Suicide is a worldwide phenomenon. This review is based on a literature search of the World Health Organization (WHO) databases and PubMed. According to the WHO, in 2015, about 800,000 suicides were documented worldwide, and globally 78% of all completed suicides occur in low- and middle-income countries. Overall, suicides account for 1.4% of premature deaths worldwide. Differences arise between regions and countries with respect to the age, gender, and socioeconomic status of the individual and the respective country, method of suicide, and access to health care. During the second and third decades of life, suicide is the second leading cause of death. Completed suicides are three times more common in males than females; for suicide attempts, an inverse ratio can be found. Suicide attempts are up to 30 times more common compared to suicides; they are however important predictors of repeated attempts as well as completed suicides. Overall, suicide rates vary among the sexes and across lifetimes, whereas methods differ according to countries. The most commonly used methods are hanging, self-poisoning with pesticides, and use of firearms. The majority of suicides worldwide are related to psychiatric diseases. Among those, depression, substance use, and psychosis constitute the most relevant risk factors, but also anxiety, personality-, eating- and trauma-related disorders as well as organic mental disorders significantly add to unnatural causes of death compared to the general population. Overall, the matter at hand is relatively complex and a significant amount of underreporting is likely to be present. Nevertheless, suicides can, at least partially, be prevented by restricting access to means of suicide, by training primary care physicians and health workers to identify people at risk as well as to assess and manage respective crises, provide adequate follow-up care and address the way this is reported by the media. Suicidality represents a major societal and health care problem; it thus should be given a high priority in many realms.

https://www.mdpi.com/1660-4601/15/7/1425/pdf

Epidemiology of Suicide and the Psychiatric Perspective.

Although recent years have seen large decreases in the overall global rate of suicide fatalities, this trend is not reflected everywhere. Suicide and suicidal behaviour continue to present key challenges for public policy and health services, with increasing suicide deaths in some countries such as the USA. The development of suicide risk is complex, involving contributions from biological (including genetics), psychological (such as certain personality traits), clinical (such as comorbid psychiatric illness), social and environmental factors. The involvement of multiple risk factors in conveying risk of suicide means that determining an individual’s risk of suicide is challenging. Improving risk assessment, for example, by using computer testing and genetic screening, is an area of ongoing research. Prevention is key to reduce the number of suicide deaths and prevention efforts include universal, selective and indicated interventions, although these interventions are often delivered in combination. These interventions, combined with psychological (such as cognitive behavioural therapy, caring contacts and safety planning) and pharmacological treatments (for example, clozapine and ketamine) along with coordinated social and public health initiatives, should continue to improve the management of individuals who are suicidal and decrease suicide-associated morbidity. Suicide and suicidal behaviour continue to present key challenges for public policy and health services. This Primer discusses the global burden of suicide and suicidal behaviours, and provides an overview of our current understanding of the mechanisms of suicide, including risk factors for suicidal ideation and the transition from ideation to suicide attempt.

/pdf/suicide-and-suicide-risk-2mwsvcppvb.pdf

Suicide and suicide risk

In 1999, the publication of Kay Redfield Jamison's Night Falls Fast (see Injury Prevention , December 2000; 6 :312) catalyzed national reassessment of suicide causes, prevention, and control in the USA. The book encouraged researchers to help find more and effective ways to prevent suicides and provided a base for institutionalization on suicide prevention.

A National Strategy for Suicide Prevention: Goals and Objectives for Action is the result of a process led by the US …

https://injuryprevention.bmj.com/content/injuryprev/8/2/171.1.full.pdf

National Strategy for Suicide Prevention: Goals and Objectives for Action.

Traditional approaches to the prediction of suicide attempts have limited the accuracy and scale of risk detection for these dangerous behaviors. We sought to overcome these limitations by applying...

Predicting Risk of Suicide Attempts Over Time Through Machine Learning

Objective Cardiac rehabilitation (CR) is pivotal in preventing recurring events of myocardial infarction (MI). This study aims to investigate the effect of a smartphone-based home service delivery (Care Assessment Platform) of CR (CAP-CR) on CR use and health outcomes compared with a traditional, centre-based programme (TCR) in post-MI patients. Methods In this unblinded randomised controlled trial, post-MI patients were randomised to TCR (n=60; 55.7±10.4 years) and CAP-CR (n=60; 55.5±9.6 years) for a 6-week CR and 6-month self-maintenance period. CAP-CR, delivered in participants’ homes, included health and exercise monitoring, motivational and educational material delivery, and weekly mentoring consultations. CAP-CR uptake, adherence and completion rates were compared with TCR using intention-to-treat analyses. Changes in clinical outcomes (modifiable lifestyle factors, biomedical risk factors and health-related quality of life) across baseline, 6 weeks and 6 months were compared within, and between, groups using linear mixed model regression. Results CAP-CR had significantly higher uptake (80% vs 62%), adherence (94% vs 68%) and completion (80% vs 47%) rates than TCR (p Conclusions This smartphone-based home care CR programme improved post-MI CR uptake, adherence and completion. The home-based CR programme was as effective in improving physiological and psychological health outcomes as traditional CR. CAP-CR is a viable option towards optimising use of CR services. Trial registration number ANZCTR12609000251224.

https://heart.bmj.com/content/heartjnl/100/22/1770.full.pdf

Smartphone-based home care model improved use of cardiac rehabilitation in postmyocardial infarction patients: results from a randomised controlled trial

The national cost of suicides and suicide attempts in the United States in 2013 was $58.4 billion based on reported numbers alone. Lost productivity (termed indirect costs) represents most (97.1%) of this cost. Adjustment for under-reporting increased the total cost to $93.5 billion or $298 per capita, 2.1-2.8 times that of previous studies. Previous research suggests that improved continuity of care would likely reduce the number of subsequent suicidal attempts following a previous nonfatal attempt. We estimate a highly favorable benefit-cost ratio of 6 to 1 for investments in additional medical, counseling, and linkage services for such patients.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/sltb.12225

Suicide and Suicidal Attempts in the United States: Costs and Policy Implications.

Social determinants of health (SDoH) are the conditions in which people live and work that shape access to essential social and economic resources. Calls for healthcare systems to intervene on unmet social needs have stimulated several large-scale initiatives across the country. Yet, such activities are underway in the absence of a unifying conceptual framework outlining the potential mechanisms by which healthcare-based unmet social need interventions can improve health outcomes. Drawing on theoretical foundations and empirical evidence about the relationship between unmet social needs and health, the authors developed the OASIS (Outcomes from Addressing SDoH in Systems) conceptual framework to map the known and hypothesized pathways by which unmet social need screening and referral interventions may impact outcomes. The OASIS framework may help guide policy makers, healthcare system leaders, clinicians, and researchers to utilize a more unified approach in their efforts to implement and evaluate unmet social need interventions and thus foster the development of an evidence base to inform healthcare systems to more effectively mitigate the consequences of unmet social needs. Adopting an overarching conceptual framework for addressing unmet social needs by healthcare systems holds promise for better achieving health equity and promoting health at the individual and population levels.

/pdf/addressing-social-determinants-of-health-within-healthcare-33q79kbw4t.pdf

Addressing Social Determinants of Health Within Healthcare Delivery Systems: a Framework to Ground and Inform Health Outcomes.

Background The Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences (PRAPARE) is a nationally recognized standardized protocol that goes beyond medical acuity to account for patients' social determinants of health (SDH). Aims We described the magnitude of patient SDH barriers at health centers. Methods Health centers across three PRAPARE implementation cohorts collected and submitted PRAPARE data using a standardized data reporting template. We analyzed the scope and intensity of SDH barriers across the cohorts. Results Nationally, patients faced an average of 7.2 out of 22 social risks. The most common SDH risks among all three cohorts were limited English proficiency, less than high school education, lack of insurance, experiencing high to medium-high stress, and unemployment. Conclusions Findings demonstrated a high prevalence of SDH risks among health center patients that can be critical for informing social interventions and upstream transformation to improve health equity for underserved populations.

Collecting Social Determinants of Health Data in the Clinical Setting: Findings from National PRAPARE Implementation.

PURPOSE: Despite well-established benefits, only 10% to 20% of eligible candidates in the United States currently use formal cardiac rehabilitation (CR) services. Existing studies identify both patient- and provider-level barriers to physician referral and patient uptake. This study, which was driven by new evidence indicating that utilization rates vary enormously from state to state, within states, and from hospital to hospital, explores the relationship between system-level factors and CR use. METHODS: Using a qualitative design with semistructured questions, we telephone-interviewed both directors of CR facility programs and presidents of CR state associations operating in states with high and low rates of CR use. We explored the political and cultural environment in which CR facilities operate and the technical capacity to secure referrals and convert referrals to enrollment. RESULTS: We identified 4 system-level factors that may help explain regional variation in CR use. These included the degree of automation and assertiveness around securing CR referrals, level of integration of CR within the hospital setting and physician community, relationship to other CR facilities, and capacity constraints. CONCLUSIONS: As some of the identified system-level factors can be altered by public and hospital-level policy, study results suggest opportunities for interventions and directions for future research that could increase the use of CR.

System-level factors and use of cardiac rehabilitation.

https://people.brandeis.edu/~shepard/AppendixB_2.pdf

Appendix B.2 Of the Evaluation of Lifestyle Modification and Cardiac Rehabilitation in Medicare Beneficiaries* SYSTEM LEVEL FACTORS AND USE OF CARDIAC REHABILITATION**

Deborah Gurewich

Papers

Suicide and Suicidal Attempts in the United States: Costs and Policy Implications.

Addressing Social Determinants of Health Within Healthcare Delivery Systems: a Framework to Ground and Inform Health Outcomes.

Collecting Social Determinants of Health Data in the Clinical Setting: Findings from National PRAPARE Implementation.

System-level factors and use of cardiac rehabilitation.

Appendix B.2 Of the Evaluation of Lifestyle Modification and Cardiac Rehabilitation in Medicare Beneficiaries* SYSTEM LEVEL FACTORS AND USE OF CARDIAC REHABILITATION**