Child burn mortality differs widely between regions and is closely related to material deprivation, but reports on their global distribution are few. Investigating their country level distribution in light of economic level and income inequality will help assess the potential for macro-level improvements. We extracted data for child burn mortality from the Global Burden of Disease study 2013 and combined data into 1-14 years to calculate rates at country, region and income levels. We also compiled potential lives saved. Then we examined the relationship between country level gross domestic product per capita from the World Bank and income inequality (Gini Index) from the Standardized World Income Inequality Database and child burn mortality using Spearman coefficient correlations. Worldwide, the burden of child burn deaths is 2.5 per 100,000 across 103 countries with the largest burden in Sub-Saharan Africa (4.5 per 100,000). Thirty-four thousand lives could be saved yearly if all countries in the world had the same rates as the best performing group of high-income countries; the majority in low-income countries. There was a negative graded association between economic level and child burns for all countries aggregated and at regional level, but no consistent pattern existed for income inequality at regional level. The burden of child burn mortality varies by region and income level with prevention efforts needed most urgently in middle-income countries and Sub-Saharan Africa. Investment in safe living conditions and access to medical care are paramount to achieving further reductions in the global burden of preventable child burn deaths.

Many refugees have been subjected to pre-migratory trauma. Evidence is needed to address the heterogeneity within refugee populations in regard to patterns of multiple trauma exposures. This study identified subgroups within a refugee population displaying different profiles of multiple trauma exposures and assessed sociodemographic predictors and differences in mental health symptom severity across these classes. Study population consisted of 1215 refugees from Syria resettled in Sweden. Latent class analysis 3-step method for modelling predictors and outcomes and a class-specific weighted multigroup approach were used to identify classes of refugees using self-reported data on violent and non-violent trauma exposures, sociodemographic variables and symptom severity scores for depression, anxiety and PTSD. Three classes were identified: class 1 'multiple violent and non-violent trauma' (39.3%, n = 546); class 2 'witnessing violence and multiple non-violent trauma' (40.8%, n = 569); and class 3 'low multiple non-violent trauma' (20.1%, n = 281). Trauma exposure and gender significantly predicted class membership. Male gender and highest severity of mental ill health defined class 1. Female gender predicted higher mental ill health within classes 1 and 2. Across all three classes living with a partner was associated with lower severity of mental ill health regardless of trauma exposure classes. There are distinct patterns within refugee populations concerning exposure to multiple trauma. Violence is a primary marker for higher likelihood of multiple trauma exposures and severity of mental health. Gender predisposes individuals to trauma exposure and its outcomes differentially.

Older people have the highest rates of suicide, yet the evidence base on effective suicide preventions in late-life is limited. This systematic review of reviews aims to synthesize data from existing reviews on the prevention and/or reduction of suicide behavior in late-life and evidence for effectiveness of interventions. A systematic database search was conducted in eight electronic databases from inception to 4/2020 for reviews targeting interventions among adults ≥ 60 to prevent and/or reduce suicide, suicide attempt, self-harm and suicidal ideation. Four high quality reviews were included and interventions categorized as pharmacological (antidepressant use: 239 RCTs, seven observational studies) and behavioral (physical activity: three observational studies, and multifaceted primary-care-based collaborative care for depression screening and management: four RCTs). The 2009 antidepressant use review found significant risk reduction for suicide attempt/self-harm (OR = 0.06, 95% CI 0.01–0.58) and suicide ideation (OR = 0.39, 95% CI 0.18–0.78) versus placebo. The 2015 review found an increased risk of attempts with antidepressants versus no treatment (RR = 1.18, 95% CI 1.10–1.27) and no statistically significant change in suicides versus no treatment (RR = 1.06, 95% CI 0.68–1.66) or ideation versus placebo (OR = 0.52, 95% CI 0.14–1.94). Protective effects were found for physical activity on ideation in 2 out of 3 studies when comparing active versus inactive older people. Collaborative care demonstrated significantly less attempts/ideation (OR = 0.80, 95% CI 0.68–0.94) in intervention group versus usual care. The results of this review of reviews find the evidence inconclusive towards use of antidepressants for the prevention of suicidal behavior in older people, thus monitoring is required prior to start, dosage change or cessation of antidepressants. Evidence to date supports physical activity and collaborative management for reduction of suicide ideation, but additional trials are required for a meta-analysis. To build on these findings, continued high-quality research is warranted to evaluate the effectiveness of interventions in late life.

Background: Child injury mortality and morbidity are a public health concern in European countries and data are scarce. Cross-national efforts are needed to identify high-risk groups, follow trends and assist in establishing European-wide safety legislation. This study investigates fatal child injuries in the home, as compared to those in transport in European countries. Methods: Injury mortality was extracted from the World Health Organization Mortality Database for the years 2002–04. The mortality rate per 100 000 population was calculated by age group for 16 contributing countries, grouped by their economic level of development. Results: Fatal home injuries were highest in children under 5 years of age and then sharply decreased, as opposed to road traffic injuries, which increased with age. The majority of the upper-middle-economy countries tended to have higher home injury incidence rates compared to the high-income countries. The top five injury causes all countries aggregated were drowning/submersion, thermal injuries, poisoning, falls and homicide, all of which account for almost 90% of home injury deaths. Conclusion: Home injuries were the leading cause of injury death in children under 5 years of age in the countries under study and the inequalities found among the countries indicate potential for improvement. Evidence-based interventions exist to prevent these injuries and the barriers to their implementation ought to be determined and addressed.

A number of post-migration stressors have been shown to adversely affect mental health in refugees resettled in high-income countries, including poor social integration, financial difficulties and discrimination, and recent evidence suggests that these effects are gender specific. Social support has been found to buffer against post-migration stress in some studies on refugee populations, though the evidence on this is mixed. The present study used cross-sectional survey data from a nationwide, randomly sampled group of adult refugees from Syria resettled in Sweden between 2008 and 2013 (N_sample = 4,000, n_respondents = 1,215, response rate 30.4%) to investigate gender-specific associations between post-migration stressors and subjective well-being (SWB) and whether these associations were modified by social support. SWB was measured with the WHO-5 Well-being Index (scaled 0–100), dichotomized into high (≥50) and low (<50) SWB. Main analyses were stratified by gender, and regressed SWB on four domains of post-migration stress (financial strain, social strain, competency strain and discrimination) using logistic regression, adjusting for sociodemographic variables and traumatic experiences. Social support was tested as an effect modifier. In fully adjusted models, main risk factors for low SWB were high financial strain, especially in males (OR_{high vs. low strain, males} = 10.30 [4.91–21.6], p < 0.001 vs. OR_{high vs. low strain, females}= 3.84 [1.68–8.79], p = 0.002), and high social strain, only in males (OR_{high vs. low strain, males} = 9.21 [3.96–21.4], p < 0.001 vs. OR_{high vs. low strain, females} = 1.03 [0.40–2.64], p = ns). There was some evidence that social support buffered the adverse association of financial strain with SWB. In conclusion, the present study found clear support of gender-specific effects of post-migration stressors on SWB. Mitigation strategies and interventions should be aware of and sensitive to these potential gendered effects, and future research exploring mental health in the context of resettlement stress should have a heightened focus on the important role of gender.