for deaths before age 1 year. CONCLUSIONS: Parents who lost a child were at increased mortality risk in this East Asian population. Special attention should be paid to the health of bereaved parents and explore the pathways leading to their risk.
Cohort Study
FEB 2023BorgesArchives of Suicide Research
Suicidal Ideation and Behavior Among Mexican University Students Before and During the COVID-19 Pandemic
OBJECTIVE: The COVID-19 pandemic has affected the mental health of populations around the world, but few longitudinal studies of its impact on suicidal thoughts and behaviors have been published especially from low- and middle-income countries. METHODS: This is a prospective cohort study of 1,385 first-year students from 5 Universities in Mexico followed-up for 1 year. We report 1-year cumulative incidence of suicidal thoughts and behaviors before (September 19, 2019-March 29, 2020) and during the COVID-19 period (March 30, 2020-June 30, 2020), focusing on those in the COVID-19 period with risk conditions and positive coping strategies during the pandemic. RESULTS: There was an increase in the incidence of suicidal ideation during the COVID-19 period compared to the pre-COVID-19 period (RR 1.65, 95%CI 1.08-2.50). This increase was mostly found among students with heightened sense of vulnerability (RR 1.95), any poor coping behavior (RR 2.40) and a prior mental disorder (RR 2.41). While we found no evidence of an increased risk of suicidal planning or attempts, there was evidence that those without lifetime mental health disorders were at greater risk of suicidal plans than those with these disorders especially if they had poor coping strategies (RR 3.14). CONCLUSION: In the short term, how students deal with the pandemic, being at high risk and having poor coping behavior, increased the new occurrence of suicidal thoughts and behaviors. Studies with longer follow-up and interventions to reduce or enhance these behaviors are needed.HIGHLIGHTSSuicidal ideation increased during the COVID-19 periodThose with heightened sense of vulnerability and poor coping were more affectedStudies with longer follow-up are needed.
Interrupted Time Series
JAN 2023RajapakseInternational Journal of Environmental Research and Public Health
The Impact of the COVID-19 Pandemic and Lockdowns on Self-Poisoning and Suicide in Sri Lanka: An Interrupted Time Series Analysis
Evidence from high-income countries suggests that the impact of COVID-19 on suicide and self-harm has been limited, but evidence from low- and middle-income countries is lacking. Using data from a hospital-based self-poisoning register (January 2019-December 2021) and data from national records (2016-2021) of suicide in Sri Lanka, we aimed to assess the impact of the pandemic on both self-poisoning and suicide. We examined changes in admissions for self-poisoning and suicide using interrupted time series (ITS) analysis. For the self-poisoning hospital admission ITS models, we defined the lockdown periods as follows: (i) pre-lockdown: 01/01/2019-19/03/2020; (ii) first lockdown: 20/03/2020-27/06/2020; (iii) post-first lockdown: 28/06/2020-11/05/2021; (iv) second lockdown: 12/05/2021-21/06/2021; and (v) post-second lockdown: 22/06/2021-31/12/2021. For suicide, we defined the intervention according to the pandemic period. We found that during lockdown periods, there was a reduction in hospital admissions for self-poisoning, with evidence that admission following self-poisoning remained lower during the pandemic than would be expected based on pre-pandemic trends. In contrast, there was no evidence that the rate of suicide in the pandemic period differed from that which would be expected. As the long-term socioeconomic impacts of the pandemic are realised, it will be important to track rates of self-harm and suicide in LMICs to inform prevention.
Original Research
JAN 2023LuEpidemiology and Psychiatric Sciences
Space–time self-harm and suicide clusters in two cities in Taiwan
Aims Suicidal acts may cluster in time and space and lead to community concerns about further imitative suicidal episodes. Although suicide clusters have been researched in previous studies, less is known about the clustering of non-fatal suicidal behaviour (self-harm). Furthermore, most previous studies used crude temporal and spatial information, e.g., numbers aggregated by month and residence area, for cluster detection analysis. This study aimed to (i) identify space–time clusters of self-harm and suicide using daily incidence data and exact address and (ii) investigate the characteristics of cluster-related suicidal acts. Methods Data on emergency department presentations for self-harm and suicide deaths in Taipei City and New Taipei City, Taiwan, were used in this study. In all-age and age-specific analyses, self-harm and suicide clusters were identified using space–time permutation scan statistics. A cut-off of 0.10 for the p value was used to identify possible clusters. Logistic regression was used to investigate the characteristics associated with cluster-related episodes. Results A total of 5,291 self-harm episodes and 1,406 suicides in Taipei City (2004–2006) and 20,531 self-harm episodes and 2,329 suicides in New Taipei City (2012–2016) were included in the analysis. In the two cities, two self-harm clusters ( n [number of self-harm episodes or suicide deaths in the cluster] = 4 and 8 in Taipei City), four suicide clusters ( n = 3 in Taipei City and n = 4, 11 and 4 in New Taipei City) and two self-harm and suicide combined clusters ( n = 4 in Taipei City and n = 8 in New Taipei City) were identified. Space–time clusters of self-harm, suicide, and self-harm and suicide combined accounted for 0.05%, 0.59%, and 0.08% of the respective groups of suicidal acts. Cluster-related episodes of self-harm and suicide were more likely to be male (adjusted odds ratio [aOR] = 2.22, 95% confidence interval [CI] 1.26, 3.89) and young people aged 10–29 years (aOR = 2.72, 95% CI 1.43, 5.21) than their cluster-unrelated counterparts. Conclusions Space–time clusters of self-harm, suicide, and self-harm and suicide combined accounted for a relatively small proportion of suicidal acts and were associated with some sex/age characteristics. Focusing on suicide deaths alone may underestimate the size of some clusters and/or lead to some clusters being overlooked. Future research could consider combining self-harm and suicide data and use social connection information to investigate possible clusters of suicidal acts.
Cohort Study
DEC 2022WarneJournal of Child Psychology and Psychiatry
Emotional dysregulation in childhood and disordered eating and self‐harm in adolescence: prospective associations and mediating pathways
In males and females, emotional dysregulation in early childhood is associated with disordered eating and self-harm in adolescence and may be a useful target for prevention and treatment. Mediating pathways appeared to differ by sex and outcome, but social cognition was a key mediating pathway for both disordered eating and self-harm.
Systematic Review
OCT 2022JohnEuropean Journal of Public Health
Suicide Trends during the COVID-19 pandemic and the International COVID-19 Suicide Prevention Research Collaboration
Introduction There was and still is much speculation about the COVID-19 pandemic impact on suicide rates. We aimed to assess the effect of the COVID-19 pandemic on suicide rates around the world. Methods We sourced real-time suicide data from countries or countries areas through a systematic internet search (official websites of Ministries of health, police agencies, and government-run statistics agencies or equivalents), recourse to our networks (e.g. ICSPRC) and the published literature (a living systematic review). We used an interrupted time-series analysis to model the trend in monthly suicides before COVID-19 in each country or country area, comparing the expected number of suicides derived from the model with the observed number of suicides in the early months of the pandemic (from April 1 to July 31, 2020, in the primary analysis). We have now updated this work to cover the first 15 months of the pandemic and stratified analyses by age and sex and method. We will present findings from the new updated data (35 countries) at the conference. Results Initially we sourced data from 21 countries (16 high-income and five upper-middle-income countries). Rate ratios (RRs) and 95% CIs based on the observed versus expected numbers of suicides showed no evidence of a significant increase in risk of suicide since the pandemic began in any country or area. There was statistical evidence of a decrease in suicide compared with the expected number in 12 countries or areas. Conclusions This was the first study to examine suicides occurring in the context of the COVID-19 pandemic in multiple countries. Early on high-income and upper-middle-income countries, suicide numbers remained largely unchanged or declined compared with the expected levels based on the pre-pandemic period. We need to remain vigilant and be poised to respond as the longer-term mental health and economic effects of the pandemic unfold. We will present updated findings with more recent data.
Meta-Analysis
AUG 2022QinJournal of Psychiatric Research
Midlife suicide: A systematic review and meta-analysis of socioeconomic, psychiatric and physical health risk factors
Suicide is an increasing contributing cause of mortality in middle-aged adults; however, knowledge to guide prevention is limited. This first systematic review and meta-analysis of studies on midlife suicide has provided an overview of published research on this issue and synthesized the evidence on socioeconomic and physical and mental health factors associated with this mortality. Using PRISMA guidelines MEDLINE, Embase, PsycINFO, Scopus and Web of Science were searched for English-language publications that involved persons aged 35 to 65, used individual-level data, and reported prevalence of exposure(s) or relative risks. The search identified 62 studies on midlife suicides and associated factors (28 for SES, 22 for psychiatric disorder and 23 for physical illness). All studies were from high income countries, and most (80.6%) used data from population registries. Meta-analyses showed that the pooled prevalence of exposure in suicide decedents was 57.8% for psychiatric disorder, 56.3% for low income, 43.2% for unemployment, and 27.3% for physical illness. The associated pooled risk ratio was 11.68 (95% confidence intervals: 5.82-23.47) for psychiatric illness of any type, 12.59 (8.29-19.12) for mood disorders, 3.91 (2.72-5.59) for unemployment, 3.18 (2.72-3.72) for being separated or divorced, 2.64 (2.26-3.10) for cancer, 2.50 (0.96-6.38) for central nervous system illness, and 2.26 (1.16-4.41) for low income. In conclusion, midlife suicide is strongly associated with socioeconomic difficulties and physical and psychiatric illnesses that are common in this age population. Future investigations should consider the interactions between risk factors, the intersectionality of sex and ethnicity, and include data from low- and middle-income countries.
Original Research
AUG 2022PirkisSHILAP Revista de lepidopterología
Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends: An interrupted time series analysis in 33 countries
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