title: Air pollution and emergency department visits for suicide attempts in vancouver, Canada.
abstract: BACKGROUND
  Comorbidity of depression, heart disease, and migraine has been observed in clinical practice, while ambient air pollution has been identified among different risk factors for these health conditions. Suicide attempts and ideations as the result of depression may be linked to air pollution exposure. Therefore the effects of ambient air pollution on emergency department (ED) visits for suicide attempts were investigated.
  
  
  METHODS
  Emergency visit data were collected in a hospital in Vancouver, Canada. The generalized linear mixed models technique was applied in the analysis of these data. A natural hierarchical structure of the data was used to define the clusters, with days nested in a 3-level structure (day of week, month, year). Poisson models were fitted to the clustered counts of ED visits with a single air pollutant, temperature and relative humidity. In addition, the case-crossover methodology was used with the same data for comparison. The analysis was performed by gender (all, males, females) and month (all: January-December, warm: April-September, cold: October-March).
  
  
  RESULTS
  Both hierarchical and case-crossover methods confirmed positive and statistically significant associations among carbon monoxide (CO), nitrogen dioxide (NO(2)), sulphur dioxide (SO(2)), and particulate matter (PM(10)) for all suicide attempts in the cold period. The largest increase was observed for males in the cold period for a 1-day lagged exposure to NO(2), with an excess risk of 23.9% (95% CI: 7.8, 42.4) and odds ratio of 1.21 (95% CI: 1.03, 1.41). In warm months the associations were not statistically significant, and the highest positive value was obtained for ozone lagged by 1 day.
  
  
  CONCLUSIONS
  The results indicate a potential association between air pollution and emergency department visits for suicide attempts.
authors.affiliation: Population Studies Division, Health Canada, Ottawa, ON, Canada.
authors.forename: Mieczysław
authors.initials: M
authors.lastname: Szyszkowicz
authors.forename: Jeff B
authors.initials: JB
authors.lastname: Willey
authors.forename: Eric
authors.initials: E
authors.lastname: Grafstein
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
authors.forename: Ian
authors.initials: I
authors.lastname: Colman