Demographic and Psychological Factors and Preparation for Earthquakes

New Zealand, like many countries, is at risk from a number of natural disasters including flooding, volcanoes, and earthquakes. The risk of exposure to such disasters over the course of a lifetime is substantial (Norris, 1992). Despite this, many New Zealanders are unprepared for the consequences of a natural disaster; nearly a quarter of New Zealand homes have flaws which could see them seriously damaged or detached from their foundations in a major earthquake (Ansell & Taber, 1996). Recent research suggests that psychological variables contribute to people's lack of preparation for natural disasters. A limitation, however, of much of this research has been the lack of attention paid to the psychometric quality of the instruments used to measure key constructs. The present investigation aimed to examine the relationships between different dimensions of personality and earthquake preparation in a large sample of Wellington residents using psychometrically sound measures. Measures of locus of control, risk, and earthquake preparation were first evaluated in a series of studies using both university students and Wellington residents. These questionnaires were then administered, along with items pertaining to the construct of unrealistic optimism, to a total of 358 Wellington residents. The results showed that locus of control, risk precaution, home ownership, and length of residence were significant predictors of earthquake preparation. Moreover, people exhibited evidence of unrealistic optimism, as demonstrated by both a belief that they were better prepared for a major earthquake than an acquaintance, or other Wellingtonians, and by a belief that they were personally less likely than others to suffer injury in a major earthquake. The implications of these results for emergency managers are discussed and several recommendations are made

Declines in the Lethality of Suicide Attempts Explain the Decline in Suicide Deaths in Australia

Background: To investigate the epidemiology of a steep decrease in the incidence of suicide deaths in Australia. Methods: National data on suicide deaths and deliberate self-harm for the period 1994–2007 were obtained from the Australian Institute of Health and Welfare. We calculated attempt and death rates for five major methods and the lethality of these methods. Negative binomial regression was used to estimate the size and significance of method-specific time-trends in attempts and lethality. Results: Hanging, motor vehicle exhaust and firearms were the most lethal methods, and together accounted for 72% of all deaths. The lethality of motor vehicle exhaust attempts decreased sharply (RR = 0.94 per year, 95% CI 0.93–0.95) while the motor vehicle exhaust attempt rate changed little; this combination of motor vehicle exhaust trends explained nearly half of the overall decline in suicide deaths. Hanging lethality also decreased sharply (RR = 0.96 per year, 95% CI 0.956–0.965) but large increases in hanging attempts negated the effect on death rates. Firearm lethality changed little while attempts decreased. Conclusion: Declines in the lethality of suicide attempts–especially attempts by motor vehicle exhaust and hanging–explain the remarkable decline in deaths by suicide in Australia since 1997

The Mortality After Release from Incarceration Consortium (MARIC) study: Strengths of international data linkage

Introduction Adults released from incarceration experience complex physical and mental health problems, and are at markedly increased risk of preventable death. Despite this, not enough is known about the granular epidemiology of mortality in this population to inform development of targeted, evidence-based responses. Objectives and Approach We created the Mortality After Release from Incarceration Consortium (MARIC), a multi-disciplinary collaboration from 12 countries representing 30 cohorts of adults with a history of incarceration. The combined sample size is 1,210,168, with 58,840 deaths recorded over 8,261,743 person-years of follow-up time. In this protocol paper, using a two-step, individual participant data meta-analysis (IPDM-A) methodology involving 22 MARIC cohorts, we calculated 1) a crude mortality rate (CMR; with 95% confidence intervals) for each individual cohort over the first 84 days (12 weeks) following release; and 2) a combined, meta-analysed CMR for the same period. Results Of 1,704,208 individual releases, we observed 4,018 deaths over the first 84 days. The overall CMR over the first 84 days after release was 1610.97 deaths per 100,000 person-years (95% CI: 1263.4 - 1958.5). The rate was highest on the day of release (5768.0; 95% CI: 3296.5 - 8239.4), which was significantly higher than on days 4-84. Conclusion/Implications Adults released from incarceration were at an acutely increased risk of death on the day of release, and this risk remained elevated for at least the first 12 weeks. The MARIC study will provide decisive and empirical evidence to guide clinicians and policy makers in reducing mortality in this marginalize

Employment transitions and mental health in a cohort of 45 years and older Australians

Background: This study investigated the associations between employment transitions and psychological distress among a cohort of 45 years and older Australians. Methods: This study was based on the 45 and Up Study, a large prospective cohort of participants aged 45 years and older (N = 267,153), followed up over the period 2006–2015. The risk of psychological distress was compared between various employment transitions categories by specifying an ordered logistic regression model adjusting for confounders. Results: Compared to participants who remained employed at baseline and follow-up, higher psychological distress was found among those who transitioned from being employed to unemployed (OR = 2.68, 95%CI 2.13–3.33) and to not being in the labour force or retired (OR = 2.21, 95%CI 1.85–2.62). Higher psychological distress was also evident among those who remained unemployed from baseline to follow-up (OR = 2.00, 95%CI 1.10–3.43), and those who transitioned from being retired to being unemployed (OR = 1.55, 95%CI 1.03–2.27). Conversely, lower psychological distress was found among those who transitioned from being unemployed to being employed (OR = 0.35, 95%CI 0.25–0.51). In general, lower psychological distress was found among ‘positive’ employment transitions (transitioning to being employed or retired). Conclusions: Policies focussing on re-employment in older age, as well as unemployment schemes, might be helpful in reducing psychological distress among middle-and old-age Australians

Self-harm following release from incarceration: Patterns and measurement issues

Introduction Despite an elevated prevalence of self-harm in the incarcerated adult population, little is known about patterns of self-harm following release from prison. Objectives and Approach Baseline self-report interviews with 1315 adults immediately prior to release from prison in Queensland, Australia, combined with interrogation of linked health data from >3750 post-release emergency department presentations, >2000 ambulance attendances, and corrections data during periods of re-incarceration. Results Approximately 5% of all contacts with medical emergency services following release from prison resulted from self-harm. These were associated with being Indigenous, having a lifetime history of a mental disorder and having been identified by prison staff as being at risk of self-harm. Agreement between self-reported self-harm and medically-verified episodes of self-harm was poor. Conclusion/Implications Emergency services contacts resulting from self-harm following release from prison are common and represent an opportunity for tertiary intervention for self-harm. Our findings suggest that a self-reported history of self-harm should not be considered a reliable indicator of prior self-harm, or of future self-harm risk, in incarcerated adults

Suicide among those who use mental health services: Suicide risk factors as evidenced from contact-based characteristics in Victoria

ObjectiveThe majority of suicide decedents have had contact with health services in the months before their death. Contacts for mental health services present potential suicide prevention opportunities. This study aims to compare contact-based characteristics among suicide decedents and living controls in the year subsequent to clinical mental health contact with the public health system in Victoria, Australia.MethodsA population-based nested case-control study of those who had mental health-related hospital and community contacts with the public health system was conducted. Cases (suicide decedents) were age and gender-matched to living controls (suicide non-decedents). These records were linked to records of suicides that occurred in the 12 months following the health service contact, between January 1, 2011, and December 31, 2016. Victorian residents aged 10 years and above were selected at the time of contact (483,933 clients). In the study population, conditional logistic regression models were used to assess the relationship between contact-based characteristics and suicide. Socio-demographics and mental health-related hospital and community contact data was retrieved from the Victorian Admitted Episodes Dataset, the Victorian Emergency Minimum Dataset and the Public Clinical Mental Health database and suicide data from the Victorian Suicide Register.ResultsDuring a six-year period, 1,091 suicide decedents had at least one mental health contact with the public health system in the 12 months preceding the suicide. Overall, controls used more mental health services than cases; however, cases used more mental health services near the event. The relationship between the type of service and suicide differed by service type: hospital admissions and emergency department presentations had a significant positive association with suicide with an OR of 2.09 (95% CI 1.82–2.40) and OR of 1.13 (95% CI 1.05–1.22), and the effect size increased as the event approached, whereas community contacts had a significant negative association with an OR of 0.93 (95% CI 0.92–0.94), this negative association diminished in magnitude as the event approached (OR∼1).ConclusionSuicide decedents had less contact with mental health services than non-decedents; however, evidence suggests suicide decedents reach out to mental health services proximal to suicide. An increase in mental health service contact by an individual could be an indication of suicide risk and therefore an opportunity for intervention. Further, community level contact should be further explored as a possible prevention mechanism considering the majority of suicide decedents do not access the public clinical mental health services

Police-reported suicides during the first 16 months of the COVID-19 pandemic in Ecuador:A time-series analysis of trends and risk factors until June 2021

Summary: Background: There are widespread concerns that the COVID-19 pandemic may increase suicides. Few studies have analysed effects beyond the pandemic's early months or examined changes in known suicide risk factors. Methods: Using time series models fit with Poisson regression, we analysed monthly police-reported suicides in Ecuador from January 2015 to June 2021. Treating March 2020 as the start of the pandemic, we calculated rate ratios (RRs) comparing the observed to the expected number of suicides for the total population and by age and sex groups. We investigated changes in risk factors, precipitants, geographic distribution, and suicide methods. Findings: There was no evidence that suicide rates were higher than expected during the pandemic (RR 0·97 [95% CI 0·92–1·02]). There was some evidence of fewer than expected male suicides (RR 0·95 [95% CI 0·90–1·00]). The proportion of suicides occurring in urban and coastal areas increased but decreased amongst indigenous and other minorities. The proportions of suicides with evidence of alcohol consumption, disability, and amongst married and cohabiting individuals decreased, whereas suicides where mental health problems were considered contributory increased. There were relative increases in the proportion of suicides by hanging but decreases in self-poisoning and other suicide methods. Interpretation: The pandemic did not appear to adversely impact overall suicide numbers nationwide during the first 16 months of the pandemic. Reduced alcohol consumption may have contributed to the decline in male suicides. Funding: None

Complaint risk among mental health practitioners compared with physical health practitioners::A retrospective cohort study of complaints to health regulators in Australia

Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. To understand complaint risk among mental health practitioners compared with physical health practitioners. Design Retrospective cohort study, using incidence rate ratios (IRRs) to analyse complaint risk and a multivariate regression model to identify predictors of complaints. Setting National study using complaints data from health regulators in Australia. Participants All psychiatrists and psychologists (a € mental health practitioners\u27) and all physicians, optometrists, physiotherapists, osteopaths and chiropractors (a € physical health practitioners\u27) registered to practice in Australia between 2011 and 2016. Outcome measures Incidence rates, source and nature of complaints to regulators. Results In total, 7903 complaints were lodged with regulators over the 6-year period. Most complaints were lodged by patients and their families. Mental health practitioners had a complaint rate that was more than twice that of physical health practitioners (complaints per 1000 practice years: psychiatrists 119.1 vs physicians 48.0, p\u3c0.001; psychologists 21.9 vs other allied health 7.5, p\u3c0.001). Their risk of complaints was especially high in relation to reports, records, confidentiality, interpersonal behaviour, sexual boundary breaches and the mental health of the practitioner. Among mental health practitioners, male practitioners (psychiatrists IRR: 1.61, 95% CI 1.39 to 1.85; psychologists IRR: 1.85, 95% CI 1.65 to 2.07) and older practitioners (≥65 years compared with 36-45 years: psychiatrists IRR 2.37, 95% CI 1.95 to 2.89; psychologists IRR 1.78, 95% CI 1.47 to 2.14) were at increased risk of complaints. Conclusions Mental health practitioners were more likely to be the subject of complaints than physical health practitioners. Areas of increased risk are related to professional ethics, communication skills and the health of mental health practitioners themselves. Further research could usefully explore whether addressing these risk factors through training, professional development and practitioner health initiatives may reduce the risk of complaints about mental health practitioners