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Biomedical subjects

J Fagg

Publications and source records attributed to J Fagg.

35 records · Page 2Linked to original sources
PubMed1994

The epidemiology of attempted suicide in the Oxford area, England (1989-1992).

The epidemiological and clinical characteristics of attempted suicide in Oxford, United Kingdom, between 1989 and 1992 are reported on the basis of data collected as part of the WHO/EURO Multicentre Study of Parasuicide in Europe. Some further findings for the period 1976-1992 are also described. Rates of attempted suicide were particularly high among females aged 15-19 years. There was a very marked association in males and females between attempted suicide and both lower socioeconomic status and unemployment. The percentage of first-time attempters entering the attempted suicide population remained steady between 1976 and 1992, with approximately two-thirds of attempters each year making their first attempts. There was a great increase in the use of paracetamol (acetominophen) for self-poisoning between 1976 and 1992, this being involved in 14.3% of overdoses in 1976 and 43.2% in 1992. On the basis of the Oxford rates, there are approximately 100,000 general hospital admissions for attempted suicide each year in England and Wales, approximately 19,000 involving teenagers (mostly girls). Oxford has a similar pattern of attempted suicide to that in the rest of the UK. The findings indicate that the UK has one of the highest rates of attempted suicide in Europe.

Adolescent↗
PubMed1993

Factors associated with suicide after parasuicide in young people.

OBJECTIVE: To determine factors associated with completed suicide in young parasuicide patients. DESIGN: Case-control study. SETTING: Regional poisoning treatment centre in a teaching general hospital. SUBJECTS: Patients who, between 1968 and 1985 when aged 15-24 years, were admitted to the regional poisoning treatment centre because of deliberate self poisoning or self injury. Cases (n = 62) consisted of those who by the end of 1985 had died locally from either suicide (n = 41) or possible suicide (n = 21). Controls (n = 124) were patients who were known not to have died locally during the study period. Two controls were selected for each case, matched by sex, age (within two years), and length of follow up. MAIN OUTCOME MEASURES: Possible predictors of completed suicide. RESULTS: Univariate analysis (conditional logistic regression) showed that risk of death due to suicide and possible suicide was associated with six factors: social class V (odds ratio 2.7, 95% confidence interval 1.1 to 6.7), unemployment (2.8, 1.4 to 5.8), previous inpatient psychiatric treatment (4.9, 2.2 to 10.9), substance misuse (3.3, 1.6 to 6.8), personality disorder (2.1, 1.03 to 4.4), and previous attempted suicide (2.3, 1.2 to 4.4). Multivariate analysis identified two factors as significantly contributing to the model that best discriminated between the cases and controls: substance misuse (alcohol or drugs, or both) (adjusted odds ratio 3.9) and previous inpatient psychiatric treatment (3.7). These factors seemed to be associated with suicide after attempted suicide in both the short term (less than 12 months) and the long term (one year or more) and were also identified when the analysis was restricted to subjects who definitely died by suicide and their controls. CONCLUSIONS: Suicide after parasuicide in young people is associated with substance misuse. This suggests that prevention of suicide in young people who attempt suicide might be improved by close liaison between general hospital services for patients who have attempted suicide and services for young substance misusers and by measures aimed at preventing substance misuse in young people.

Adolescent↗
PubMed1993

Key symptoms in the detection of affective disorders in medical patients.

Psychiatric disorder in medical patients often goes undetected. In this study we have attempted to identify a minimum set of key symptoms from an extensive research interview [Present State Examination (PSE)] that might assist in the identification of psychiatric disorders among general medical patients. Stepwise logistic regression analysis was used to identify PSE-items that contributed most to the PSE-CATEGO classification of psychiatric disorders in 192 Dutch medical out-patients. A risk score based on two core symptoms (panic and depressed mood) and five supplementary symptoms classified patients with a sensitivity of 0.94 and a specificity of 0.91. In a separate U.K. sample of medical in-patients, consisting of 37 PSE cases and age and sex matched controls, the risk score yielded a sensitivity and specificity of 0.89 and 0.97 respectively. The results suggest that a few questions concerning psychiatric symptoms may facilitate the identification of the majority of patients with anxiety and depressive disorders in medical populations.

Adaptation, Psychological↗
PubMed1993

Do psychosocial factors influence outcome in severely depressed female psychiatric in-patients?

Fifty-nine women admitted to hospital because of severe depression were studied prospectively during hospital admission and nine months following hospital discharge in order to identify psychosocial and illness factors associated with prognosis. Outcome was measured in terms of both depression scores and recovery at the time of follow-up. In keeping with the findings of other studies, the outcome was often poor, with only 54% having recovered nine months after discharge, poorer outcome being associated with more negative self-esteem measured when the women were depressed and with suicidal ideas. The findings indicate that in severely depressed women likely to be admitted to hospital, psychosocial factors may have less relevance to outcome, at least in the short term, than in less severely depressed patients studied in community or out-patient samples.

Adult↗
PubMed1992

Trends in deliberate self poisoning and self injury in Oxford, 1976-90.

OBJECTIVE: To review trends in deliberate self poisoning and self injury (attempted suicide) over 15 years (1976-90) on the basis of general hospital referrals. DESIGN: Prospective data collection by computerised monitoring system. SETTING: Teaching general hospital. SUBJECTS: All patients aged 15 and over (n = 9605) referred to the hospital after episodes (n = 13,340) of deliberate self poisoning or self injury. MAIN OUTCOME MEASURES: Rates based on population of Oxford city; changes in substances used for self poisoning; history and repetition of attempts; and rates of admission to the hospital and of referral to the psychiatric service. RESULTS: Attempted suicide rates for women declined during the late 1970s and early 1980s but increased again during the late 1980s. Those for men remained relatively steady throughout the period. Highest mean annual rates occurred in women aged 15-19 (711/100,000) and in 20-34 year old men (334/100,000). The proportion of overdoses with paracetamol increased from 14.3% (125/873) in 1976 to 42% (365/869) in 1990 (chi 2 for trend = 481, p less than 0.01). Throughout the period the proportions of referred patients admitted to hospital and of those attempting suicide for the first time (over two thirds) did not decrease. Annual rates of repetition of attempts by women declined from 15.1% (257/1700) in 1976-8 to 11.9% (161/1356) in 1987-9 (chi 2 for trend = 7.8, p less than 0.01). Lower repetition rates occurred in women admitted to hospital and referred to the psychiatric service (431/4585, 9.4%) than in those not referred (42/235, 17.9%; chi 2 = 17.2, p less than 0.0001). CONCLUSIONS: Rates of attempted suicide declined in the 1970s and early 1980s, in women, but there are probably at least 100,000 hospital referrals a year in England and Wales because of this problem. Prevention of paracetamol self poisoning requires urgent attention, and psychosocial assessment should be conducted with as many of those who attempt suicide as possible.

Adult↗
PubMed1992

Sex therapy for erectile dysfunction: characteristics of couples, treatment outcome, and prognostic factors.

Outcome and prognostic factors were studied in 36 couples who entered sex therapy because of the male partners' erectile dysfunction. Treatment was completed by two thirds. Noncompletion was associated with lower socioeconomic status, the female partner having a history of psychiatric treatment, pretreatment poorer motivation of the male partner, poor communication in the general relationship, and less sexual pleasure experienced by the female. A positive treatment outcome occurred in 69.4%, and was associated with better pretreatment communication and general sexual adjustment, especially the female partner's interest and enjoyment of sex, absence of a positive psychiatric history in the female partner, and a couple's early engagement in homework assignments. Results highlight important aspects of the initial assessment, indicate couples for whom the initial phase of treatment should be prolonged and modified or an alternative approach considered, and have implications for assignment of couples to treatment groups in evaluative studies of therapy.

Adult↗
PubMed1992

Deliberate self-poisoning and self-injury in adolescents. A study of characteristics and trends in Oxford, 1976-89.

In Oxford during the late 1970s and early 1980s a decline in rates of deliberate self-poisoning and self-injury in older female teenagers was followed by a steady increase between 1986 and 1989. Rates for male adolescents and young female adolescents remained relatively stable throughout 1976-89. Applying the Oxford rates to England and Wales suggest a total of 18,000-19,000 hospital-referred cases per year. While self-poisoning with minor tranquillisers and sedatives has declined, there has been a marked increase in paracetamol self-poisoning, such that by 1988-89 it was involved in 48.3% of overdoses. Relationship difficulties were the most frequent problems faced by these adolescents, especially the females, with unemployment and alcohol and drug problems also being common, especially in males, but psychiatric disorders relatively rare. Substantial proportions of the adolescents, especially the males, were not living with either relatives or friends, and had a history of violence or a criminal record. The annual rate of repetition of attempts, which was 8.9% overall, was higher in adolescents not admitted to the general hospital, and in females not referred to the hospital psychiatric service. Adolescent attempted suicide clearly continues to be a major health problem for which both effective preventive and therapeutic strategies are badly needed.

Adult↗
PubMed1991

Low sexual desire: sex therapy results and prognostic factors.

In a prospective study of 60 couples who entered sex therapy because of the female partners' low sexual desire, 38 (63.3%) completed treatment and 34 (56.7%) had a positive outcome. The principal predictor of completion of treatment was the male partners' apparent motivation at the outset. Poorer outcome was associated with younger age of the couple (especially the male partner) and a shorter duration of the sexual problem. Surprisingly, few aspects of the couples' general relationships prior to treatment were related to outcome, except for poorer outcome being associated with a history of previous separations. The apparent lack of significant contribution of general relationship factors and psychopathology to outcome probably reflects the stringency of the initial selection process. Eventual outcome was also related to couples' progress by the third treatment session. The modest outcome of treatment for low sexual desire in this and other studies emphasises the need for further understanding of factors which contribute to this problem and for the development of novel treatment strategies.

Adult↗
PubMed1989

Alcoholism, alcohol and attempted suicide.

Attempted suicide patients referred to a general hospital over a 10 year period were studied with regard to alcoholism and drinking in association with suicide attempts. Alcoholism was diagnosed in 7.9% of patients (14.6% of males and 4.2% females), and this diagnosis became proportionately more common in both sexes during the study period. However, only male alcoholic attempters showed an increase in absolute numbers during the study period, the increase in the proportion of females diagnosed as alcoholic being due to a decline in attempts by non-alcoholics. Particularly high rates of alcoholism were found in the unemployed of both sexes and in housewives. Alcoholic attempters were at greatly increased risk of making repeat attempts. Alcohol consumption shortly before a suicide attempt and as part of the act was extremely common, especially among alcoholics. In addition to increasing the likelihood of an attempt, alcohol may add considerably to the danger of overdoses. Careful investigation of drinking patterns should be an integral part of the assessment of all attempted suicide patients, and there should be close liaison between general hospital services for such patients and local alcoholism treatment services.

Adolescent↗
PubMed1988

Recent clinical and epidemiological trends in parasuicide in Edinburgh and Oxford: a tale of two cities.

This is a report of clinical and epidemiological trends in parasuicide in Edinburgh and Oxford over the period of 1976 to 1984. Rates of parasuicide declined in both cities, but more markedly among women than men. Male rates tended to be higher in Edinburgh and female rates higher in Oxford. Age-specific rates were similar for the two cities in 1983-84, with peak rates for females among 15-19 year olds and those for males among 20-24 year olds in Edinburgh and 25-34 year olds in Oxford. Parasuicide incidence was higher in lower social class groups and among the unemployed in both cities. During the study period there was a massive decline in barbiturate overdoses, a more modest decline in minor tranquillizer overdoses but, in Oxford, a marked increase in self-poisoning with paracetamol. By the end of the study period the proportion of patients receiving a diagnosis of drug addiction had doubled in Edinburgh, although it had remained fairly constant in Oxford. There were differences in patterns of aftercare offered to patients in the two cities; these almost certainly reflect differing clinical policies.

Adolescent↗
PubMed1988

Suicide, and other causes of death, following attempted suicide.

The number of deaths in a large series of suicide attempters followed up after their attempts was 3.3 times greater than expected. Suicide or probable suicide occurred in 2.8% by the end of the eighth year of follow-up, the rate of suicidal deaths being 26.9 times the expected rate. The highest risk of suicide was during the first 3 years, especially in the first 6 months, following an attempt. Factors identified at the time of the attempts which were associated with suicide risk included: being male, advancing age (females only), psychiatric disorder (especially schizophrenia), long-term use of hypnotics, poor physical health, and repeat attempts. Recent disruption of a relationship with a partner and major rows rarely preceded the attempts of those who later killed themselves. Factors predicting long-term risk of suicide also predicted short-term risk. There were more than double the expected number of deaths from natural causes, the excess being greatest in females. Markedly high death rates were found for endocrine, circulatory and respiratory diseases, and accidents.

Adolescent↗
PubMed1988

Female unemployment and attempted suicide.

Unemployment became more common among females attempting suicide in Oxford between 1976 and 1985, although the rise was less than expected from the increased general-population female unemployment rate. Rates of attempted suicide among unemployed women between 1979 and 1982 were 7.5-10.9 times higher than those of employed women, and were particularly high in women unemployed for more than a year. Many more unemployed than employed women attempting suicide had a history of psychiatric difficulties, were suffering from alcoholism, and made repeat attempts. Two possible explanations are: firstly, the secondary consequences of unemployment increase the risk of suicidal behaviour; and, secondly, women already predisposed to psychiatric difficulties and hence attempted suicide are more likely to become unemployed.

Adolescent↗
PubMed1981

The attitudes of psychiatrists to deliberate self-poisoning: comparison with physicians and nurses.

The attitudes of junior psychiatrists to deliberate self-poisoning were assessed on the basis of their answers to a series of questions concerning four case vignettes. They spontaneously indicated goals for the behaviour in only a minority of cases. Emphasis should be placed on identifying instrumental aspects of overdoses during training in the assessment of self-poisoning patients. The psychiatrists attributed similar reasons for the cases as did physicians and nurses who were previously investigated using the same method. However, compared with the physicians, the psychiatrists showed more sympathetic attitude to the patients and their behaviour, and a greater willingness to help them. The psychiatrists and nurses were similar in this respect. The findings are discussed in the light of recent innovations in the management of self-poisoning patients in general hospitals.

Attitude of Health Personnel↗
PubMed1980

Comparison of doctors and nurses in the assessment of deliberate self-poisoning patients.

The assessments of deliberate self-poisoning patients carried out by 8 doctors and 8 nurses were compared. Both groups of staff had undergone special training in the assessment procedure. The adequacy of the assessments was determined by blind judges' ratings of transcripts of assessment interviews, comparisons of the types of treatment offered and repetition of self-poisoning The attitudes of the patients and their general practitioners were also investigated. No major differences were found between the assessments of the 2 groups of subjects. It is concluded that nurses under supervision of a senior psychiatrist can safely carry out the assessment of self-poisoning patients, provided they have received appropriate training. The findings suggest that services in which nurses assess most self-poisoning patients could be established in district general hospitals. This would reduce the demands currently placed on psychiatrists and physicians.

Adult↗
PubMed1980

Association between epilepsy and attempted suicide.

In a two-year study of patients admitted to hospital after deliberate self-poisoning or self-injury, a fivefold excess of patients with epilepsy was found compared with general population prevalence rates. Males with epilepsy were particularly over-represented. Patients with epilepsy were prone to make repeat attempts. Anticonvulsants, particularly barbiturates, were used in most cases of self poisoning.

Adult↗