Biomedical subjects

Greg Carter

Publications and source records attributed to Greg Carter.

15 recordsLinked to original sources

PubMed2006

Divergent trends in suicide by socio-economic status in Australia.

OBJECTIVES: This study investigated secular trends in socio-economic status (SES) differentials in Australian suicide (1979-2003), which includes overall declines in male suicide from 1998. METHOD: Suicide rates were stratified by approximate equal-population quintiles of area-based SES for the period 1979-2003 and examined across five quinquennia, centred on each Australian Census from 1981 to 2001, to determine if (1) SES differentials in suicide have persisted over time, and (2) if SES differentials have widened or narrowed. Suicide rates (per 100,000) were adjusted for confounding by sex, age, country-of-birth, and urban-rural residence using Poisson regression models, and secular changes in SES differentials were assessed using trend tests on suicide rate ratios (low to high SES quintiles). RESULTS: Socio-economic status (SES) differentials persisted across the study period for both males and females after adjusting for the effects of age, migrant status, and urban-rural residence, with the largest differences between low and high SES groups evident in males, and especially young males (20-34 years). For males, suicide rates increased significantly in all SES groups until 1998, before diverging significantly in the most recent 5-year period, particularly in younger males (P<0.0001). In young males, suicide rates in the most recent period increased in the low SES group from 44.8 in 1994-1998 to 48.6 in 1999-2003 (an 8% increase). In contrast, suicide rates in the middle SES group decreased from a peak of 37.3 to 33.5 (a 10% decrease), and in the high SES group from a peak of 33.0 to 27.9 (a 15% decrease). A similar statistically significant divergence of a lesser magnitude was also evident in all age males and younger females (20-34 years). CONCLUSION: This study shows that SES differentials in suicide persisted in Australia for most of the period 1979-2004. The decline in suicide in young males in the most recent quinquennium was limited to middle and high SES groups, while the low SES group displayed a continued increase. The continued increase in suicide in low SES males has implications for social and economic intervention and suicide control programs.

Adolescent↗

PubMed2005

Mental health and socio-economic variations in Australian suicide.

This paper investigates the relationship between suicide rates and prevalence of mental disorder and suicide attempts, across socio-economic status (SES) groups based on area of residence. Australian suicide data (1996-1998) were analysed in conjunction with area-based prevalences of mental disorder derived from the National Survey of Mental Health and Well-Being (1997). Poisson regression models of suicide risk included age, quintile of area-based SES, urban-rural residence, and country of birth (COB), with males and females analysed separately. Analysis focussed on the association between suicide and prevalences of (ICD-10) affective disorders, anxiety disorders, substance use disorders and suicide attempts by SES group. Prevalences of other psychiatric symptomatology, substance use problems, health service utilisation, stressful life-events and personality were also investigated. Significant increasing gradients were evident from high to low SES groups for prevalences of affective disorders, anxiety disorders (females only), and substance use disorders (males only); sub-threshold drug and alcohol problems and depression; and suicide attempts and suicide (males only). Prevalences of mental disorder, other sub-threshold mental health items and suicide attempts were significantly associated with suicide, but in most cases associations were reduced in magnitude and became statistically non-significant after adjustment for COB, urban-rural residence, and SES. For male suicide the relative risk (RR) in the lowest SES group compared to the highest was 1.40 (95% CI 1.29-1.52, p<0.001) for all ages, and 1.46 (95% CI 1.27-1.67, p<0.001) for male youth (20-34 years). This relationship was not substantially modified in males when regression models included prevalences of affective disorders, and other selected mental health variables and demographic factors. From a population perspective, SES remained significantly associated with suicide after controlling for the prevalence of mental disorders and other psychiatric symptomatology. Mental conditions and previous suicidal behaviour may play an intermediary role between SES and suicide, but this study suggests that an independent relationship between suicide and SES also exists.

Adult↗

PubMed2005

Repeated self-poisoning: increasing severity of self-harm as a predictor of subsequent suicide.

BACKGROUND: Prediction of suicide risk is difficult in clinical practice. AIMS: To identify changes in clinical presentation predictive of suicide in patients treated for repeated episodes of self-poisoning. METHOD: A nested case-control study used the Hunter Area Toxicology Service database to identify exposure variables and the National Death Index to identify suicide. Cases were patients who had hospital treatment on more than one occasion between 15 January 1987 and 31 December 2000. RESULTS: There were 31 cases, for which 93 controls were selected. Study variables associated with an increased risk of subsequent suicide were an increase in the number of drugs ingested (odds ratio 2.59, 95% CI 1.48-4.51), an increase in the dose ingested (OR 1.33, 95% CI 1.01-1.76), an increase in coma score (OR 1.71, 95% CI 1.11-2.66), a decrease in Glasgow Coma Score (OR 1.21, 95% CI 1.03-1.43) and an increase in drug or alcohol misuse (OR 2.33, 95% CI 1.06-5.10). CONCLUSIONS: Patients who have escalating severity of self-poisoning episodes are at high risk of completed suicide.

Adolescent↗

PubMed2005

Social and psychiatric influences on urban-rural differentials in Australian suicide.

The purpose of this study was to investigate urban-rural differentials in Australian suicide rates, and to examine influences that previously have remained largely speculative. Suicide rates for males (all ages and young adults) were significantly higher in rural areas compared to urban areas. Urban-rural suicide rate differences in males were rendered nonsignificant after adjustment for migrant and area socioeconomic status. Adjusting for mental disorder prevalence, in addition to migrant status, reduced the excess suicide risk in rural areas; the excess was reduced further with addition of mental health service utilization. The implications of this study are that socioeconomic circumstances in rural populations contribute to higher male suicide rates compared to urban areas, but these conditions may be partly mediated by mental disorder prevalence and mental health service utilization.

Adolescent↗

PubMed2004

Risk factors for suicide and other deaths following hospital treated self-poisoning in Australia.

OBJECTIVE: To analyze the risk factors for suicide, premature death and all-cause death in a representative population of hospital-treated deliberate self-poisoning patients. METHOD: A prospective cohort study using data-linkage between the Hunter Area Toxicology Service Database and the National Death Index of the Australian Institute of Health and Welfare, from January 1991 to December 2000. RESULTS: There were 4105 subjects, of whom 228 (5.6%) died, 122 (2.9%) by premature death and 58 (1.4%) by suicide. The probability of suicide after 10 years follow-up was 2%. The adjusted hazard ratios (95% CI) for suicide were: 'disorders usually diagnosed in infancy, childhood and adolescence', 5.28 (95% CI = 2.04-13.65): male gender, 4.25 (95% CI = 2.21-8.14); discharge to involuntary psychiatric hospital admission, 3.20 (95% CI = 1.78-5.76); and increasing age, 1.02 (95% CI = 1.01-1.04). Men and women showed different patterns of multivariate risks, although increased risk with increasing age and discharge to an involuntary psychiatric admission was true for both. The standardized all-cause mortality ratio (95% CI) was: for men, 6.42 (95% CI = 5.44-7.57), and for women 4.39 (95% CI = 3.56-5.41). The standardized suicide mortality ratio (95% CI) was: for men, 20.55 (95% CI = 15.24-27.73), and for women 22.95 (95% CI = 13.82-38.11). CONCLUSIONS: Men and women have different risk factors for subsequent suicide after self-poisoning. Hospital-treated self-poisoning patients have increased risk of subsequent suicide, premature and all-cause death. Psychiatric assessment, leading to discharge decisions, is worthwhile in identifying patients at long-term risk of suicide, premature and all-cause death.

Adolescent↗

PubMed2004

Barriers to providing lung-protective ventilation to patients with acute lung injury.

OBJECTIVE: No studies have explored the barriers to implementing lung-protective ventilation in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Our objective was to identify barriers to using lung-protective ventilation in patients with ALI/ARDS. DESIGN: Survey with content analysis of open-ended responses. SETTING: Medical center. PARTICIPANTS: Experienced intensive care unit nurses and respiratory therapists network identified through purposive sampling at hospitals from the ARDS Network, a National Institutes of Health-sponsored research consortium. INTERVENTIONS: Survey. RESULTS: Fifty-five surveys representing all ten ARDS Network sites were received. Twenty-seven (49%) of the respondents were intensive care unit nurses, 24 (44%) were respiratory therapists, and four did not indicate their profession. Clinicians had used lung-protective ventilation in a median of 20 (interquartile range, 10-50) patients with ALI/ARDS. Respondents identified physician willingness to relinquish control of ventilator, physician recognition of ALI/ARDS, and physician perceptions of patient contraindications to low tidal volumes as important barriers to initiating lung-protective ventilation. Important barriers to continuing patients on lung-protective ventilation were concerns over patient discomfort and tachypnea and concerns over hypercapnia, acidosis, and hypoxemia. Techniques for overcoming barriers were identified including specific ventilator setup recommendations, clinician education, and tools to assess patient discomfort. CONCLUSIONS: Experienced bedside clinicians perceive important barriers to implementing lung-protective ventilation. Successful strategies to increase use of lung-protective ventilation should target these barriers.

Attitude of Health Personnel↗

PubMed2004

Socio-economic differentials in mental disorders and suicide attempts in Australia.

BACKGROUND: Responses to mental disorders usually focus on treatment; socio-economic conditions are less likely to be considered. AIMS: To examine social determinants of mental disorders and attempted suicide in Australia. METHOD: Data from the 1997 Australian National Survey of Mental Health and Wellbeing (n=10 641) were used to estimate associations between socio-economic status, mental disorders and attempted suicide. Logistic regression was used to adjust for age, urban/rural residence and country of birth. Socio-economic status differentials in suicide attempts were also adjusted for mental disorders. RESULTS: Significant increasing gradients from high to low levels of education and occupational status (employed) were evident for affective disorders and anxiety disorders in both men and women and for substance use disorders in men. Similar gradients were found for suicide attempts, which decreased after adjusting for mental disorders, but remained significant in the working-age employed. CONCLUSIONS: These findings suggest social causation of mental disorders and suicide attempts, and the need for social and economic responses beyond provision of mental health services.

Adult↗

PubMed2003

Adolescent self-poisoning: a cohort study of subsequent suicide and premature deaths.

Previous self-harm has been identified as a risk factor for subsequent suicide by adolescents. The objective of the study was to identify further risk factors for subsequent premature death and suicide in a population of adolescents presenting with self-poisoning. A longitudinal cohort design using data-linkage of consecutive adolescent patients presenting to the Hunter Area Toxicology Service, a regional toxicology service for Newcastle, Australia, with the National Death Index of the Australian Institute of Health and Welfare was used. A total of 441 adolescents aged 10 to 19 years presented with self-poisoning over 5 years from January 1991 to December 1995, with follow-up to March 2001. There were 14 deaths total, eight of which were likely suicides. There was a 22-fold increase in suicide rate for males and a 14-fold increase for females compared with age-normalized population rates. Adjusted hazard ratios (95% CI) forpremature death were male gender 3.77 (1.11-12.78), nonaffective psychotic disorders 16.3 (3.83-69.34) and the mental illnesses of childhood 6.12 (1.68-22.23). There was a similar pattern for suicide: Male gender, nonaffective psychotic disorders, and the mental illnesses of childhood confer greater risk for subsequent suicide or premature death in this population.

Adolescent↗

PubMed2003

Repetition risk for adolescent self-poisoning: a multiple event survival analysis.

OBJECTIVES: To examine risk factors associated with re-presentation (event rates) following an initial episode of hospital treated self-poisoning. METHOD: A longitudinal cohort study using the Hunter Area Toxicology Service (HATS) database of all presentations to hospital of self-poisoned patients aged 10-19 in Newcastle and Lake Macquarie Regions of New South Wales from January 1991 to December 1995. The study factors were: age, gender, employment status, 'substance abuse' and psychiatric diagnosis at index (first documented episode during the study time-period) admission. The main outcome measure was re-presentations per unit time. Time-event analysis (multivariate) was used to compare re-presentation rates per person-year exposure to the study factors. RESULTS: There were 450 patients who presented on a total of 551 occasions. The median and modal age at initial presentation was 17. Three hundred and nine (69%) were female and 141 (31%) were male. The probability (95% CI) of a patient re-presenting within one year of an index admission with self poisoning was 0.09 (0.07-0.12) and within 5 years was 0.16 (0.12-0.21). The adjusted rate ratios for episodes of re-presentation were: any 'substance abuse (ever)' 3.87 (2.08-7.21), 'alcohol abuse' 2.32 (1.15-4.68),'benzodiazepine abuse' 4.89 (1.63-14.62), schizophrenia and other psychotic disorders (DSM-IV) 2.85 (1.2-6.79), and any personality disorder (DSM-IV) 2.68 (1.73-4.16). CONCLUSIONS: Interventions to decrease recurrence rates for adolescent self poisoning should be directed towards substance (particularly alcohol or benzodiazepine) abuse, non-affective psychoses and personality disorder.

Adolescent↗

PubMedDate not supplied

Non-suicidal deaths following hospital-treated self-poisoning.

OBJECTIVE: To quantify the non-suicidal mortality subsequent to hospital treated self-poisoning, and to identify risk factors for non-suicidal death. METHOD: A prospective longitudinal cohort design was used, with data-linkage between the Hunter Area Toxicology Service database and the National Death Index. All patients with deliberate self-poisoning for a 10-year period (1991-2000) were studied and the first episode in the period was used as the index episode. The outcomes were: accidental, 'natural' and non-suicidal death, with follow-up for the study duration. RESULTS: There were 4044 patients studied, and 170 (4.2%) of these had non-suicidal death; 64 were accidental and 106 were 'natural' cause deaths. The standardized mortality ratio (95% CI) for non-suicidal death for males, females and combined were 4.98 (4.08-6.07), 3.78 (3.0-4.75) and 4.20 (3.62-4.88), respectively. The increased mortality was apparent for both males and females, and was more marked in the younger age groups. For non-suicidal death the adjusted hazard ratio (95% CI) for increased risk were: increasing age 1.07 (1.06-1.08), male gender 1.77 (1.24-2.52), psychiatric diagnosis of substance related disorder 1.49 (1.03-2.16), prescription of a respiratory drug 2.69 (1.31-5.55), and prescription of an anti-diabetic drug 1.95 (0.93-4.07), while psychiatric diagnosis of adjustment disorder 0.64 (0.38-1.053) was associated with decreased risk. CONCLUSIONS: Patients who present with self-poisoning have increased mortality from accidental and 'natural' causes. Long-term treatment goals for these patients need to address non-suicide mortality in addition to suicide mortality.

Accidents↗

PubMedDate not supplied