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Chen SC, Huang HC, Liu SI, Chen SH. Prediction of Repeated Self-Harm in Six Months: Comparison of Traditional Psychometrics With Random Forest Algorithm. OMEGA-JOURNAL OF DEATH AND DYING 2024; 88:1403-1429. [PMID: 34920680 DOI: 10.1177/00302228211060596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Suicidal risk has been a significant mental health problem. However, the predictive ability for repeated self-harm (SH) has not improved over the past decades. This study thus aimed to explore a potential tool with theoretical accommodation and clinical application by employing traditional logistic regression (LR) and newly developed machine learning, random forest algorithm (RF). Starting with 89 items from six commonly used scales (i.e., proximal suicide risk factors) as preliminary predictors, both LR and RF resulted in a better solution with much fewer items in two phases of item selections and analyses, with prediction accuracy 88.6% and 79.8%, respectively. A combination with 12 selected items, named LR-12, well predicted repeated self-harm in 6-month follow-up with satisfactory performance (AUC = 0.84, 95% CI: 0.76-0.92; cut-off point by 1/2 with sensitivity 81.1% and specificity 74.0%). The psychometrically appealing LR-12 could be used as a screening scale for suicide risk assessment.
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Affiliation(s)
- Shu-Chin Chen
- Department of Psychology, National Taiwan University, Taipei, Taiwan
- Suicide Prevention Center, MacKay Memorial Hospital, Taipei, Taiwan
| | - Hui-Chun Huang
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Shen-Ing Liu
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan
| | - Sue-Huei Chen
- Department of Psychology, National Taiwan University, Taipei, Taiwan
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Shen JE, Huang YH, Huang HC, Liu HC, Lee TH, Sun FJ, Huang CR, Liu SI. Psychometric properties of the Chinese Mandarin version of the Borderline Symptom List, short form (BSL-23) in suicidal adolescents. Borderline Personal Disord Emot Dysregul 2023; 10:23. [PMID: 37553717 PMCID: PMC10411024 DOI: 10.1186/s40479-023-00230-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/21/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND The short form of the Borderline Symptom List (BSL-23) is a self-rated instrument developed from the initial 95-item German version of the Borderline Symptom List (BSL-95). It is widely used among Chinese adults, but its applicability, factor structure and validity remain uncertain in adolescents. This study aimed to evaluate the psychometric properties of the Chinese Mandarin version of the BSL-23 in a sample of suicidal adolescents. METHODS The Chinese Mandarin BSL-23 was given to 279 outpatient adolescents with self-injurious thoughts or behaviors. The factor structure, reliability, convergent validity, criterion-related validity and cut-off value were investigated. RESULTS The Chinese Mandarin version of the BSL-23 demonstrated a one-factor structure and replicated the original version. The scale had high reliability and good test-retest stability. The Chinese Mandarin BSL-23 was correlated with depression, hopelessness, impulsivity, emotional dysregulation, self-esteem, loneliness, childhood trauma and parental bonding patterns evaluated with a variety of scales. The measure showed good criterion-related validity and predictive accuracy (AUC = 0.87) for self-injurious and suicidal adolescents with borderline personality disorder (BPD) at a cut-off point of 60/61 (mean score 2.60/2.65), with a sensitivity of 0.76 and specificity of 0.83. CONCLUSIONS The Chinese Mandarin version of the BSL-23 is a reliable and valid self-reported instrument to assess BPD symptomatology among suicidal adolescents.
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Affiliation(s)
- Jui-En Shen
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yu-Hsin Huang
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Hui-Chun Huang
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Hui-Ching Liu
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan
| | - Tsung-Han Lee
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan
| | - Fang-Ju Sun
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Chiu-Ron Huang
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shen-Ing Liu
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan.
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.
- MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.
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Cortés H, Cariño-Calvo L, Reyes-Hernández OD, Rojas-Márquez M, Magaña JJ, Vizcaino-Dorado PA, Villegas-Vazquez EY, Quintas-Granados LI, Jiménez-Islas E, Cortés-Mollinedo VA, Leyva-Gómez G, González-Del Carmen M. High Levels of Anxiety, Depression, Risk of Suicide, and Implications for Treatment in Patients with Lamellar Ichthyosis. Healthcare (Basel) 2023; 11:2071. [PMID: 37510511 PMCID: PMC10380064 DOI: 10.3390/healthcare11142071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Lamellar ichthyosis (LI) is a genodermatosis that injures the structure and function of the skin, affecting the appearance and self-esteem of patients, which may seriously impair their mental health and quality of life. In the present study, we determined anxiety, depression, and suicidal risk levels in patients with LI through the Beck anxiety and depression inventories (BAI and DBI-II, respectively) and the SAD PERSONS scale (SPS). We observed that anxiety, depression, and suicidal ideation were strongly associated with the LI (Cramér's V = 0.429, 0.594, and 0.462, respectively). Furthermore, patients with LI showed a significant increase in the scores of anxiety, depression, and suicidal risk (p = 0.011, <0.001, and 0.001, respectively) compared to individuals without the disease. Additionally, the suicide risk increased even more in patients who presented comorbidity of anxiety and depression than in patients who presented only anxiety or depression (p = 0.02). Similarly, the increase in the BAI scores correlated with the score observed on the SPS. Our results indicate that patients with LI have higher levels of anxiety and depression compared to individuals without the disease, which could be associated with suicidal risk. Therefore, the collaborative involvement of skin and mental health professionals is necessary to manage patients with LI appropriately. We believe that psychiatric studies and individual evaluations must be performed in LI patients to determine a treatment that, in addition to reducing skin symptoms, focuses on reducing the levels of depression and anxiety and improving the quality of life to reduce the risk of suicide.
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Affiliation(s)
- Hernán Cortés
- Laboratorio de Medicina Genómica, Departamento de Genómica, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México 14389, Mexico
| | | | - Octavio D Reyes-Hernández
- Laboratorio de Biología Molecular del Cáncer, UMIEZ, FES Zaragoza, Universidad Nacional Autónoma de México, Ciudad de México 09230, Mexico
| | - Martín Rojas-Márquez
- Hospital Psiquiátrico Infantil Dr. Juan N. Navarro, Secretaría de Salud, Ciudad de México 14080, Mexico
| | - Jonathan J Magaña
- Laboratorio de Medicina Genómica, Departamento de Genómica, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México 14389, Mexico
| | - Pablo A Vizcaino-Dorado
- Laboratorio de Medicina Genómica, Departamento de Genómica, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México 14389, Mexico
| | - Edgar Y Villegas-Vazquez
- Laboratorio de Farmacogenética, UMIEZ, FES Zaragoza, Universidad Nacional Autónoma de México, Ciudad de México 09230, Mexico
| | | | - Elizabeth Jiménez-Islas
- Departamento de Farmacia, Facultad de Química, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico
| | | | - Gerardo Leyva-Gómez
- Departamento de Farmacia, Facultad de Química, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico
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Saab MM, Murphy M, Meehan E, Dillon CB, O'Connell S, Hegarty J, Heffernan S, Greaney S, Kilty C, Goodwin J, Hartigan I, O'Brien M, Chambers D, Twomey U, O'Donovan A. Suicide and Self-Harm Risk Assessment: A Systematic Review of Prospective Research. Arch Suicide Res 2022; 26:1645-1665. [PMID: 34193026 DOI: 10.1080/13811118.2021.1938321] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Suicide and self-harm are widespread yet underreported. Risk assessment is key to effective self-harm and suicide prevention and management. There is contradicting evidence regarding the effectiveness of risk assessment tools in predicting self-harm and suicide risk. This systematic review examines the effect of risk assessment strategies on predicting suicide and self-harm outcomes among adult healthcare service users. METHOD Electronic and gray literature databases were searched for prospective research. Studies were screened and selected by independent reviewers. Quality and level of evidence assessments were conducted. Due to study heterogeneity, we present a narrative synthesis under three categories: (1) suicide- and self-harm-related outcomes; (2) clinician assessment of suicide and self-harm risk; and (3) healthcare utilization due to self-harm or suicide. RESULTS Twenty-one studies were included in this review. The SAD PERSONS Scale was the most used tool. It outperformed the Beck Scale for Suicide Ideation in predicting hospital admissions and stay following suicide and self-harm, yet it failed to predict repeat suicide and self-harm and was not recommended for routine use. There were mixed findings relating to clinician risk assessment, with some studies recommending clinician assessment over structured tools, whilst others found that clinician assessment failed to predict future attempts and deaths. CONCLUSIONS There is insufficient evidence to support the use of any one tool, inclusive of clinician assessment of risk, for self-harm and suicidality. The discourse around risk assessment needs to move toward a broader discussion on the safety of patients who are at risk for self-harm and/or suicide.HIGHLIGHTSThere is insufficient evidence to support using standalone risk assessment tools.There are mixed findings relating to clinician assessment of risk.Structured professional judgment is widely accepted for risk assessment.
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Stewart I, Lees-Deutsch L. Risk Assessment of Self-Injurious Behavior and Suicide Presentation in the Emergency Department: An Integrative Review. J Emerg Nurs 2021; 48:57-73. [PMID: 34782168 DOI: 10.1016/j.jen.2021.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 09/17/2021] [Accepted: 10/04/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Globally, there is a lack of clarity regarding the best practice to distinguish patients at the highest risk of suicide. This review explores the use of risk assessment tools in emergency departments to identify patients at high risk of repeat self-harm, suicide attempts, or death by suicide. METHODS The review question ("Does the use of risk assessment tools in emergency departments identify patients at high risk of repeat self-harm, suicide attempts, or death by suicide?") focused on exposure and outcome. Studies of any design were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used. Study characteristics and concepts were extracted, compared, and verified. An integrative approach was used for reporting through narrative synthesis. RESULTS Nine studies were identified for inclusion. Two risk assessment tools were found to have good predictive ability for suicide ideation and self-harm. Three had modest prediction of patient disposition, but in one study, the clinical impression of nurses had higher predictive ability. One tool showed modest predictive ability for patients requiring admission. DISCUSSION This review found no strong evidence to indicate that any particular risk tool has a superior predictive ability to identify repeat self-harm, suicide attempts, or death by suicide. Best practice lacks clarity to determine patients at highest risk of suicide, but the use of risk assessment tools has been recommended. Nevertheless, such tools should not be used in isolation from clinical judgment and experience to evaluate patients at risk. Education and training to augment risk assessment within the emergency department are recommended.
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Odejimi O, Webb K, Bagchi D, Tadros G. Root causes of deaths by suicide among patients under the care of a mental health trust: thematic analysis. BJPsych Bull 2021; 45:140-145. [PMID: 33183400 PMCID: PMC9059293 DOI: 10.1192/bjb.2020.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIMS AND METHOD This study explored the root causes of deaths by suicide among patients under the care of a mental health trust. Thematic analysis was carried out to identify themes from the serious incident reports for patients between 1 January 2017 and 31 July 2018. RESULTS In total, 48 cases were reviewed. Three main themes emerged from this study: patient-, professional- and organisation-related factors. The majority of the deaths were caused by patient-related factors, particularly exacerbation of the patient's mental health condition. CLINICAL IMPLICATIONS This study provides insight into perceived causes of death by suicide among mental health patients. It is hoped that this will, in turn, influence the manner in which decisions, policies and resource allocation are carried out to further prevent and reduce the incidence of suicide, particularly among mental health patients.
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Affiliation(s)
| | - Kerry Webb
- Birmingham and Solihull Mental Health Foundation Trust, UK
| | - Dhruba Bagchi
- Birmingham and Solihull Mental Health Foundation Trust, UK
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7
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Lin C, Huang CM, Karim HT, Liu HL, Lee TMC, Wu CW, Toh CH, Tsai YF, Yen TH, Lee SH. Greater white matter hyperintensities and the association with executive function in suicide attempters with late-life depression. Neurobiol Aging 2021; 103:60-67. [PMID: 33845397 DOI: 10.1016/j.neurobiolaging.2020.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/27/2020] [Accepted: 12/15/2020] [Indexed: 10/21/2022]
Abstract
Late-life depression (LLD) is associated with greater risk of suicide and white matter hyperintensities (WMH), which are also found in suicide attempters regardless of age. Greater periventricular WMH are related to worse cognitive function. We investigated the spatial distribution of WMH in suicide attempters with LLD and its association with cognitive function. We recruited 114 participants with LLD (34 with history of suicide attempt and 80 without) and 47 older adult controls (individuals without LLD or history of suicide attempt). WMH were quantified by an automated segmentation algorithm and were classified into different regions. Suicide attempters with LLD had significantly higher global WMH (F3, 150 = 2.856, p = 0.039) and periventricular WMH (F3, 150 = 3.635, p = 0.014) compared to other groups. Suicide attempters with high WMH had significantly lower executive function, which could be an underlying mechanism for cognitive decline in older adults with suicidality.
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Affiliation(s)
- Chemin Lin
- Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan County, Taiwan; Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chih-Mao Huang
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Helmet T Karim
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ho-Ling Liu
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tatia Mei-Chun Lee
- Laboratory of Neuropsychology, The University of Hong Kong, Hong Kong; State Key Laboratory of Brain and Cognitive Science, The University of Hong Kong, Hong Kong
| | - Changwei W Wu
- Brain and Consciousness Research Center, Shuang-Ho Hospital, New Taipei, Taiwan; Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan
| | - Cheng Hong Toh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taoyuan County, Taiwan
| | - Yun-Fang Tsai
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan City, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan City, Taiwan
| | - Tzung-Hai Yen
- College of Medicine, Chang Gung University, Taoyuan County, Taiwan; Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shwu-Hua Lee
- College of Medicine, Chang Gung University, Taoyuan County, Taiwan; Department of Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan County, Taiwan.
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8
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Shin HD, Price S, Aston M. A poststructural analysis: Current practices for suicide prevention by nurses in the emergency department and areas of improvement. J Clin Nurs 2020; 30:287-297. [PMID: 32956549 DOI: 10.1111/jocn.15502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/07/2020] [Accepted: 09/06/2020] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To use a poststructuralist framework to critique historical, social and institutional constructions of emergency nursing and examine conflicting discourses surrounding suicide prevention. The aim is to also demonstrate practical guidance for enhancing emergency nursing practice and research with regard to suicide prevention. BACKGROUND Emergency departments have been historically constructed as places for treating life-threatening physical crises, thereby constructing other "nonurgent" health needs as less of a priority. Physical needs take priority over psychological needs, such as suicide-related thoughts and behaviours, negatively impacting the quality of care that certain groups of patients receive. DESIGN A theoretical analysis of the published literature on the topic of emergency nursing and suicide prevention was conducted and analysed using a poststructuralist framework. METHODS Relevant literature on the topic of emergency nursing related to suicide prevention was analysed for a poststructuralist construct of power, language, subjectivity and discourse. Implications to practice and research were identified, as well as expanding emergency nursing using a poststructuralist framework. SQUIRE guidelines were used (see Supporting Information). DISCUSSION The emergency department is a critical point of intervention for patients with urgent and life-threatening needs. However, the biomedical model and historical, social, and institutional expectations that influence emergency nurses' beliefs and values do not effectively respond to the needs of suicidal patients. One step to address this issue is to deconstruct the current understanding of emergency nursing as a treatment for only life-threatening physical crises in order to become inclusive of psychological crises such as suicide-related thoughts and behaviours. RELEVANCE TO CLINICAL PRACTICE How a poststructural framework can be used to expand emergency care is discussed. Examples include empowering nurses to challenge the "taken-for-granted" emergency nursing and recognizing the health needs that fall outside of the dominant discourse of emergency care.
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Affiliation(s)
| | - Sheri Price
- Dalhousie University School of Nursing, Halifax, NS, Canada.,IWK Health Centre, Halifax, NS, Canada
| | - Megan Aston
- Dalhousie University School of Nursing, Halifax, NS, Canada.,IWK Health Centre, Halifax, NS, Canada
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Lin CJ, Huang YH, Huang KY, Wu SI, Chang YH, Yeh HM, Chang CH, Lin IC, Huang HC, Sun FJ, Berk M, Liu SI. A Randomized Controlled Trial of Transcultural Validation of Group-Based Psychosocial Intervention for Patients with Bipolar Disorder. Psychiatry Res 2020; 290:113139. [PMID: 32512353 DOI: 10.1016/j.psychres.2020.113139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/24/2020] [Accepted: 05/24/2020] [Indexed: 11/25/2022]
Abstract
Adjunctive psychosocial interventions are part of the preferred method to treat bipolar disorder (BD). This study aimed to conduct a randomized control and protocol-guided trial, in order to evaluate the feasibility and effectiveness of adjunctive group-based treatments for Chinese outpatients with BD. A single-blind trial in which 68 outpatients with BD were randomly assigned to either treatment as usual (TAU) or to an experimental group with 12 additional weekly sessions and 3 monthly booster sessions. Participants were assessed at baseline for mood condition, suicidal ideation, medication adherence, and quality of life (QoL), with follow-up assessments every 3 months over a 1-year period. The overall retention rate of this study was 89.7%. The results showed significant differences between groups for the variables evaluated, which included achieving euthymia, decrease of depression symptoms, and improvement of QoL. No improvements in medication adherence, reduction in manic symptoms, or suicidal ideation was observed. The results of this study support the transcultural validity and efficacy of group-based psychosocial intervention as anadjunct to TAU among Chinese outpatients with BD to promote improvements during the course of the illness including achieving euthymia, reducing depressive symptoms, and improving QoL.
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Affiliation(s)
- Chen-Ju Lin
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan; Institute of Health and Welfare Policy, National Yang-Ming University
| | - Yu-Hsin Huang
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, Taipei, Taiwan
| | - Kuo-Yang Huang
- Department of Psychiatry, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Shu-I Wu
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan; Department of Audiology and Speech Language Pathology, MacKay Medical College, Taipei, Taiwan
| | - Yi-Hung Chang
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan
| | - Hsiao-Mei Yeh
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chih-Hung Chang
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, Taipei, Taiwan
| | - I-Chieh Lin
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan
| | - Hui-Chun Huang
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Fang-Ju Sun
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Michael Berk
- School of Medicine, Deakin University, Victoria, Australia
| | - Shen-Ing Liu
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, Taipei, Taiwan; Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan.
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Lin YC, Liu SI, Chen SC, Sun FJ, Huang HC, Huang CR, Chiu YC. Brief Cognitive-based Psychosocial Intervention and Case Management for Suicide Attempters Discharged from the Emergency Department in Taipei, Taiwan: A Randomized Controlled Study. Suicide Life Threat Behav 2020; 50:688-705. [PMID: 32067261 DOI: 10.1111/sltb.12626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 11/12/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We examined the effectiveness of brief cognitive-based psychotherapy plus standard case management in the prevention of further suicide attempts, clinical severity, and treatment adherence in a randomized clinical trial compared with standard case management. METHOD Among five hundred and ninety-seven patients presenting with suicide attempts, 147 participants were included. They were randomized into two groups. After a 6-session intervention over four months, all participants were re-evaluated at the 6th and 12th months. RESULTS At a 6-month assessment, the intervention had approximately halved the odds of following suicide attempts and doubled the odds of outpatient visits in comparison with standard case management, although the differences did not attain statistical significance. At a 12-month assessment, the two groups did not differ significantly in any of the outcome variables. Generalized linear mixed models indicated that intervention did not significantly decrease the subsequent suicide risk and severity of clinical symptoms, but it did increase psychiatric outpatient treatment adherence. The subgroup analysis revealed that the intervention increased the outpatient clinic visits only for repetitive attempters, not for first-time attempters. CONCLUSIONS Further studies are needed to test whether more intensive psychotherapy sessions might be more effective in decreasing the probability of further attempt and the severity of symptoms.
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Affiliation(s)
- Yi-Chun Lin
- Department of Psychiatry, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Shen-Ing Liu
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan.,Center of Suicide Prevention, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Shu-Chin Chen
- Center of Suicide Prevention, Mackay Memorial Hospital, Taipei, Taiwan
| | - Fang-Ju Sun
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Hui-Chun Huang
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Chiu-Ron Huang
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yu-Chuan Chiu
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, Taipei, Taiwan
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Development and validation of the 9-item Concise Mental Health Checklist (CMHC-9) for suicide risk assessment. J Formos Med Assoc 2019; 118:1308-1316. [DOI: 10.1016/j.jfma.2019.05.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/05/2019] [Accepted: 05/28/2019] [Indexed: 11/23/2022] Open
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12
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Koweszko T, Gierus J, Mosiołek A, Kamiński M, Janus MD, Szulc A. The Development and the Structure of the Verbal Suicide Scale (VSS) - Measuring Attitudes Toward Suicide in the Group of Patients Hospitalized in the Psychiatric Unit. Arch Psychiatr Nurs 2016; 30:476-9. [PMID: 27455921 DOI: 10.1016/j.apnu.2016.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 06/20/2016] [Accepted: 06/20/2016] [Indexed: 11/17/2022]
Abstract
AIM The assessment of suicidal risk is one of the most difficult diagnostic challenges. The aim of present article is to report the process of development and preliminary validation of the Verbal Suicide Scale. MATERIAL AND METHOD A total of 121 psychiatric inpatients aged 19-67 anonymously completed Verbal Suicide Scale (VSS). The study took place in the Clinic of Psychiatry, Medical University of Warsaw in Mazovia Specialist Health Center in Pruszków, Poland. RESULTS Factor analysis validated the three factor structure. Cronbach's alpha reliability for each factor was satisfactory: 0.876 for scale 1, 0.700 for scale 2 and 0.710 for scale 3. CONCLUSIONS VSS is a short instrument for evaluating the attitude toward suicide and can be a useful tool in mental health nursing practice. Further research and analyses are required to refine the theoretical and external reliability of the method.
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Affiliation(s)
- Tytus Koweszko
- Department of Psychiatry, Faculty of Health Sciences, Medical University of Warsaw, Poland.
| | - Jacek Gierus
- Department of Psychiatry, Faculty of Health Sciences, Medical University of Warsaw, Poland
| | - Anna Mosiołek
- Department of Psychiatry, Faculty of Health Sciences, Medical University of Warsaw, Poland
| | - Marcin Kamiński
- Department of Psychiatry, Faculty of Health Sciences, Medical University of Warsaw, Poland
| | - Marta Dagmara Janus
- Department of Psychiatry, Faculty of Health Sciences, Medical University of Warsaw, Poland
| | - Agata Szulc
- Department of Psychiatry, Faculty of Health Sciences, Medical University of Warsaw, Poland
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13
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Wu CY, Lee JI, Lee MB, Liao SC, Chang CM, Chen HC, Lung FW. Predictive validity of a five-item symptom checklist to screen psychiatric morbidity and suicide ideation in general population and psychiatric settings. J Formos Med Assoc 2016; 115:395-403. [DOI: 10.1016/j.jfma.2015.05.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 05/08/2015] [Accepted: 05/11/2015] [Indexed: 10/23/2022] Open
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Isaac V, Wu CY, Huang CT, Baune BT, Tseng CL, McLachlan CS. Elevated neutrophil to lymphocyte ratio predicts mortality in medical inpatients with multiple chronic conditions. Medicine (Baltimore) 2016; 95:e3832. [PMID: 27281085 PMCID: PMC4907663 DOI: 10.1097/md.0000000000003832] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Neutrophil to lymphocyte ratio (NLR) is an easy measurable laboratory marker used to evaluate systemic inflammation. Elevated NLR is associated with poor survival and increased morbidity in cancer and cardiovascular disease. However, the usefulness of NLR to predict morbidity and mortality in a hospital setting for patients with multiple chronic conditions has not been previously examined. In this study, we investigate the association between NLR and mortality in multimorbid medical inpatients. Two hundred thirty medical in-patients with chronic conditions were selected from a single academic medical center in Taiwan. Retrospective NLRs were calculated from routine full blood counts previously obtained during the initial hospital admission and at the time of discharge. Self-rated health (using a single-item question), medical disorders, depressive symptoms, and medical service utilization over a 1-year period were included in the analyses. Mortality outcomes were ascertained by reviewing electronic medical records and follow-up. The mortality rate at 2-year follow-up was 23%. Depression (odds ratio [OR] 1.9 [95% CI 1.0-3.7]), poor self-rated health (OR 2.1 [95% CI 1.1-3.9]), being hospitalized 2 or more times in the previous year (OR 2.3 [95% CI 1.2-4.6]), metastatic cancer (OR 4.7 [95% CI 2.3-9.7]), and chronic liver disease (OR 4.3 [95% CI 1.5-12.1]) were associated with 2-year mortality. The median (interquartile range) NLR at admission and discharge were 4.47 (2.4-8.7) and 3.65 (2.1-6.5), respectively. Two-year mortality rates were higher in patients with an elevated NLR at admission (NLR <3 = 15.5%, NLR >3 = 27.6%) and discharge (NLR < 3 = 14.7%, NLR >3 = 29.1%). Multivariate logistic regression demonstrated that an elevated NLR >3.0 at admission (OR 2.3 [95% CI 1.0-5.2]) and discharge (OR 2.3 [95% CI 1.1-5.0]) were associated with mortality independent of baseline age, sex, education, metastatic cancer, liver disease, depression, and previous hospitalization. Increased NLR is associated with mortality among medical inpatients with multiple chronic conditions. NLR may provide added value to predict both risk of mortality for the inpatients with chronic conditions, in addition to allowing predictions of likely hospital service needs such as re-admissions that are associated with long-term mortality.
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Affiliation(s)
- Vivian Isaac
- Rural Clinical School, University of New South Wales, Sydney, Australia
| | - Chia-Yi Wu
- School of Nursing, College of Medicine, National Taiwan University
- ∗Correspondence: Chia-Yi Wu, School of Nursing, College of Medicine National Taiwan University 1, Jen-Ai Road, Section 1, Taipei 100, Taiwan (e-mail: )
| | - Chun-Ta Huang
- Department of Traumatology, National Taiwan University Hospital, Taiwan
| | - Bernhard T. Baune
- Department of Psychiatry, School of Medicine, University of Adelaide, Adelaide, Australia
| | - Chia-Lin Tseng
- Department of Traumatology, National Taiwan University Hospital, Taiwan
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Marco CA, Fagan C, Eggers C, Trautman W, Mann D, Olson JE. Self-assessment of hunger among ED patients with abdominal pain: lack of association with disease severity. Am J Emerg Med 2015; 34:104-6. [PMID: 26521194 DOI: 10.1016/j.ajem.2015.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 10/03/2015] [Accepted: 10/04/2015] [Indexed: 11/18/2022] Open
Affiliation(s)
- Catherine A Marco
- Department of Emergency Medicine, 3525 Southern Blvd, Kettering, OH 45429.
| | | | - Catherine Eggers
- Wright State University Boonshoft School of Medicine, Dayton, OH
| | - William Trautman
- Wright State University Boonshoft School of Medicine, Dayton, OH
| | - Dennis Mann
- Department of Emergency Medicine, 3525 Southern Blvd, Kettering, OH 45429
| | - James E Olson
- Department of Emergency Medicine, 3525 Southern Blvd, Kettering, OH 45429
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Isaac V, McLachlan CS, Baune BT, Huang CT, Wu CY. Poor Self-Rated Health Influences Hospital Service Use in Hospitalized Inpatients With Chronic Conditions in Taiwan. Medicine (Baltimore) 2015; 94:e1477. [PMID: 26356706 PMCID: PMC4616650 DOI: 10.1097/md.0000000000001477] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Our aim was to investigate the association between self-rated health (SRH) and use of hospital services (ie, medical outpatient department, emergency department, and general ward. admissions). Cross-sectional study data were collected from 230 consecutive patients admitted to medical departments of a 2000-bed academic medical center in Taiwan using standardized operating procedures for data collection of SRH (ie, a single-item question inquiring overall perceived health status), medical disorders, depressive symptoms, and combined service utilization over a 1-year period (ie, number of visits to outpatient department, number of visits to emergency department, and number of hospitalizations). Electronic medical records were retrieved, with self-reported external medical visits added to in-hospital frequencies of service use to provide better estimation of health service utilization. Fifty-two percent of study patients rated their health as poor or very poor. Poor SRH was associated with more visits to medical outpatient department, emergency department, and hospital admission. Multivariate logistic regression demonstrated an independent association between poor SRH and services utilization after adjustment for age, gender, hypertension, diabetes, metastatic cancer, number of chronic illness, life-threatening event, life-time suicidal ideation, and depression. SRH may be a useful research tool to model medical service use for inpatients with chronic conditions.
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Affiliation(s)
- Vivian Isaac
- From the Rural Clinical School, University of New South Wales, Sydney, Australia (VI, CSM); Department of Psychiatry, School of Medicine, University of Adelaide, Adelaide, Australia (BTB); Departments of Internal Medicine and Traumatology, National Taiwan University Hospital, Taipei, Taiwan (C-TH); and Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan (C-YW)
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Wu CY, Lin YY, Yeh MC, Huang LH, Chen SJ, Liao SC, Lee MB. Effectiveness of interactive discussion group in suicide risk assessment among general nurses in Taiwan: a randomized controlled trial. NURSE EDUCATION TODAY 2014; 34:1388-1394. [PMID: 24768204 DOI: 10.1016/j.nedt.2014.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 02/20/2014] [Accepted: 03/25/2014] [Indexed: 06/03/2023]
Abstract
The evidence of suicide prevention training for nurses is scarce. Strategies to enhance general nurses' ability in suicide risk assessment are critical to develop effective training programs in general medical settings. This study was aimed to examine the effectiveness of an interactive discussion group in a suicide prevention training program for general nurses. In this randomized study with two groups of pre-post study design, the sample was recruited from the Medical, Surgical, and Emergency/Intensive Care Sectors of a 2000-bed general hospital via stratified randomization. Among the 111 nurses, 57 participants randomly assigned to the control group received a two-hour baseline suicide gatekeeper lecture, and 54 participants assigning to the experimental group received an additional five-hour group discussion about suicide risk assessment skills. Using a case vignette, the nurses discussed and assessed suicide risk factors specified in a 10-item Chinese SAD PERSONS Scale during a group discussion intervention. The findings revealed that the nurses achieved significant and consistent improvements of risk identification and assessment after the intervention without influencing their mental health status for assessing suicide risks. The result suggested an effective approach of interactive group discussion for facilitating critical thinking and learning suicide risk assessment skills among general nurses.
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Affiliation(s)
- Chia-Yi Wu
- Department of Nursing, College of Medicine, National Taiwan University, Taiwan.
| | - Yi-Yin Lin
- Department of Nursing, College of Medicine, National Taiwan University, Taiwan
| | - Mei Chang Yeh
- Department of Nursing, College of Medicine, National Taiwan University, Taiwan
| | - Lian-Hua Huang
- Department of Nursing, College of Medicine, National Taiwan University, Taiwan; Department of Nursing, National Taiwan University Hospital, Taiwan
| | - Shaw-Ji Chen
- Department of Psychiatry, Mackay Memorial Hospital, Taitung Branch, Taiwan
| | - Shih-Cheng Liao
- Department of Psychiatry, National Taiwan University Hospital, Taiwan
| | - Ming-Been Lee
- Department of Psychiatry, National Taiwan University Hospital, Taiwan; National Suicide Prevention Centre, Taiwan
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