Suicide OR Research Articles

Fatores explicativos do suicídio pela visão indígena: uma revisão de literatura

Abstract Objective Indigenous suicide in Brazil is an epidemiological, complex, and multifactorial phenomenon for which conclusive answers to risk factors remain elusive. Based on a literature review, the objective is to identify factors that contribute to the phenomenon of suicide from the perspective of Indigenous people. Method The PRISMA model was employed, and literature was sought in the Scientific Electronic Library Online, Literatura Latino-Americana e do Caribe em Ciências da Saúde, and the Periódicos Capes databases between August and November 2022, utilizing the Portuguese descriptors “indígena AND suicídio” (indigenous AND suicide), “índio AND suicídio” (indian AND suicide), and “indígena OR suicídio OR Brasil” (indigenous OR suicide OR Brazil). Results The search yielded 235 articles, and after applying exclusion and inclusion criteria, 14 were retained. These articles formed the basis for identifying several categories which indicate the explanatory factors of indigenous people’s suicide, the first three of which are shared with Western scientific explanations: loss of “good living”, especially among young people; alcohol consumption; abandonment of Indigenous traditions; symbolic universe and myths; witchcraft and harm; and collective suicide. Conclusion Our analysis critiques the exclusively Western perspective and psychological approach, emphasizing the need to embrace Indigenous perspectives on this phenomenon.

Insomnia During the Perinatal Period and its Association with Maternal and Infant Psychopathology: A Systematic Review and Meta-Analysis.

While sleep serves important regulatory functions for mental health, sleep disturbances, in particular insomnia, may contribute to mental disorders. Since insomnia symptoms are frequent during the perinatal period, the aim of this work is to systematically review the potential association between perinatal insomnia and maternal and infant psychopathology. A systematic search was conducted according with PRISMA guidelines, and meta-analytic calculations were conducted. Totally, 34 studies were included and involved 835,021 perinatal women. Four meta-analysis yielded four statistically significant random-effect models. All models show that women with perinatal symptoms of insomnia possess increased odds of developing clinically relevant symptoms of depression OR = 3.69, p = 0.001 and anxiety OR = 2.81; p < 0.001, as well as increased suicidal risk OR = 3.28; p < 0.001, and distress in the newborn OR = 2.80 (P = 0.007). These findings emphasize the role of assessing and addressing insomnia during the perinatal period to mitigate its negative effect on maternal and infant mental health via sleep regulation.

Suicide and attempted suicide by insulin: A systematic review

Background: Intentional insulin overdose either in people with diabetes or without can be used to attempt suicide. Massive insulin administration may result in coma and unexplained hypoglycemia. In this study, we aim at reviewing the demographic data of suicidal cases, the relation of psychiatric illness to dying by suicide and attempting suicide using insulin, route of insulin administration and outcome, post-mortem findings in suicide by insulin and collaborative evidence, initial presentation, blood glucose level and complications in attempting suicide cases. Methods: PubMed, Web of Science, and Scopus databases were searched on October 4, 2021, using a comprehensive strategy review. The following search terms were applied: (Insulin) AND (toxicity OR overdose OR toxicology OR poisoning OR intoxication) AND (Suicide OR attempted suicide OR Self-harm OR Self harm). The search strategy was set based on PRISMA guideline; 11 papers were eligible for inclusion and additional 23 studies were added from the citation search. All English articles related to suicide and attempted suicide using insulin were included and no specific timeline or filter was used. Any non-English article and accidental or homicidal cases were excluded from the review. Results: The analysis included 179 victims, aged between 13 to 76 years with male predominance and people with diabetes, especially T1DM, having higher prevalence, with subcutaneous injection being the most common route of administration. In addition, psychiatric illnesses and multiple suicide attempts were identified in many cases besides the use of insulin in a combination with other medications. Conclusions: Dying by suicide using insulin is uncommon, however, as diabetes mellitus prevalence increases worldwide, it is expected that intentional insulin overdose will also increase. Furthermore, psychiatric illnesses and easy access to insulin are important factors that should be put into consideration.

Long-term suicide risk of children and adolescents with attention deficit and hyperactivity disorder – a systematic review

IntroductionSeveral studies showed the high suicide risk of patients with attention deficit and hyperactivity disorder (ADHD), however most of these studies had cross-sectional design.ObjectivesThe aim of the current study was to review systematically those studies which investigated the suicide risk among ADHD patients with longitudinal design.MethodsThe systematic search was made on OVID Medline, PsychInfo, PubMed, Scopus, and Web of Science. The search terms were (ADHD OR attention deficit hyperactivity disorder) AND (suicide OR suicidal OR suicidality) AND (follow-up OR longitudinal study OR prospective study). Inclusion criteria were: written in English; participants under 18 years at the baseline; longitudinal, prospective studies; ADHD population at the baseline and at the follow-up; suicide behavior as primary outcome. Exclusion criteria were: the study did not contain empirical data, and reviews/meta-analyses and studies which aimed to investigate the drug treatment efficacy of ADHD.Results18 papers were included in the systematic review. 10 articles were published in the last 5 years. 9 studies enrolled children aged under 12 at baseline. The follow-up periods varied between 2 and 17 years. 17 studies found a significant positive association between ADHD diagnosis at baseline and the future suicidal behavior and/or attempts at the follow-up. The affective comorbidity showed an association with the future suicide risk.ConclusionsThese results highlight the importance of screening suicidality in patient with ADHD and consider it during treatment. Further studies are needed to clarify the role of the treatment and comorbidities of ADHD in the increased suicide risk.DisclosureNo significant relationships.

Development of Autonomic Nervous System Assays as Point-of-Care Tests to Supplement Clinical Judgment in Risk Assessment for Suicidal Behavior: A Review.

A biomarker point-of-care (POC) test that supplements the psychiatric interview and improves detection of patients at risk for suicide would be of value, and assays of autonomic nervous system (ANS) activity would satisfy the logistical requirements for a POC test. We performed a selective review of the available literature of ANS assays related to risk for suicide. We searched PubMed and Web of Science with the strategy: "suicide OR suicidal" AND "electrodermal OR heart rate variability OR pupillometry OR pupillography." The search produced 119 items, 21 of which provided original data regarding ANS methods and suicide. These 21 studies included 6 for electrodermal activity, 14 for heart rate variability, and 1 for the pupillary light reflex. The 21 papers showed associations between ANS assays and suicide risk in a direction suggesting underlying hyperarousal in patients at risk for suicide. ANS assays show promise for future development as POC tests to supplement clinical decision making in estimating risk for suicide.

Suicídio entre idosos: do que tratam as publicações brasileiras?

O estudo objetiva caracterizar as publicações científicas nacionais sobre o suicídio entre idosos, por meio de uma revisão integrativa da literatura. As buscas foram realizadas nas bases de dados do Scientific Eletronic Library Online (SCIELO), Literatura Latino Americana em Ciências da Saúde (LILACS) e Medical Literature Analisys and Retrieval System Online (MEDLINE), considerando o período de janeiro de 2000 a junho de 2020, utilizando a expressão: (suicídio OR “ideação suicida” OR “tentativa de suicídio”) AND (idoso OR idosos OR envelhecimento OR velhice). Foram encontrados 248 artigos, dos quais 24 estudos atenderam aos critérios de seleção, destes 29% das publicações (n=7) foram publicados no ano de 2012. De modo geral, os trabalhos utilizam o método epidemiológico e das autópsias psicológicas ou psicossociais, investigando fatores de risco relacionados ao fenômeno. Percebe-se que há uma complexidade de fatores biopsicossociais que permeiam o suicídio, sendo imprescindível o desenvolvimento de políticas públicas que voltem a atenção à saúde psíquica dos idosos.

Trend in the Prevalence of Non-Daily Smoking and Their Relationship with Mental Health Using the Korea Health and Nutrition Examination Survey.

Introduction: Non-Daily Smoking (NDS), which is increasingly prevalent worldwide, has not yet attracted as much attention as has daily smoking in Asia. The aims of this study were to identify trends in the prevalence of NDS and to compare characteristics by age, gender, and mental health indicators such as depression, suicidality, and alcohol consumption in South Korea. Methods: We included 33,806 adults (aged ≥ 19 years) who participated in the Korean National Health and Nutrition Examination Survey (KNHNES) from 2010 to 2015. The dataset includes self-reported medical history and questionnaires that explore depression, suicidality, and alcohol use, which are known to be highly related to smoking. We divided the respondents into four groups according to smoking status: Never Smoking (NS, N = 20,270); Past Smoking (PS = 6835); Daily Smoking (DS = 5927), who reported smoking every day; and Non-Daily Smoking (NDS = 774), who reported that they sometimes smoke. Results: Increased NDS prevalence is observed in most age groups in both male and female adults despite the prevalence of total smoking and daily smoking gradually decreasing. Depression and suicidality were significantly more prevalent in the NDS than the NS group (Depression Odds ratio, OR = 1.72, 95% Confidence interval, CI = 1.31–2.26; Suicidality OR = 3.14, 95% CI = 1.40–7.02). NDS is also associated with a higher frequency of binge drinking and alcohol use disorder than NS (OR = 4.17, 95% CI = 3.49–4.99). Conclusions: This study suggests that more concern is warranted for NDS given the increasing prevalence and characteristics of poor mental health in NDS respondents.

Male and Female Physician Suicidality

Population-based findings on physician suicide are of great relevance because this is an important and understudied topic. To evaluate male and female physician suicide risks compared with the general population from 1980 to date and test whether there is a reduction of SMR in cohorts after 1980 compared with before 1980 via a meta-analysis, modeling studies, and a systematic review emphasizing physician suicide risk factors. This study uses studies retrieved from PubMed, Scielo, PsycINFO, and Lilacs for human studies published by October 3, 2019, using the search term "(((suicide) OR (self-harm) OR (suicidality)) AND ((physicians) OR (doctors)))." Databases were also searched from countries listed in articles selected for review. Data were also extracted from an existing article by other authors to facilitate comparisons of the pre-1980 suicide rate with the post-1980 changes. Original articles assessing male and/or female physician suicide were included; for the meta-analysis, only cohorts from 1980 to the present were included. The preregistered systematic review and meta-analysis followed Cochrane, PRISMA, and MOOSE guidelines. Data were extracted into standardized tables per a prespecified structured checklist, and quality scores were added. Heterogeneity was tested via Q test, I2, and τ2. For pooled effect estimates, we used random-effects models. The Begg and Egger tests, sensitivity analyses, and meta-regression were performed. Proportional mortality ratios were presented when SMR data could not be extracted. Suicide SMRs for male and female physicians from 1980 to the present and changes over time (before and after 1980). Of 7877 search results, 32 articles were included in the systematic review and 9 articles and data sets in the meta-analysis. Meta-analysis showed a significantly higher suicide SMR in female physicians compared with women in general (1.46 [95% CI, 1.02-1.91]) and a significantly lower suicide SMR in male physicians compared with men in general (0.67 [95% CI, 0.55-0.79]). Male and female physician SMRs significantly decreased after 1980 vs before 1980 (male physicians: SMR, -0.84 [95% CI, -1.26 to -0.42]; P < .001; female physicians: SMR, -1.96 [95% CI, -3.09 to -0.84]; P = .002). No evidence of publication bias was found. In this study, suicide SMR was found to be high in female physicians and low in male physicians since 1980 but also to have decreased over time in both groups. Physician suicides are multifactorial, and further research into these factors is critical.

A Systematic Review: Adolescent Cannabis Use and Suicide

Objective: We aim to review studies on the relationship between cannabis use and suicide risk among adolescents. Materials and Methods: Data were collected from a PubMed and Google Scholar search, resulting in a close examination of 12 papers from 1990 to 2019 concerning cannabis use and suicide in relation to adolescents. Key search words included “marijuana OR cannabis OR THC OR tetrahydrocannabinol, AND suicide, AND adolescents” and only published studies between 1990 and 2019 were included. Included are a single review, 3 longitudinal studies, 7 cross-sectional investigations, and 1 letter to the editor. We referred to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 checklist and flowchart in the selection of our studies. Results: The review of the literature suggests that there is an association between cannabis use and suicidal behavior, as well as suicidal thoughts and attempts. Among cannabis users, adolescents were found to be most at risk for suicidal behavior. Our comprehensive examination of the literature suggests that cannabis is an independent predictor of suicide, with the frequency of use being associated with increased suicide attempts. Conclusions: Findings underscore the significance of the relationship between cannabis use and suicidal behavior in adolescents. Increased awareness of the detrimental outcomes due to adolescent cannabis use is necessary due to changing cannabis laws. The increasing legalization of cannabis use may change adolescents’ attitudes on using marijuana. Health care providers need to be increasingly aware of the potential effects that cannabis use has on adolescents.

A narrative review of suicide and suicidal behavior in medical students.

Studies across different countries have consistently demonstrated high rates of several psychiatric disorders among medical students. These findings, in turn, may be correlated with the higher than expected rate of suicide in student doctors. We aimed to provide a narrative review of the literature concerning suicidality in medical students worldwide. A narrative review is not a systematic review. Using Pub Med, we identified articles including our defined search terms: ((suicide) OR self-harm) (attempted suicide, deliberate self-harm AND medical students) OR future doctors. Particular credence was given to review articles and original research conducted this decade. We find that medical student suicide is likely related to a number of social and environmental factors. Structural systems in medical schools may play a role, for example, curricula, accommodation, social support, and academic pressures. Interpersonal factors that may be implicated include social isolation, the competitive nature of learning, and being away from home at an early age. There may also be endemic factors unique to medical training, which may contribute to higher rates of depression and suicidality; these include simulation training, working with cadavers, and witnessing trauma throughout placements. The socio-cultural environment, for example, the role of ragging, expectations from teachers, and patients, may place extra pressure on vulnerable individuals. Rates have been shown to be higher among females, which raises further discussion on the nature of gender roles and gender role expectations within medicine. As the medical workforce of the future, today's students require a considerable emotional and financial investment. It is, therefore, crucial that educators and supervisors understand the needs of this student body while delivering the essential skills to be a doctor in a sensitive nonstigmatizing manner.

Mental health outcomes associated with the use of amphetamines: A systematic review and meta-analysis

BackgroundThe use of amphetamines is a global public health concern. We summarise global data on use of amphetamines and mental health outcomes. MethodsA systematic review and meta-analysis (CRD 42017081893). We searched Medline, EMBASE, PsycInfo for methamphetamine or amphetamine combined with psychosis, violence, suicidality, depression or anxiety. Included studies were human empirical cross-sectional surveys, case-control studies, cohort studies and randomised controlled trials that assessed the association between methamphetamine and one of the mental health outcomes. Random effects meta-analysis was used to pool results for any use of amphetamines and amphetamine use disorders. Findings149 studies were eligible and 59 were included in meta-analyses. There was significant heterogeneity in effects. Evidence came mostly from cross-sectional studies. Any use of amphetamines was associated with higher odds of psychosis (odds ratio [OR] = 2.0, 95%CI 1.3–3.3), violence (OR = 2.2, 95%CI 1.2–4.1; adjusted OR [AOR] = 1.4, 95%CI 0.8–2.4), suicidality OR = 4.4, 95%CI 2.4–8.2; AOR = 1.7, 95%CI 1.0–2.9) and depression (OR = 1.6, 95%CI 1.1–2.2; AOR = 1.3, 95%CI 1.2–1.4). Having an amphetamine use disorder was associated with higher odds of psychosis (OR = 3.0, 95%CI 1.9–4.8; AOR = 2.4, 95%CI 1.6–3.5), violence (OR = 6.2, 95%CI 3.1–12.3), and suicidality (OR = 2.3, 95%CI 1.8–2.9; AOR = 1.5, 95%CI 1.3–1.8). InterpretationMethamphetamine use is an important risk factor for poor mental health. High quality population-level studies are needed to more accurately quantify this risk. Clinical responses to methamphetamine use need to address mental health harms.

Prevalence of suicidal thoughts and behaviours among medical professionals: a meta-analysis and systematic review

BackgroundSuicidal thoughts and behaviours (STB) are common among medical professionals, which is a risk factor for death by suicide. However, the prevalence of STB among medical professionals is highly variable in published studies. We aimed to provide accurate prevalence estimates of STB. MethodsWe searched PubMed, Embase, and PsycINFO for relevant studies published in English between Jan 1, 1990, and Dec 14, 2018, using the search terms “(suicide OR suicidal ideation OR suicide plan OR suicide attempt OR suicidal behaviour OR suicidality OR suicid*) AND (physician OR surgeon OR nurse OR medical graduate OR medical undergraduate OR internship OR residency OR health-care provider OR medical trainee OR doctor) AND (prevalence OR incidence)”. Prevalence estimates for suicidal thoughts and attempts during lifetime, in the past 12 months, and recently (in the past 1 month) among medical professionals were pooled using random-effects meta-analyses. We evaluated heterogeneity using the I2 statistic and did sensitivity analysis to identify the sources for substantial heterogeneity. We did subgroup analysis and meta-regression to assess the differences among screening instruments, income groups, and phases of medical practice. We assessed publication bias using Begg's and Egger's tests. FindingsOur search identified 5509 records, among which 73 longitudinal and cross-sectional studies were included. Pooled global prevalence estimates were 25·5% for lifetime suicidal thoughts, 9·8% for suicidal thoughts in the past 12 months, and 8·0% for recent suicidal thoughts among medical professionals. Pooled global prevalence estimates were 2·3% for lifetime suicide attempts and 0·5% for suicide attempts in the past 12 months. The aggregated estimates were substantially heterogeneous. Subgroup analysis and meta-regression showed that the prevalence of recent suicidal thoughts and lifetime suicide attempts among medical professionals from low-income and middle-income countries were higher than those from high-income countries. Medical students, compared with physicians and nurses, had a higher prevalence of suicidal thoughts within the past 12 months. The prevalence estimate of recent suicidal thoughts in women was higher than that in men. InterpretationSTB is a strong risk factor for suicide and early identification can be helpful to prevent the tragedies of committing suicide. The prevalence of STB among medical professionals is relatively high. Effective programmes are urgently needed to prevent death by suicide among medical professionals. FundingNational Natural Science Foundation of China.

Suicide in Parkinson's Disease: A Systematic Review.

Psychiatric disorders and suicide have been reported in patients suffering from Parkinson's disease. The aims of the present paper were to determine whether patients with Parkinson's disease have an increased rate of suicide and to identify the clinical features possibly associated with suicide risk in Parkinson's disease. We also reviewed the studies on suicide risk in Parkinson's disease in patients after deep brain stimulation. We performed a Medline, Excerpta Medica, PsycLit, PsycInfo and Index Medicus search to identify all articles published on this topic from 1970 to 2019. The following search terms were used: suicide OR suicide attempt OR suicidal ideation OR suicide risk AND Parkinson's disease AND Parkinson's disease and deep brain stimulation. The studies we identified that assessed the suicide rate associated with Parkinson's disease yielded contrasting results, although an increase in suicidal ideation did emerge. The studies on the effect of deep brain stimulation on suicide risk in Parkinson's disease also reported mixed findings. Psychiatric symptoms, including depression, appear to be associated with suicide risk in patients with Parkinson's disease undergoing medical and after surgical treatment. The studies reviewed suggest that suicidal ideation is increased in Parkinson's disease. Further longitudinal studies designed to assess suicidality in this condition are still needed.

Internet Addiction and Its Relationship With Suicidal Behaviors: A Meta-Analysis of Multinational Observational Studies.

To perform a systematic review and meta-analysis of observational studies that investigated the putative association between internet addiction and suicidality. Major electronic databases (PubMed, Embase, ClinicalKey, Cochrane Library, ProQuest, Science Direct, and ClinicalTrials.gov) were searched using the following keywords (internet addiction OR internet gaming disorder OR internet use disorder OR pathological internet use OR compulsive internet use OR problematic internet use) AND (suicide OR depression) to identify observational studies from inception to October 31, 2017. We included 23 cross-sectional studies (n = 270,596) and 2 prospective studies (n = 1,180) that investigated the relationship between suicide and internet addiction. We extracted the rates of suicidal ideation, planning, and attempts in individuals with internet addiction and controls. The individuals with internet addiction had significantly higher rates of suicidal ideation (odds ratio [OR] = 2.952), planning (OR = 3.172), and attempts (OR = 2.811) and higher severity of suicidal ideation (Hedges g = 0.723). When restricted to adjusted ORs for demographic data and depression, the odds of suicidal ideation and attempts were still significantly higher in the individuals with internet addiction (ideation: pooled adjusted OR = 1.490; attempts: pooled adjusted OR = 1.559). In subgroup analysis, there was a significantly higher prevalence rate of suicidal ideation in children (age less than 18 years) than in adults (OR = 3.771 and OR = 1.955, respectively). This meta-analysis provides evidence that internet addiction is associated with increased suicidality even after adjusting for potential confounding variables including depression. However, the evidence was derived mostly from cross-sectional studies. Future prospective studies are necessary to confirm these findings.

The association between teen dating violence, dates’ substance abuse, depression, anxiety, and suicide: Fez city as a case study

Introduction Teen dating in an Arab and a Muslim country as Morocco happens very often in secret and without parents’ knowledge. The secretive nature of such relationships increases the likelihood of negative practices’ occurrence, which have traumatic effects on the mental and physical health of daters. This study aimed to explore and analyse the association between intimate partners’ substance abuse, violence occurrence, and participants’ feelings of depression, anxiety, and suicidality. Methods This cross sectional study was conducted in Fez city, and self-administered questionnaires were distributed among a sample of 407 Moroccan secondary school students. Socio-demographic data were obtained using a standard questionnaire. Information on mental and physical health of daters was collected using validated scales. Statistical analyses were performed using SPSS 20.0. Results The mean age of participants was 16.67 ± 1.71, and about 52.8% were males. As many as 72% of participants were in high school, and the majority (41.5%) were from poor families. Concerning teen dating violence occurrence, dates’ substance abuse was found to be a risk factor OR = 3.60; IC 95% (1.77–7.31). Indeed, dates’ drugs consumption was associated with participants’ victimization OR = 3.27; IC 95% (1.72–6.21) participants’ feelings of depression OR = 1.92; IC 95% (1.08–3.41), anxiety OR = 1.71; IC 95% (1.00–3.00), and the development of suicidal behaviours OR = 2.40; IC 95% (1.42–4.07). Conclusion The strong correlation between dates’ substance abuse, teen dating violence occurrence, participants’ feelings of depression, anxiety, and suicide commands urgent intervention for secondary school students in Fez city even though it conflicts with traditions and norms.

Suicide and traumatic spinal cord injury-a cohort study.

Retrospective and prospective observational. The main objective of this study was to analyse suicide attempt as a cause of traumatic spinal cord injury (tSCI) and suicide as a cause of death after tSCI. This study was conducted at two British spinal centres, Stoke Mandeville and Southport. Long-term survival of patients who were newly admitted between 1991 and 2010, had survived the first post-injury year and had neurological deficit on discharge. Follow-up was discontinued on 31 December 2014. Among the 2304 newly admitted cases of tSCI, suicide attempt was the cause of injury in 63 cases (2.7%). By the end of 2014 there were 533 deaths of which 4.2% deaths were by suicide, with 91% of suicides happening in the first 10 years post injury. Multiple logistic regression analyses showed a higher mortality odds ratio (OR=4.32, P<0.001) and a much higher suicide OR (9.46, P<0.001) for persons injured in suicide attempts when compared with all other SCI aetiologies. The overall age-standardised suicide mortality rate was 62.5 per 100 000 persons per year (95% confidence interval=36.4-88.6), five times higher than the general population suicide rate for England and Wales in 2014 (12.2 per 100 000). Suicide attempt was the cause of tSCI in 2.7% of the sample and suicide was the cause of death in 4.2% of all deaths. The overall mortality and death by suicide were significantly higher in persons whose tSCI was caused by an attempted suicide when compared with the rest of the sample. Continued psychological attention following SCI, especially to those who were injured by suicide attempt, is warranted.

Clinical Use of Curcumin in Depression: A Meta-Analysis

IntroductionThere is growing interest in the use of curcumin, a plant polyphenol with potent anti-inflammatory, anti-oxidant, and neuroprotective properties, as a novel antidepressant. Clinical trials have yielded conflicting conclusions pertaining to its effectiveness in depression. A meta-analysis of the topic, which has not been done until now, is therefore necessary to summarize current evidence and generate hypotheses for further research. MethodsUsing the keywords [curcumin OR diferuloylmethane OR curcuminoid OR turmeric OR Indian saffron] AND [depression OR MDD OR suicide], a preliminary search on the PubMed, Ovid, Clinical Trials Register of the Cochrane Collaboration Depression, Anxiety and Neurosis Group (CCDANTR), and Cochrane Field for Complementary Medicine database yielded 2081 articles published in English between January 1, 1960, and August 1, 2016. ResultsSix clinical trials with a total of 377 patients were reviewed, comparing the use of curcumin to placebo. In patients with depression, the pooled standardized mean difference from baseline Hamilton Rating Scale for Depression scores (pooled standardized mean difference −0.344, 95% confidence interval −0.558 to −0.129; P = .002) support the significant clinical efficacy of curcumin in ameliorating depressive symptoms. Significant anti-anxiety effects were also reported in 3 of the trials. Notably, no adverse events were reported in any of the trials. Most trials had a generally low risk of bias, except for an open trial of curcumin and a single-blinded study. LimitationsBecause of the small number of studies available, a funnel plot or sensitivity analysis was not possible. Evidence on the long-term efficacy and safety of curcumin is also limited as the duration of all available studies ranged from 4 to 8 weeks. ConclusionsCurcumin appears to be safe, well-tolerated, and efficacious among depressed patients. More robust randomized controlled trials with larger sample sizes and follow-up studies carried out over a longer duration should be planned to ascertain its benefits.

Prevention of Firearm Suicide in the United States: What Works and What Is Possible.

About 21,000 suicides in the United States in 2014 involved a firearm. The authors reviewed evidence from around the world regarding the relationship between firearm ownership rates and firearm suicide rates and the potential effectiveness of policy-based strategies for preventing firearm suicides in the United States. Relevant publications were identified by searches of PubMed, PsycINFO, MEDLINE, and Google Scholar from 1980 to September 2015, using the search terms suicide AND firearms OR guns. Excluding duplicates, 1,687 results were found, 60 of which were selected for inclusion; these sources yielded an additional 10 studies, for a total of 70 studies. Case-control and ecological studies investigating geographic and temporal variations in firearm ownership and firearm suicide rates indicate that greater firearm availability is associated with higher firearm suicide rates. Time-series analyses, mostly from other countries, show that legislation reducing firearm ownership lowers firearm suicide rates. Because the Second Amendment curtails legislation broadly restricting firearm access in the United States, the emphasis is shifted to restricting access for those at risk of harming themselves or others. Most suicides involve guns purchased years earlier. Targeted initiatives like gun violence restraining orders, smart gun technology, and gun safety education campaigns potentially reduce access to already purchased firearms by suicidal individuals. Such measures are too new to have evidence of effectiveness. Broadly reducing availability and access to firearms has lowered firearm suicide rates in other countries but does not appear feasible in the United States. Approaches restricting access of at-risk individuals to already purchased firearms by engaging the public and major stakeholders require urgent implementation and outcome evaluation for firearm suicide prevention.

Making the invisible visible: a systematic review of sexual minority women's health in Southern Africa.

BackgroundOver the past two decades research on sexual and gender minority (lesbian, gay, bisexual and transgender; LGBT) health has highlighted substantial health disparities based on sexual orientation and gender identity in many parts of the world. We systematically reviewed the literature on sexual minority women’s (SMW) health in Southern Africa, with the objective of identifying existing evidence and pointing out knowledge gaps around the health of this vulnerable group in this region.MethodsA systematic review of publications in English, French, Portuguese or German, indexed in PubMed or MEDLINE between the years 2000 and 2015, following PRISMA guidelines. Additional studies were identified by searching bibliographies of identified studies. Search terms included (Lesbian OR bisexual OR “women who have sex with women”), (HIV OR depression OR “substance use” OR “substance abuse” OR “mental health” OR suicide OR anxiety OR cancer), and geographical specification. All empirical studies that used quantitative or qualitative methods, which contributed to evidence for SMW’s health in one, a few or all of the countries, were included. Theoretical and review articles were excluded. Data were extracted independently by 2 researchers using predefined data fields, which included a risk of bias/quality assessment.ResultsOf 315 hits, 9 articles were selected for review and a further 6 were identified through bibliography searches. Most studies were conducted with small sample sizes in South Africa and focused on sexual health. SMW included in the studies were racially and socio-economically heterogeneous. Studies focused predominately on young populations, and highlighted substance use and violence as key health issues for SMW in Southern Africa.ConclusionsAlthough there are large gaps in the literature, the review highlighted substantial sexual-orientation-related health disparities among women in Southern Africa. The findings have important implications for public health policy and research, highlighting the lack of population-level evidence on the one hand, and the impact of criminalizing laws around homosexuality on the other hand.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-2980-6) contains supplementary material, which is available to authorized users.

The Psychological and Medical Factors Associated With Untreated Binge Eating Disorder.

Although binge eating disorder (BED) is the most prevalent eating disorder, the impact of untreated BED is underappreciated. This review describes the relationship of BED to physical and mental health, quality of life, and functionality. PubMed searches were conducted on March 21, 2014; searches were limited to English-language research articles, meta-analyses, and reviews published between January 1, 2003 and March 21, 2014. Search terms included (binge eating OR binge-eating OR binge eating disorder) AND (cardiovascular OR metabolic OR metabolic syndrome OR gastrointestinal OR health OR rehabilitation OR recovery OR sleep OR pregnancy OR quality of life OR functional impairment OR activities of daily living OR QoL OR SF-12 OR ED-5D OR SF-36 OR psychosocial OR depressive OR anxiety OR self-esteem OR suicidality OR suicide OR productivity OR family). Of 326 identified publications, 43 were relevant to the topic and reported on the association of BED with psychiatric and medical comorbidities, quality of life, and functional outcomes. Individuals diagnosed with BED have increased rates of mental health comorbidities (eg, depression and anxiety) and more pronounced medical impairments (eg, cardiovascular disorders) compared with individuals without BED. BED is also associated with functional impairment and reduced quality of life. Binge eating disorder is associated with impairments in physical and mental health, which can decrease quality of life and functionality and lead to increased health care utilization and decreased productivity. However, some caution is warranted in interpreting these findings because it remains unclear whether BED is an antecedent condition, a complication associated with a comorbid psychiatric condition, or an unrelated feature that occurs concurrently with these comorbidities and impairments. Much of the research on BED is based on observational or epidemiologic studies. Controlled studies are needed to clearly define the long-term impairments associated with BED.