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There is growing interest in brief contact interventions for self-harm
and suicide attempt.
To synthesise the evidence regarding the effectiveness of brief contact
interventions for reducing self-harm, suicide attempt and suicide.
A systematic review and random-effects meta-analyses were conducted of
randomised controlled trials using brief contact interventions (telephone
contacts; emergency or crisis cards; and postcard or letter contacts).
Several sensitivity analyses were conducted to examine study quality and
We found 14 eligible studies overall, of which 12 were amenable to
meta-analyses. For any subsequent episode of self-harm or suicide
attempt, there was a non-significant reduction in the overall pooled odds
ratio (OR) of 0.87 (95% CI 0.74–1.04, P = 0119) for
intervention compared with control. The number of repetitions per person
was significantly reduced in intervention v. control
(incidence rate ratio IRR = 066, 95% CI 0.54–0.80,
P<0001). There was no significant reduction in the
odds of suicide in intervention compared with control (OR = 0.58, 95% CI
A non-significant positive effect on repeated self-harm, suicide attempt
and suicide and a significant effect on the number of episodes of
repeated self-harm or suicide attempts per person (based on only three
studies) means that brief contact interventions cannot yet be recommended
for widespread clinical implementation. We recommend further assessment
of possible benefits in well-designed trials in clinical populations.
After an epidemic rise in Australian young male suicide rates over the 1970s to 1990s, the period following the implementation of the original National Youth Suicide Prevention Strategy (NYSPS) in 1995 saw substantial declines in suicide in young men.
To investigate whether areas with locally targeted suicide prevention activity implemented after 1995 experienced lower rates of young adult suicide, compared with areas without such activity.
Localities with or without identified suicide prevention activity were compared during the period of the NYSPS implementation (1995–1998) and a period subsequent to implementation (1999–2002) to establish whether annual average suicide rates were lower and declined more quickly in areas with suicide prevention activity over the period 1995–2002.
Male suicide rates were lower in areas with targeted suicide prevention activity (and higher levels of funding) compared with areas receiving no activity both during (RR = 0.89, 95% CI 0.80–0.99, P = 0.030) and after (RR = 0.86, 95% CI 0.77–0.96, P = 0.009) implementation, with rates declining faster in areas with targeted activity than in those without (13% v. 10% decline). However, these differences were reduced and were no longer statistically significant following adjustment for sociodemographic variables. There was no difference in female suicide rates between areas with or without targeted suicide prevention activity.
There was little discernible impact on suicide rates in areas receiving locally targeted suicide prevention activities in the period following the NYSPS.
Measurement of the ion energy distributions (IED's) of N2+ ions produced in an inductively coupled plasma (ICP) source revealed that adding argon to the nitrogen gas before excitation in the source increased the nitrogen ion current. Adding helium resulted in an increase of the most probable ion energy, and a higher-energy component of the N2+ IED at about 20 eV. Preliminary calculations of the electron energy distributions (EED's) correlate well to the IED's for both inert gas additions. Experiments were performed to determine the effect of these modified energy distributions of the reactive species on titanium nitride thin film growth rates, microstructure and mechanical properties. Deposition experiments were conducted using the ICP source and an unbalanced magnetron with a titanium cathode. Results showed that the argon inert gas addition resulted in increased deposition rate and reduced 3-D features. Film roughness was decreased to 1.61 nm from 2.05 nm when helium was mixed with the nitrogen. Mixing both argon and helium with the nitrogen yielded combined effects of deposition rate increase, reduced 3-D features and increased smoothness. The inert gas additions increased hardness of the TiN films from 17.3 GPa to 21.1 GPa with the argon addition and to 25.0 GPa with the helium addition
In this work, the adhesion of CVD dielectric caps to ULK MSQ spin-on
dielectric materials with k values of 2.2 and 2.0, and a ULK CVD material
with a k value of 2.7 is presented. A substantial improvement in cap
adhesion to both the k2.2 ULK MSQ and the k2.7 ULK CVD material is
demonstrated. The improvement is obtained using a low-k CVD glue material
between the ULK dielectric and the subsequent cap material and/or by
optimizing the CVD cap film deposition. Four-point bend measurement of
adhesion strength is used to quantify the improvement in interface adhesion.
The improvement in CVD cap adhesion is demonstrated to be strongly dependent
upon both the glue layer film and the cap deposition conditions. While
optimization of the CVD cap materials results in adequate adhesion for the
k2.2 ULK MSQ, these improvements are demonstrated not to extend to the k2.0
ULK MSQ film.
Prediction of suicide risk is difficult in clinical practice.
To identify changes in clinical presentation predictive of suicide in patients treated for repeated episodes of self-poisoning.
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.
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 (OR1.33, 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).
Patients who have escalating severity of self-poisoning episodes are at high risk of completed suicide.
Responses to mental disorders usually focus on treatment; socio-economic conditions are less likely to be considered.
To examine social determinants of mental disorders and attempted suicide in Australia.
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.
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.
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.
Treatment coverage for mental disorders is poor in most developed countries.
To explore some reasons for the poor treatment coverage for mental disorders in developed countries.
Data were taken from Australian national surveys and from the World Health Report.
Only one-third of people with a mental disorder consulted. Probability of consulting varied by diagnosis: 90% for schizophrenia, which is accounted for by external factors; 60% for depression; and 15% for substance use and personality disorders. The probability of consulting varied by gender, age, marital status and disability, from 73% among women aged 25–54 years, disabled and once married to 9% among males without these risk factors. Those who did not consult but were disabled or comorbid said that they “preferred to manage themselves”. Data from five countries showed no evidence that overall health expenditure, out-of-pocket cost or responsiveness of the health system affected the overall consulting rates.
Societal, attitudinal and diagnostic variables account for the variation. Funding does not. Public education about the recognition and treatment of mental disorders and the provision of effective treatment by providers might remedy the shortfall.
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