MENTAL HEALTH
Suicide and race: Uncovering patterns underlying increasing suicide rates in the USA
Researchers have identified specific communities in the United States where the majority of suicides occur by firearm and hanging
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SUICIDE MORTALITY RATES HAVE INCREASED RAPIDLY IN THE UNITED STATES COMPARED TO THOSE GLOBALLY. IN THIS STUDY, RESEARCHERS SHOW THAT AIAN AND WHITE PEOPLE HAVE THE HIGHEST RISK OF SUICIDE BY FIREARM OR HANGING.
view moreCREDIT: A/PROF. BIBHA DHUNGEL FROM WASEDA UNIVERSITY
Are there specific communities that bear the brunt of suicide mortality? Certain studies have revealed that historically marginalized and economically deprived indigenous populations are linked with higher rates of cluster suicides—especially in Canada, the United States, and Australia. Public health officials need to consider that the risk of suicide contagion—social transmission due to insufficient interventions and resources—is real and must be countered. Now, a consortium of public health experts from Japan, Australia, and China have analyzed trends in suicide mortality in American Indian or Alaskan Native (AIAN) populations, while exploring health inequality among vulnerable populations. The team, led by Assistant Professor Bibha Dhungel from the School of International Liberal Studies, Waseda University, including co-authors Dr. Fiona Shand, Associate Professor, University of New South Wales, Australia, Dr. Jinghua Li, Associate Professor, Sun Yat-sen University, China, and Dr. Stuart Gilmour, Professor, St. Luke’s International University, Japan, published their findings in the Annals of Internal Medicine on December 19, 2023.“In contrast to global suicide rates which decreased by nearly a third between 1990 and 2016, those in the United States saw a rapid increase. ” explains Dr. Dhungel. She further added, “We wanted to study these trends over time in the hopes of distilling underlying patterns specific to sex and the method of suicide.” Studies have reported that the life expectancy of AIAN individuals is seven years less than that of the White population.
The team examined age-specific data on self-harm from the Centers for Disease Control and Prevention’s WONDER database over the study period. They profiled suicides by poisoning, hanging, firearms, jumping from high places, and other methods and compared mortality rates per 100,000 persons by method and race for both sexes. Suicide methods were classified using the 10th Edition of the International Classification of Diseases. Dr. Dhungel notes, “Suicide mortality rates among White and AIAN men increased rapidly between 1999 and 2020. The highest rates were observed among White individuals, followed by AIAN populations. Furthermore, the relative increase in rates since 2000 among AIAN men and women was 35% and 65%, respectively. In fact, suicide by firearm and hanging was prevalent among AIAN men, and suicide by hanging increased by nearly 200% among AIAN women.”
Furthermore, the team believes that these trends reflect the historical trauma and that ongoing inequality and discrimination contribute to the high suicide rates in AIAN people, potentially rendering AIAN communities more vulnerable to mental health issues. The study underscores the imperative to address mental health in vulnerable populations and equip clinicians to identify high-risk groups associated with various suicide methods
Dr. Dhungel concludes, “By implementing comprehensive and focused community-based suicide prevention strategies that are racially relevant, communities can work towards a more inclusive approach to suicide prevention. The goal is to reduce suicide rates by addressing the specific needs and challenges faced by different racial groups, ultimately fostering mental well-being and resilience across diverse populations.”
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Reference
Authors: Bibha Dhungel1, Fiona Shand2, Phuong Nguyen3, Yijing Wang4, Sayuri Fujita-Imazu5, July Khin Maung Soe5, Jinzhao Xie6, Xinran Wang6, Jinghua Li7, Stuart Gilmour8
Title of original paper: Method-Specific Suicide Mortality in the United States in the 21st Century
Journal: Annals of Internal Medicine
DOI: https://doi.org/10.7326/M23-2533
Affiliations
1School of International Liberal Studies, Waseda University, and Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
2The Black Dog Institute, University of New South Wales, Randwick, New South Wales, Australia
3Graduate School of Public Health, St. Luke’s International University, and Division of Surveillance and Policy Evaluation, National Cancer Center Institute for Cancer Control, Tokyo, Japan
4Shenzhen Center for Disease Control and Prevention, Shenzhen, China
5Graduate School of Public Health, St. Luke’s International
University, Tokyo, Japan
6School of Public Health, Sun Yat-sen University, Guangzhou,
China
7School of Public Health and Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, China
8Graduate School of Public Health, St. Luke’s International University, Tokyo, Japan
About Waseda University
Located in the heart of Tokyo, Waseda University is a leading private research university that has long been dedicated to academic excellence, innovative research, and civic engagement at both the local and global levels since 1882. The University has produced many changemakers in its history, including nine prime ministers and many leaders in business, science and technology, literature, sports, and film. Waseda has strong collaborations with overseas research institutions and is committed to advancing cutting-edge research and developing leaders who can contribute to the resolution of complex, global social issues. The University has set a target of achieving a zero-carbon campus by 2032, in line with the Sustainable Development Goals (SDGs) adopted by the United Nations in 2015.
To learn more about Waseda University, visit https://www.waseda.jp/top/en
About Dr Bibha Dhungel from Waseda University
Assistant Professor Bibha Dhungel is affiliated with the School of International Liberal Studies at Waseda University and holds a Doctor of Public Health Degree from St. Luke’s International University. She completed the Global Tobacco Control Program at the Johns Hopkins Bloomberg School of Public Health. Dr. Dhungel has played vital roles in cancer screening and tobacco control projects, and her work spans various areas of health. Trained in epidemiology and biostatistics, her research interests focus on the analysis of mental health issues and non-communicable diseases. She is currently working as a joint researcher at the National Center for Child Health and Development and serves as a Review Editor for Public Mental Health and Life-Course Epidemiology and Social Inequalities in Health sections of the Frontiers in Public Health journal.
JOURNAL
Annals of Internal Medicine
METHOD OF RESEARCH
Data/statistical analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Method-Specific Suicide Mortality in the United States in the 21st Century
COI STATEMENT
Disclosures can be viewed at https://rmed.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-2533
A study of how Americans die may improve their end of life
A Rutgers Health analysis of millions of Medicare records has laid the groundwork for improving end-of-life care by demonstrating that nearly all older Americans follow one of nine trajectories in their last three years of life.
“Identifying which paths people actually take is a necessary precursor to identifying which factors send different people down different paths and designing interventions that send more people down whatever path is right for them,” said Olga Jarrín, the Hunterdon Professor of Nursing Research at Rutgers and corresponding author of the study published in BMC Geriatrics.
The team pulled the final three years of clinical records from a randomly selected 10 percent of all 2 million Medicare beneficiaries who died in 2018. Analysis of how much personal care each patient received and where they received care revealed three major care clusters – home, skilled home care and institutional care. Each cluster contains three distinct trajectories.
Roughly 59 percent of patients fell into the “home” cluster, meaning they spent most of their last three years at home while friends and family helped them with any tasks they couldn’t do for themselves. Such patients typically received little professional care, either in their own homes or in nursing homes, until the last year of life.
Another 27 percent of patients fell into the “skilled home care” cluster, meaning nurses and other skilled professionals helped friends and family care for them inside their own homes for most of their final three years.
The final 14 percent of patients fell in the “institutional care” cluster and spent most of their final three years either in hospitals or (more commonly) nursing homes, receiving nearly all necessary care from paid professionals.
The researchers used a group-based trajectory modeling approach, evaluating associations between care trajectories and both sociodemographic and health-related metrics. Patients in both the skilled home care and institutional care clusters were more likely than patients in the home cluster to be female, Black, enrolled in Medicaid or suffering from dementia. Extensive use of skilled home care was more prevalent in Southern states, while extensive use of institutional care was more common in Midwestern states.
“Our study not only identifies different patterns of care but also sheds light on the clinical and policy factors that dictate where and when patients receive care,” said Haiqun Lin, lead author of the study and a professor of biostatistics who is also co-director of the Center for Health Equity and Systems Research within Rutgers School of Nursing. “Understanding these patterns is crucial for advance care planning, and ultimately, for achieving the triple aim of improving care experiences, reducing care costs, and improving care quality.”
The study is the first of several the researchers plan to base on their analysis of the Medicare data. Now that they have identified the trajectories that people actually follow in their last years of life, they will look for the key factors that direct people down each path and interventions that will help more people stick to the path they prefer.
For most but not all people, that means one of the paths in the home cluster.
“Most people want to stay at home with minimal professional help,” said Jarrín, who also is the director of the Community Health and Aging Outcomes Laboratory within Rutgers Institute for Health, Health Care Policy, and Aging Research. “However, the goal for a significant minority of people is to avoid being a burden to family and friends, and such people tend to want professional care.”
Jarrín added: “Our goal isn’t forcing people toward any particular type of care. It’s helping them to plan for and get the care that’s right for them.”
This research was supported by the National Institutes of Health’s National Institute on Aging, grants R33AG068931 and R01AG066139.
JOURNAL
BMC Geriatrics
METHOD OF RESEARCH
Data/statistical analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Place of Care in the Last Three Years of Life for Medicare Beneficiaries
ARTICLE PUBLICATION DATE
25-Jan-2024
Suicidal thoughts and trajectories of psychopathological and behavioral symptoms in adolescence
JAMA Network Open
Peer-Reviewed PublicationAbout The Study: This study of 2,780 adolescents found that persistent withdrawn symptoms and increasing somatic symptoms during early to mid-adolescence were associated with an increased risk of suicidal thoughts in mid-adolescence, even after accounting for comorbid symptoms and confounders. Attention should be paid to the suicidal risk associated with these symptoms, particularly when they persist or increase in the longitudinal follow-up.
Authors: Shuntaro Ando, Ph.D., of the University of Tokyo, is the corresponding author.
To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/
(doi:10.1001/jamanetworkopen.2023.53166)
Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.
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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.
JOURNAL
JAMA Network Open
Can we predict when a migraine attack will occur?
MINNEAPOLIS – Migraine is often underdiagnosed and untreated, and even when it is treated, it can be difficult to treat early enough as well as find strategies to prevent attacks. A new study looks at ways to more accurately predict when a migraine will occur—through the use of mobile apps to track sleep, energy, emotions and stress—to enhance the ability to prevent attacks. The study is published in the January 24, 2024, online issue of Neurology®, the medical journal of the American Academy of Neurology.
The study found that poor perceived sleep quality as well as a lower than usual quality of sleep on the prior night were both associated with an increased risk of having a migraine the next morning. A lower than usual energy level the prior day was also associated with headache the next morning. Those factors did not lead to an increased risk of migraine in the afternoon or evening. The only predictors of an afternoon or evening headache were increased stress levels or having higher-than-average energy the day before.
“These different patterns of predictors of morning and later-day headaches highlight the role of the circadian rhythms in headache,” said study author Kathleen R. Merikangas, PhD, of the National Institute of Mental Health, part of the National Institutes of Health in Bethesda, Maryland. “The findings may give us insight into the processes underlying migraine and help us improve treatment and prevention.”
The study involved 477 people ages 7 through 84, including 291 female participants. Through a mobile app, participants were asked to rate their mood, energy, stress, and headaches four times a day for two weeks. They also rated their sleep quality once a day and wore sleep and physical activity monitors. Nearly half of the participants had a history of migraine and 59% had at least one morning headache attack during the study.
People with poorer perceived sleep quality on average had a 22% increased chance of a headache attack the next morning. A decrease in the self-reported usual quality of sleep was also associated with an 18% increased chance of a headache attack the next morning. Likewise, a decrease in the usual level of energy on the prior day was associated with a 16% greater chance of headache the next morning. In contrast, greater average levels of stress and substantially higher energy than usual the day before was associated with a 17% increased chance of headache on the following afternoon or evening. After considering sleep, energy and stress, neither anxious nor depressed mood were associated with headache attacks.
“Surprisingly, we found no link between a person’s anxiety and depression symptoms—either having more symptoms or having higher-than-average levels of symptoms—and their likelihood of having a migraine attack the next day,” Merikangas said. “Perhaps most interesting, headaches were associated with self-rated sleep quality rather than actual measures of sleep patterns. This highlights the importance of perceived physical and emotional states in the underlying causes of migraine.”
“Our study demonstrates the importance of monitoring sleep changes as a predictor of headache attacks,” said study author Tarannum M. Lateef, MD, of the Children’s National Health System in Washington, D.C. “The use of apps that track sleep and other health, behavioral and emotional states in real time can provide valuable information that can help us to manage migraine.”
A limitation of the study is that participants were tracked over a short period of time.
The study was supported by the National Institute of Mental Health of the National Institutes of Health under grant numbers 1ZIAMH002804 and 1ZIAMH002954. The content of the study is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Learn more about migraine at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life® on Facebook, X and Instagram.
When posting to social media channels about this research, we encourage you to use the hashtags #Neurology and #AANscience.
The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 40,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.
For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, X, Instagram, LinkedIn and YouTube.
JOURNAL
Neurology
Mood interventions may reduce inflammation in Crohn’s and Colitis
Peer-Reviewed PublicationNew King’s College London research reveals that interventions which improve mood can reduce levels of inflammation in people with inflammatory bowel disease by 18 per cent, compared to having no mood intervention.
Researchers at the Institute of Psychiatry, Psychology & Neuroscience at King’s College London found that interventions designed to improve mood, including psychological therapy, antidepressants, and exercise, were associated with significant reductions in inflammatory biomarker levels in individuals with inflammatory bowel disease (IBD). Interventions for mood may present an alternative treatment for IBD that is both effective and low-cost.
The research – supported by the National Institute for Health and Care (NIHR) and Medical Research Council (MRC) - indicates that interventions for mood can present an alternative treatment for IBD that is both effective and low-cost.
IBD, comprising Crohn’s disease and ulcerative colitis, is a chronic autoimmune condition affecting over 500,000 people in the UK that causes inflammation of the digestive tract. This results in abdominal pain, diarrhoea, fatigue, incontinence, and other debilitating symptoms. Alongside the physical symptoms, IBD can have major implications on mental health and wellbeing.
Inflammatory biomarkers can be found in the body to indicate areas and types of inflammation. Researchers analysed existing studies on levels of the biomarkers C-Reactive Protein and faecal calprotectin which are specific indicators of IBD, as well as a combined measure of other inflammatory biomarkers.
The systematic review and meta-analysis published in eBiomedicine, part of The Lancet Discovery Science, is the first to investigate the relationship between interventions aiming to treat mood and levels of inflammatory biomarkers in IBD. The findings suggest that interventions for mood present a strategy to improve mental health and reduce inflammation in IBD.
Natasha Seaton, first author of the study and PhD student at King’s IoPPN, said:
“IBD is a distressing condition and current medication that reduces inflammation is expensive and can have side effects. Our study showed that interventions that treat mental health reduce levels of inflammation in the body. This indicates that mood interventions could be a valuable tool in our approach to help those with IBD.”
The researchers conducted a search of more than 15,000 articles, looking for all randomised controlled trials in adults with IBD that measured levels of inflammatory biomarkers and tested a mood intervention (for example, interventions to reduce depression, anxiety, stress and distress, or improve emotional wellbeing).
They reviewed and analysed data from 28 randomised controlled trials involving over 1,700 participants to establish whether interventions targeting mood outcomes impact inflammation levels in IBD.
Researchers found that psychological therapies, including Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy, and Mindfulness Based Stress Reduction, had the best outcomes on inflammation in IBD, compared with antidepressants and exercise interventions. Interventions which had a larger positive effect on mood had a greater effect on reducing inflammatory biomarkers. These findings suggest that the mechanism underlying the effect of psychological and social interventions on inflammation in IBD could be improved mood.
Individual analyses on IBD-specific inflammatory markers revealed a small reduction in C-Reactive Protein and faecal calprotectin following mood intervention. This suggests that treatments which improve mood have beneficial effects on generic inflammation as well as disease-specific biomarkers.
Professor Valeria Mondelli, co-lead of the Psychosis and Mood Disorders Theme at the NIHR Maudsley BRC and Clinical Professor of Psychoneuroimmunology at King’s IoPPN, said:
“Our study suggests that improvements in mood can influence physical diseases through modulation of the immune system. We know stress-related feelings can increase inflammation and the findings suggest that by improving mood we can reduce this type of inflammation. This adds to the growing body of research demonstrating the role of inflammation in mental health and suggests that interventions working to improve mood could also have direct physical effects on levels of inflammation. However, more research is needed to understand exact mechanisms in IBD.”
Many IBD medications have negative side effects, and they are often very costly. For example, the anti-inflammatory medication infliximab costs about £12,584 per year. The study suggests that interventions that aim to improve mood, particularly psychological therapies costing approximately £480-£800 in the UK (an eight-week course of face-to-face CBT) could reduce inflammation in IBD and potentially provide an alternative treatment or one that works alongside medication to reduce costs and increase effectiveness.
Professor Rona Moss-Morris, Digital Therapies theme lead at NIHR Maudsley BRC, Professor Psychology as Applied to Medicine at King’s IoPPN, and senior author of the study, said:
“Interventions for mood show considerable promise for the management of IBD in improving mental health, inflammation, and disease outcomes. Integrated mental health support alongside pharmacological treatments may offer a more holistic approach to IBD care, potentially leading to reduced disease and healthcare costs. Currently, medications taken to reduce inflammation are often very costly compared to psychological therapies in the UK. Given this, including psychological interventions, such as cost-effective digital interventions, within IBD management might reduce the need for anti-inflammatory medication, resulting in an overall cost benefit.”
This study was funded by the NIHR Maudsley Biomedical Research Centre (BRC), hosted by South London and Maudsley NHS Foundation Trust in partnership with King's College London, and the Medical Research Council. Natasha Seaton is funded by an MRC Doctoral Training Partnership.
Ends
For more information, please contact:
- Franca Davenport, Communications and Engagement Manager (part-time), NIHR Maudsley Biomedical Research Centre, franca.davenport@kcl.ac.uk
- Alex Booth, Communications and Engagement Manager (part-time), NIHR Maudsley Biomedical Research Centre, alex.booth@kcl.ac.uk
‘Do interventions for mood improve inflammatory biomarkers in Inflammatory Bowel Disease?: A Systematic Review and Meta-Analysis’ (Natasha Seaton, Joanna Hudson, Sophie Harding, Sam Norton, Valeria Mondelli, Annie Jones, Rona Moss-Morris) was published in eBiomedicine. DOI: 10.1016/j.ebiom.2023.104910.
Notes to editors
The labels have been added to this press release as part of a project run by the Academy of Medical Sciences seeking to improve the communication of evidence. For more information, please see: http://www.sciencemediacentre.org/wp-content/uploads/2018/01/AMS-press-release-labelling-system-GUIDANCE.pdf
About King’s College London and the Institute of Psychiatry, Psychology & Neuroscience
King’s College London is amongst the top 35 universities in the world and top 10 in Europe (THE World University Rankings 2023), and one of England’s oldest and most prestigious universities.
With an outstanding reputation for world-class teaching and cutting-edge research, King’s maintained its sixth position for ‘research power’ in the UK (2021 Research Excellence Framework).
King's has more than 33,000 students (including more than 12,800 postgraduates) from some 150 countries worldwide, and some 8,500 staff. The Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s is a leading centre for mental health and neuroscience research in Europe. It produces more highly cited outputs (top 1% citations) on psychiatry and mental health than any other centre (SciVal 2021), and on thilas metric has risen from 16th (2014) to 4th (2021) in the world for highly cited neuroscience outputs. In the 2021 Research Excellence Framework (REF), 90% of research at the IoPPN was deemed ‘world leading’ or ‘internationally excellent’ (3* and 4*). World-leading research from the IoPPN has made, and continues to make, an impact on how we understand, prevent and treat mental illness, neurological conditions, and other conditions that affect the brain.
www.kcl.ac.uk/ioppn | Follow @KingsIoPPN on Twitter, Instagram, Facebook and LinkedIn
The National Institute for Health and Care Research (NIHR)
The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:
- Funding high quality, timely research that benefits the NHS, public health and social care;
- Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;
- Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;
- Attracting, training and supporting the best researchers to tackle complex health and social care challenges;
- Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;
- Funding applied global health research and training to meet the needs of the poorest people in low and middle income countries.
NIHR is funded by the Department of Health and Social Care. Its work in low and middle income countries is principally funded through UK Aid from the UK government.
JOURNAL
EBioMedicine
SUBJECT OF RESEARCH
People
ARTICLE TITLE
‘Do interventions for mood improve inflammatory biomarkers in Inflammatory Bowel Disease?: A Systematic Review and Meta-Analysis
ARTICLE PUBLICATION DATE
24-Jan-2024
Furry fruit improves mental health – fast
Kiwifruit has proven itself as a powerful mood booster and new research from the University of Otago has shown just how fast its effects can be.
In a study, published in The British Journal of Nutrition, researchers found the furry fruit improved vitality and mood in as little as four days.
Co-author Professor Tamlin Conner, of the Department of Psychology, says the findings provide a tangible and accessible way for people to support their mental well-being.
“It’s great for people to know that small changes in their diet, like adding kiwifruit, could make a difference in how they feel every day.”
Vitamin C intake has been associated with improved mood, vitality, well-being, and lower depression, while vitamin C deficiency is associated with higher depression and cognitive impairment.
However, Professor Conner says limited research has assessed how quickly mood improvements occur after introducing vitamin C supplements or whole food sources.
The researchers aimed to fill that gap with an 8-week dietary intervention of 155 adults with low vitamin C.
Participants took daily either a vitamin C supplement, placebo, or two kiwifruit. They then reported their vitality, mood, flourishing, sleep quality, sleep quantity, and physical activity using smartphone surveys.
The researchers found kiwifruit supplementation improved vitality and mood within four days, peaking around 14-16 days, and improved flourishing from day 14. Vitamin C, on the other hand, marginally improved mood until day 12.
Lead author Dr Ben Fletcher, who conducted the research as part of his PhD at Otago, says understanding the nuances of when and how these effects occur day-to-day contributes to our knowledge of the potential benefits of vitamin C-rich foods and supplements on mental health.
“This helps us see that what we eat can have a relatively fast impact on how we feel.
“Our participants had relatively good mental health to begin with so had little room for improvement, but still reported the benefits of kiwifruit or vitamin C interventions,” he says.
He adds that, while vitamin C tablets showed some improvements, the study underscores the potential synergistic effects of consuming whole foods like kiwifruit.
“We encourage a holistic approach to nutrition and well-being, incorporating various nutrient-rich foods into your diet.”
In addition to the direct implications for individuals seeking to improve their mental well-being, Professor Conner says the study introduces a novel methodology in nutritional research.
“The use of intensive smartphone surveys offers a real-time understanding of the day-to-day changes in mood-related outcomes.”
JOURNAL
British Journal Of Nutrition
ARTICLE TITLE
Smartphone survey data reveals the timecourse of changes in mood outcomes following vitamin C or kiwifruit intervention in adults with low vitamin C
