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      Role of individual deprivation and community-level deprivation on suicidal behaviors: Insights from the UK Biobank study

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          Abstract

          Introduction

          This study aimed to investigate the impact of individual- and community-level deprivation on suicidal behaviors among community members.

          Methods

          Data from 350,884 UK Biobank participants were employed to construct an individual deprivation index. Absolute poverty was defined as a pre-tax annual household income below ₤18,000. Predictors for absolute poverty incorporated variables such as sex, ethnicity, type of accommodation, tenure status, number of vehicles owned, educational qualifications, current employment status, and subjective health rating. The individual deprivation index was constructed using a logistic regression model to predict absolute poverty. Townsend Deprivation Index (TDI) was employed to represent community-level deprivation. The associations between the individual deprivation index, TDI, and suicidal behaviors were examined through multivariate linear regression. Interaction analyses were conducted to investigate effect modification.

          Results

          The logistic regression model demonstrated high predictive accuracy for absolute poverty (area under the receiver operating curve = 0.840). The associations between individual deprivation index and suicidal behaviors were observed to be more substantial than those between TDI and suicidal behaviors. A positive interaction between the individual deprivation index and TDI was detected, indicating an amplifying effect of community-level deprivation on the impact of individual-level deprivation on suicidal behaviors.

          Conclusion

          Our study successfully constructed a comprehensive individual deprivation index that could be applied widely to measure individual-level deprivation. Our findings revealed that individual-level deprivation and community-level deprivation have a synergistic effect on suicidal behaviors, underscoring the importance of multilevel interventions in suicide prevention.

          Highlights

          • •

            Social deprivation increases risk of suicidal behaviors.

          • •

            Individual and community-level deprivation act both independently and interactively.

          • •

            Preventive measures against suicide should be provided for deprived individuals.

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          Most cited references44

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          A brief measure for assessing generalized anxiety disorder: the GAD-7.

          Robert L Spitzer, Kurt Kroenke, Janet B W Williams … (2006)
          Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
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            The PHQ-9: validity of a brief depression severity measure.

            K Kroenke, R L Spitzer, J. Williams (2001)
            While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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              Comparison of Sociodemographic and Health-Related Characteristics of UK Biobank Participants With Those of the General Population

              Anna Fry, Thomas Littlejohns, Cathie Sudlow … (2017)
              Abstract The UK Biobank cohort is a population-based cohort of 500,000 participants recruited in the United Kingdom (UK) between 2006 and 2010. Approximately 9.2 million individuals aged 40–69 years who lived within 25 miles (40 km) of one of 22 assessment centers in England, Wales, and Scotland were invited to enter the cohort, and 5.5% participated in the baseline assessment. The representativeness of the UK Biobank cohort was investigated by comparing demographic characteristics between nonresponders and responders. Sociodemographic, physical, lifestyle, and health-related characteristics of the cohort were compared with nationally representative data sources. UK Biobank participants were more likely to be older, to be female, and to live in less socioeconomically deprived areas than nonparticipants. Compared with the general population, participants were less likely to be obese, to smoke, and to drink alcohol on a daily basis and had fewer self-reported health conditions. At age 70–74 years, rates of all-cause mortality and total cancer incidence were 46.2% and 11.8% lower, respectively, in men and 55.5% and 18.1% lower, respectively, in women than in the general population of the same age. UK Biobank is not representative of the sampling population; there is evidence of a “healthy volunteer” selection bias. Nonetheless, valid assessment of exposure-disease relationships may be widely generalizable and does not require participants to be representative of the population at large.
              Article 0 comments Cited 1136 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Sun Jae Jung
                Journal
                Journal ID (nlm-ta): SSM Popul Health
                Journal ID (iso-abbrev): SSM Popul Health
                Title: SSM - Population Health
                Publisher: Elsevier
                ISSN (Electronic): 2352-8273
                Publication date PMC-release: 20 March 2024
                Publication date Collection: June 2024
                Publication date (Electronic): 20 March 2024
                Volume: 26
                Electronic Location Identifier: 101654
                Affiliations
                [a ]Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
                [b ]Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea
                [c ]Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
                [d ]Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
                [e ]Institute of Health Services Research, Yonsei University, Seoul, South Korea
                [f ]Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
                [g ]Harvard Medical School, Boston, MA, USA
                [h ]Harvard Center for Population and Development Studies, Cambridge, MA, USA
                Author notes
                [* ]Corresponding author. Department of Preventive Medicine, Yonsei University, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, South Korea. sunjaejung@ 123456yuhs.ac
                [1]

                These authors contributed equally to the manuscript.

                Article
                Publisher Item ID: S2352-8273(24)00054-5 Publisher ID: 101654
                DOI: 10.1016/j.ssmph.2024.101654
                PMC ID: 10966313
                PubMed ID: 38544695
                SO-VID: c27b6c38-8cb0-48e1-bab4-c91b46955cb9
                Copyright © © 2024 The Authors. Published by Elsevier Ltd.
                License:

                This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/).

                History
                Date received : 20 December 2023
                Date revision received : 6 March 2024
                Date accepted : 7 March 2024
                Categories
                Subject: Regular Article

                Keywords: social deprivation,suicide,self-harm,multilevel analysis,effect modifier,epidemiologic
                Data availability:
                Keywords: social deprivation, suicide, self-harm, multilevel analysis, effect modifier, epidemiologic

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