1
|
Tong Y, Yin Y, Lan Z, Conner KR. Case fatality of repeated suicidal acts among suicide attempters in rural China: a retrospective cohort study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 46:101068. [PMID: 38659430 PMCID: PMC11040130 DOI: 10.1016/j.lanwpc.2024.101068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/22/2024] [Accepted: 04/01/2024] [Indexed: 04/26/2024]
Abstract
Background Individuals presenting to hospital due to suicide attempt are at high risk for repeated suicidal act, yet there are meager data on the extent to which repeated suicidal acts result in death. Methods This retrospective cohort study was based on a general hospital self-harm register system in a rural county in China. Identified individuals who attempted suicide were contacted and followed up for up to 8 years. Main outcomes over follow-up were: 1) suicide death, 2) nonlethal suicide attempt, and 3) suicidal acts including suicide death and nonlethal attempt. Incidence densities, correlates, and case fatality of repeated suicidal acts were estimated. Findings A total of 1086 individuals (two-thirds females, mean age 40.6 years) with a suicide attempt presenting to hospital (index attempt) were identified and followed up, with most of the index attempts by pesticide ingestion (79%). Over follow-up, there were 116 suicidal acts carried out by 108 individuals (69 females, 39 males), including 34 suicide deaths (21 females, 13 males), yielding a high case-fatality of 29.3%. During follow-up, suicide death rates were also high overall and in the first year of follow-up (846.7 and 1787.2 per 100,000 person years). Over follow-up, pesticide was the most common method (47/116) of repeated suicidal act and yielded a higher case-fatality than other methods (46.8% vs 17.4%, χ2 = 11.68, P < 0.001). The incidence densities of repeated suicidal acts and nonlethal attempts were low compared to rates reported in previous literature. Interpretation Incidence densities of repeated suicidal acts in a rural China cohort were low compared to previous studies. However, rates of suicide deaths over follow-up were high, a result driven by the high case-fatality of suicidal acts and attributable to the common use of pesticides. Reducing suicidal acts with pesticides is a key target for suicide prevention in rural China. Funding Beijing Municipal High Rank Public Health Researcher Training Program, Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support, and Beijing Hospitals Authority's Ascent Plan.
Collapse
Affiliation(s)
- Yongsheng Tong
- Department of Clinical Psychology, Beijing Huilongguan Hospital, Beijing, China
- WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
- Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Yi Yin
- WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Zhichao Lan
- Center of Disease Control and Prevention of Meixian County, Shaanxi Province, China
| | - Kenneth R. Conner
- Departments of Emergency Medicine and Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|
2
|
Arunpongpaisal S, Assanangkornchai S, Chongsuvivatwong V. Developing a risk prediction model for death at first suicide attempt-Identifying risk factors from Thailand's national suicide surveillance system data. PLoS One 2024; 19:e0297904. [PMID: 38598456 PMCID: PMC11006158 DOI: 10.1371/journal.pone.0297904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 01/15/2024] [Indexed: 04/12/2024] Open
Abstract
More than 60% of suicides globally are estimated to take place in low- and middle-income nations. Prior research on suicide has indicated that over 50% of those who die by suicide do so on their first attempt. Nevertheless, there is a dearth of knowledge on the attributes of individuals who die on their first attempt and the factors that can predict mortality on the first attempt in these regions. The objective of this study was to create an individual-level risk-prediction model for mortality on the first suicide attempt. We analyzed records of individuals' first suicide attempts that occurred between May 1, 2017, and April 30, 2018, from the national suicide surveillance system, which includes all of the provinces of Thailand. Subsequently, a risk-prediction model for mortality on the first suicide attempt was constructed utilizing multivariable logistic regression and presented through a web-based application. The model's performance was assessed by calculating the area under the receiver operating curve (AUC), as well as measuring its sensitivity, specificity, and accuracy. Out of the 3,324 individuals who made their first suicide attempt, 50.5% of them died as a result of that effort. Nine out of the 21 potential predictors demonstrated the greatest predictive capability. These included male sex, age over 50 years old, unemployment, having a depressive disorder, having a psychotic illness, experiencing interpersonal problems such as being aggressively criticized or desiring plentiful attention, having suicidal intent, and displaying suicidal warning signals. The model demonstrated a good predictive capability, with an AUC of 0.902, a sensitivity of 84.65%, a specificity of 82.66%, and an accuracy of 83.63%. The implementation of this predictive model can assist physicians in conducting comprehensive evaluations of suicide risk in clinical settings and devising treatment plans for preventive intervention.
Collapse
Affiliation(s)
- Suwanna Arunpongpaisal
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
- Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sawitri Assanangkornchai
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Virasakdi Chongsuvivatwong
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| |
Collapse
|
3
|
Lu Z, Chen M, Yan S, Deng W, Wu T, Liu L, Zhou Y. The relationship between depressive mood and non-suicidal self-injury among secondary vocational school students: the moderating role of borderline personality disorder tendencies. Front Psychiatry 2023; 14:1187800. [PMID: 37867773 PMCID: PMC10585263 DOI: 10.3389/fpsyt.2023.1187800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Background Non-suicidal self-injury (NSSI) has become an important public health issue of global concern, often occurring in adolescents, and depressive mood is closely related to NSSI. In addition, NSSI is considered a symptom of borderline personality disorder. It has been found that adolescents in secondary vocational schools are more vulnerable to behavior and emotional disorders than those in general high schools. This study investigated the risk factors associated with NSSI affecting secondary vocational school students and analyzed the role of borderline personality disorder tendencies in promoting the occurrence of NSSI among students with depressive moods. Methods A total of 1,848 Chinese secondary vocational students completed a self-report questionnaire. The homemade NSSI behavior questionnaire, Patient Health Questionnaire-9 and Personality Diagnostic Questionnaire-4 were used in this survey. Binary logistic regression and PROCESS software analysis were used to explore the influencing factors associated with NSSI and to test for moderating effects. Results Female (OR = 3.412, 95% CI 2.301-5.060), drinking history (OR = 2.007, 95% CI 1.383-2.911), history of suicidal death exposure (OR = 3.161, 95% CI 1.999-4.999), depressive mood (OR = 2.436, 95% CI 1.668-3.558) and borderline personality disorder tendencies (OR = 2.558, 95% CI = 1.764-3.711) were independent risk factors for NSSI. Borderline personality disorder tendencies (B = 0.047, p = 0.000) moderated the relationship between depressive mood and NSSI. The stronger the borderline personality tendencies, the more NSSI behavior occurred when they were depressive. Conclusions Borderline personality disorder tendencies in secondary vocational school adolescents significantly enhance the association of depressive mood with NSSI. There is a moderating role for borderline personality disorder tendencies in depressive mood and NSSI.
Collapse
Affiliation(s)
- Zhaoyuan Lu
- School of Medicine, Jianghan University, Wuhan, China
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Affiliated Wuhan Mental Health Center, Jianghan University, Wuhan, China
| | - Mo Chen
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
| | - Shu Yan
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
| | - Weixi Deng
- Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Taimin Wu
- Institute of Education, China University of Geosciences (Wuhan), Wuhan, China
| | - Lianzhong Liu
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Affiliated Wuhan Mental Health Center, Jianghan University, Wuhan, China
- Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Yang Zhou
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
| |
Collapse
|
4
|
Liu BP, Jia CX, Qin P, Zhang YY, Yu YK, Luo X, Li SX. Associating factors of suicide and repetition following self-harm: A systematic review and meta-analysis of longitudinal studies. EClinicalMedicine 2022; 49:101461. [PMID: 35747199 PMCID: PMC9126760 DOI: 10.1016/j.eclinm.2022.101461] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/26/2022] [Accepted: 05/04/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Longitudinal evidence for sociodemographic and clinic factors deviating risk for suicide and repetition following SH (self-harm) varied greatly. METHODS A comprehensive search of PubMed, Web of Science, EMBASE, and PsycINFO was conducted from January 1st, 2010 to April 5th, 2022. Longitudinal studies focusing on examining associating factors for suicide and repetition following SH were included. PROSPERO registration CRD42021248695. FINDINGS The present meta-analysis synthesized data from 62 studies published from Jan. 1st, 2010. The associating factors of SH repetition included female gender (RR, 95%CI: 1.11, 1.04-1.18, I2=82.8%), the elderly (compared with adolescents and young adults, RR, 95%CI: 0.67, 0.52-0.87, I2=86.3%), multiple episodes of SH (RR, 95%CI: 1.97, 1.51-2.57, I2=94.3%), diagnosis (RR, 95%CI: 1.60, 1.27-2.02, I2=92.7%) and treatment (RR, 95%CI: 1.59, 1.40-1.80, I2=93.3%) of psychiatric disorder. Male gender (RR, 95%CI: 2.03, 1.80-2.28, I2=83.8%), middle-aged adults (compared with adolescents and young adults, RR, 95%CI: 2.40, 1.87-3.08, I2=74.4%), the elderly (compared with adolescents and young adults, RR, 95%CI: 4.38, 2.98-6.44, I2=76.8%), physical illness (RR, 95%CI: 1.95, 1.56-2.43, I2=0), multiple episodes of SH (RR, 95%CI: 2.02, 1.58-2.58, I2=87.4%), diagnosis (RR, 95%CI: 2.13, 1.67-2.71, I2=90.9%) and treatment (RR, 95%CI: 1.36, 1.16-1.58, I2=58.6%) of psychiatric disorder were associated with increased risk of suicide following SH. INTERPRETATION Due to the substantial heterogeneity for clinic factors of suicide and repetition following SH, these results need to be interpreted with caution. Clinics should pay more attention to the cases with SH repetition, especially with poor physical and psychiatric conditions. FUNDING This work was supported by National Natural Science Foundation of China (NSFC) [No: 82103954; 30972527; 81573233].
Collapse
Affiliation(s)
- Bao-Peng Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Cun-Xian Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
- Corresponding author at: Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine of University of Oslo, Oslo, Norway
| | - Ying-Ying Zhang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Yao-Kun Yu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Xiao Luo
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Shi-Xue Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Corresponding author at: Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
| |
Collapse
|
5
|
Thomas NM, Barber C, Miller M. A cohort study of initial self-harm events: method-specific case fatality of index events, predictors of fatal and nonfatal repetition, and frequency of method-switching. Int Rev Psychiatry 2021; 33:598-606. [PMID: 34238099 DOI: 10.1080/09540261.2021.1901668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Most studies evaluating self-harm repetition risk factors are from Asia and Europe, use cohorts of people who self-injure without differentiating incident and prevalent self-harm episodes, and do not stratify by suicide method. The current study uses an incident user design to (a) examine case fatality at index self-harm events and at each repeat event, by method, (b) describe method-switching, and (c) identify factors associated with repetition of self-harm among those who survive their index hospitalization. Specifically, this study reports psychiatric history and method-specific case fatality for the initial self-harm event among Utah residents with an index event in 2014 or 2015 and who have no history of prior self-harm in hospital records. For survivors of the index self-harm episode, we use Accelerated Failure Time models to identify risk factors for nonfatal repetition and separately for suicide. Key findings: 10,521 Utah residents with no 3-year self-harm hospital history experienced a 2014 or 2015 index event. Of the 9.5% with index deaths, 53.6% used firearms. Of the 90.5% who survived, 63.1% used drugs. Among the index nonfatal cases, over an average 1-year follow-up, 11.7% experienced a nonfatal repetition and 0.8% died by suicide. Most subsequent nonfatal repetitions (59.7%) and suicides (56.8%) had presented with an index drug poisoning; over half (56.8%) of those who died switched methods. For those who subsequently fatally self-harmed, most used poisoning by drugs (33.8%), hanging/strangulation (28.4%), or firearms (24.3%) in the terminal episode. Nonfatal repetition was associated with younger age, index cutting/piercing instruments, and past-year psychiatric and drug abuse diagnoses. Subsequent suicide was associated with male gender, older age, and index gas poisoning and hanging/suffocation. Of the 56 people who survived an index firearm event, none subsequently died by suicide during the study period.
Collapse
Affiliation(s)
- Nicole M Thomas
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Catherine Barber
- Department of Health Policy and Management, Injury Control Research Center, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Matthew Miller
- Department of Health Sciences, Harvard T.H. Chan School of Public Health, Northeastern University, Boston, MA, USA
| |
Collapse
|
6
|
Liu BP, Lunde KB, Jia CX, Qin P. The short-term rate of non-fatal and fatal repetition of deliberate self-harm: A systematic review and meta-analysis of longitudinal studies. J Affect Disord 2020; 273:597-603. [PMID: 32560959 DOI: 10.1016/j.jad.2020.05.072] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Deliberate self-harm (DSH) is often recurrent, but the reported rate of short-term repetition of DSH has varied greatly. This systematic review and meta-analysis aim to synthesize findings through providing pooled rate estimates and to explore their differences by age, gender, and other factors. METHODS A comprehensive search of PubMed, Web of Science, EMBASE, and PsycINFO was conducted to include longitudinal studies from 1999 to 2018. Random effects model was applied to pool rates of non-fatal and fatal repetition at 0.5, 1, 2, and 3 years intervals. RESULTS Of 9201 potentially eligible articles 76 studies were included for this systematic review and meta-analysis. The pooled rates of non-fatal repetition were 15.01%, 17.03%, 20.82%, and 24.20% during the 0.5-year, 1-year, 2-year, and 3-year follow-up, respectively. The corresponding rates of fatal repetition were 0.77%, 1.34%, 1.49% and 2.46%, respectively. When focusing on the 1-year follow-up, the pooled rate of fatal, not non-fatal, repetition was significantly higher in males than females. The rate of non-fatal DSH repetition was highest in middle-aged adults, while the rate of fatal repetition was highest among the elderly. Geographically, Europe had higher rate of non-fatal repetition whilst Asia had higher rate of repetition leading to death. LIMITATION Search was limited to English language and publication bias was observed. CONCLUSIONS Both non-fatal and fatal repetitions are common among people with DSH, but the rates differ considerably by gender, age and geographical location. These insights may guide provision of follow-up care and effort of suicide prevention for this high-risk population.
Collapse
Affiliation(s)
- Bao-Peng Liu
- Department of Epidemiology, Shandong University School of Public Health, Jinan 250012, China; Shandong University Center for Suicide Prevention Research, Shandong University School of Public Health, Jinan 250012, China; National Centre for Suicide Research and Prevention, Institute of Clinical Medicine of University of Oslo, Sognsvannsveien 21, Oslo N-0372, Norway
| | - Ketil Berge Lunde
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine of University of Oslo, Sognsvannsveien 21, Oslo N-0372, Norway
| | - Cun-Xian Jia
- Department of Epidemiology, Shandong University School of Public Health, Jinan 250012, China; Shandong University Center for Suicide Prevention Research, Shandong University School of Public Health, Jinan 250012, China
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine of University of Oslo, Sognsvannsveien 21, Oslo N-0372, Norway.
| |
Collapse
|
7
|
Choo CC, Harris KM, Chew PKH, Ho RC. Clinical assessment of suicide risk and suicide attempters' self-reported suicide intent: A cross sectional study. PLoS One 2019; 14:e0217613. [PMID: 31276556 PMCID: PMC6611556 DOI: 10.1371/journal.pone.0217613] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 12/22/2018] [Indexed: 11/19/2022] Open
Abstract
This study explored medical doctors’ clinical assessment of suicide risk and suicide attempters’ self-reported suicide intent. Three years of archival assessment records related to suicide attempters who were admitted to the emergency department of a large teaching hospital in Singapore were subjected to analysis. Records related to 460 suicide attempters (70.4% females; 28.6% males) were analysed using logistic regressions. Their ages ranged from 12 to 85 (M = 29.08, SD = 12.86). The strongest predictor of suicide intent was habitual poor coping, followed by serious financial problems, and expressed regret. The strongest predictor of suicide risk was hiding the attempt followed by prior planning. The findings were discussed in regards to implications in clinical assessments and suicide prevention efforts.
Collapse
Affiliation(s)
- Carol C. Choo
- College of Healthcare Sciences, James Cook University, Singapore, Singapore
- * E-mail:
| | - Keith M. Harris
- School of Psychology, Charles Sturt University, Port Macquarie, NSW, Australia
- School of Psychology, University of Queensland, St Lucia, Queensland, Australia
| | - Peter K. H. Chew
- College of Healthcare Sciences, James Cook University, Singapore, Singapore
| | - Roger C. Ho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
- Centre of Excellence in Behavioral Medicine, Nguyen Tat Thanh University (NTTU), Ho Chi Minh City, Vietnam
| |
Collapse
|
8
|
Choo CC, Harris KM, Ho RC. Prediction of Lethality in Suicide Attempts: Gender Matters. OMEGA-JOURNAL OF DEATH AND DYING 2017; 80:87-103. [PMID: 28828921 DOI: 10.1177/0030222817725182] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study explores gender differences in lethality of suicide attempts. Three years of medical records related to suicide attempters (N = 666) were subjected to analysis. Of the sample, 69.2% were female, 30.8% male; 63.8% Chinese, 15.8% Indian, and 15.0 % Malay. Ages ranged from 10 to 85 years old (M = 29.7, SD = 16.1). More males than females made attempts with high perceived lethality (χ2 = 12.10, p < .0001) and high medical lethality (χ2 = 10.59, p < .0001). Available variables were subjected to regression analyses. The regression models predicted more than 60% of high medical lethality suicide attempts and more than 80% of high perceived lethality attempts. Suicide intent and opportunity for rescue were significant predictors for both measures of lethality. Gender differences were examined. Findings were discussed in regard to implications in suicide assessments and interventions.
Collapse
Affiliation(s)
- Carol C Choo
- 1 College of Healthcare Sciences, James Cook University, Singapore, Singapore
| | - Keith M Harris
- 2 School of Medicine, University of Tasmania, Hobart, Australia.,3 School of Psychology, University of Queensland, St Lucia, Queensland, Australia
| | - Roger C Ho
- 4 Yong Loo Lin School of Medicine, National University of Singapore. Singapore
| |
Collapse
|
9
|
Mäki NE, Martikainen PT. Premature mortality after suicide attempt in relation to living arrangements. A register-based study in Finland in 1988-2007. Eur J Public Health 2017; 27:73-79. [PMID: 28177491 DOI: 10.1093/eurpub/ckw130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Netta E Mäki
- City of Helsinki Urban Facts, City of Helsinki, Finland
| | | |
Collapse
|
10
|
Chen HM, Hung TH, Chou SY, Tsai CS, Su JA. Three-year mortality rate of suicide attempters in consultation-liaison service. Int J Psychiatry Clin Pract 2016; 20:254-9. [PMID: 27541986 DOI: 10.1080/13651501.2016.1213853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Suicide attempters might be sent to the emergency room for urgent medical intervention. Some with more severe physical morbidity may be hospitalised, and psychiatrists might be consulted for suicide evaluation. The aim of our study was to investigate the three-year all-cause mortality rate of hospitalised suicide attempters with regard to the effect of consultation-liaison services, and to identify any risk factors associated with mortality. METHODS Between 2002 and 2006, 196 inpatients from medical or surgical wards in a general hospital who had consulted psychiatrists because of suicide attempts were collected consecutively. We traced their mortality incidence during a three-year period, and calculated the mortality rate and time (days) to death. RESULTS Three-year all-cause mortality was 20.4%, and there was a higher risk of mortality in the first two years after the index suicide attempt. In the adjusted Cox regression model, associated risks included male gender, older age, diagnosis of depressive disorders and lack of psychiatric follow-up. CONCLUSIONS We found that hospitalised suicide attempters had higher all-cause mortality after discharge, and determined that psychiatric follow-up is helpful. More attention should be paid to those with potential risk factors, and timely intervention is suggested in order to reduce mortality.
Collapse
Affiliation(s)
- Hong-Ming Chen
- a Department of Psychiatry , Chang Gung Memorial Hospital , Chiayi , Taiwan ;,b Graduate Institute of Clinical Medical Sciences , Chang Gung University , Taoyuan , Taiwan ;,c Department of Nursing , Chang Gung Institute of Technology , Taoyuan , Taiwan
| | - Tai-Hsin Hung
- a Department of Psychiatry , Chang Gung Memorial Hospital , Chiayi , Taiwan ;,b Graduate Institute of Clinical Medical Sciences , Chang Gung University , Taoyuan , Taiwan ;,c Department of Nursing , Chang Gung Institute of Technology , Taoyuan , Taiwan
| | - Shih-Yong Chou
- a Department of Psychiatry , Chang Gung Memorial Hospital , Chiayi , Taiwan ;,b Graduate Institute of Clinical Medical Sciences , Chang Gung University , Taoyuan , Taiwan ;,c Department of Nursing , Chang Gung Institute of Technology , Taoyuan , Taiwan
| | - Ching-Shu Tsai
- a Department of Psychiatry , Chang Gung Memorial Hospital , Chiayi , Taiwan ;,b Graduate Institute of Clinical Medical Sciences , Chang Gung University , Taoyuan , Taiwan ;,c Department of Nursing , Chang Gung Institute of Technology , Taoyuan , Taiwan
| | - Jian-An Su
- a Department of Psychiatry , Chang Gung Memorial Hospital , Chiayi , Taiwan ;,b Graduate Institute of Clinical Medical Sciences , Chang Gung University , Taoyuan , Taiwan ;,c Department of Nursing , Chang Gung Institute of Technology , Taoyuan , Taiwan
| |
Collapse
|
11
|
Chan MKY, Bhatti H, Meader N, Stockton S, Evans J, O'Connor RC, Kapur N, Kendall T. Predicting suicide following self-harm: systematic review of risk factors and risk scales. Br J Psychiatry 2016; 209:277-283. [PMID: 27340111 DOI: 10.1192/bjp.bp.115.170050] [Citation(s) in RCA: 253] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 03/21/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND People with a history of self-harm are at a far greater risk of suicide than the general population. However, the relationship between self-harm and suicide is complex. AIMS To undertake the first systematic review and meta-analysis of prospective studies of risk factors and risk assessment scales to predict suicide following self-harm. METHOD We conducted a search for prospective cohort studies of populations who had self-harmed. For the review of risk scales we also included studies examining the risk of suicide in people under specialist mental healthcare, in order to broaden the scope of the review and increase the number of studies considered. Differences in predictive accuracy between populations were examined where applicable. RESULTS Twelve studies on risk factors and 7 studies on risk scales were included. Four risk factors emerged from the meta-analysis, with robust effect sizes that showed little change when adjusted for important potential confounders. These included: previous episodes of self-harm (hazard ratio (HR) = 1.68, 95% CI 1.38-2.05, K = 4), suicidal intent (HR = 2.7, 95% CI 1.91-3.81, K = 3), physical health problems (HR = 1.99, 95% CI 1.16-3.43, K = 3) and male gender (HR = 2.05, 95% CI 1.70-2.46, K = 5). The included studies evaluated only three risk scales (Beck Hopelessness Scale (BHS), Suicide Intent Scale (SIS) and Scale for Suicide Ideation). Where meta-analyses were possible (BHS, SIS), the analysis was based on sparse data and a high heterogeneity was observed. The positive predictive values ranged from 1.3 to 16.7%. CONCLUSIONS The four risk factors that emerged, although of interest, are unlikely to be of much practical use because they are comparatively common in clinical populations. No scales have sufficient evidence to support their use. The use of these scales, or an over-reliance on the identification of risk factors in clinical practice, may provide false reassurance and is, therefore, potentially dangerous. Comprehensive psychosocial assessments of the risks and needs that are specific to the individual should be central to the management of people who have self-harmed.
Collapse
Affiliation(s)
- Melissa K Y Chan
- Melissa K. Y. Chan, MSc, Centre for Suicide Research and Prevention, University of Hong Kong, Pok Fu Lam, Hong Kong; Henna Bhatti, MSc, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Nick Meader, PhD, Centre for Reviews and Dissemination, The University of York, York, UK; Sarah Stockton, BA(Hons), National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK; Jonathan Evans, MRCPsych, Centre for Academic Mental Health, School of Social & Community Medicine, University of Bristol, Bristol, UK; Rory C. O'Connor, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, University of Manchester, and Manchester Mental Health and Social Care Trust, Manchester, UK; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK
| | - Henna Bhatti
- Melissa K. Y. Chan, MSc, Centre for Suicide Research and Prevention, University of Hong Kong, Pok Fu Lam, Hong Kong; Henna Bhatti, MSc, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Nick Meader, PhD, Centre for Reviews and Dissemination, The University of York, York, UK; Sarah Stockton, BA(Hons), National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK; Jonathan Evans, MRCPsych, Centre for Academic Mental Health, School of Social & Community Medicine, University of Bristol, Bristol, UK; Rory C. O'Connor, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, University of Manchester, and Manchester Mental Health and Social Care Trust, Manchester, UK; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK
| | - Nick Meader
- Melissa K. Y. Chan, MSc, Centre for Suicide Research and Prevention, University of Hong Kong, Pok Fu Lam, Hong Kong; Henna Bhatti, MSc, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Nick Meader, PhD, Centre for Reviews and Dissemination, The University of York, York, UK; Sarah Stockton, BA(Hons), National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK; Jonathan Evans, MRCPsych, Centre for Academic Mental Health, School of Social & Community Medicine, University of Bristol, Bristol, UK; Rory C. O'Connor, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, University of Manchester, and Manchester Mental Health and Social Care Trust, Manchester, UK; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK
| | - Sarah Stockton
- Melissa K. Y. Chan, MSc, Centre for Suicide Research and Prevention, University of Hong Kong, Pok Fu Lam, Hong Kong; Henna Bhatti, MSc, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Nick Meader, PhD, Centre for Reviews and Dissemination, The University of York, York, UK; Sarah Stockton, BA(Hons), National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK; Jonathan Evans, MRCPsych, Centre for Academic Mental Health, School of Social & Community Medicine, University of Bristol, Bristol, UK; Rory C. O'Connor, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, University of Manchester, and Manchester Mental Health and Social Care Trust, Manchester, UK; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK
| | - Jonathan Evans
- Melissa K. Y. Chan, MSc, Centre for Suicide Research and Prevention, University of Hong Kong, Pok Fu Lam, Hong Kong; Henna Bhatti, MSc, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Nick Meader, PhD, Centre for Reviews and Dissemination, The University of York, York, UK; Sarah Stockton, BA(Hons), National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK; Jonathan Evans, MRCPsych, Centre for Academic Mental Health, School of Social & Community Medicine, University of Bristol, Bristol, UK; Rory C. O'Connor, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, University of Manchester, and Manchester Mental Health and Social Care Trust, Manchester, UK; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK
| | - Rory C O'Connor
- Melissa K. Y. Chan, MSc, Centre for Suicide Research and Prevention, University of Hong Kong, Pok Fu Lam, Hong Kong; Henna Bhatti, MSc, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Nick Meader, PhD, Centre for Reviews and Dissemination, The University of York, York, UK; Sarah Stockton, BA(Hons), National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK; Jonathan Evans, MRCPsych, Centre for Academic Mental Health, School of Social & Community Medicine, University of Bristol, Bristol, UK; Rory C. O'Connor, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, University of Manchester, and Manchester Mental Health and Social Care Trust, Manchester, UK; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK
| | - Nav Kapur
- Melissa K. Y. Chan, MSc, Centre for Suicide Research and Prevention, University of Hong Kong, Pok Fu Lam, Hong Kong; Henna Bhatti, MSc, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Nick Meader, PhD, Centre for Reviews and Dissemination, The University of York, York, UK; Sarah Stockton, BA(Hons), National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK; Jonathan Evans, MRCPsych, Centre for Academic Mental Health, School of Social & Community Medicine, University of Bristol, Bristol, UK; Rory C. O'Connor, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, University of Manchester, and Manchester Mental Health and Social Care Trust, Manchester, UK; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK
| | - Tim Kendall
- Melissa K. Y. Chan, MSc, Centre for Suicide Research and Prevention, University of Hong Kong, Pok Fu Lam, Hong Kong; Henna Bhatti, MSc, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Nick Meader, PhD, Centre for Reviews and Dissemination, The University of York, York, UK; Sarah Stockton, BA(Hons), National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK; Jonathan Evans, MRCPsych, Centre for Academic Mental Health, School of Social & Community Medicine, University of Bristol, Bristol, UK; Rory C. O'Connor, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, University of Manchester, and Manchester Mental Health and Social Care Trust, Manchester, UK; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK
| |
Collapse
|
12
|
Pien FC, Chang YC, Feng HP, Hung PW, Huang SY, Tzeng WC. Changes in Quality of Life After a Suicide Attempt. West J Nurs Res 2015; 38:721-37. [DOI: 10.1177/0193945915620306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The aim of this follow-up study was to examine factors related to a suicide attempt within 3 months of a prior attempt. Participants were recruited from a suicide-prevention center. Of 96 suicidal individuals who had participated in the baseline study, only 51 completed all measures at follow-up assessment. Study results showed that suicidal individuals who reattempted suicide during the first 3 months of follow-up care exhibited lower mean scores on all four domains of the brief version of the World Health Organization Quality-of-Life Instrument at follow-up assessment than at baseline. In contrast, individuals who did not reattempt suicide had higher quality-of-life scores across all domains between baseline and 3 months. The reattempt and no-reattempt groups differed significantly in the physical health and environmental domains. These results can be used by nurses to develop their abilities to recognize and prevent suicide reattempts in high-risk groups.
Collapse
Affiliation(s)
- Feng-Chen Pien
- National Defense Medical Center, Taipei City, Taiwan (R.O.C.)
| | | | - Hsin-Pei Feng
- National Defense Medical Center, Taipei City, Taiwan (R.O.C.)
| | - Pin-Wei Hung
- National Defense Medical Center, Taipei City, Taiwan (R.O.C.)
| | - San-Yuan Huang
- National Defense Medical Center, Taipei City, Taiwan (R.O.C.)
| | - Wen-Chii Tzeng
- National Defense Medical Center, Taipei City, Taiwan (R.O.C.)
| |
Collapse
|
13
|
Chen IM, Liao SC, Lee MB, Wu CY, Lin PH, Chen WJ. Risk factors of suicide mortality among multiple attempters: A national registry study in Taiwan. J Formos Med Assoc 2015; 115:364-71. [PMID: 26279174 DOI: 10.1016/j.jfma.2015.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 07/04/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND/PURPOSE Little is known about the risk factors of suicide mortality among multiple attempters. This study aims to investigate the predictors of suicidal mortality in a prospective cohort of attempters in Taiwan, focusing on the time interval and suicide method change between the last two nonfatal attempts. METHODS The representative data retrieved from the National Suicide Surveillance System (NSSS) was linked with National Mortality Database to identify the causes of death in multiple attempters during 2006-2008. Cox-proportional hazard models were applied to calculate the hazard ratios for the predictors of suicide. RESULTS Among the 55,560 attempters, 6485 (11.7%) had survived attempts ranging from one to 11 times; 861 (1.5%) eventually died by suicide. Multiple attempters were characterized by female (OR = 1.56, p < 0.0001), nonrecipient of national aftercare service (OR = 1.62, p < 0.0001), and current contact with mental health services (OR = 3.17, p < 0.0001). Most multiple attempters who survived from hanging (68.1%) and gas poisoning (61.9%) chose the same method in the following fatal episode. Predictors of suicidal death were identified as male, older age (≥ 45 years), shorter interval and not maintaining methods of low lethality in the last two nonfatal attempts. Receipt of nationwide aftercare was associated with lower risk of suicide but the effect was insignificant. CONCLUSION The time interval of the last two nonfatal attempts and alteration in the lethality of suicide method were significant factors for completed suicide. Risk assessment involving these two factors may be necessary for multiple attempters in different clinical settings. Effective strategies for suicide prevention emphasizing this high risk population should be developed in the future.
Collapse
Affiliation(s)
- I-Ming Chen
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shih-Cheng Liao
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Been Lee
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Department of Psychiatry, National Taiwan University College of Medicine, Taipei, Taiwan; National Suicide Prevention Centre, Taipei, Taiwan.
| | - Chia-Yi Wu
- School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Hsien Lin
- Department of Psychiatry, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Wei J Chen
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| |
Collapse
|