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Suicide Prevention

Concern for prehospital care/ambulance services

10 Aug, 15 | by jmagoola

I spent last week travelling in Adjumani district (located in Northern Uganda) as part of an exercise in improving the quality of immunization data through support supervision and mentor-ship. This required us as a team to visit as many of the health facilities in the district as possible. Due to the limited sources of our country, we had to make do with one of the hospital ambulances as a means of transport. In between ferrying us from one health facility to another, the driver would get calls to go pick up emergency cases that required urgent transportation to hospital.

In this scenario, all the ambulance is manned by only a driver (no paramedic, no nurse) whose role is to pick you up and drop you at the nearest health facility. One of 2 ambulanes currently used by the district to transport patients during emergencies.No triage, no first aid, no prehospital care until arrival. This could contribute to the trauma mortality rates, which are already higher in rural areas before victims reach the hospital. It is known that travel time is a predictor of the outcome of an injury and as such many fatal injuries or their severity may be reduced by adequate prehospital trauma care. A previous study in Uganda found that fewer than 5% of injured patients are transported by ambulance to hospital  most of which ambulances are privately run and expensive. In neighboring Tanzania, a study evaluating access to prehospital care found there was no prehospital care in the region.

The interior of the ambulance, lacking paramedic supplies for first aid.

The interior of the ambulance, lacking paramedic supplies for first aid.

This highlights a major need to prioritize the development of prehospital trauma care if we are to address the issue of injuries. In addition, while the presence of an ambulance will reduce the travel time to hospital and thus increase the chance of survival, the ambulances themselves should be equipped with materials to offer some basic first aid during the course of transportation. They key policy and clinical practice questions we should ask ourselves should include; how equipped are the ambulances?; what should be the minimum standards a vehicle should attain before it is designated as an ambulance?

 

Firearms in the house and risk of suicide

8 Jul, 15 | by jsantaella

Suicide is an important form of external-cause mortality. The World Health Organization estimates that every 40 seconds a person commits suicide in the world. Given that a high proportion of suicides happen impulsively it makes sense that limiting the easy access to lethal means of suicide, such as firearms, during the suicidal crisis, could help to reduce the occurrence of suicides.

The recent work of Barber and Miller – Reducing a Suicidal Person’s Access to Lethal Means of Suicide -
A Research Agenda, provides an interesting review of studies with evidence supporting the link between firearm ownership and suicide risk. This is a particularly important area of research in the U.S. given the fact that most suicides are committed using firearms, firearms are one of the most lethal methods, and also because firearms are highly accessible and cognitively acceptable in U.S. culture. In their review, the authors provide evidence from different individual and ecological studies that consistently show an association between firearm ownership and higher risk of dying by suicide. The authors also present evidence from studies showing that among firearm households there is lower risk of suicides when firearms are stored unloaded, locked, and separately from ammunition. In addition, the review shows information from studies suggesting that personal factors, that could influence both the likelihood of buying a firearm and of committing suicide, are not likely to be explaining the firearms-suicide risk connection, given that people living in homes with firearms are no more likely to screen positive for psychopathology or suicidal ideation, or to report suicide attempts, than those living in homes without firearms.

Given the evidence, it is possible that alternative solutions may be effective. For example, raising awareness about the increased risk of suicide when there is a firearm in the home is key especially during critical times. Simultaneously providing information on available services (e.g. counseling available through hotlines or apps in mobile phones) may be effective, at least in part, in counteracting the current U.S. scenario in which approximately 19,000 individuals commit suicide using firearms every year.

More background on our blogging team

19 Jun, 15 | by Bridie Scott-Parker

Blog 3: So today I wanted to share some more background on our blogging team. As an applied social psychologist, I find this information very interesting indeed!

What excites you about being part of the Injury Prevention social media editorial team?  

Sheree Bekker: The invaluable conversation that has sprung up around scholarly work through the collaborative power of social media and blogs inspires me to no end. I tend to find more relevant scholarly content through Twitter than through traditional platforms, and Injury Prevention has played a big part in that. As researchers, I believe that we should own our voice on social media, and constructively add value to this conversation.

David Bui: Through my studies in medical school I have seen the costs of injuries to society and individuals worldwide.  This is a great opportunity to harness the underutilised power of Social Media in health promotion and Injury Prevention, across multiple disciplines and multiple borders.

Angy El-Khatib: Being a part of the Injury Prevention social media editorial team is a great opportunity personally and collectively. By being a part of the social media editorial team, I am able to stay up to date on various topics within the realm of Injury Prevention while acquiring different perspectives from individuals from different backgrounds, disciplines, and locations. I’m also excited to be able to potentially increase readership and engage readers to create a conversation around the latest Injury Prevention research and ideas.

Klara Johansson: I am very interested to explore ways to share and disseminate knowledge and research results, outside the “old-school”, regular channels. I look forward to learning from my new co-editors, who all seem to be great communicators.

Joseph Magoola: The opportunity to work and collaborate with a variety of scholars on the injury prevention platform is nothing short of exciting. It also excites and inspires me to have an opportunity to represent Africa since low and medium income countries bear the brunt of the injury burden.

Julian Santaella-Tenorio: It is really exciting to be part of this team and to have a space to communicate and express ideas on ways to improve injury prevention, and to discuss about new studies and topics relevant to this field. I am very motivated to learn more and continue growing as a researcher as I walk through this experience.

What are you passionate about?

Sheree Bekker: Intersectional issues drive my life’s work, and my aim is that my research is, and always will be, an extension of that.

David Bui: Passionate about bringing people and ideas together.

Angy El-Khatib: I am passionate about translating scientific evidence and research into public health action. My goal is to improve the health and wellbeing of myself as well as my community. Outside of my work, I am passionate about health, fitness, and wellness.

Klara Johansson: Open discussions and innovative research in collaborative teams with high scientific ambition + high levels of tolerance and kindness; I also enjoy making difficult subjects understandable to students and the general population. Passions on my free time: nature, gardening, books, movies, writing fiction, playing music (clarinet, harmonium, piano, accordion).

Joseph Magoola: Writing on my social media accounts (facebook, twitter and my blog) as a way of reaching out to the masses. I am also interested travelling a lot, especially by road and as such, ensuring road safety is part and parcel of my aims to contribute towards reducing the carnage of our roads.

Julian Santaella-Tenorio: I am passionate about things that can make people have a better, healthier and happier life. I am inspired by ideas challenging previous knowledge, creative thinking finding answers from different angles, and the power of multidisciplinary groups. That is why I am passionate about public health research.

 

I hope you are looking forward to hearing from our bloggers, starting next month!

Non-suicidal self-injury: Another effective avenue of intervention?

15 Oct, 14 | by Bridie Scott-Parker

The 10th of October is World Mental Health Day, and here in Australia a variety of activities helped ensure that mental health was openly discussed during Mental Health Week (5-12 October). As a researcher who works with adolescents, I am interested in their mental health, particularly as it can have pervasive implications for their injury prevention. I thought I would share an interesting article regarding non-suicidal self-injury (NSSI), an intentional injury which unfortunately has been found to be associated with a breadth of other injuries including suicide.

As part of a larger study exploring how adolescents cope with emotional problems, Voon, Hasking, and Martin (2014) explored the role of a number of variables in NSSI amongst a sample of 41 Australian high schools (Time 1 n = 2637 students; Time 2: 12 months post-baseline, n = 2328; Time 3: 24 months post-baseline n = 1984). Lifetime prevalence of NSSI increased over time (8.1% – 10.1%), with adolescents engaging in NSSI typically starting the behaviour aged 12-14 years. Experiencing more adverse life events and high psychological distress increased the risk of the first episode of NSSI, consistent with other research findings that adolescents respond to acute life stress and emotional distress through NSSI. This suggests that adolescents in these tumultuous states could benefit from NSSI-targeted interventions which could prevent NSSI include cognitive reappraisal in particular.

The ripple effect of such support for adolescents in particular could indeed offer another effective avenue of intervention for a breadth of injuries during the developmental period of adolescence and young adulthood.

Talking about Suicides

15 Apr, 14 | by gtung

The Board of the American Association of Suicidology recently voted to create a new division to represent and recognize individuals who have attempted suicide and survived.  This move seems to be representative of the beginning of a shift in how those involved in suicide prevention view openly talking about and learning from those who have made suicide attempts and survived.  A trend summarized nicely in this NY Times article:

http://www.nytimes.com/2014/04/14/us/suicide-prevention-sheds-a-longstanding-taboo-talking-about-attempts.html?src=xps

Those involved in suicide prevention have taken a cautious approach toward openly talking about or publicizing individual stories about completed suicides and attempts.  The issue of copycat suicides and suicide clusters gives justifiable concern toward publicizing completed suicides but what will be the effect of increased discussion around suicide attempts?

There is optimism around what can be learned from suicide attempt survivors and how those experiences can be used to prevent future suicides.  The website LiveThroughThis.org provides a collection of portraits and survivor stories in an attempt in part to build greater awareness and humanize survivors.

It will be interesting to see how this trend progresses, what is learned, and what impact, if any, it ultimately has on the very real need to develop effective interventions to prevent suicides.

The most popular suicide location in the world

8 Apr, 14 | by gtung

San Francisco’s Golden Gate Bridge looks poised to get a safety net to prevent suicides, something that various people and organizations have been requesting for over 60 years.  Since the Bridge was first opened in 1937 approximately 1,600 people have committed suicide by jumping off the bridge, more than any other location in the world.  In 2013, 46 people committed suicide from the bridge (that authorities know about) and another 118 were talked down or otherwise stopped from jumping by bridge workers.

In May of this year authorities will vote on the installation of a safety net that will be 20 feet below the walkway and is estimated to cost $66 million US dollars.  The proposal seems likely to pass.

http://www.nytimes.com/2014/03/27/us/suicides-mounting-golden-gate-looks-to-add-a-safety-net.html?src=xps

Arguments against installing some type of guard railing or safety net have included concerns about negatively impacting the bridge’s appearance and assertions that suicidal individuals will simply find some other way of committing suicide and therefore a safety net would not actually save lives.  Scientific studies examining means restrictions on suicides clearly indicate that lives will be saved if safety measures are put in place on the Golden Gate Bridge.  In addition, work done by Richard Seiden at UC Berkeley looking at individuals that have been stopped from jumping and those that have survived the jump has revealed that the vast majority (over 90%) do not go on to commit suicide by other means.  All of this research has been summarized nicely by the Bridge Rail Foundation, an organization devoted to installing a safety net and preventing suicides from the Golden Gate Bridge.

http://www.bridgerail.org/lives-can-be-saved/what-science-tells-us

Why has it taken so long when there has clearly been a need for a safety net?  The policy process is complex and it is difficult to say for certain but the media is referencing the recent increase in the number of suicides as motivation.  It can’t hurt that in 2012 the federal government passed legislation making federal funding available for the construction of safety barriers on bridges.  This is an interesting example of the complex interplay of science, misinformation, advocacy, and incentives in policy outcomes of public health consequence.  Too bad it took 60 years.

Suicides in the U.S. among 35-64 year olds from 1999-2010

28 May, 13 | by gtung

Earlier this month the Centers for Disease Control and Prevention (CDC) in the United States released one of their Morbidity and Mortality Weekly Reports highlighting statistics from the National Vital Statistics System that suggests that the suicide rate among adults age 35-64 years of age in the country have increase significantly from 1999-2010.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6217a1.htm?s_cid=mm6217a1_w

During the ten year period from 1999-2010 the age adjusted suicide rate among 35-64 year olds increased 28.4% from 13.7/100,000 in 1999 to 17.6/100,000 in 2010.  No statistically significant increase was observed among the younger or older age groups.  The report also showed that firearms remain the most prominent mechanism of suicide but that suicides via suffocation had increased 81.3% during the time period.  Whites remain the racial group with the highest suicide rate at 22.3/100,000 in 2010 but American Indians/Alaska Natives saw the greatest percentage increase (65.2%) with a rate of 11.2/100,000 in 1999 and 18.5/100,000 in 2010.

Exactly why this age group has experienced such a large increase is a topic that needs additional research but possible factors referenced by the CDC report highlight the economic downturn and possibly a cohort effect associated with the “baby boomer” generation.  Historically, suicide prevention activities have focused on youth and older adults.  While there is uncertainty regarding why the increase has taken place among this age group, the fact that is has highlights the need to ensure suicide prevention measures address the full life spectrum.

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