Gender and age differences among youth, in utilization of mental health services in the year preceding suicide in Taiwan

Healthcare utilization, psychiatric disorders, and physical illnesses shortly before suicide mortality in adolescents in Taiwan

BACKGROUND

This study examined the pattern of medical utilization and the distribution of comorbidities shortly before death among adolescents who died from suicide and compared these data with those of living controls.

METHODS

From Taiwan's National Health Insurance Research Database, this study identified adolescents aged 10-19 years who died from suicide (n = 935) between 1 January 2000, and 31 December 2016, by linking each patient with the national mortality database. The researchers conducted a nested case-control study through risk set sampling, and for each case, 20 age- and sex-matched controls (n = 18 700) were selected from the general population. The researchers applied conditional logistic regression to investigate differences in medical utilization and physical and psychiatric comorbidities between cases and controls.

RESULTS

Cases had a higher proportion of contact with the psychiatric department but a similar proportion of contact with any non-psychiatric medical department within 1 year before suicide compared with controls. There were 18.6% of adolescent suicide victims who only had contacted with a psychiatric department 3 months before suicide. Moreover, cases had a higher proportion of contact with non-psychiatric services within 3 months before suicide, particularly with emergency, surgery, and internal medicine departments. Cases had higher risks of several psychiatric disorders and physical illnesses, including heart diseases, pneumonia, and ulcer disease, than did controls.

CONCLUSIONS

The findings of increased medical utilization and higher risks of physical and psychiatric comorbidities in adolescent suicide victims are crucial for developing specific interventions to prevent suicide in this population.

People Who Die by Suicide Without Receiving Mental Health Services: A Systematic Review

Introduction

The majority of people who die by suicide have never seen a mental health professional or been diagnosed with a mental illness. To date, this majority group has largely been ignored, with most existing research focusing on predictors of suicide such as past suicide attempts. Identifying the characteristics of people who die by suicide without receiving services, often with a fatal first attempt, is crucial to reduce suicide rates through guiding improvements to service pathways and “just in time” interventions.

Methods

In this systematic review, PsycInfo, PubMed, CINAHL, and Web of Science were searched for peer-reviewed articles published from 1980 to 1st March 2021. Included studies examined predictors of non-receipt of formal mental health services among people who died by suicide. Data were extracted from published reports and the quality of included studies was assessed using a modified version of the Joanna Briggs Institute Checklist for Analytical Cross Sectional Studies. This review was registered with PROSPERO, CRD 42021226543.

Results

Sixty-seven studies met inclusion criteria, with sample sizes ranging from 39 to 193,152 individuals. Male sex, younger or older age, and rural location were consistently associated with non-receipt of mental health services. People not receiving mental health services were also less likely to have a psychiatric diagnosis, past suicidal behavior or contact with general health services, and more likely to use violent means of suicide. There was some evidence that minority ethnicity and psychosocial stressors were associated with service non-receipt.

Conclusion

People who die by suicide without receiving mental health services are likely to have diverse profiles, indicating the need for multifaceted approaches to effectively support people at risk of suicide. Identifying the needs and preferences of individuals who are at risk of suicide is crucial in developing new support pathways and services, and improving the quality of existing services.

Systematic Review Registration

http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42021226543.

Prevalence, determinants and knowledge about herbal medicine and non-hospital utilisation in southwest Nigeria: a cross-sectional study

OBJECTIVES

To examine the prevalence, determinants, safety perceptions, effectiveness and knowledge of herbal medicines (HMs) and reasons for non-hospital utilisation.

DESIGN

Cross-sectional study.

SETTING

Ekiti state, southwest Nigeria.

PARTICIPANTS

A representative sample (n=1600) of adults (18 years or above) currently living in Ekiti state, southwest Nigeria for at least 2 years, at the time of study.

RESULTS

The majority of the respondents (85% n=1265) have used HMs in the last 2 years. Across economic classes use, middle income (88.3%) was the highest (p<0.001), suggesting poverty is not a major factor, even with income inequality. Their use was the most common among respondents with a primary level of education (91.4%, p=0.001); and 100% use (p=0.009) of respondents practising African traditional religion; farmers and those 70 years or above. Our study also reveals more men (p<0.001) used HMs (89.9%) than women (78.6%) and effectiveness was a major reason for use (39.6%) followed by affordability (31.9%). Although the majority of the respondents (90%) knew the difference between certified and uncertified HMs, uncertified ones were the most commonly used (37.3%) in the population.

CONCLUSION

Although there is a cultural history of HM use within the study population, the choice of use was based on their effectiveness. Therefore, a scientifically valid analysis of this claim within the study population may help achieve a cheaper and affordable healthcare alternative which will be safe. This is important, considering that uncertified HMs were chosen over certified ones, even though a large majority of respondents were aware of differences and likely consequences. This study highlights the need for further investment by the government, individuals and corporate stakeholders in HM research and improvement of conventional healthcare system. This is in addition to public health awareness on the danger of use of uncertified herbal products.

Evidence-Based Interventions for Youth Suicide Risk

PURPOSE OF REVIEW

To review and discuss recent advances in evidence-based interventions (EBIs) for youth suicide risk.

RECENT FINDINGS

There is a growing body of research on the effectiveness of interventions targeting suicidal ideation and behavior among adolescents. Dialectical Behavioral Therapy-Adolescent has shown effectiveness across two independent randomized controlled trials (RCTs). Several other interventions have shown effectiveness in only one trial and are in need of replication. New interventions are also being developed that incorporate developments in technology and adaptive intervention designs. It is recommended that future research focus on strategies for engaging underserved youth with interventions, consider the broader needs of youth living in poverty, and further tailor interventions to subgroups with distinct risk profiles. Limited EBIs exist for preadolescents, despite evidence for an increasing rate of suicidal behavior for these youth. Several interventions for youth suicide risk are highly promising, but further investigation is necessary. EBIs that are effective for preadolescents are needed, and greater efforts to tailor interventions for distinct subgroups of youth at risk are recommended.

Use of primary health care services prior to suicide in the Norwegian population 2006-2015

BACKGROUND

Studies report high rates of contact with general practitioners (GPs) in primary care in the time leading up to suicide, particularly among individuals with a history of mental health contact. However, the near lack of studies including population representative controls have prevented investigations into how the contact patterns of suicide victims compares to those of the general population.

METHODS

By linking data from two national registries, this study investigated primary health care use in suicide victims aged 15 years and older during the period from 2007 to 2015 (n = 4926). Their rates of contact one year and one month prior to suicide were compared to the average rates in the general Norwegian population during the period by estimating relative risks across sex and age. Contact patterns one month prior to suicide were also investigated according to prior mental health consultations in primary care.

RESULTS

The findings revealed a stable trend in contact with GPs in primary care during the observation period, with 79.6% of male and 89.0% of female suicide victims having consulted their GP within a year of the suicide. Corresponding rates one month prior to the suicide were 34.8 and 46.4%, respectively. At both points in time and across all age groups, suicide victims were considerably more likely to consult their GP than were the general population. Suicide victims without prior mental health contact were only modestly more likely to consult their GP within a month of the suicide as compared to the general population, while both the general population and suicide victims with prior mental health consultations had rates of contact well above those without, evident for both sexes.

CONCLUSIONS

Contact with GPs in primary care prior to suicide is common in both sexes and across most age groups, in particular for victims with prior mental health consultations. Younger males show the overall lowest rates of contact, and increased alternative efforts to reach this group, in addition to larger population strategies, may pose the most prominent preventive measures.

Suicide Risk Screening in Healthcare Settings: Identifying Males and Females at Risk

Suicide is the tenth leading cause of death in the United States, accounting for more than 42,000 deaths in 2014. Although this tragedy cuts across groups defined by age, gender, race/ethnicity, and geographic location, it is striking that nearly four times as many males as females die by suicide in the U.S. We describe the current regulations and recommendations for suicide risk screening in healthcare systems and also describe the aspirational goal of "Zero Suicide," put forth by the National Action Alliance for Suicide Prevention. We then provide information about suicide risk screening tools and steps to take when a patient screens positive for suicide risk. Given the substantially higher suicide rate among males than females, we argue that it is important to consider how we could optimize suicide risk screening strategies to identify males at risk and females at risk. Further research is needed to accomplish this goal. It is recommended that we consider multi-factorial suicide risk screens that incorporate risk factors known to be particularly important for males as well as computerized, adaptive screens that are tailored for the specific risk considerations of the individual patient, male or female. These strategies are not mutually exclusive. Finally, universal suicide risk screening in healthcare settings, especially primary care, specialty medical care, and emergency department settings, is recommended.

Contact with primary and mental health care prior to suicide: A systematic review of the literature from 2000 to 2017

Aim: To examine rates of contact with primary and mental health care prior to suicide in men and women and across a range of age categories. Method: The authors performed a systematic review of 44 studies from 2000 to 2017 of which 36 reported rates on contact with primary health care and 14 reported on contact with mental health care prior to suicide. Results: Contact with primary health care was highest in the year prior to suicide with an average contact rate of 80%. At one month, the average rate was 44%. The lifetime contact rate for mental health care was 57%, and 31% in the final 12 months. In general, women and those over 50 years of age had the highest rates of contact with health care prior to suicide. Conclusions: Contact with primary health care prior to suicide is common even in the final month before death. The findings presented in this study highlight the importance of placing suicide prevention strategies and interventions within the primary health care setting.

Factors Influencing Professional Help-Seeking for Suicidality

BACKGROUND

Evidence suggests that the majority of people with suicidality do not seek help. Little systematic evaluation of factors influencing professional help-seeking has been done.

AIMS

To systematically evaluate the factors that influence professional help-seeking for suicidality.

METHOD

Published quantitative and qualitative studies in Medline and PsycInfo databases were reviewed following PRISMA.

RESULTS

In all, 55 relevant studies were identified. Of these, 15 studies examined professional help-seeking intentions for perceived suicidal ideation, among people with or without suicidality; 21 studies examined professional help-seeking behavior among people with suicidality; and 19 studies examined suicidal decedents' health services use. Several potential important barriers were identified including high self-reliance, lack of perceived need for treatment, and stigmatizing attitudes toward suicide, toward mental health issues, and toward seeking professional treatment. The presence of suicidality and mental health issues was found to generally decrease help-seeking intentions for perceived suicidal ideation while facilitating actual service use. Social support and informal support from family and friends also played an important role in professional help-seeking.

LIMITATIONS

Although the majority of the included studies were of sound quality, some of the factors identified in the review were assessed in relatively few studies, and most of the included studies were conducted in industrialized countries.

CONCLUSION

Further quantitative and qualitative studies examining the potential important factors in broader community samples, especially in developing countries, are needed.

Sex Differences in the Risk of Developing Acute Coronary Syndrome in Patients With Sleep Disorders: A Population-Based Cohort Study

Studies that focus on the relationship between sex and the risk of acute coronary syndrome (ACS) are scant. The current study investigated the effects of sex differences in the risk of developing ACS in patients with sleep disorders (SDs). This longitudinal population-based cohort study evaluated the incidence and risk of ACS development in 40,232 men and 65,519 women newly diagnosed with SDs between 2002 and 2008 from the Longitudinal Health Insurance Database. The follow-up period began from the entry date and ended on the date of an ACS event or December 31, 2010. Univariable and multivariable Cox proportional hazard regression models were conducted to estimate the sex differences in the risk of ACS. Men with SDs exhibited an increased incidence of ACS compared with women with SDs in all age- and comorbidity-specific subgroups. After covariates were adjusted, the men with SDs exhibited a 1.48-fold adjusted hazard ratio (aHR) of ACS compared with the women with SDs (95% confidence interval [CI] = 1.36-1.60). After age group stratification, the men with SDs in the young adult group exhibited the highest risk of subsequent ACS development compared with the women with SDs (aHR = 2.07, 95% CI = 1.69-2.55), followed by those in middle-aged adults (aHR = 1.52, 95% CI = 1.32-1.76) and older adults groups (aHR = 1.24, 95% CI = 1.11-1.39). This study determined that men with SDs, particularly young men, are at a higher risk of subsequent ACS development compared with women with SDs.

Gender Differences in Youth Suicide and Healthcare Service Use

BACKGROUND

Healthcare service use among suicide decedents must be well characterized and understood since a key strategy for preventing suicide is to improve healthcare providers' ability to effectively detect and treat those in need.

AIMS

To determine gender differences in healthcare service use 12 months prior to suicide.

METHOD

Data for 1,231 young Quebec residents (≤ 25 years) who died by suicide between 2000 and 2007 were collected from public health insurance agency databases and coroner registers. Healthcare visits were categorized according to the setting (emergency department [ED], outpatient, and hospital) and their nature (mental health vs. non-mental health).

RESULTS

Girls were more likely than boys (82.5% vs. 74.9%, p = .011) to have used healthcare services in the year prior to death. A higher proportion of girls had used outpatient services (79.0% vs. 69.5%, p = .003), had been hospitalized (25.7% vs. 15.6%, p < .001) and had received a mental health-related diagnosis (46.7% vs. 33.1%, p < .001). However, no gender differences were observed in ED visits (59.5% vs. 54.5%, p = .150).

CONCLUSION

There is an important proportion of suicide decedents who did not receive a mental health diagnosis and healthcare services in the year prior to death. Future studies should focus on examining gender-specific individual and health system barriers among suicide decedents as well as the quality of care offered regarding detection and treatment.

Population-based analysis of health care contacts among suicide decedents: identifying opportunities for more targeted suicide prevention strategies

The objective of this study was to detail the nature and correlates of mental health and non-mental health care contacts prior to suicide death. We conducted a systematic extraction of data from records at the Office of the Chief Coroner of Ontario of each person who died by suicide in the city of Toronto from 1998 to 2011. Data on 2,835 suicide deaths were linked with provincial health administrative data to identify health care contacts during the 12 months prior to suicide. Sub-populations of suicide decedents based on the presence and type of mental health care contact were described and compared across socio-demographic, clinical and suicide-specific variables. Time periods from last mental health contact to date of death were calculated and a Cox proportional hazards model examined covariates. Among suicide decedents, 91.7% had some type of past-year health care contact prior to death, 66.4% had a mental health care contact, and 25.3% had only non-mental health contacts. The most common type of mental health contact was an outpatient primary care visit (54.0%), followed by an outpatient psychiatric visit (39.8%), an emergency department visit (31.1%), and a psychiatric hospitalization (21.0%). The median time from last mental health contact to death was 18 days (interquartile range 5-63). Mental health contact was significantly associated with female gender, age 25-64, absence of a psychosocial stressor, diagnosis of schizophrenia or bipolar disorder, past suicide attempt, self-poisoning method and absence of a suicide note. Significant differences between sub-populations of suicide decedents based on the presence and nature of their health care contacts suggest the need for targeting of community and clinical-based suicide prevention strategies. The predominance of ambulatory mental health care contacts, often close to the time of death, reinforce the importance of concentrating efforts on embedding risk assessment and care pathways into all routine primary and specialty clinical care, and not only acute care settings.

PTSD, Depression, and Substance Use in Relation to Suicidality Risk among Traumatized Minority Lesbian, Gay, and Bisexual Youth

Youths who are lesbian, gay, or bisexual (LGB) are more likely than heterosexuals to commit suicide. Substance use, PTSD, and depression are independent risk factors for suicidality; however, the extent to which these factors interact to predict suicidality is unclear. The current study examined the association between substance use, PTSD symptoms (PTSS), depressive symptoms, and suicidality in a sample of 68 traumatized minority LGB youths. Participants were recruited from an LGBT community center and completed a packet of questionnaires. Substance use and depressive symptoms were positively associated with prior suicide attempts. A significant three-way interaction revealed that substance use interacted with both PTSS and depressive symptoms to increase the odds of attempted suicide. Results underscore the importance of integrating substance use components into PTSD/depression treatment to reduce suicide risk in LGB youth.

Depression symptom and professional mental health service use

BACKGROUND

Despite the sharp rise in antidepressant use, the underutilization of mental healthcare services for depression remains a concern. We investigated factors associated with the underutilization of mental health services for potential depression symptoms in the Republic of Korea, using a nationally representative sample.

METHODS

Data were obtained from the Community Health Survey (2011-2012) conducted in the Republic of Korea. Participants comprised adults who reported potential depression symptoms during the year prior to the study (n = 21,644); information on professional mental healthcare use for their symptoms was obtained. The association of demographic, socioeconomic, and health-related factors with consultation use was analysed via multiple logistic regression. Adjusted odds ratio and 95% confidence intervals were estimated.

RESULTS

Among those reporting potential depression symptoms, only 17.4% had consulted a medical/mental health professional. Elderly individuals of both genders had significantly lower consultation rates compared to middle-aged individuals. Unmet healthcare needs and a history of diabetes mellitus were associated with lower consultation rates. After stratification by age, elderly individuals with the lowest education and income level were significantly less likely to seek professional mental health services. Married, separated, or divorced men had lower consultation rates compared to unmarried individuals, whereas married, separated, or divorced women had higher rates.

CONCLUSIONS

The results suggest that target strategies for vulnerable groups identified in this study--including elderly individuals--need to be established at the community level, including strengthening social networks and spreading awareness to reduce the social stigma of depression.

The predictive validity of bipolar at-risk (prodromal) criteria in help-seeking adolescents and young adults: a prospective study

OBJECTIVES

There are no established tools to identify individuals at risk for developing bipolar disorder. We developed a set of ultra-high-risk criteria for bipolar disorder [bipolar at-risk (BAR)]. The primary aim of the present study was to determine the predictive validity of the BAR criteria.

METHODS

This was a 12-month prospective study that was conducted at Orygen Youth Health Clinical Program, a public mental health program for young people aged 15-24 years in metropolitan Melbourne, Australia. At intake, BAR screen-positive individuals and a matched group of individuals who did not meet BAR criteria were observed over a period of 12 months. The BAR criteria include general criteria such as being in the peak age range for the onset of the disorder, as well as sub-threshold mania, depression plus cyclothymic features, and depression plus genetic risk. Conversion to first-episode mania/hypomania was defined by the presence of DSM-IV manic symptoms for more than four days, in line with the DSM-IV definition of hypomania/mania.

RESULTS

A total of 559 help-seeking patients were screened. Of the eligible participants, 59 (10.6%) met BAR criteria. Thirty-five participants were included in the BAR group and 35 matched participants were selected to be in the control group. During the follow-up, five BAR patients out of 35 (14.3%) converted to first-episode hypomania/mania as opposed to none in the non-BAR group [χ(2) (1) = 5.38, p = 0.020]. Four out of these five converters had a DSM-IV diagnosis of bipolar I or bipolar II disorder.

CONCLUSIONS

These findings support the possibility of identification of persons prior to the onset of mania/hypomania. The proposed criteria need further evaluation in larger, prospective studies with longer follow-up periods.