Correspondence

Suicidality and the economic crisis in Greece

Household debt is a psychological stressor for those who take the debt on, but it remains unclear whether and how this money-related stressor influences children’s psychological well-being.

The study investigated the association of household debt with children’s psychological well-being and further explored the mediating role of parent–child relations.

Data were obtained from two waves (2016 and 2018) of the China Family Panel Studies, with a sample of 1,828 children included. The Center for Epidemiological Studies of Depression Scale was applied to measure psychological well-being. Household debt was assessed by absolute and relative amounts of total debt, mortgage debt, and non-mortgage debt. We used positive and negative parent–child interaction to measure parent–child relations. The characteristics of children, parents, and households were included as covariates.

Household debt, especially mortgage debt, was positively associated with psychological illnesses among children, and the link was substantially explained by parent–child relations.

Household debt exerted detrimental effects on children’s psychological well-being by jeopardizing parent–child relations in China. Strategies that address the need of vulnerable children are required to reduce the potentially negative psychological well-being outcomes of household debt.

Policy-makers can use a menu of pharmaceutical policy options. This study aimed to survey these measures that were implemented in European countries between 2010 and 2015.

We did bi-annual surveys with competent authorities of the Pharmaceutical Pricing and Reimbursement Information network. Additionally, we consulted posters produced by members of this network as well as further published literature. Information on 32 European countries (all European Union Member States excluding Luxembourg; Iceland, Norway, Serbia, Switzerland, Turkey) was included.

557 measures were reported between January 2010 and December 2015. The most frequently mentioned measure was price reductions and price freezes, followed by changes in patient co-payments, modifications related to the reimbursement lists and changes in distribution remuneration. Most policy measures were identified in Portugal, Greece, Belgium, France, the Czech Republic, Iceland, Spain and Germany. 22% of the measures surveyed could be classified as austerity.

Countries that were strongly hit by the financial crisis implemented most policy changes, usually aiming to generate savings and briefly after the emergence of the crisis. Improvements in the economic situation tended to lead to an easing of austerity measures. Countries also implemented policies that aimed to enhance enforcement of existing measures and increase efficiency.

To examine national trends in hospital utilization, costs, and expenditures for children with mental health conditions.

The analyses of children aged 1 to 17 are based on AHRQ's 2006 and 2011 Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) and Nationwide Emergency Department Sample (NEDS) databases, and on AHRQ's pooled 2006 to 2011 Medical Expenditure Panel Survey (MEPS). All estimates are nationally representative, and standard errors account for the complex survey designs.

Although overall all-cause children's hospitalizations did not increase between 2006 and 2011, hospitalizations for all listed mental health conditions increased by nearly 50% among children aged 10 to 14 years, and by 21% for emergency department (ED) visits. Behavioral disorders experienced a shift in underlying patterns between 2006 and 2011: inpatient stays for alcohol-related disorders declined by 44%, but ED visits increased by 34% for substance-related disorders and by 71% for impulse control disorders. Inpatient visits for suicide, suicidal ideation, and self-injury increased by 104% for children ages 1 to 17 years, and by 151% for children ages 10 to 14 years during this period. A total of $11.6 billion was spent on hospital visits for mental health during this period. Medicaid covered half of the inpatient visits, but with 50% to 30% longer length of stays in 2006 and 2011, respectively, than private payers. Medicaid's overall share of the ED visits increased from 45% in 2006 to 53% in 2011.

These alarming trends highlight the renewed need for research on mental health care for children. This study also provides a baseline for evaluating the impact of the Affordable Care Act and the mental health parity legislation on mental health utilization and expenditures for children.

Analizar la evolución temporal de la mortalidad por suicidio en Andalucía entre 1975 y 2012, y su relación con el uso de antidepresivos y el desempleo.

Para estimar los cambios de tendencia se utilizaron modelos segmentados de regresión de Poisson. La correlación se midió mediante el coeficiente de Spearman.

La tendencia de la mortalidad por suicidio es ascendente, y son las personas de 15 a 44 años de edad las que presentan aumentos más acusados, con un porcentaje de cambio anual de 1,21 (intervalo de confianza del 95% [IC95%]: 0,7-1,7) para los hombres y de 0,93 (IC95%: 0,4-1,4) para las mujeres.

La mortalidad por suicidio ha aumentado desde 1975 en todos los grupos de edad y sexo, salvo en las mujeres ancianas. En las últimas décadas se aprecian tendencias ascendentes en los jóvenes, y estables o descendentes en el resto, que no están asociadas con el desempleo ni con el uso de antidepresivos.

To analyze the trend in suicide mortality in Andalusia from 1975 to 2012 and its relationship with unemployment and the use of antidepressants.

Poisson's segmented regression models were used to estimate changes over time. The association between suicide and the factors examined was measured using Spearman's correlation coefficient.

Suicide mortality patterns in men and women are rising. The largest increase was found in people aged from 15 to 44 years, with an annual percentage rate change of 1.21 (95%CI: 0.7-1.7) for men and 0.93 (95%CI: 0.4-1.4) for women.

Mortality by suicide has increased in Andalusia since 1975 in all age and gender groups except for women aged 65 years or above. During the last few decades, an upward trend has been observed in young people and a stable or falling trend in the remaining population. Temporary variations in suicide rates are not associated with unemployment rates or with changes in antidepressant prescription.