| 1. |
- Armocida, Benedetta, et al.
(författare)
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Burden of non-communicable diseases among adolescents aged 10-24 years in the EU, 1990-2019 : a systematic analysis of the Global Burden of Diseases Study 2019
- 2022
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Ingår i: The Lancet. Child & adolescent health. - : Elsevier. - 2352-4650. ; 6:6, s. 367-383
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Disability and mortality burden of non-communicable diseases (NCDs) have risen worldwide; however, the NCD burden among adolescents remains poorly described in the EU.METHODS: Estimates were retrieved from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Causes of NCDs were analysed at three different levels of the GBD 2019 hierarchy, for which mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) were extracted. Estimates, with the 95% uncertainty intervals (UI), were retrieved for EU Member States from 1990 to 2019, three age subgroups (10-14 years, 15-19 years, and 20-24 years), and by sex. Spearman's correlation was conducted between DALY rates for NCDs and the Socio-demographic Index (SDI) of each EU Member State.FINDINGS: In 2019, NCDs accounted for 86·4% (95% uncertainty interval 83·5-88·8) of all YLDs and 38·8% (37·4-39·8) of total deaths in adolescents aged 10-24 years. For NCDs in this age group, neoplasms were the leading causes of both mortality (4·01 [95% uncertainty interval 3·62-4·25] per 100 000 population) and YLLs (281·78 [254·25-298·92] per 100 000 population), whereas mental disorders were the leading cause for YLDs (2039·36 [1432·56-2773·47] per 100 000 population) and DALYs (2040·59 [1433·96-2774·62] per 100 000 population) in all EU Member States, and in all studied age groups. In 2019, among adolescents aged 10-24 years, males had a higher mortality rate per 100 000 population due to NCDs than females (11·66 [11·04-12·28] vs 7·89 [7·53-8·23]), whereas females presented a higher DALY rate per 100 000 population due to NCDs (8003·25 [5812·78-10 701·59] vs 6083·91 [4576·63-7857·92]). From 1990 to 2019, mortality rate due to NCDs in adolescents aged 10-24 years substantially decreased (-40·41% [-43·00 to -37·61), and also the YLL rate considerably decreased (-40·56% [-43·16 to -37·74]), except for mental disorders (which increased by 32·18% [1·67 to 66·49]), whereas the YLD rate increased slightly (1·44% [0·09 to 2·79]). Positive correlations were observed between DALY rates and SDIs for substance use disorders (rs=0·58, p=0·0012) and skin and subcutaneous diseases (rs=0·45, p=0·017), whereas negative correlations were found between DALY rates and SDIs for cardiovascular diseases (rs=-0·46, p=0·015), neoplasms (rs=-0·57, p=0·0015), and sense organ diseases (rs=-0·61, p=0·0005).INTERPRETATION: NCD-related mortality has substantially declined among adolescents in the EU between 1990 and 2019, but the rising trend of YLL attributed to mental disorders and their YLD burden are concerning. Differences by sex, age group, and across EU Member States highlight the importance of preventive interventions and scaling up adolescent-responsive health-care systems, which should prioritise specific needs by sex, age, and location.FUNDING: Bill & Melinda Gates Foundation.
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| 2. |
- Castelpietra, Giulio
(författare)
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Suicide : a pharmacoepidemiological database study in the region Friuli Venezia Giulia, Italy
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims: The objective of this thesis is to examine the relationship between suicide and health care in Italy’s Friuli Venezia Giulia (FVG) region. First, it explores the correlation between suicide rates and antidepressant sales. Second, it analyses, at the individual level, the risk of suicide associated with the main suicidal risk factors, such as non-fatal self-harm, psychiatric disorders and somatic disorders. Third, it investigates the differences in suicide risk related to qualitative parameters in the use of antidepressants, such as adherence and treatment modifications. The overall aim is to help improve interventions to prevent suicide. Methods: All data were retrieved from the FVG Regional Social and Health Information System (SISSR), which links data using a unique anonymous key from different regional databases. Paper I analyses changes in individual-based data on antidepressant use and the rates of suicide during years 1997-2006. The other three papers are designed as case-control studies. All suicides that occurred in the region during years 2002-2008 (Paper II) and 2003-2013 (Paper III) were classified as cases, which were then age- and gender-matched to controls from the general population. In Paper IV, cases and controls from 2005 to 2014 must have had at least one prescription of antidepressant in the 730 days prior to the index date. Regression analysis was used to assess the association between suicide risk and its predictors. Results: In Paper I, suicide rates decreased by one-third in all genders and age groups. In parallel, both the number of individual users of antidepressant and the number of Defined Daily Doses per patient increased by 5-fold and 7-fold, respectively. In Paper II, the risk of suicide was highly increased by previous self-harm (OR = 53.1 for a single episode and OR = 98. for repeated episodes), as by psychiatric disorders (OR = 19.5). In Paper III, somatic disorders were strong predictors of suicide (OR = 2.9), particularly in case of comorbid disorders (OR from 2.6 to 9.8 when the number of disorders raised from 1 to ≥4) and in the elderly (OR = 4.3). No significant risk of suicide was found when medically-ill patients adhere to antidepressants. In Paper IV, none of the antidepressants compounds and classes was associated to suicide except SSRI (OR = 1.6). The association to suicide tended to decrease with adherence or current use of antidepressants. In all studies, on average only 10-20% of suicide cases adhere to antidepressants and 20-40% were currently using them at the time of death. Conclusions: Our findings support the hypothesis that treatment with antidepressant medication lowers the risk of suicide. The treatment at a proper dosage and for a proper length of time further decreased the risk, particularly in somatic-ill persons. Well-known risk factors, such as non-fatal self-harm and psychiatric and somatic disorders, were confirmed to highly increase the risk of suicide. Only a minority of suicides, however, had adhered to antidepressants or were under antidepressant treatment at the time of death.
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| 3. |
- Castelpietra, Giulio, et al.
(författare)
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Working draft : Classifications of interventions in mental health care. An expert review
- 2017
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Ingår i: European Journal of Psychiatry. - : Elsevier. - 0213-6163 .- 2340-4469. ; 31:4, s. 127-144
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Tidskriftsartikel (refereegranskat)abstract
- Background and objectives: Specific classifications of mental health interventions have encountered many issues in their integration into a general classification of interventions. Nonetheless, there has not been any previous review on the content and structure of current classifications in relation to mental health care. This expert review aimed to compare the mental health interventions provided in a series of reference classification systems for the incorporation of mental health care into the International Classification of Health Interventions (ICHI).Methods: Twelve classifications are described with regards to the structure of the classification (unit of analysis, sections, multiaxiality, granularity) and context of utilization (purpose, descriptors, neutrality, interoperability and implementation).Results: Major problems identified include a granularity unbalance (i.e. differences in the number of codes and its specificity with other areas such as rehabilitation), unclear units of analysis (i.e. differences between procedures, interventions, packages of care and care programs), lack of clearly stated evidence-based interventions in a mental health context; and lack of a well-defined taxonomical tree. An ontology approach to the definition of the different entities involved in the throughput of mental care, including their hierarchical relationships and conceptual map, may have contributed to the failure of previous systems together with the development of systems to classify mental health interventions separate from generic health interventions.Conclusions: The present review provides additional ground for the development of the ICHI knowledge-base and highlights the importance of taxonomical disambiguation and international comparability in the development and implementation of classifications of mental care interventions.
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| 4. |
- Gorasso, Vanessa, et al.
(författare)
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Burden of disease attributable to risk factors in European countries: a scoping literature review
- 2023
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Ingår i: Archives of Public Health. - 0778-7367 .- 2049-3258. ; 81:1
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Forskningsöversikt (refereegranskat)abstract
- Objectives: Within the framework of the burden of disease (BoD) approach, disease and injury burden estimates attributable to risk factors are a useful guide for policy formulation and priority setting in disease prevention. Considering the important differences in methods, and their impact on burden estimates, we conducted a scoping literature review to: (1) map the BoD assessments including risk factors performed across Europe; and (2) identify the methodological choices in comparative risk assessment (CRA) and risk assessment methods. Methods: We searched multiple literature databases, including grey literature websites and targeted public health agencies websites. Results: A total of 113 studies were included in the synthesis and further divided into independent BoD assessments (54 studies) and studies linked to the Global Burden of Disease (59 papers). Our results showed that the methods used to perform CRA varied substantially across independent European BoD studies. While there were some methodological choices that were more common than others, we did not observe patterns in terms of country, year or risk factor. Each methodological choice can affect the comparability of estimates between and within countries and/or risk factors, since they might significantly influence the quantification of the attributable burden. From our analysis we observed that the use of CRA was less common for some types of risk factors and outcomes. These included environmental and occupational risk factors, which are more likely to use bottom-up approaches for health outcomes where disease envelopes may not be available. Conclusions: Our review also highlighted misreporting, the lack of uncertainty analysis and the under-investigation of causal relationships in BoD studies. Development and use of guidelines for performing and reporting BoD studies will help understand differences, avoid misinterpretations thus improving comparability among estimates.
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| 5. |
- Pirkis, Jane, et al.
(författare)
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Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends : An interrupted time series analysis in 33 countries
- 2022
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Ingår i: eClinicalMedicine. - : Elsevier. - 2589-5370. ; 51
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Tidskriftsartikel (refereegranskat)abstract
- Background Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally. Methods We identified suicide data from official public-sector sources for countries/areas-within-countries, searching websites and academic literature and contacting data custodians and authors as necessary. We sent our first data request on 22nd June 2021 and stopped collecting data on 31st October 2021. We used interrupted time series (ITS) analyses to model the association between the pandemic's emergence and total suicides and suicides by sex-, age-and sex-by-age in each country/area-within-country. We compared the observed and expected numbers of suicides in the pandemic's first nine and first 10-15 months and used meta-regression to explore sources of variation. Findings We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries' COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries' income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well. Interpretation Although there are some countries/areas-within-countries where overall suicide numbers and numbers for certain sex- and age-based groups are greater-than-expected, these countries/areas-within-countries are in the minority. Any upward movement in suicide numbers in any place or group is concerning, and we need to remain alert to and respond to changes as the pandemic and its mental health and economic consequences continue. Copyright (C) 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
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