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Journal article

Comparison of elderly suicide rates among migrants in England and Wales with their country of origin

Authors:
SHAH Ajit, LINDESAY James, DENNIS Mick
Journal article citation:
International Journal of Geriatric Psychiatry, 24(3), March 2009, pp.292-299.
Publisher:
Wiley-Blackwell

The black and minority ethnic (BME) elderly population size in England and Wales has progressively increased over the last three decades. A study comparing suicide rates among elderly migrants in England and Wales and in their country of origin using the latest available mortality data from the Office of National Statistics and the World Health Organization was conducted. There were wide variations in standardised mortality ratios for elderly suicides among migrants from different countries compared with those born in England and Wales and in their country of origin. There was convergence towards elderly suicide rates for England and Wales in some migrant groups in males in the age-bands 65-74 years and 75 + years, and in females in the age-band 75 + years. However, males aged 75 + years from most migrant groups had higher rates than those born in England and Wales. A more detailed analysis of suicide of older people from migrant groups is required to determine vulnerability and protective influences.

Journal article

Is there a relationship between elderly suicide rates and educational attainment? A cross-national study

Authors:
SHAH Ajit, CHATTERJEE Santanu
Journal article citation:
Aging and Mental Health, 12(6), November 2008, pp.795-799.
Publisher:
Taylor and Francis

Suicides are associated with both high and low levels of intelligence and educational attainment in both individual-level and aggregate-level studies, but this has been rarely studied in the elderly.  A cross-national study examining the relationship between elderly suicide rates (y-axis) and educational attainment (x-axis) was undertaken with the 'a priori' hypothesis that the relationship would be curvilinear and follow a U-shaped curve with the quadratic equation Y = A + BX + CX2, where A, B and C are constants. Data on suicide rates for both sexes in the age-bands 65-74 years and 75+ years, and the Education Index (a proxy measure of educational attainment) were ascertained from the World Health Organisation and the United Nations websites, respectively. The main finding was the predicted curvilinear relationship between suicide rates, in both sexes in both the elderly age-bands, and the Education Index fitting the quadratic equation Y = A + BX + CX2.  Given the cross-sectional study design, a causal relationship cannot be assumed. The impact of educational attainment on elderly suicide rates may occur through interaction with other factors, mediation of the effects of other factors, or by its effects being mediated by other factors, and require further study.

Journal article

Recent trends in elderly suicide rates in England and Wales

Authors:
HOXEY Kate, SHAH Ajit
Journal article citation:
International Journal of Geriatric Psychiatry, 15(3), March 2000, pp.274-279.
Publisher:
Wiley-Blackwell

This study examines the following in England and Wales: recent trends in the elderly suicide rate and method-specific elderly suicide rate; the relationship between elderly population size and elderly suicide rate in recent years; and the sex difference in overall and method-specific elderly suicide rate. Discusses the findings and the need to ensure a further decline in suicide rates to meet the 'Our Healthier Nations' target.

Journal article

Methods of elderly suicides in England and Wales by country of birth groupings

Authors:
DENNIS Michael, SHAH Ajit, LINDESAY James
Journal article citation:
International Journal of Geriatric Psychiatry, 24(11), November 2009, pp.1311-1313.
Publisher:
Wiley-Blackwell

This brief article presents statistics on methods of suicide used by older males and females, using data on suicides and open verdicts for England and Wales obtained from the Office for National Statistics for the period 2001 to 2005. As data concerning ethnicity are not recorded on death certificates, country of birth was used as a proxy. Although this approach only provides mortality data of first generation migrants rather than for entire black and minority ethnic (BME) groups, there is a close match between ethnicity and country of birth for older people. Individual countries of birth were grouped into broader regional country of birth categories, and the number of suicides for each method was calculated by gender for each country of birth grouping. A combined BME group was then calculated for each gender by combining those born outside England and Wales. The results show that hanging, drug overdose and drowning were the commonest methods of suicide in older people in England and Wales in most country of birth groups; in the female Indian subcontinent group the commonest methods were drug overdose, drowning, and burning; methods of suicide in older people were generally similar in the BME population compared to people born in England and Wales.

Journal article

Is there a relationship between elderly suicide rates and smoking? A cross-national study

Author:
SHAH Ajit
Journal article citation:
International Journal of Geriatric Psychiatry, 23(3), March 2008, pp.308-312.
Publisher:
Wiley-Blackwell

An independent relationship between smoking cigarettes and completed suicides has been reported in several cohort and case-control studies of younger subjects, but this relationship has rarely been examined in the elderly. The relationship between the prevalence of smoking in males and females and suicide rates in males and females in the age-bands 65-74 years and 75 + years was examined using national-level aggregate data from the World Health Organisation and the United Nations Development Programme websites. In addition to univariate analysis, multivariate analysis were conducted to ascertain an independent relationship between the prevalence of smoking and elderly suicide rates. The main findings were: (i) on univariate analysis, the prevalence of smoking in males was positively correlated with suicide rates in males aged 65-74 years and males aged 75 + years, but this relationship was absent in females and (ii) on multivariate analysis there was no independent relationship between the prevalence of smoking in males and suicide rates in males in both the elderly age-bands. There is a case for examination of the relationship between smoking and elderly suicides in individual-level cohort or case-control studies because of the potential methodological difficulties in cross-national studies using national- level aggregate data, paucity of cohort or case-control studies at an individual-level in the elderly, and the observation of an independent relationship between smoking and completed suicides in individual-level cohort and case-control studies in younger age groups.

Journal article

Some predictors of mortality in acutely medically ill elderly inpatients

Authors:
SHAH Ajit, HOXEY Katharina, MAYADUNNE Vidurah
Journal article citation:
International Journal of Geriatric Psychiatry, 15(6), June 2000, pp.493-499.
Publisher:
Wiley-Blackwell

The prevalence of depression and suicide ideation in acutely mentally ill elderly patients is high. Depression and suicide ideation are associated with increased mortality. Reports on a study to examine the hypothesis that suicidal ideation and functional disability may have a causal effect on mortality.

Journal article

The ‘Count Me In’ psychiatric in-patient census for 2007 and the elderly: evidence of improvement or cause for concern?

Author:
SHAH Ajit
Journal article citation:
Psychiatric Bulletin, 33(6), June 2009, pp.201-203.
Publisher:
Royal College of Psychiatrists

The recently published Count Me In 2007 census specifically reported age-standardised admission rates for individuals aged over 65 years from different Black and minority ethnic groups. The standardised admission ratio was higher in the White Irish, other White, White and Black Caribbean, other Asian, Black Caribbean, Black African and other Black ethnic groups; and lower in the White British and Chinese ethnic groups. As this census was undertaken on a single day for all psychiatric in-patients, it measured bed occupancy rather than admission rates and so it was actually referring to standardised bed occupancy ratios. Bed occupancy is a function of admission rates and length of stay. This editorial critically explores factors (including those related to institutional racism) that may affect both admission rates and length of stay, and ultimately bed occupancy, of Black and minority ethnic elders.

Journal article

Estimating the absolute number of cases of dementia and depression in the black and minority ethnic elderly population in the United Kingdom

Author:
SHAH Ajit
Journal article citation:
International Journal of Migration Health and Social Care, 4(2), October 2008, pp.4-15.
Publisher:
Emerald

The prevalence of dementia and depression among BME elders from different groups in the United Kingdom is generally similar to or higher than in indigenous white British elders. Two methods were used to provide a conservative estimate of the absolute number of cases of dementia and depression among BME elders. Data on prevalence from published studies of different BME elderly groups and the number of those over the age of 65 years from different BME groups in the general population in the 2001 population census were used for analysis. The most conservative estimates of the absolute number of cases of dementia among BME elders were 7,270 and 10,786 for the two methods of analysis; the corresponding figures for depression were 33,559 and 52,980. There is a significant amount of psychiatric morbidity among the elderly from BME groups. A multi-faceted approach is needed to ensure that commissioning, design, development and delivery of culturally capable, appropriate and sensitive old age psychiatry actually occurs and improves the equity of service access by BME elders.

Journal article

Behavioural and psychological signs and symptoms of dementia across cultures: current status and the future

Authors:
SHAH Ajit, DALVI Madusudan, THOMPSON Tade
Journal article citation:
International Journal of Geriatric Psychiatry, 20(12), December 2005, pp.1187-1195.
Publisher:
Wiley-Blackwell

The literature on BPSD from developing countries, ethnic minority groups in a given country and cross-national studies was examined. The results found that there is emerging literature on BPSD from the settings was studied. These studies provide useful preliminary data on the prevalence and correlates of BPSD. Moreover, the data illustrate possible cross-cultural differences in BPSD and their correlates. A number of instruments measuring either individual BPSD within a BPSD domain, measuring features of a BPSD domain or features of a range of BPSD domains have been developed in languages other than English for use in developing countries and ethnic minority groups in a given country. The authors conclude that there is a need for methodologically similar and uniform studies of BPSD across countries and ethnic groups in a given country using appropriately validated instruments. It is suggested that a consensus should be reached by researchers on the best instrument(s) to be developed in languages other than English for use in these settings and, in turn, these instruments should be developed using appropriate methodology. This could allow identification of the genetic and environmental aetiology of BPSD and the influence of gene-environment interaction.

Journal article

Is mental health economics important in geriatric psychiatry in developing countries?

Authors:
SHAH Ajit, MURTHY Srinivasa, SUH Guh-Kee
Journal article citation:
International Journal of Geriatric Psychiatry, 17(8), August 2002, pp.758-764.
Publisher:
Wiley-Blackwell

This article found that there were no health economic studies in geriatric psychiatry from developing countries against a background of many such studies in developed countries. There were a greater number of health economic studies in other areas of psychiatry in developing countries. Several reasons for the paucity of such studies, the feasibility of undertaking these studies and their significance are discussed.Mental health economic studies in geriatric psychiatry in developing countries are feasible, realistic and may well have an important part to play in the allocation of resources. Also, data sets necessary for such studies are emerging from many developing countries.

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