Suicidal behaviour across the African continent:a review of the literature

Background: Suicide is a major cause of premature mortality worldwide, but data on its epidemiology in Africa, the world’s second most populous continent, are limited. Methods: We systematically reviewed published literature on suicidal behaviour in African countries. We searched PubMed, Web of Knowledge, PsycINFO, African Index Medicus, Eastern Mediterranean Index Medicus and African Journals OnLine and carried out citation searches of key articles. We crudely estimated the incidence of suicide and suicide attempts in Africa based on country-specific data and compared these with published estimates. We also describe common features of suicide and suicide attempts across the studies, including information related to age, sex, methods used and risk factors. Results: Regional or national suicide incidence data were available for less than one third (16/53) of African countries containing approximately 60% of Africa’s population; suicide attempt data were available for <20% of countries (7/53). Crude estimates suggest there are over 34,000 (inter-quartile range 13,141 to 63,757) suicides per year in Africa, with an overall incidence rate of 3.2 per 100,000 population. The recent Global Burden of Disease (GBD) estimate of 49,558 deaths is somewhat higher, but falls within the inter-quartile range of our estimate. Suicide rates in men are typically at least three times higher than in women. The most frequently used methods of suicide are hanging and pesticide poisoning. Reported risk factors are similar for suicide and suicide attempts and include interpersonal difficulties, mental and physical health problems, socioeconomic problems and drug and alcohol use/ abuse. Qualitative studies are needed to identify additional culturally relevant risk factors and to understand how risk factors may be connected to suicidal behaviour in different socio-cultural contexts. Conclusions: Our estimate is somewhat lower than GBD, but still clearly indicates suicidal behaviour is an important public health problem in Africa. More regional studies, in both urban and rural areas, are needed to more accurately estimate the burden of suicidal behaviour across the continent. Qualitative studies are required in addition to quantitative studies

Parents with recurrent depression: heterogeneity in course, severity and symptoms as risks for offspring depression

Depression is a significant global problem and is among the leading causes of disability worldwide. Depression in children and adolescents is associated with wide-ranging impairments and often marks the beginning of a lifelong, chronic illness. Early treatment and prevention of depression is therefore a major public health concern. Parental depression is one of the most consistently identified risk factors for depression in young people. Although depression is a highly heterogeneous disorder, most studies examining cross-generational depression risk have simply dichotomised parents into ‘depressed’ and ‘non-depressed’ groups and clinical characteristics beyond diagnostic status are rarely presented. In this thesis I examine how differences in clinical features of parental depression including variations in depression course, severity, timing and symptom manifestation differentially relate to offspring depression risk. Data were drawn from the Early Prediction of Adolescent Depression study. A three-wave longitudinal study of the offspring of 337 parents with a history of recurrent unipolar depression. Within this high risk group of offspring, specific clinical features of parental depression were identified that may serve as useful markers of current and/or future offspring depression risk. These included a recent episode of clinical depression, an episode involving severe impairment or hospitalisation and symptoms of appetite or weight loss. In addition, findings from this thesis highlight that there is considerable variability in the course of parent depression over time and suggest that any persistent symptoms of depression in parents, even those at low levels, may be clinically important in indexing offspring risk for depression symptoms. vi Findings highlight the importance of considering clinical characteristics of depression in parents beyond diagnostic status when examining cross-generational depression risk. The identification of subgroups of offspring who are at greatest risk can help ensure that clinical services and preventative interventions are targeted to those with greatest need

An ecological study of temporal trends in ‘deaths of despair’ in England and Wales

PURPOSE: There is growing interest in the concept of ‘deaths of despair’ (DoD)—defined as deaths from three causes: suicide, drug poisoning, and alcohol-related conditions—as a more comprehensive indicator of the impact of psychological distress on mortality. The purpose of this study is to investigate the degree of commonality in trends and geographic patterning of deaths from these causes in England and Wales. METHODS: WHO mortality data were used to calculate age-standardised, sex-specific temporal trends in DoD mortality and in mortality from suicide, drug poisonings, and alcohol-related conditions in England and Wales, 2001–2016. Three-year average crude rates were calculated for English local authorities for 2016–2018 and associations between rates were assessed using Spearman’s rank correlation. RESULTS: Between 2001 and 2016, the DoD mortality rate increased by 21·6% (males) and 16·9% (females). The increase was largely due to a rise in drug poisoning deaths, with limited tracking between trends in mortality by each cause. DoD mortality risk was highest in middle-aged people; there were rises in all age groups except 15–24 year old males and 65 + females. There were strong positive correlations (r = 0.66(males) and 0.60(females)) between local authority-area drug poisoning and alcohol-specific mortality rates in 2016–2018. Correlations of these outcomes with suicide were weaker (r = 0.29–0.54). CONCLUSIONS: DoD mortality is increasing in England and Wales but there is limited evidence of commonality in the epidemiology of cause-specific mortality from the component causes of DoD (suicide, drug poisoning and alcohol-related conditions), indicating the need for tailored prevention for each outcome

Trends in the recording of anxiety in UK primary care:a multi-method approach

PURPOSE: Anxiety disorders are common. Between 1998 and 2008, in the UK, GP recording of anxiety symptoms increased, but the recording of anxiety disorders decreased. We do not know whether such trends have continued. This study examined recent trends in the recording of anxiety and explored factors that may influence GPs’ coding of anxiety. METHODS: We used data from adults (n = 2,569,153) registered with UK general practices (n = 176) that contributed to the Clinical Practice Research Datalink between 2003 and 2018. Incidence rates and 95% confidence intervals were calculated for recorded anxiety symptoms and diagnoses and were stratified by age and gender. Joinpoint regression was used to estimate the years trends changed. In addition, in-depth interviews were conducted with 15 GPs to explore their views and management of anxiety. Interviews were audio-recorded, transcribed verbatim and analysed thematically. RESULTS: The incidence of anxiety symptoms rose from 6.2/1000 person-years at risk (PYAR) in 2003 to 14.7/1000 PYAR in 2018. Between 2003 and 2008, the incidence of anxiety diagnoses fell from 13.2 to 10.1/1000 PYAR; markedly increasing between 2013 and 2018 to 15.3/1000 PYAR. GPs mentioned that they preferred using symptom codes to diagnostic codes to avoid assigning potentially stigmatising or unhelpful labels, and commented on a rise in anxiety in recent years, especially in young adults. CONCLUSION: Recent increases in the recording of both anxiety diagnoses and symptoms may reflect increased presentation to primary care, especially in young adults. There is a clear need to understand the reasons for this, and this knowledge may be critical in the prevention and treatment of anxiety. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00127-021-02131-8

Social media use and social connectedness among adolescents in the United Kingdom:a qualitative exploration of displacement and stimulation

BACKGROUND: Connectedness to family and peers is a key determinant of adolescent mental health. Existing research examining associations between social media use and social connectedness has been largely quantitative and has focused primarily on loneliness, or on specific aspects of peer relationships. In this qualitative study we use the displacement hypothesis and the stimulation hypothesis as competing theoretical lenses through which we examine the complex relationship between social media use and feelings of connectedness to family and peers. METHODS: In-depth paired and individual interviews were conducted with twenty-four 13–14-year-olds in two inner-city English secondary schools. Interviews were transcribed verbatim, coded and thematically analysed. RESULTS: Analysis identified four themes: (i) ‘Displacement of face-to-face socialising’ (ii) ‘Social obligations’ (iii) ‘(Mis)Trust’ and (iv) ‘Personal and group identity’. Results indicated stronger support for the stimulation hypothesis than the displacement hypothesis. We found evidence of a complex set of reciprocal and circular relationships between social media use and connectedness consistent with a ‘rich-get-richer’ and a ‘poor-get-poorer’ effect for family and peer connectedness – and a ‘poor-get-richer’ effect in peer connectedness for those who find face-to-face interactions difficult. CONCLUSION: Our findings suggest that parents should take a measured approach to social media use, providing clear guidance, promoting trust and responsible time management, and acknowledging the role of social media in making connections. Understanding and sharing in online experiences is likely to promote social connectedness. Supporting young people to negotiate breathing space in online interactions and prioritising trust over availability in peer relationships may optimise the role of social media in promoting peer connectedness. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-021-11802-9

Prevalence and patterns of antidepressant switching amongst Primary Care patients in the UK

Objective: Non-response to antidepressant treatment is a substantial problem in primary care, and many patients with depression require additional second-line treatments. This study aimed to examine the prevalence and patterns of antidepressant switching in the UK, and identify associated demographic and clinical factors. Method: Cohort analysis of antidepressant prescribing data from the Clinical Practice Research Datalink, a large, anonymised UK primary care database. The sample included 262,844 patients who initiated antidepressant therapy between 1 January 2005 and 31 June 2011. Results: 9.3% of patients switched to a different antidepressant product, with most switches (60%) occurring within 8 weeks of the index date. The proportion switching was similar for selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants and other antidepressants (9.3%, 9.8% and 9.2%, respectively). Most switches were to an SSRI (64.5%), and this was the preferred option regardless of initial antidepressant class. Factors predictive of switching included male gender, age, and history of self-harm and psychiatric illness. Conclusion: Over one in every 11 patients who initiates antidepressant therapy will switch medication, suggesting that initial antidepressant treatment has been unsatisfactory. Evidence to guide choice of second-line treatment for individual patients is currently limited. Additional research comparing different pharmacological and psychological second-line treatment strategies is required in order to inform guidelines and improve patient outcomes. </jats:sec