Sónia Quintão

Antidepressant utilization and suicide in Europe: an ecological multi-national study

Background Research concerning the association between use of antidepressants and incidence of suicide has yielded inconsistent results and is the subject of considerable controversy. The first aim is to describe trends in the use of antidepressants and rates of suicide in Europe, adjusted for gross domestic product, alcohol consumption, unemployment, and divorce. The second aim is to explore if any observed reduction in the rate of suicide in different European countries preceded the trend for increased use of antidepressants. Methods Data were obtained for 29 European countries between 1980 and 2009. Pearson correlations were used to explore the direction and magnitude of associations. Generalized linear mixed models and Poisson regression distribution were used to clarify the effects of antidepressants on suicide rates, while an autoregressive adjusted model was used to test the interaction between antidepressant utilization and suicide over two time periods: 1980–1994 and 1995–2009. Findings An inverse correlation was observed in all countries between recorded Standardised Death Rate (SDR) for suicide and antidepressant Defined Daily Dosage (DDD), with the exception of Portugal. Variability was marked in the association between suicide and alcohol, unemployment and divorce, with countries depicting either a positive or a negative correlation with the SDR for suicide. Every unit increase in DDD of an antidepressant per 1000 people per day, adjusted for these confounding factors, reduces the SDR by 0.088. The correlation between DDD and suicide related SDR was negative in both time periods considered, albeit more pronounced between 1980 and 1994. Conclusions Suicide rates have tended to decrease more in European countries where there has been a greater increase in the use of antidepressants. These findings underline the importance of the appropriate use of antidepressants as part of routine care for people diagnosed with depression, therefore reducing the risk of suicide.

What Are Reasons for the Large Gender Differences in the Lethality of Suicidal Acts? An Epidemiological Analysis in Four European Countries

Background In Europe, men have lower rates of attempted suicide compared to women and at the same time a higher rate of completed suicides, indicating major gender differences in lethality of suicidal behaviour. The aim of this study was to analyse the extent to which these gender differences in lethality can be explained by factors such as choice of more lethal methods or lethality differences within the same suicide method or age. In addition, we explored gender differences in the intentionality of suicide attempts. Methods and Findings Methods. Design: Epidemiological study using a combination of self-report and official data. Setting: Mental health care services in four European countries: Germany, Hungary, Ireland, and Portugal. Data basis: Completed suicides derived from official statistics for each country (767 acts, 74.4% male) and assessed suicide attempts excluding habitual intentional self-harm (8,175 acts, 43.2% male). Main Outcome Measures and Data Analysis. We collected data on suicidal acts in eight regions of four European countries participating in the EU-funded “OSPI-Europe”-project (www.ospi-europe.com). We calculated method-specific lethality using the number of completed suicides per method * 100 / (number of completed suicides per method + number of attempted suicides per method). We tested gender differences in the distribution of suicidal acts for significance by using the χ2-test for two-by-two tables. We assessed the effect sizes with phi coefficients (φ). We identified predictors of lethality with a binary logistic regression analysis. Poisson regression analysis examined the contribution of choice of methods and method-specific lethality to gender differences in the lethality of suicidal acts. Findings Main Results Suicidal acts (fatal and non-fatal) were 3.4 times more lethal in men than in women (lethality 13.91% (regarding 4106 suicidal acts) versus 4.05% (regarding 4836 suicidal acts)), the difference being significant for the methods hanging, jumping, moving objects, sharp objects and poisoning by substances other than drugs. Median age at time of suicidal behaviour (35–44 years) did not differ between males and females. The overall gender difference in lethality of suicidal behaviour was explained by males choosing more lethal suicide methods (odds ratio (OR) = 2.03; 95% CI = 1.65 to 2.50; p < 0.000001) and additionally, but to a lesser degree, by a higher lethality of suicidal acts for males even within the same method (OR = 1.64; 95% CI = 1.32 to 2.02; p = 0.000005). Results of a regression analysis revealed neither age nor country differences were significant predictors for gender differences in the lethality of suicidal acts. The proportion of serious suicide attempts among all non-fatal suicidal acts with known intentionality (NFSAi) was significantly higher in men (57.1%; 1,207 of 2,115 NFSAi) than in women (48.6%; 1,508 of 3,100 NFSAi) (χ2 = 35.74; p < 0.000001). Main limitations of the study Due to restrictive data security regulations to ensure anonymity in Ireland, specific ages could not be provided because of the relatively low absolute numbers of suicide in the Irish intervention and control region. Therefore, analyses of the interaction between gender and age could only be conducted for three of the four countries. Attempted suicides were assessed for patients presenting to emergency departments or treated in hospitals. An unknown rate of attempted suicides remained undetected. This may have caused an overestimation of the lethality of certain methods. Moreover, the detection of attempted suicides and the registration of completed suicides might have differed across the four countries. Some suicides might be hidden and misclassified as undetermined deaths. Conclusions Men more often used highly lethal methods in suicidal behaviour, but there was also a higher method-specific lethality which together explained the large gender differences in the lethality of suicidal acts. Gender differences in the lethality of suicidal acts were fairly consistent across all four European countries examined. Males and females did not differ in age at time of suicidal behaviour. Suicide attempts by males were rated as being more serious independent of the method used, with the exceptions of attempted hanging, suggesting gender differences in intentionality associated with suicidal behaviour. These findings contribute to understanding of the spectrum of reasons for gender differences in the lethality of suicidal behaviour and should inform the development of gender specific strategies for suicide prevention.

Methylphenidate in mania project (MEMAP): study protocol of an international randomised double-blind placebo-controlled study on the initial treatment of acute mania with methylphenidate

BackgroundTreatment of patients with acute mania remains a considerable medical challenge since onset of action of antimanic medication is delayed for several days. Psychostimulants could have an earlier onset of action. This assumption is based on the ‘vigilance regulation model of mania’ which postulates that vigilance is unstable in manic patients. Accordingly, vigilance-stabilising psychostimulants could be more useful than conventional treatment in acute mania. We present here the study protocol of a trial intended to study the efficacy and safety of methylphenidate in the initial treatment of acute mania.Methods/designA multi-centre, randomised, double-blind, placebo-controlled clinical trial will be conducted in 88 bipolar inpatients with acute mania. Male and female patients older than 18 years will be randomised to treatment with either methylphenidate (20 to 40 mg/day) or placebo for 2.5 days, given once or twice daily. The main outcome measure is the reduction in the Young Mania Rating Scale (YMRS) after 2.5 days of treatment. Other outcome measures include the Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) the Clinical Global Impression–Bipolar Scale (CGI-BP), the Screen for Cognitive Impairment in Psychiatry (SCIP), actigraphy and the EEG-‘Vigilance Algorithm Leipzig’ (VIGALL).DiscussionA positive study outcome of the proposed study could substantially impact our understanding of the etiopathogenesis of mania and open new treatment perspectives.Trial registrationClinicalTrials.gov:NCT01541605

[Burnout in teachers: its relationship with personality, coping strategies and life satisfaction].

INTRODUCTION/OBJECTIVES Burnout Syndrome is characterized by feelings of physical and emotional exhaustion, depersonalization, and low personal fulfillment and teaching has been considered one of the contexts of work where the professionals seem to be more exposed to suffer from Burnout. The aim of this study was to relate Burnout, personality, affectivity, Coping strategies and life satisfaction. MATERIAL AND METHODS It was used a sample of 404 teachers aged between 23 and 64 years (M = 41.20; SD = 9.79), ranging from the first cycle to university education. The following instruments were used: Coping Responses Inventory (CRI), Big Five Inventory (BFI), Positive and Negative Affective Schedule (PANAS), Maslach Burnout Inventory (MBI) and Satisfaction with Life Scale (SWLS). RESULTS The results showed that teachers with higher levels of neuroticism presented more Burnout, on the other hand teachers with a higher level of extraversion and agreeableness showed more personal accomplishment. Teachers who were high on negative affectivity where also high on Burnout, those who presented Coping strategies focused on the problem had higher results on personal accomplishment, conscientiousness, extraversion and openness to experience. Teachers who presented strategies more focused on emotions also revealed higher levels of neuroticism and Burnout. Results also showed that greater the satisfaction with life is correlated with higher personal accomplishment and extraversion and lower Burnout. Those who teach in higher levels of education revealed higher satisfaction with life and those who teach in lower levels showed higher emotional exhaustion. CONCLUSIONS We cannot understand Burnout ignoring personality processes and selection of coping strategies that accompany it.

Validity Study of the Beck Anxiety Inventory (Portuguese version) by the Rasch Rating Scale Model

Our objective was to conduct a validation study of the Portuguese version of the Beck Anxiety Inventory (BAI) by means of the Rasch Rating Scale Model, and then compare it with the most used scales of anxiety in Portugal. The sample consisted of 1,160 adults (427 men and 733 women), aged 18-82 years old (M=33.39; SD=11.85). Instruments were Beck Anxiety Inventory, State-Trait Anxiety Inventory and Zung Self-Rating Anxiety Scale. It was found that Beck Anxiety Inventorys system of four categories, the data-model fit, and people reliability were adequate. The measure can be considered as unidimensional. Gender and age-related differences were not a threat to the validity. BAI correlated significantly with other anxiety measures. In conclusion, BAI shows good psychometric quality.

Contribution to the Validation of the Kutcher Adolescent Depression Scale (KADS-6) in a Portuguese Population

A Kutcher Adolescent Depression Scale (KADS-6) e uma medida de autorrelato, conhecida pela sua facilidade de aplicacao na avaliacao da depressao em jovens. Este estudo teve como objetivos contribuir para a validacao da versao portuguesa desta ferramenta e analisar as suas caracteristicas psicometricas em comparacao com outros instrumentos de autorrelato para a avaliacao da depressao em adolescentes, em Portugal. Foram recolhidas duas amostras, uma nao clinica, formada por jovens em contexto escolar (n=773; 52,4% rapazes) e outra amostra clinica (n=134; 44% rapazes). Foram tambem utilizados o Beck Depression Inventory (BDI-II) e o Childrens Depression Inventory (CDI). A analise fatorial revelou a unidimensionalidade da medida. A KADS-6 demonstrou boa consistencia interna (alfa de Cronbach) nas amostras nao clinica (.74) e clinica (.80). A validade convergente com a BDI-II e CDI foi, respetivamente, r = .44; r = .61 na amostra clinica e r = .60; r = .57 na amostra nao clinica. Conclui-se que a KADS-6 mostrou boas caracteristicas psicometricas em termos de consistencia interna e validade convergente em comparacao com o BDI-II e o CDI. Dada a sua facilidade de uso e interpretacao, a KADS-6 pode ser considerada para uso em contexto escolar e em ambientes clinicos, para avaliar a depressao adolescente.

EPA-1387 – The case for a structured up-to-date suicide national prevention strategy based on the 4-level approach: lessons from EAAD and OSPI-Europe in Portugal

In OECD countries with a national suicide prevention strategy there is a correlation with the reduction of suicides. Most national strategies refer to common elements such as focus on depression and other mental health and addictive disorders diagnosis and treatment, attention on medical chronic patients, improvement of suicide risk assessment, suicide postvention, education of health professionals and the population, increased care accessibility, action on reducing access to lethal means, school programs, media intervention, etc. These elements, for most European national suicide prevention strategies, fit the EAAD 4-level interventions, which tend to be evidence-based. Portugal is considered to be a country with low suicide rates compared to other European countries though it also presents one of the worst ratios of suicide to undetermined violent deaths and evidence points towards a huge number of masked suicides amongst undetermined violent deaths making suicide much commoner than officially pointed out. In April 2013, a ‘National suicide prevention plan’ was presented in Portugal listing most of the suitable actions that could be implemented. There might be strategic advantages to integrate these actions within a sustainable intervention comprehensive model and referring to clear measurable outcomes, in a given period of time. There is a ten-year track record on the successful use of the EAAD 4-level model in three municipalities in Portugal and other possible examples on ‘how to’ disseminate at the national level are presented.