National Suicide Research Foundation Research Programme and Priorities Dr Ella Arensman 22nd January 2009
National Suicide Research Foundation Research Strategy 2009 2010 General objective: To produce a nationally and internationally recognised body of reliable knowledge from a multidisciplinary perspective on the risk and protective factors associated with suicidal behaviour. Outcome: A solid evidence base for policy development and intervention in the prevention of suicide and the management of patients presenting with deliberate self harm. I Epidemiology of deliberate self harm and suicide: 10 studies II Efficacy of intervention and prevention programmes for deliberate self harm and suicide, and attitudes towards suicidal behaviour and its prevention: 9 studies
National Suicide Research Foundation Objectives NSRF Main objective: Research into the risk and protective factors of suicidal behaviour to support intervention and prevention of suicidal behaviour and the management of people engaging in deliberate self harm Research related tasks: -Advisory role - Training / education - Supervision of students and trainees
Research priorities NSRF 2009-2010 In line with Reach Out, Irish National Strategy for Action on Suicide Prevention (2005-2014) Suicide ca 500 p.a. Deliberate self harm medically treated ca. 11,000 p.a. - Form 104 study - Development Suicide Support and Information System - - - Nat. Registry of DSH - Pilot Registry NI - Injury Database - Standardised assessment of DSH Hidden cases of Deliberate self harm ca. 60,000 p.a. - OSPI-Europe - SAYLE - Mind Yourself
National Registry of Deliberate Self Harm (NRDSH) HSE Dublin/ Mid-Leinster Coverage: All 40 Hospital Emergency departments in Ireland HSE Dublin/ North East HSE South HSE West
National Registry of Deliberate Self Harm (NRDSH) - Methodology Systematic monitoring of attendances to hospital emergency departments Identification of deliberate self harm presentations in accordance with an internationally-recognised definition (Platt et al, 1992) Data registration officers operate independently of the hospitals Follow a standard operating procedures manual Show a high level of agreement in case-ascertainment Data items: Standard sociodemographic characteristics, characteristics of self harm act and aftercare
Deliberate self harm in Ireland 2002-2007 Person-based rates per 100,000 by gender Year Women Men Rate % difference Rate % difference 2002 237-167 - 2003 241 +2% 177 +7% 2004 233-4% 170-4% 2005 229-1% 167-2% 2006 210-8% 160-4% 2007 216 +3% 163 +2% Average annual number of DSH presentations: N=10,899; Average number of persons involved: N=8,542 ; Ratio episodes: persons: annually 2002-2007: 1.25 to 1.28
10-14yrs 75-79yrs 15-19yrs 20-24yrs 25-29yrs 30-34yrs 35-39yrs 40-44yrs 45-49yrs 50-54yrs 55-59yrs 60-64yrs 65-69yrs 70-74yrs 80-84yrs 85yrs+ 650 600 550 500 450 400 350 300 250 200 150 100 50 0 Incidence of DSH in Ireland by age and gender, 2006-2007 Person-based rates per 100,000 Men Women Age group Rate per 100,000
Main Method of DSH, 2002-2007 24% 3% 5% 2% 1% Men Women 2% 16% 4% 2% 2% 1% 60% 1% 76% Overdose Alcohol Poisoning Hanging Drowning Cutting Other Alcohol was involved in 46% and 38% of male and female DSH acts, respectively p<.01 Women: N=34,213; Men: N=26,254
Repetition of DSH by gender 24 months prospectively following index DSH act 22 20 Cumulative % who repeated 18 16 14 12 10 8 6 4 Male Female 2 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Months since index act Kaplan-Meier survival analysis 2002-2007
Repetition of DSH 6 months prospectively by method of index DSH act and gender Women Men 20 Risk of repeated DSH (%) 18 16 14 12 10 8 6 4 2 0 Cutting Hanging Overdose Drowning Poisoning p<.01 Method of index DSH act
Repetition of DSH 6 months prospectively by type of aftercare following index DSH act and gender Women Men 20 Risk of repeated DSH (%) 18 16 14 12 10 8 6 4 2 0 Psychiatric admission Refused/Left unseen General admission Not admitted p<.01 Type of aftercare following index DSH act
Participating regions in the Network on International Collaboration on Evidence in Suicide Prevention (NICE-SP) Sor-Trondelag Manchester Umea Vilnius Limerick Gent Ljubljana Cork Oxford Padua
Methodology Data collection in 8 regions in 6 European countries Patients, aged > 15 years presenting to hospital following DSH from hospital catchment area Standardised method of data collection, developed as a standard for European regions collaborating in the WHO Multicentre Study on Suicidal behaviour (Platt et al, 1992; Schmidtke et al, 1996; Schmidtke et al, 2004): Demographic variables and characteristics of the DSH episode. All regions except Manchester participated in the WHO Multicentre study between 1989 and 2000. Data on suicides for the countries involved was obtained from the national statistics offices in each country (ICD9 / ICD10).
Methodology ctd. Start monitoring of DSH: Oxford, Gent, Sor-Trondelag, Umea, Padua: 1989 Cork, Limerick, Ljubljana: 1995 Manchester: 1998 Total number of DSH episodes 1989-2003: N=44,495 Data analysis: - Annual person-based rates of DSH agestandardised - Three-year rolling averages
Deliberate Self Harm: person-based three-year rolling average rates per 100,000 for women in 8 European regions Rate per 100,000 Smoothed Local Suicide Rate 550 500 450 400 350 300 250 200 150 100 50 Gent Oxford Sor-Trondelag Umea Limerick Cork Ljubljana Manchester 1989 1991 1993 1995 1997 1999 2001 2003 Year Year
550 Deliberate Self Harm: person-based three-year rolling average rates per 100,000 for men in 8 European regions 500 Rate per 100,000 Smoothed Local Suicide Rate 450 400 350 300 250 200 150 100 50 Gent Oxford Sor-Trondelag Umea Limerick Cork Ljubljana Manchester 1989 1991 1993 1995 1997 1999 2001 2003 Year Year
Suicide: three-year rolling average rates per 100,000 for men ( ) and women( ) 35 30 Rate per 100,000 25 20 15 10 5 0 1989 1994 1999 2003 1989 1994 1999 2003 1989 1994 1999 2003 1989 1994 1999 2003 1989 1994 1999 2003 Flanders Ir ela n d Norway Sweden UK-EW Year Year Year SuicideRate Rate per 100,000
Suicide: three-year rolling average rates per 100,000 for men ( ) and women( ) Slovenia 60 55 50 Rate per SuicideRate 100,000 45 40 35 30 25 20 15 10 5 0 1989 1991 1993 1995 1997 1999 2001 2003 Y e a r Year
For males a significant association was found between the rate of change in DSH rates at regional level and suicide rates nationally (r=0.71, p<0.05), but not for females (r=0.57, p=0.14)
Summary Trends in DSH rates varied considerably across the different European regions and by gender DSH rates were consistently higher for women, with highest rates in Manchester, Oxford and Gent In most regions similar trends in DSH were found for female and male DSH rates Across the European regions there was greater temporal variation in both genders in the incidence of DSH compared to the temporal variation in the incidence of suicide
Summary ctd. Regions with high DSH rates did not consistently show a pattern of high suicide rates at national level However, in males a significant association was found between the rate of change in DSH rates at regional level and national suicide rates The extremely high suicide rates among males in Slovenia may be particularly related to high levels of alcohol abuse and access to firearms (Bilban and Skibin, 2005)
Contact details Dr Ella Arensman National Suicide Research Foundation 1 Perrott Avenue College Road Cork Ireland T: 00 353 (0)21 4277499 E-mail: ella.nsrf@iol.ie