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Rates of self-harm and suicide are increasing world-wide, particularly in young females. Emergency departments (EDs) are a common first point-of-contact for young people who self-harm. We examined age- and sex-related differences in: (1) rates of self-harm over an eight-year period; (2) changes in demographic, presentation, and treatment characteristics over this period, and; (3) rates of, and time to, self-harm re-presentation. This was a retrospective observational study of all self-harm presentations in persons aged nine years and older to the Royal Melbourne Hospital ED over an eight-year period, 1 January 2012–31 December 2019. The Royal Melbourne Hospital is one of the largest and busiest public EDs in Melbourne, Australia and serves a primary catchment area of approximately 1.5 million people. There were 551,692 presentations to the Royal Melbourne Hospital ED over this period (57.6 % by females). Of these, 7736 (1.4 %) were self-harm related. These self-harm presentations involved 5428 individuals (54.8 % female), giving an overall repetition event-rate of 11.2 %. Self-harm related presentations increased by 5 % per year (Incidence Rate Ratio [IRR 1.05, 95 % CI 1.02–1.08); a 44 % increase over the eight-year period (IRR 1.44, 95 % CI 1.15–1.80). This increase was more pronounced for young people aged< 25 years. The most common method was self-poisoning, primarily by anxiolytics or analgesics. The proportion of presentations involving self-poisoning alone declined modestly over time, whilst the proportion involving self-injury alone increased. For just over half of all presentations the person was seen by ED mental health staff. The median time to first re-presentation was 4.5 months (Inter-Quartile Range [IQR] 0.7–13.2 months). Rates of hospital presenting self-harm may be increasing, particularly amongst young people, whilst most self-harm presentations occurred outside office hours; so appropriate ED staffing, training and clinical care models are needed. Around half of those with a repeat episode of self-harm repeated within three months of their index (i.e., first recorded) presentation. Efforts to establish appropriate aftercare services, including alternatives to ED services with service availability 24 h a day 7 days a week, aimed at reducing repetition rates, should be prioritised. [ABSTRACT FROM AUTHOR]

The benefits of helplines are particularly valuable during a pandemic when face-to-face services and natural supports are difficult to access. Kids Helpline, Australia's national youth helpline, provides children and young people with free 24/7 information and counseling through telephone, WebChat, and e-mail. We aimed to examine the use of Kids Helpline during the COVID-19 pandemic. We analyzed monthly and weekly time trends of demand for and response by the Kids Helpline. The frequency of counseling contacts by common concern types, age, and gender were also examined. We used Joinpoint regression. Analyses of weekly demand for Kids Helpline showed an increase when the pandemic was declared, followed by a gradual decline. A second rise from 12 July 2020 when parts of Australia experienced a second wave of infections, followed by another decline, occurred more recently. Increased demand was almost entirely in the WebChat modality. Most answered counseling contacts were from girls and those aged 13–18 years. The number of contacts about mental health, suicide/self-harm, and family relationships increased, with mental health contacts also increasing as a proportion of total contacts. COVID-19–related concerns were the most common reason for contact in April 2020. In Australia, the COVID-19 pandemic saw a rapid increase in demand for Kids Helpline, mainly by WebChat, with the virus itself, mental health, suicide/self-harm, and relationships common reasons for contact. Responding to rapid changes in demand for particular modalities is challenging and understanding of the use and effectiveness of different modalities is needed. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To estimate the prevalence of depression among older adults in Australia. Method: All general practitioners in Australia''s five most populous states who satisfied certain eligibility criteria (e.g., sufficient weekly working hours, sufficient numbers of elderly patients) were invited to participate. Those who consented were asked to identify all of their patients aged 60+ and invite them (either directly or via the study team) to complete a questionnaire. The questionnaire identified those who had experienced ‘clinically significant depression’ and those who had experienced a ‘major depressive episode’ in the past two weeks, via the Patient Health Questionnaire (PHQ-9). Consenting patients completed the questionnaire and returned it to the study team in a reply-paid envelope. Results: In total, 22,251 patients returned questionnaires. Overall, the age-adjusted rate of clinically significant depression was 8.2% (95%CI=7.8%–8.6%), with the age-adjusted rates for males being 8.6% (95%CI=7.9%–9.2%) and for females being 7.9% (95%CI=7.4%–8.4%). The overall, male and female age-adjusted rates for a major depressive episode were 1.8% (95%CI=1.6%–2.0%), 1.9% (95%CI=1.6%–2.2%) and 1.7% (95%CI=1.5%–2.0%), respectively. Discussion: Our study suggests that depression among older people is a major public health problem. The above estimates provide guidance for efficient planning of services, and establish a baseline against which preventive and treatment interventions can be assessed. Armed with this information, we can progress efforts at reducing this major health problem and its consequences. [Copyright &y& Elsevier]

Abstract: This study aimed to determine whether media items about suicide were associated with differential increases in actual suicides. Data were available on 4635 suicide-related items appearing in Australian newspapers and on radio and television news and current affairs shows between March 2000 and February 2001. These data were combined with national data on completed suicides occurring during the same period, by a process that involved identifying the date and geographical reach of the media items and determining the number of suicides occurring in the same location in selected weeks pre- and post-item. Regression analyses were conducted to determine whether the likelihood of an increase in post-item suicides could be explained by particular item characteristics. We found that 39% of media items were followed by an increase in male suicides, and 31% by an increase in female suicides. Media items were more likely to be associated with increases in both male and female suicides if they occurred in the context of multiple other reports on suicide (versus occurring in isolation), if they were broadcast on television (versus other media), and if they were about completed suicide (versus attempted suicide or suicidal ideation). Different item content appeared to be influential for males and females, with an increase in male suicides being associated with items about an individual''s experience of suicide and opinion pieces, and an increase in female suicides being associated with items about mass- or murder-suicide. Item prominence and quality were not differentially associated with increases in male or female suicides. Further research on this topic is required, but in the meantime there is a need to remain vigilant about how suicide news is reported. Mental health professionals and suicide experts should collaborate with media professionals to try to balance ‘public interest’ against the risk of harm. [Copyright &y& Elsevier]

: PurposeTo compare prevalence estimates of adolescents'' cigarette, alcohol and marijuana use from one Australian and two U.S. surveys, and to consider the effect of methodological differences on reported use.: MethodsSecondary analysis of data from the Australian Child and Adolescent Component of the National Survey of Mental Health and Well-being (NSMHWB, 1998), the U.S. Youth Risk Behavior Survey (YRBS, 1999), and National Household Survey on Drug Abuse (NHSDA, 1998). Prevalence estimates and 95% confidence intervals were derived for three substance use behaviors. Differences between estimates were considered statistically significant if the 95% confidence intervals did not overlap.: ResultsWhen Australian and U.S. adolescents were compared using NSMHWB and YRBS data, the former were generally found to be less likely to report using cigarettes, alcohol and marijuana than the latter. However, when NHSDA was used as the comparator, the prevalence of substance use among Australian adolescents was either no different from, or greater than, that of U.S. adolescents. Likely explanations for the discrepant findings include the population focus (i.e., whether the survey targeted only young people or adults as well), sampling issues (i.e., whether school-based and household-based sampling frames introduced different biases in terms of who was likely to be absent when the survey was administered), response rates, the survey context (i.e., whether school-based and household-based survey administration methods promoted different kinds of response behavior), the wording of questions and the precision of estimates of the different surveys.: ConclusionsCross-national data on adolescent substance use should be interpreted cautiously. Cross-national comparisons that are done well (i.e., using standard, uniform approaches) can be invaluable in highlighting worthwhile policy directions; cross-national comparisons that are done poorly may lead to erroneous assumptions. [Copyright &y& Elsevier]

Increased efforts are needed to promote adolescent health in all areas investigated in this study. Differences both in prevalence and socioeconomic patterning between Norway and the United States indicate that the major challenges differ between the two countries. The results also emphasize the need to undertake joint efforts to use measurements that make national data sets comparable across countries. [Copyright &y& Elsevier]

Abstract: Around 100 studies have been conducted to examine the ‘Werther effect’ – the phenomenon whereby there is an increased rate of completed or attempted suicide following the depiction of an individual’s suicide in the media. These ‘media influence studies’ provide strong evidence for the existence of the Werther effect in the news media, and equivocal evidence for its existence in the entertainment media. Having established this, there is now a need to complement these media influence studies with inter-related studies that draw on approaches from a range of disciplines, particularly that of communication. The studies can be thought of as investigating the full spectrum of news and entertainment media processes and content, from how suicide stories are produced (news/entertainment production studies), to what information they contain and how this is framed (content analysis studies), to how this information is received and perceived (audience reception studies). This will assist in explicating the mechanisms by which the Werther effect might operate, and in designing and evaluating interventions to improve the practices of news and entertainment media professionals. [Copyright &y& Elsevier]

Provides the abstract of the research titled 'Receipt of Psychological or Emotional Counseling by Suicidal Adolescents,' which was presented at the annual meeting of the Society for Adolescent Medicine in Seattle, Washington on March 19-22, 2003.

Background: There has been substantial discussion as to whether the mental health and socio-economic consequences of the COVID-19 pandemic might impact suicide rates. Although India accounts for the largest proportion of global suicides, the early impacts of the COVID-19 pandemic on suicide rates in this country are unknown.Methods: National Crime Records Bureau (NCRB) data were used to calculate annual suicide rates for the period 2010-2020, stratified by sex and state. Rate Ratios (RRs) stratified by sex and state were calculated to estimate the extent of change in suicide rates.Results: Suicide rates in India generally showed a decreasing trend from 2010 until 2017, with the trend reversing after this period, particularly for males. Among males and females, the highest increase post 2017 was noted in 2020 (compared to 2017) (males: RR = 1.18 95% UI 1.17-1.19; females: RR = 1.05 95% UI 1.03-1.06).Limitation: Suicide rates based on the NCRB data might be an underestimation of the true suicide rates.Conclusion: Suicide rates in India increased during the first year of the COVID-19 pandemic, and although the increase in suicide rates, especially among males, predates the pandemic, the increase in suicide rates was highest in 2020, compared to increases in previous years. Further research is warranted to understand the potential ongoing impact of the COVID-19 pandemic on suicide in India. [ABSTRACT FROM AUTHOR]

Abstract: Studies of suicide epidemiology in regions of Australia have been conducted, but the spatial pattern in the whole country has not been fully investigated. This study aimed at visualizing the sex-specific suicide pattern over the country from 2004 to 2008, and studying the metropolitan-rural-remote differentials of suicide across all states/territories. We applied a Poisson hierarchical model to yield smoothed sex specific, age standardized mortality ratios of suicide in all postal areas, and compiled the age-standardized suicide rates across different levels of remoteness and different jurisdictions. We identified the area variation of suicide risk across states/territories, and metropolitan-rural-remote differential with rates higher in rural and remote areas for males. Spatial clusters of some high risk postal areas were also identified. Socio-economic deprivation, compositional factors, high risks for Indigenous people and low access to mental health service are the underlying explanations of the elevation of suicide risk in some areas. These findings suggest that it is important to take geographical variations in suicide risk into account in national policy making. Particular suicide prevention interventions might be targeted at males living in remote areas, and some localized areas in metropolitan zones. [Copyright &y& Elsevier]

Abstract Primary care in Australia is undergoing significant reform, with a particular focus on cost-effective tailoring of mental health care to individual needs. Link-me is testing whether a patient-completed Decision Support Tool (DST), which predicts future severity of depression and anxiety symptoms and triages individuals into care accordingly, is clinically effective and cost-effective relative to usual care. The trial is set in general practices, with English-speaking patients invited to complete eligibility screening in their general practitioner's waiting room. Eligible and consenting patients will then complete the DST assessment and are randomised and stratified according to predicted symptom severity. Participants allocated to the intervention arm will receive feedback on DST responses, select treatment priorities, assess motivation to change, and receive a severity-matched treatment recommendation (information about and links to low intensity services for those with mild symptoms, or assistance from a specially trained health professional (care navigator) for those with severe symptoms). All patients allocated to the comparison arm will receive usual GP care plus attention control. Primary (psychological distress) and secondary (depression, anxiety, quality of life, days out of role) outcomes will be assessed at 6 and 12 months. Differences in outcome means between trial arms both across and within symptom severity group will be examined using intention-to-treat analyses. Within trial and modelled economic evaluations will be conducted to determine the value for money of credentials of Link-me. Findings will be reported to the Federal Government to inform how mental health services across Australia are funded and delivered in the future. [ABSTRACT FROM AUTHOR]

Objective: To understand why some users call crisis helplines frequently.Methods: Nineteen semi-structured telephone interviews were conducted with callers to Lifeline Australia who reported calling 20 times or more in the past month and provided informed consent. Interviews were audio-recorded and transcribed verbatim. Inductive thematic analysis was used to generate common themes. Approval was granted by The University of Melbourne Human Research Ethics Committee.Results: Three overarching themes emerged from the data and included reasons for calling, service response and calling behaviours. Respondents called seeking someone to talk to, help with their mental health issues and assistance with negative life events. When they called, they found short-term benefits in the unrestricted support offered by the helpline. Over time they called about similar issues and described reactive, support-seeking and dependent calling behaviours.Conclusion: Frequent users of crisis helplines call about ongoing issues. They have developed distinctive calling behaviours which appear to occur through an interaction between their reasons for calling and the response they receive from the helpline.Practice Implications: The ongoing nature of the issues prompting frequent users to call suggests that a service model that includes a continuity of care component may be more efficient in meeting their needs. [ABSTRACT FROM AUTHOR]

A number of studies have investigated the presence of suicide clusters, but few have sought to identify risk and protective factors of a suicide occurring within a cluster. We aimed to identify socio-demographic and contextual characteristics of suicide clusters from national and regional analyses of suicide clusters. We searched the National Coroners Information System for all suicides in Australia from 2004 to 2008. Scan statistics were initially used to identify those deaths occurring within a spatial-temporal suicide cluster during the period. We then used logistic regression and generalized estimation equations to estimate the odds of each suicide occurring within a cluster differed by sex, age, marital status, employment status, Indigenous status, method of suicide and location. We identified 258 suicides out of 10,176 suicides during the period that we classified as being within a suicide cluster. When the deceased was Indigenous, living outside a capital city, or living in the northern part of Australia (in particular, Northern Territory, Queensland and Western Australia) then there was an increased likelihood of their death occurring within a suicide cluster. These findings suggest that suicide clustering might be linked with geographical and Indigenous factors, which supported sociological explanations of suicide clustering. This finding is significant for justifying resource allocation for tackling suicide clustering in particular areas. [ABSTRACT FROM AUTHOR]