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Hou H, Yu B, He C, Li G, Pei Y, Wang J, Tang J, Chen X, Gao X, Wang W. Secular trends of suicide risk for residents in mainland China (2004 to 2019): An updated age-period-cohort analysis. J Affect Disord 2023; 329:235-242. [PMID: 36849004 DOI: 10.1016/j.jad.2023.02.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 02/18/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND The overall suicide rate in China has dropped substantially since the 1990s, but a slowdown in the decrease and even a reversing trend was observed in specific groups in recent years. This study aims to investigate the latest suicide risk in mainland China by using the age-period-cohort (APC) analysis. METHOD This population-based multiyear cross-sectional study included Chinese ages 10 to 84 years using data from the China Health Statistical Yearbook (2005-2020). Data were analyzed by the APC analysis and intrinsic estimator (IE) technique. RESULTS The data satisfactorily fit the constructed APC models. The cohort effect indicated a high risk of suicide among people birth in 1920-1944 and a sharp decline in the 1945-1979 cohort. The lowest risk occurred in the 1980-1994 cohort before a sharp increase in generation Z (birth years in 1995-2009). The period effect showed a declining trend since 2004. The age effect indicated that the suicide risk increased over time, except for a gradual decline from age 35 to 49. The suicide risk increased greatly in adolescents and reached the highest among the elderly. LIMITATIONS The aggregated population-level data and the non-identifiability of the APC model could result in bias in the accuracy of results in this study. CONCLUSIONS This study successfully updated the Chinese suicide risk from the age, period and cohort perspective using the latest available data (2004-2019). The findings enhance the understanding of suicide epidemiology and provide evidence supporting policies and strategies at the macro-level for suicide prevention and management. Immediate action is needed to focus on a national suicide prevention strategy that targets generation Z, adolescents and the elderly which will require a collaborative effort by government officials, public/community health planners and health care agencies.
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Affiliation(s)
- Hao Hou
- School of Public Health, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China; School of Public Health, Wuhan University, Wuhan 430064, Hubei, China
| | - Bin Yu
- School of Public Health, Wuhan University, Wuhan 430064, Hubei, China
| | - Chenlu He
- School of Public Health, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Guiyuan Li
- School of Public Health, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Yifei Pei
- School of Public Health, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Jingjing Wang
- School of Public Health, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Jie Tang
- School of Public Health, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Xinguang Chen
- Department of Epidemiology, University of Florida, 2004 Mowry Road, Gainesville, USA
| | - Xiuyin Gao
- School of Public Health, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Wei Wang
- School of Public Health, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China; Center for Medical Statistics and Data Analysis, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China; Key Laboratory of Human Genetics and Environmental Medicine, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China.
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Lam BCP, Bond MH, Chen SX, Wu WCH. Worldviews and Individual Vulnerability to Suicide: The Role of Social Axioms. EUROPEAN JOURNAL OF PERSONALITY 2020. [DOI: 10.1002/per.762] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Research investigating the role of generalized beliefs about the world or worldviews is relatively scarce in the suicide literature. Two studies, using Hong Kong Chinese samples, examined how worldviews, as assessed by the Social Axioms Survey (SAS), were linked with individual vulnerability to suicide. In Study 1, we investigated the relationships of social axioms with various suicide indicators in cognitive, emotional and interpersonal domains, viz., suicidal ideation, negative self–esteem, psychache, burdensomeness and thwarted belongingness. Results from canonical correlation analysis showed that beliefs along the axiom dimensions of social cynicism, reward for application, and social complexity were linked to these suicide indicators. In Study 2, we tested the interplay of worldviews and personality traits in the prediction of suicidal thoughts. Hierarchical regression results demonstrated the predictive power of social axioms over and above that provided by the Big Five personality dimensions. Moreover, a significant interaction was observed between belief in reward for application and negative life events in predicting suicidal ideation, showing that reward for application buffered the effect of negative life events on suicidal ideation. Based on these results, we discussed the significance of worldviews as a consideration in suicide research and their implications for clinical assessment and intervention. Copyright © 2010 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ben C. P. Lam
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong, SAR, PR China
| | - Michael Harris Bond
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong, SAR, PR China
| | - Sylvia Xiaohua Chen
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong, SAR, PR China
| | - Wesley C. H. Wu
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong, SAR, PR China
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Wang Q, Chang R, Wang Y, Jiang X, Zhang S, Shen Q, Wang Z, Ma T, Lau JTF, Cai Y. Correlates of alcohol and illicit drug use before commercial sex among transgender women with a history of sex work in China. Sex Health 2020; 17:45-52. [DOI: 10.1071/sh18194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 08/13/2019] [Indexed: 12/27/2022]
Abstract
Background Research on substance use among transgender female sex workers in China is scarce. The aims of this study were to examine: (1) the prevalence of alcohol or illicit drug use before commercial sex among this population; and (2) correlates of alcohol and illicit drug use. Methods: Complete survey data were analysed from 397 transgender female sex workers recruited from three of the largest cities in China: Shenyang, Shanghai and Guangzhou. Information was collected about demographics, alcohol or illicit drug use, alone or in combination, and their psychosocial correlates using structured questionnaires. Multinomial logistic regression models were used to examine the association between substance use and its correlates. Results: Before commercial sex, approximately one-third of the sample reported exclusive alcohol use (28.5%), 9.3% reported exclusive drug use and 7.3% reported combined use of alcohol and drugs. Before commercial sex, participants with low self-esteem had twice the odds of using alcohol exclusively (adjusted odds ratio (aOR) 2.05; 95% confidence interval (CI) 1.01–4.17), those with higher levels of loneliness had almost threefold the odds of exclusive drug use (aOR 2.92; 95% CI 1.21–7.07) and those with depression (aOR 2.97; 95% CI 1.11–7.96) and unknown HIV status (aOR 3.00; 95% CI 1.02–8.87) had threefold the odds of combined use of alcohol and drugs. Conclusion: Programs aimed at reducing alcohol or drug use among transgender female sex workers in China may consider adding components that help support mental health and encouraging HIV screening.
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Guedria-Tekari A, Missaoui S, Kalai W, Gaddour N, Gaha L. Suicidal ideation and suicide attempts among Tunisian adolescents: prevalence and associated factors. Pan Afr Med J 2019; 34:105. [PMID: 31998428 PMCID: PMC6961937 DOI: 10.11604/pamj.2019.34.105.19920] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/01/2019] [Indexed: 11/11/2022] Open
Abstract
Introduction Studies directed on suicidal behavior in North African adolescents are rare. This study was conducted to estimate the prevalence of suicidal thoughts and attempts among high school students in Tunisia and to determine factors associated with this suicidal behavior. Methods This is an analytical cross-sectional study composed of a population containing 821 high school students obtained through cluster sampling. The participants completed a pre-established form related to socio-demographic characteristics and anxiety symptoms, the Suicide Behavior Questionnaire-Revised, the Beck depression scale, and the Rosenberg self-esteem scale. Results The mean age of the adolescents was 17.7±0.97 years. Prevalence of suicidal behavior was 26.9% for brief passing suicidal thoughts, 9.6% for serious suicidal thoughts, and 7.3% for suicide attempts. Six determining factors of suicidal behavior were found: female gender (OR=2.56 (1.32-4.95); p= 0.005), personal history of depression (OR=2.29 (1.38-3.80); p=0.001), tobacco smoking (OR=3.59 (1.61-8.01); p=0.002), current depression symptoms (OR=5.50 (2.14-14.11); p<0.001), history of non-suicidal self-injurious behavior (OR= 3.16 (2.05-4.86); p<0.001), and low self-esteem (OR=2.74 (1.71-4.38); p<0.001). Conclusion Suicidal ideation and attempts are frequent among Tunisian adolescents and represent a serious public health problem. An urgent national prevention program is required.
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Affiliation(s)
- Asma Guedria-Tekari
- Department of Psychiatry, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,University of Monastir, Monastir, Tunisia
| | - Sonia Missaoui
- Service de Pédopsychiatrie, CISSS de Lanaudière, Québec, Canada
| | | | - Naoufel Gaddour
- Department of Psychiatry, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,University of Monastir, Monastir, Tunisia
| | - Lotfi Gaha
- Department of Psychiatry, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,University of Monastir, Monastir, Tunisia
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Walker RL, Talavera DC, Nomamiukor F, Madubata IJ, Alfano C, Vujanovic AA. Sleep-related problems and suicide behavior and ideation among Black and White trauma-exposed psychiatric inpatients. Compr Psychiatry 2019; 91:22-28. [PMID: 30992121 DOI: 10.1016/j.comppsych.2019.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 02/05/2019] [Accepted: 03/11/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Sleep-related problems (SRPs) are associated with increased risk for suicide-related behavior and death. Given that Black adults report greater SRPs as compared to White adults, the purpose of the current study was to examine sleep problems, suicide-related psychiatric admission, and suicide ideation, in Black and White trauma-exposed adults. METHOD Suicide-related behavior (i.e., intent, plan, and/or behavior) as reason for hospital admission was obtained via medical records review for 172 Black and White adults who were admitted to an acute-care psychiatric facility; all participants completed validated measures of sleep quality and suicide ideation. RESULTS Adjusted logistic regression analyses revealed that sleep-related daytime dysfunction (AOR = 4.32, p < .05) and poor sleep quality (AOR = 3.64, p < .05) were associated with significantly increased odds that Black participants were admitted for suicide-related psychiatric care. Poorer sleep quality (AOR = 2.10, p < .05) was also associated with increased odds of suicide-related admission among White participants. However, shorter sleep duration was marginally associated with suicide ideation in Black participants only. CONCLUSIONS SRPs may be related to suicide-related behavior and ideation differently for vulnerable Black and White adults. More research is needed to understand potential race group differences and mechanisms by which SRPs increase risk for suicide crisis across racial groups.
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Affiliation(s)
- Rheeda L Walker
- Department of Psychology, University of Houston, Houston, TX 30602-3013, USA.
| | - David C Talavera
- Department of Psychology, University of Houston, Houston, TX 30602-3013, USA; Harvard Medical School/Cambridge Health Alliance, Cambridge, MA 02139, USA
| | - Faith Nomamiukor
- Department of Psychology, University of Houston, Houston, TX 30602-3013, USA
| | - Ijeoma J Madubata
- Department of Psychology, University of Houston, Houston, TX 30602-3013, USA
| | - Candice Alfano
- Department of Psychology, University of Houston, Houston, TX 30602-3013, USA; Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX 30602-3013, USA
| | - Anka A Vujanovic
- Department of Psychology, University of Houston, Houston, TX 30602-3013, USA
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Chung J, Lam K, Ho KY, Cheung AT, Ho L, Gibson F, Li W. Relationships among resilience, self-esteem, and depressive symptoms in Chinese adolescents. J Health Psychol 2018; 25:2396-2405. [PMID: 30229681 DOI: 10.1177/1359105318800159] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study explored the relationships among resilience, self-esteem, and depressive symptoms in Hong Kong Chinese adolescents. We selected a stratified random sample of 1816 Form 1 students from all 18 districts of Hong Kong. This study revealed that about 21 percent adolescents are experiencing some depressive symptoms. Our results contribute novel findings to the literature showing that resilience is a strong indicator of adolescents at a higher risk of depression and increasing adolescents' resilience to psychological distress is crucial to enhance their mental well-being. It is crucial to develop interventions that can enhance resilience and promote positive mental well-being among adolescents.
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Affiliation(s)
- Jok Chung
- The University of Hong Kong, Hong Kong (SAR)
| | - Kkw Lam
- The University of Hong Kong, Hong Kong (SAR)
| | - K Y Ho
- The University of Hong Kong, Hong Kong (SAR)
| | - A T Cheung
- The University of Hong Kong, Hong Kong (SAR)
| | - Llk Ho
- The University of Hong Kong, Hong Kong (SAR)
| | - F Gibson
- University of Surrey, United Kingdom
| | - Whc Li
- The University of Hong Kong, Hong Kong (SAR)
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7
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Psychotherapy Services in China: Current Provisions and Future Development. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2016. [DOI: 10.1007/s10879-016-9345-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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8
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Sun X, Chan DW, Chan LK. Self-compassion and psychological well-being among adolescents in Hong Kong: Exploring gender differences. PERSONALITY AND INDIVIDUAL DIFFERENCES 2016. [DOI: 10.1016/j.paid.2016.06.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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9
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Chang SS, Steeg S, Kapur N, Webb RT, Yip PSF, Cooper J. Self-harm amongst people of Chinese origin versus White people living in England: a cohort study. BMC Psychiatry 2015; 15:79. [PMID: 25880647 PMCID: PMC4409751 DOI: 10.1186/s12888-015-0467-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 03/31/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been little previous research on self-harm among people of Chinese origin living in the UK, although this population has grown substantially in recent years and China is now the largest source of international students at UK universities. METHODS We conducted a prospective cohort study using self-harm presentation data (1997-2011) collected from three hospitals in the City of Manchester, which has the largest Chinese population across all UK Local Authorities. Rate ratios between the Chinese and White groups were calculated using Poisson regression models. Chi-square tests (or Fisher's exact tests), logistic regression, and log-binomial regression were used to examine differences in characteristics and clinical management between groups. RESULTS Ethnicity was known in the study cohort for 23,297 (87%) amongst 26,894 individuals aged 15 years and above. A total number of 97/23,297 (0.4%) people of Chinese ethnic origin presented with self-harm over the study period and 20,419 (88%) were White people. Incidence of self-harm in the Chinese group (aged 16-64 years) was less than one fifth of that found in White people (0.6 versus 3.2 per 1000 person-years; rate ratio 0.18, 95% confidence interval 0.13-0.24), and was particularly low amongst men of Chinese origin. Individuals of Chinese origin who presented with self-harm were younger, more likely to be female and students, and more likely to self-injure and describe relationship problems as a precipitant than White people. They were less likely to have clinical risk factors such as drug/alcohol misuse and receiving psychiatric treatment, and were rated to have lower risk of self-harm repetition by treating clinicians. CONCLUSION Future research needs to investigate whether the low incidence of self-harm presenting to hospitals amongst people of Chinese origin truly reflects a lower frequency of self-harm, or alternatively is due to markedly different post-episode help-seeking behaviours or student overrepresentation in this ethnic group. Relevant healthcare professionals need to be aware of the risk characteristics of people of Chinese origin who self-harm.
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Affiliation(s)
- Shu-Sen Chang
- Institute of Health Policy and Management, and Department of Public Health, College of Public Health, National Taiwan University, No 17, Xuzhou Road, Taipei, 10055, Taiwan. .,The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, 5 Sassoon Road, Pokfulam, Hong Kong, SAR, China.
| | - Sarah Steeg
- Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford road, Manchester, M13 9PL, UK.
| | - Navneet Kapur
- Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford road, Manchester, M13 9PL, UK.
| | - Roger T Webb
- Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford road, Manchester, M13 9PL, UK.
| | - Paul SF Yip
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, 5 Sassoon Road, Pokfulam, Hong Kong, SAR China
| | - Jayne Cooper
- Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford road, Manchester, M13 9PL, UK.
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Zhang Y, Yip PSF, Fu KW. Validation of the Chinese version of the Reynolds' Suicidal Ideation Questionnaire: psychometric properties and its short version. Health Qual Life Outcomes 2014; 12:33. [PMID: 24612650 PMCID: PMC3996563 DOI: 10.1186/1477-7525-12-33] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 03/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aims to validate the Chinese version of the Reynolds' Suicidal Ideation Questionnaire (SIQ) in a Chinese society and explore a convenient short version. METHODS A sample of 711 cases was derived from two territory-wide surveys of Hong Kong adolescents aged between 15 and 19 years old. RESULTS The SIQ and the Suicidal Ideation Questionnaire-Junior (SIQ-JR) demonstrated good reliability and concurrent validity among Hong Kong adolescents. However, the factor structure for both SIQ and SIQ-JR appeared to be unclear. A four-item short form of the SIQ-JR, namely, SIQ-JR-4, was proposed. CONCLUSION The SIQ-JR-4 is an ideal substitute of the SIQ/SIQ-JR for future quick assessment of suicidal ideation in Chinese young adolescents.
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Affiliation(s)
- Yi Zhang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong Special Administration Region, People's Republic of China.
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Eskin M, Voracek M, Stieger S, Altinyazar V. A cross-cultural investigation of suicidal behavior and attitudes in Austrian and Turkish medical students. Soc Psychiatry Psychiatr Epidemiol 2011; 46:813-23. [PMID: 20563550 DOI: 10.1007/s00127-010-0254-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 06/07/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE This cross-cultural study investigated the prevalence of suicidal behavior and attitudes towards suicide and reactions to suicidal individuals in 320 Austrian and 326 Turkish medical students. METHODS Data were collected using a self-report questionnaire consisting of sections on demographic information, suicidal behavior, current mood, religiosity, attitudes towards suicide, and reactions to suicidal individuals. RESULTS More Austrian (37.8%) than Turkish (27.3%) students reported life-time, past 12-month, or current suicidal ideation, while more Turkish (6.4%) than Austrian (2.2%) students reported life-time or past 12-month suicide attempts. Austrian students had more permissive and liberal attitudes towards suicide, while those of Turkish students were more rejecting. Conversely, attitudes of Turkish medical students towards an imagined suicidal close friend were more accepting than those of Austrian medical students. Comparisons of suicidal versus nonsuicidal students showed that those reporting suicidal ideation or suicide attempts generally were more accepting of suicide and viewed suicide as a solution to a greater extent than the nonsuicidal group. CONCLUSION The findings suggest that cultural factors play a role in observed country differences in suicidal ideation and behavior and in attitudes towards suicide and reactions to suicidality among Austrian and Turkish medical students.
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Affiliation(s)
- Mehmet Eskin
- Department of Psychiatry, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey.
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Milner A, McClure R, Sun J, De Leo D. Globalisation and suicide: An empirical investigation in 35 countries over the period 1980–2006. Health Place 2011; 17:996-1003. [DOI: 10.1016/j.healthplace.2011.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 03/14/2011] [Accepted: 03/14/2011] [Indexed: 11/24/2022]
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13
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William Li HC, Chung OKJ, Ho KY. Center for Epidemiologic Studies Depression Scale for Children: psychometric testing of the Chinese version. J Adv Nurs 2010; 66:2582-91. [DOI: 10.1111/j.1365-2648.2010.05440.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Li HCW, Chan SLP, Chung OKJ, Chui MLM. Relationships among mental health, self-esteem and physical health in Chinese adolescents: an exploratory study. J Health Psychol 2010; 15:96-106. [PMID: 20064888 DOI: 10.1177/1359105309342601] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study explored the relationships among mental health, self-esteem and physical health in Hong Kong Chinese adolescents. Chinese students (N = 1945) between the ages of 12 and 19 from four secondary schools of different regions were invited to participate in the study. This study revealed that a significant number of adolescents in Hong Kong are experiencing depressive symptoms. The overall results indicated that self-esteem of adolescents was correlated to and a predictor of their physical and mental health. Health care professionals should take a more assertive role in promoting relevant health education to the community with emphasis on helping adolescents develop positive self-esteem.
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15
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Li WHC, Chung JOK, Chui MML, Chan PSL. Factorial structure of the Chinese version of the 12-item General Health Questionnaire in adolescents. J Clin Nurs 2009; 18:3253-61. [PMID: 19732241 DOI: 10.1111/j.1365-2702.2009.02905.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To evaluate the underlying factor structure of the Chinese version of General Health Questionnaire-12 using exploratory and confirmatory factor analyses in Chinese adolescents and find out which factor model proposed by previous empirical research is the best-fit model. BACKGROUND The 12-item General Health Questionnaire has been extensively used with adolescents in the West. Yet, it has not been used with adolescents in a Hong Kong Chinese context. DESIGN A cross-sectional study was employed. METHOD Chinese students between the ages of 12-19 from four secondary schools were invited to participate in the study using the multiple-stage stratified random sampling method during the period from December 2007-February, 2008. The total sample size included in the final analysed was 1883. RESULTS The General Health Questionnaire-12 was found to be internally consistent. The results of exploratory factor analysis showed that there are two factors underlying the General Health Questionnaire-12. Of nine factor models were tested by means of confirmatory factor analysis, only three factor model: the eight-item two-factor model, 12-item three-factor model and 10-item two-factor model, demonstrated good model fit across all model fit indices. CONCLUSION This study addressed a gap in the literature by evaluating the factorial structure of the Chinese version of General Health Questionnaire-12 using exploratory and confirmatory factor analyses in Chinese adolescents. The findings revealed that the eight-item two-factor model is the best-fit model. RELEVANCE TO CLINICAL PRACTICE The adolescent mental health problem is alarming and aggravating and warrants special attention. It is essential for community nurses to differentiate psychological distress in adolescents and to identify those adolescents who are at a higher risk of suffering from mental health problems. The availability of a valid and reliable instrument that measures adolescents' psychological distress is crucial before any nursing interventions to promote their mental health can be appropriately planned, implemented and evaluated.
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Affiliation(s)
- William H C Li
- The Department of Nursing Studies, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, China.
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Nguyen HT, Dunne MP, Le AV. Multiple types of child maltreatment and adolescent mental health in Viet Nam. Bull World Health Organ 2009; 88:22-30. [PMID: 20428350 DOI: 10.2471/blt.08.060061] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Revised: 02/06/2009] [Accepted: 04/16/2009] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To examine the prevalence of multiple types of maltreatment (MTM), potentially confounding factors and associations with depression, anxiety and self-esteem among adolescents in Viet Nam. METHODS In 2006 we conducted a cross-sectional survey of 2591 students (aged 12-18 years; 52.1% female) from randomly-selected classes in eight secondary schools in urban (Hanoi) and rural (Hai Duong) areas of northern Viet Nam (response rate, 94.7%). Sequential multiple regression analyses were performed to estimate the relative influence of individual, family and social characteristics and of eight types of maltreatment, including physical, emotional and sexual abuse and physical or emotional neglect, on adolescent mental health. FINDINGS Females reported more neglect and emotional abuse, whereas males reported more physical abuse, but no statistically significant difference was found between genders in the prevalence of sexual abuse. Adolescents were classified as having nil (32.6%), one (25.9%), two (20.7%), three (14.5%) or all four (6.3%) maltreatment types. Linear bivariate associations between MTM and depression, anxiety and low self-esteem were observed. After controlling for demographic and family factors, MTM showed significant independent effects. The proportions of the variance explained by the models ranged from 21% to 28%. CONCLUSION The combined influence of adverse individual and family background factors and of child maltreatment upon mental health in adolescents in Viet Nam is consistent with research in non-Asian countries. Emotional abuse was strongly associated with each health indicator. In Asian communities where child abuse is often construed as severe physical violence, it is important to emphasize the equally pernicious effects of emotional maltreatment.
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Chan WSC, Law CK, Liu KY, Wong PWC, Law YW, Yip PSF. Suicidality in Chinese adolescents in Hong Kong: the role of family and cultural influences. Soc Psychiatry Psychiatr Epidemiol 2009; 44:278-84. [PMID: 18836885 DOI: 10.1007/s00127-008-0434-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Revised: 08/26/2008] [Indexed: 01/09/2023]
Abstract
BACKGROUND Adolescent suicidal ideation has found to predict suicidal behaviors and psychopathology in adulthood. Previous studies focused solely on the medical and environmental risk factors, which were insufficient to give a holistic picture of adolescent suicidality. OBJECTIVES To assess the role of affective and cognitive attributes in the identification and prevention of adolescent suicidal ideation. METHOD A community sample of 511 participants (age 15-19 years) were asked to indicate their suicidality in the 12 months and in their lifetime. Generalized estimating equation regression models were used to examine the effect of psychosocial and socio-environmental correlates in relation to adolescent suicidal ideation. RESULTS The data show that perceived responsibilities for family was the only protective factor, while a coping mechanism by behavioral disengagement, severity of depressive symptoms, a history of deliberate self-harm, chronic physical illness or pain, media reporting of suicide news, and low household income were the risk factors for adolescent suicidal ideation. CONCLUSIONS The results suggest that a multilayer effort for preventing adolescent suicide is needed by providing support for children in deprived families; enhancing life skills in the teens; strengthening family relationship; improving mental and health services; and promoting responsible media reporting on suicide.
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Affiliation(s)
- Wincy S C Chan
- HKJC Centre for Suicide Research and Prevention, University of Hong Kong, Pokfulam, Hong Kong SAR
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Rudatsikira E, Muula AS, Siziya S, Twa-Twa J. Suicidal ideation and associated factors among school-going adolescents in rural Uganda. BMC Psychiatry 2007; 7:67. [PMID: 18034906 PMCID: PMC2219990 DOI: 10.1186/1471-244x-7-67] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Accepted: 11/23/2007] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Mental health is a neglected area of health research and practice in most of sub-Saharan African countries where the largest burden of morbidity is from infectious diseases. This even occurs despite the fact that some mental health problems may arise from infectious diseases. METHODS We conducted secondary analysis of the Uganda Global School-Based Health Survey-2003 to obtain the prevalence of, and assess factors that may be associated with suicidal ideation among school-going adolescents in rural Uganda. Assessment of association was conducted through both bi-variate and multivariate logistic regression analysis. RESULTS Altogether 21.6% of the study participants, 21.3% males and 23.5% females had seriously considered committing suicide within the past 12 months. Loneliness, worry were positively associated with suicide ideation after adjusting for age, gender, smoking, drinking, and experience of having been bullied (OR = 1.59; 95% CI [1.12, 2.26] and OR = 1.19; 95% CI [1.12, 2.25]) respectively. Males were less likely to seriously consider committing suicide than females (OR = 0.70; 95% CI [0.50, 0.98]). CONCLUSION Adolescent suicidal ideation is a major public health issue in rural Uganda. Measures aimed to prevent adolescent suicides in Uganda should incorporate our understanding of factors that are associated with suicide in rural Uganda such the gender disparity and the association observed with substance use.
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Affiliation(s)
- Emmanuel Rudatsikira
- Departments of Biostatistics and Epidemiology and Global Health, Loma Linda University, School of Public Health, Loma Linda, California, USA
| | - Adamson S Muula
- Department of Community Health, University of Malawi, College of Medicine, Blantyre, Malawi
| | - Seter Siziya
- Department of Community Medicine, University of Zambia, School of Medicine, Lusaka, Zambia
| | - Jeremiahs Twa-Twa
- Principal Medical Officer, Child Health Division, Ministry of Health, Kampala, Uganda
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Wong JPS, Stewart SM, Claassen C, Lee PWH, Rao U, Lam TH. Repeat suicide attempts in Hong Kong community adolescents. Soc Sci Med 2007; 66:232-41. [PMID: 17919796 DOI: 10.1016/j.socscimed.2007.08.031] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Indexed: 12/20/2022]
Abstract
It has been well documented that a history of suicide attempts confers risk for subsequent attempts; however, efforts to explain how variables may change after a previous attempt and in turn relate to future suicide attempts are rare in the literature. This study presents longitudinal data on adolescent suicide attempts in Hong Kong, and examines whether the data support the "crescendo" model to explain repeat suicide attempts. One thousand and ninety-nine community adolescents aged 12-18 years were evaluated at two assessment points 12 months apart (T1 and T2). The study assessed (1) risk factors at T1 for a suicide attempt between T1 and T2, (2) whether a suicide attempt during the 12 months prior to T1 predicted an attempt between the two assessment points, and (3) whether the indicators of distress worsened from T1 to T2 if an attempt had taken place in the interim. The results indicated that: (1) depressive symptoms, substance use, and suicidal ideation measured at T1 were independent predictors of a suicide attempt between T1 and T2; (2) suicide attempt in the year prior to T1 predicted suicide attempt between T1 and T2 after controlling for other predictors; and (3) suicide attempt between T1 and T2 was a predictive factor for a negative change from T1 to T2 in substance use, suicidal ideation, family relationships, depression, anxiety, and life stress. These findings are consistent with the "crescendo" model proposing that the risk of repeat attempts is enhanced following a previous suicide attempt.
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Wong JPS, Stewart SM, Ho SY, Lam TH. Risk factors associated with suicide attempts and other self-injury among Hong Kong adolescents. Suicide Life Threat Behav 2007; 37:453-66. [PMID: 17896885 DOI: 10.1521/suli.2007.37.4.453] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study examined 1,361 Chinese adolescents who reported self-injurious behaviors. Groups A and B both acknowledged deliberate self-injury, but only Group A had made a suicide attempt. Group C reported accidental self-injury. Deliberate self-injurers (Groups A and B) were more frequently girls, older, and with more suicidal ideation. Group A had more psychopathology, environmental and suicide-related risk factors than group B and C. Group C had higher depressive symptoms than noninjured controls. The study clarifies differences among self-injurious behavior groups based on expressed deliberate self-injury and self-reported suicide attempt. These three groups appear to present a continuum of risk.
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Affiliation(s)
- Joy P S Wong
- Department of Community Medicine, University of Hong Kong, Pokfulam, Hong Kong
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Cheung YB, Liu KY, Yip PSF. Performance of the CES-D and its short forms in screening suicidality and hopelessness in the community. Suicide Life Threat Behav 2007; 37:79-88. [PMID: 17397282 DOI: 10.1521/suli.2007.37.1.79] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A measurement scale should be short and quick to complete if it is to be practically useful. Drawing on data from a community-based survey of 2,178 people in Hong Kong, we compared five short forms (5- to 10-item) and the original version (20-item) of the Center for Epidemiologic Studies-Depression Scale (CES-D; Radloff, 1977) in predicting suicidal attempts and suicidal thoughts. Short forms with as few as nine items performed in ways very similar to the full version; a version with only five items had a detectable difference from the full version. Sensitivity, specificity, and predictive values in differentiating people with and without suicidal thought or attempt change almost linearly with the cut-offs.
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Affiliation(s)
- Yin Bun Cheung
- Tropical Epidemiology Group, IDEU, London School of Hycidal Tropical Medicine
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Yip PSF, Cheung YB. Quick assessment of hopelessness: a cross-sectional study. Health Qual Life Outcomes 2006; 4:13. [PMID: 16509984 PMCID: PMC1413514 DOI: 10.1186/1477-7525-4-13] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2006] [Accepted: 03/01/2006] [Indexed: 02/06/2023] Open
Abstract
Background Lengthy questionnaires reduce data quality and impose a burden on respondents. Previous researchers proposed that a single item ("My future seems dark to me") and a 4-item component of the Beck's Hopelessness Scale (BHS) can summarise most of the information the BHS provides. There is no clear indication of what BHS cutoff values are useful in identifying people with suicide tendency. Methods In a population-based study of Chinese people aged between 15 and 59 in Hong Kong, the Chinese version of the BHS and the Centre for Epidemiologic Studies – Depression scale were administered by trained interviewers and suicidal ideation and suicidal attempts were self-reported. Receiver operating characteristics curve analysis and regression analysis were used to compare the performance of the BHS and its components in identifying people with suicidality and depression. Smoothed level of suicidal tendency was assessed in relation to scores on the BHS and its component to identify thresholds. Results It is found that the 4-item component and, to a lesser extent, the single item of the BHS perform in ways similar to the BHS. There are non-linear relationship between suicidality and scores on the BHS and the 4-item component; cutoff values identified accordingly have sensitivity and specificity of about 65%. Conclusion The 4-item component is a useful alternative to the BHS. Shortening of psycho-social measurement scales should be considered in order to reduce burden on patients or respondents and to improve response rate.
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Affiliation(s)
- Paul SF Yip
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam Road, Hong Kong SAR
| | - Yin Bun Cheung
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, UK
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Wong JPS, Stewart SM, Ho SY, Rao U, Lam TH. Exposure to suicide and suicidal behaviors among Hong Kong adolescents. Soc Sci Med 2005; 61:591-9. [PMID: 15899318 DOI: 10.1016/j.socscimed.2004.12.012] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2004] [Accepted: 12/14/2004] [Indexed: 11/16/2022]
Abstract
Suicidal behaviors (deliberate self-injury with the intent to hurt or kill oneself) have been little examined outside the West. The aims of this study were to (a) determine the correlates of suicidal behaviors, and (b) examine whether depression and suicide ideation moderated the effects of exposure to completed and attempted suicide on suicidal behaviors among a community sample of Hong Kong youth ages 12-17. Adolescents responded to questions regarding self-injurious behaviors, and also indicated presence of intention to hurt or kill themselves in the past 12 months. Based on their responses, two groups of interest were formed: 96 youths reported both self-injurious behaviors and the intent to hurt or kill themselves, and formed the "suicidal behaviors" group; and, 1213 adolescents reported neither self-injurious behaviors nor intent to hurt self or die, and formed the control group. The participants also responded to questions about depressive symptoms, anxiety, suicidal ideation and attempt, alcohol/drug use, stressful life events, and family relationships. They indicated whether anyone they knew had attempted or completed suicide in the previous 12 months. Logistic regression indicated that depressive symptoms, stressful life events, suicidal ideation and exposure to suicide attempt (but not completed suicide) contributed unique variance to the presence of suicidal behaviors, after controlling for demographic variables. Depression (and at trend levels, suicidal ideation) moderated the effect of exposure to suicide attempt by others on suicidal behaviors. Our results indicate that completed suicide in the social network increases risk for suicidal behaviors, but not when other risk factors are controlled. By contrast, a suicide attempt independently increases risk for suicidal behaviors. Furthermore, those youths who experience depressive symptoms or suicidal ideation are at particularly high risk for engaging in suicidal behaviors when an exposure to suicide attempt occurs.
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Affiliation(s)
- Joy P S Wong
- Department of Community Medicine, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
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Abstract
PURPOSE OF REVIEW We outline research developments in 2004 and early 2005 published in English language journals on deliberate self-harm among children and adolescents up to the age of 18 years. RECENT FINDINGS The main issue of concern in recent times has been the risk/benefit profile of using antidepressants, especially selective serotonin reuptake inhibitors, in depressed children and adolescents. Other important topics include treatment approaches, particularly cognitive behaviour therapy, dialectical behaviour therapy and multisystemic therapy, barriers to help seeking, the Internet and prevention. SUMMARY Rates of deliberate self-harm appear to be rising among young people. Risk factors associated with deliberate self-harm are becoming clearer and the evaluation of treatments is progressing. However, the recent conflicting evidence and guidelines regarding selective serotonin reuptake inhibitors and suicidality are presenting major difficulties for clinicians. The role of the Internet and initiatives to prevent suicidal behaviour in adolescents require further research.
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Affiliation(s)
- Sarah A Fortune
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
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Stewart SM, Kennard BD, Lee PWH, Mayes T, Hughes C, Emslie G. Hopelessness and suicidal ideation among adolescents in two cultures. J Child Psychol Psychiatry 2005; 46:364-72. [PMID: 15819645 DOI: 10.1111/j.1469-7610.2004.00364.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study examines the cross-sectional and longitudinal associations among cognitive variables, depressive symptoms and suicidal ideation in Hong Kong Chinese and Caucasian American adolescents. METHODS Community adolescents (n = 2,044) ages 14-18 years from Hong Kong and the United States provided information regarding their suicidal ideation, depressive symptoms, and cognitions (self-efficacy, cognitive errors and hopelessness), at two surveys, six months apart. RESULTS Self-efficacy was a weak unique predictor of suicidal ideation in both cultures. Hopelessness was the strongest of cognitive variables in concurrent associations with suicidal ideation in bivariate and multivariate models, in both cultures, and in both boys and girls. Hopelessness continued to offer unique prediction when depressive symptoms were controlled, both concurrently and prospectively. CONCLUSIONS Our results support hopelessness theories of suicidal ideation and behavior in Hong Kong, and extend the cognitive theory of suicidality to a modernized Asian culture.
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Affiliation(s)
- Sunita Mahtani Stewart
- Psychiatry Department, University of Texas Southwestern Medical Center at Dallas, TX 75390-8589, USA.
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