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Biomedical subjects

Keith Hawton

Publications and source records attributed to Keith Hawton.

At least 55 records · Page 3Linked to original sources
PubMed2004

UK legislation on analgesic packs: before and after study of long term effect on poisonings.

OBJECTIVE: To evaluate the long term effect of legislation limiting the size of packs of analgesics sold over the counter. DESIGN: Before and after study. SETTING: Suicides in England and Wales, data from six liver units in England and Scotland and five general hospitals in England, and UK data on sales of analgesics, between September 1993 and September 2002. DATA SOURCES: Office for National Statistics; six liver units in England and Scotland; monitoring systems in general hospitals in Oxford, Manchester, and Derby; and Intercontinental Medical Statistics Health UK. MAIN OUTCOME MEASURES: Deaths by suicidal overdose with paracetamol, salicylates, or ibuprofen; numbers of patients admitted to liver units, listed for liver transplant, and undergoing transplantations for paracetamol induced hepatotoxicity; non-fatal self poisonings with analgesics and numbers of tablets taken; and sales figures for analgesics. RESULTS: Suicidal deaths from paracetamol and salicylates were reduced by 22% (95% confidence interval 11% to 32%) in the year after the change in legislation on 16 September 1998, and this reduction persisted in the next two years. Liver unit admissions and liver transplants for paracetamol induced hepatotoxicity were reduced by around 30% in the four years after the legislation. Numbers of paracetamol and salicylate tablets in non-fatal overdoses were reduced in the three years after the legislation. Large overdoses were reduced by 20% (9% to 29%) for paracetamol and by 39% (14% to 57%) for salicylates in the second and third years after the legislation. Ibuprofen overdoses increased after the legislation, but with little or no effect on deaths. CONCLUSION: Legislation restricting pack sizes of analgesics in the United Kingdom has been beneficial. A further reduction in pack sizes could prevent more deaths.

Analgesics↗
PubMed2004

Strategies for managing sexual dysfunction induced by antidepressant medication.

BACKGROUND: Sexual dysfunction (including altered desire, orgasmic dysfunction, erectile and ejaculatory problems) is a relatively common side effect of antidepressant medication. These sexual side effects may compromise a person's lifestyle and result in a lack of compliance with the prescribed antidepressant to the detriment of the person's mental health. OBJECTIVES: The objective of this review was to assess the effectiveness of management strategies for sexual dysfunction caused by antidepressant medication. SEARCH STRATEGY: We searched the CCDANCTR (March 2003), the Cochrane Central Register of Controlled Trials (Cochrane Library issue 2, 2004), MEDLINE (1966 - June 2004), EMBASE (1980 - March 2004), CINAHL (1982 - March 2004), PsycINFO (1984 - March 2004) and the reference lists of articles. We also contacted pharmaceutical companies and experts in the field of sexology. SELECTION CRITERIA: Randomised controlled trials comparing the management strategies for antidepressant induced sexual dysfunction were included. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed trial quality. Study authors were contacted for additional information. Adverse effect information was collected from the trials. MAIN RESULTS: Fifteen trials involving 904 people were included. One trial involving 75 people with sexual dysfunction due to sertraline assessed changing antidepressant. Switching to nefazodone was significantly less likely to result in the re-emergence of sexual dysfunction than restarting sertraline (RR 0.34, 95% CI 0.15 - 0.6) and was not associated with any worsening of depression. Fourteen trials involving 829 people assessed the addition of other medication while continuing the same antidepressant. Meta-analysis of two trials involving 113 men with erectile dysfunction found that the addition of sildenafil resulted in less sexual dysfunction at endpoint on rating scales including the International Index of Erectile Function (IIEF; WMD 19.36, 95% CI 15.00 to 23.72). There was no significant difference in dropout rates between sildenafil and placebo. One trial found the addition of bupropion led to improved scores on the Changes in Sexual Functioning Questionnaire desire-frequency subscale (WMD 0.88, 95% CI 0.21 - 1.55). One trial found that the addition of tadalafil was associated with greater improvement in the erectile function domain of the IIEF than placebo (WMD 8.10; 95% CI 4.62 to 11.68). Other augmentation strategies failed to show statistically significant improvements in sexual dysfunction compared with placebo. REVIEWERS' CONCLUSIONS: The currently available evidence is rather limited, with small numbers of trials assessing each strategy. However, while further randomised data is awaited, for men with antidepressant-induced erectile dysfunction, the addition of sildenafil appears to be an effective strategy.

Antidepressive Agents↗
PubMed2004

Factors associated with suicidal phenomena in adolescents: a systematic review of population-based studies.

Suicidal phenomena (suicide attempts, deliberate self-harm, and suicidal plans, threats and thoughts) are common in adolescents. Identification of factors associated with these phenomena could play an important role in the development of school or community-based prevention and intervention programs. In this article, we report the results of a systematic review of the international literature on population-based studies of factors associated with suicidal phenomena in adolescents. These factors encompass psychiatric, psychological, physical, personal, familial and social domains. The quantity of evidence in support of associations between suicidal phenomena and specific factors is compared with the quantity of evidence against such associations. We conclude with a summary of the findings, including identification of new or neglected areas, which require further investigation. Methodological considerations are highlighted and implications of the findings for clinicians and other professionals concerned with prevention of suicidal behavior by adolescents are discussed.

Adolescent↗
PubMed2004

Suicide in doctors. A psychological autopsy study.

OBJECTIVES: Doctors are at higher risk of suicide than many other occupational groups. This study was conducted to investigate factors associated with suicide in doctors. METHOD: Psychological autopsy study of 38 working doctors who died by suicide in England and Wales between January 1991 and December 1993. RESULTS: Psychiatric illness was present in 25 of the doctors. Depressive illness and drug or alcohol abuse were the most common diagnoses. Twenty-five doctors had significant problems related to work, 14 had relationship problems and 10 had financial problems. Multiple and interrelated problems were often present. The most common method of suicide was self-poisoning, often with drugs taken from work. CONCLUSION: Prevention of suicide in doctors requires a range of strategies, including improved management of psychiatric disorder, measures to reduce occupational stress and restriction of access to means of suicide when doctors are depressed.

Adult↗
PubMed2004

Self-reported suicidal behavior in juvenile offenders in custody: prevalence and associated factors.

Suicide rates in prisons in England and Wales are high, including those in juvenile detention centers. Previous deliberate self-harm (DSH) is the strongest predictor of suicide in the general population. There is limited information on how many juvenile offenders (15 to 18 year-olds) have a history of DSH at the time of entering custody, or on factors associated with previous DSH. We aimed to determine the prevalence of previous DSH and suicidal ideation in a population of juvenile offenders in custody and to identify factors associated with DSH and suicidal ideation. Seven out of 45 subjects (15.6%) reported an act of DSH in the past. Twelve (26.6%) reported past suicidal ideation. Peer relationship difficulties and sexual abuse were significantly associated with DSH (p < 0.05). Other factors showed a trend toward being more common among those with DSH, but the premature ending of the project by the juvenile detention center prevented full investigation of the extent of DSH and associated factors. Nevertheless, the results indicated a much higher rate of DSH in this population than in young males in the community. A larger joint project with juvenile detention centers is required to confirm the extent of previous DSH at the time young offenders are admitted, and the associated risk factors, in order to assist prevention and intervention strategies.

Adolescent↗
PubMed2004

Reasons for deliberate self-harm: comparison of self-poisoners and self-cutters in a community sample of adolescents.

OBJECTIVE: To compare motives and premeditation between adolescent deliberate self-poisoners and self-cutters. METHOD: In a sample of 6,020 pupils aged 15 and 16 years who completed a self-report questionnaire, those who had deliberately cut themselves in the previous year (n = 220) were compared with those who had taken overdoses (n = 86). RESULTS: More adolescents who took overdoses than those who cut themselves said that they had wanted to die (66.7% versus 40.2%, chi2 = 14.94, p <.0001) and had wanted to find out if someone loved them (41.2% versus 27.8%, chi2 = 4.14, p =.042). Female self-cutters were more likely than male self-cutters to say that they had wanted to punish themselves (51.0% versus 25.0%, chi2 = 9.25, p =.002) and had tried to get relief from a terrible state of mind (77.2% versus 60.9%, chi2 = 4.78, p =.029). More self-cutters than self-poisoners had thought about the act of self-harm for less than an hour beforehand (50.9% versus 36.1%, chi2 = 5.25, p =.021). CONCLUSIONS: There are differences between adolescents' motives for overdoses and for self-cutting, and also gender differences in the reasons for self-cutting. The often impulsive nature of these acts (especially self-cutting) means that prevention should focus on encouraging alternative methods of managing distress, problem-solving, and help-seeking before thoughts of self-harm develop.

Adolescent↗
PubMed2004

Long-term lithium therapy for bipolar disorder: systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: The authors sought to determine the efficacy and acceptability of lithium for relapse prevention in bipolar disorder. METHOD: A systematic review and meta-analysis of randomized controlled trials comparing lithium with placebo in the long-term treatment of bipolar disorders was conducted. Data were obtained from searching the registers of the Cochrane Collaboration; reviewing reference lists, journals, and conference abstracts; and contacting authors, experts, and pharmaceutical companies. Outcomes investigated included risk of relapse (manic, depressive, and total) as well as risk of specific adverse effects and total withdrawal rates. RESULTS: Five randomized controlled trials (770 participants) were included. Lithium was more effective than placebo in preventing all relapses (random effects relative risk=0.65, 95% CI=0.50 to 0.84) and manic relapses (relative risk=0.62, 95% CI=0.40 to 0.95). The protective effect of lithium on depressive relapses was smaller and was less robust (relative risk=0.72, 95% CI=0.49 to 1.07). CONCLUSIONS: Lithium treatment reduces the risk of relapse in bipolar disorder. The preventive effect is clear for manic episodes, although it is equivocal for depressive episodes.

Antimanic Agents↗
PubMed2004

Repetition of deliberate self-harm and subsequent suicide risk: long-term follow-up study of 11,583 patients.

BACKGROUND: Repetition of deliberate self-harm (DSH) is a risk factor for suicide. Little information is available on the risk for specific groups of people who deliberately harm themselves repeatedly. AIMS: To investigate the long-term risk of suicide associated with repetition of DSH by gender, age and frequency of repetition. METHOD: A mortality follow-up study to the year 2000 was conducted on 11 583 people who presented to the general hospital in Oxford between 1978 and 1997. Repetition of DSH was determined from reported episodes prior to the index episode and episodes presenting to the same hospital during the follow-up period. Deaths were identified through national registers. RESULTS: Thirty-nine per cent of patients repeated the DSH. They were at greater relative risk of suicide than the single-episode DSH group (2.24; 95% CI 1.77-2.84). The relative risk of suicide in the repeated DSH group compared with the single-episode DSH group was greater in females (3.5; 95% CI 1.3-2.4) than males (1.8; 95% CI 2.3-5.3) and was inversely related to age (up to 54 years). Suicide risk increased further with multiple repeat episodes of DSH in females. CONCLUSIONS: Repetition of DSH is associated with an increased risk of suicide in males and females. Repetition may be a better indicator of risk in females, especially young females.

Adolescent↗
PubMed2004

Suicide by gunshot in the United Kingdom: a review of the literature.

This paper reviews the research literature on gunshot suicide in the United Kingdom and the international literature with reference to strategies aimed at preventing gunshot suicides. Trends in gun ownership and changes in firearm legislation in the UK over the past 20 years are described. Most UK gunshot suicides are male, middle-aged and living with a partner and involve the use of shotguns. They are less likely to have current or past mental health problems, or a previous act of self-harm, than people who commit suicide by other methods, and their suicide is more likely to have been precipitated by a relationship dispute. Where alcohol is consumed the amount tends to be large. The international literature provides evidence of a strong association between rates of gun ownership and gunshot suicide, and some evidence of a reduction in firearm suicide rates following the introduction of restrictive firearm legislation. Over the past 20 years the number of gunshot suicides in the UK has declined by over 50% to a little over a hundred deaths per annum. At the same time, firearm legislation has become progressively more restrictive and rates of gun ownership have declined. Measures, which might further reduce the prevalence of gunshot suicides in the UK, are discussed.

Death Certificates↗
PubMed2004

Self-cutting: patient characteristics compared with self-poisoners.

A large ( n = 14,892) consecutive sample of deliberate self-harm (attempted suicide) patients who presented to a general hospital in the United Kingdom during a 23-year study period was examined (over two consecutive time periods) in order to compare the characteristics of those who used self-cutting ( n = 428) and those who self-poisoned ( n = 11,065). Patients who used different methods on other occasions, or were not assessed by the psychiatric service, were excluded. In the first time period (January 1976-June 1988), the self-cutters were distinguished from the self-poisoners by more often being male, single, not employed, and having a history of previous deliberate self-harm. In the second time period (July 1988-December 1998) the self-cutters were again distinguished by more often being male and having a history of previous deliberate self-harm, but also by being more likely to live alone, misuse alcohol, and have low suicidal intent scores. The finding of an excess of males among the self-cutters is contrary to the impression in the literature that self-cutting presentations to general hospitals more often involve females. It also indicates that the treatment needs of those who deliberately cut themselves are likely to differ from those of self-poisoners.

Adolescent↗
PubMed2003

Co-proxamol and suicide: a study of national mortality statistics and local non-fatal self poisonings.

OBJECTIVES: To examine the incidence of suicides due to co-proxamol compared with tricyclic antidepressants and paracetamol, and to compare fatality rates for self poisonings with these drugs. DESIGN: Analysis of routinely collected national and local data on suicides and self poisonings. SETTING: Records of suicides in England and Wales 1997-9; non-fatal self poisonings in Oxford District 1997-9. DATA SOURCES: Office for National Statistics and Oxford monitoring system for attempted suicide. MAIN OUTCOME MEASURES: Incidence of suicides with co-proxamol or tricyclic antidepressants or paracetamol. Ratios of fatal to non-fatal self poisonings. RESULTS: Co-proxamol alone accounted for 5% of all suicides. Of 4162 drug related suicides, 18% (766) involved co-proxamol alone, 22% (927) tricyclic antidepressants alone, and 9% (368) paracetamol alone. A higher proportion of suicides in the 10-24 year age group were due to co-proxamol than in the other age groups. The odds of dying after overdose with co-proxamol was 2.3 times (95% confidence interval 2.1 to 2.5) that for tricyclic antidepressants and 28.1 times (24.9 to 32.9) that for paracetamol. CONCLUSIONS: Self poisoning with co-proxamol is particularly dangerous and contributes substantially to drug related suicides. Restricting availability of co-proxamol could have an important role in suicide prevention.

Acetaminophen↗
PubMed2003

Seasonality in suicide: a study of farming suicides in England and Wales.

Seasonality in suicide rates has long been reported. Spring peaks in suicide deaths have been positively correlated with the proportion of the workforce engaged in agriculture. Some studies have indicated that suicides using violent methods are more likely to show seasonality. Recent research has suggested that seasonal patterns have diminished. This study examined deaths in male farmers, an occupational group which might be expected to be more vulnerable to seasonal influences because of the nature of their work and the relatively high proportion of farmers using violent methods for suicide. Data on suicides between 1982 and 1999 by males in England and Wales aged 15 years and over were provided by the Office for National Statistics. Seasonal patterns of suicide in farmers and nonfarmers were examined by nonparametric tests and harmonic analysis. No significant seasonal variation was found for farmers. For nonfarmers, although a chi-square test showed significant variation in monthly distribution, this was not found when a harmonic analysis was applied. There was no significant difference in the variation of violent suicides throughout the year. This study reinforces recent findings that seasonal variation in suicide appears to be diminishing, even in an occupational group where this might be expected.

Adolescent↗
PubMed2003

Assessment and aftercare for deliberate self-harm patients provided by a general hospital psychiatric service.

We report on a sample of 135 deliberate self-harm (DSH) patients who were assessed by a general hospital DSH service, and on those who were offered aftercare by, or telephone open access to, the service. Patients' satisfaction with assessment and treatment, and their outcome were investigated at follow-up 12-20 months later. Four-fifths of patients reported the assessment following DSH to have been helpful and the assessor sympathetic. Thirty-three (24%) of the 135 patients assessed were offered treatment by the DSH service but 13 declined or failed to attend. Of the 20 who engaged in treatment, 17 (94%) were satisfied with their care. Open access to the DSH service by telephone was offered to 53 (39%) patients, nine (22%) of whom reported at follow-up that they had used this facility. A specialist DSH service can effectively assess and treat patients following DSH. It is important that the service is accessible and acceptable to patients.

Adolescent↗
PubMed2003

Deliberate self-harm in adolescents: a study of characteristics and trends in Oxford, 1990-2000.

BACKGROUND: Deliberate self-harm (DSH) is a major healthcare problem in adolescents. Identification of targets for prevention and treatment requires ongoing monitoring of trends and characteristics of those involved. METHOD: Using data from the Oxford Monitoring System for Attempted Suicide, we have examined trends and characteristics in adolescents aged 12-18 years presenting to a general hospital because of DSH between 1990 and 2000. RESULTS: The numbers of presentations by females increased during the study period. An association of DSH with school stress was suggested by there being fewer presentations during the school holiday periods, the largest number in term times occurring on Mondays, and study problems being common. Self-poisoning was involved in more than 90% of episodes. Paracetamol overdoses decreased following legislation on pack sizes of analgesics. Antidepressant overdoses increased during the study period, in keeping with the rise in prescriptions. Drug misuse increased markedly in the boys, as did a history of violence to others. Being a victim of violence increased in girls. Suicide intent was higher in males. Problems faced by the adolescents showed marked gender differences, and differed between age groups and between those carrying out their first DSH episode and repeaters. CONCLUSIONS: Clinical management of DSH in adolescents requires a range of responses, often involving multiservice and multidisciplinary input. Preventive initiatives in schools are also required.

Adolescent↗