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Clapperton A, Spittal MJ, Dwyer J, Nicholas A, Pirkis J. Suicide within five years of hospital-treated self-harm: A data linkage cohort study. J Affect Disord 2024; 356:528-534. [PMID: 38657761 DOI: 10.1016/j.jad.2024.04.092] [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: 02/25/2024] [Revised: 04/17/2024] [Accepted: 04/21/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Hospital-treated self-harm is a strong predictor of suicide and hospital contacts may include missed opportunities for suicide prevention. We conducted a data linkage study to identify factors associated with suicide in people treated in hospital for self-harm in Victoria, Australia. METHOD We undertook a cohort study following 14,307 people treated in hospital for an episode of self-harm (i.e., either admitted or non-admitted ED presentations) over the period 2011 and 2012 and used data from the Victorian Suicide Register to identify suicides within 5 years. We estimated unadjusted hazard ratios (HRs) for suicide using survival analysis for each exposure variable and then computed adjusted HRs using a multivariate model that included all exposure variables. RESULTS Among females, the risk of suicide was higher in those aged 50-74 years (HR 1.78; Cl: 1.02, 3.10), residing in areas of least disadvantage (HR 2.58; Cl: 1.21, 5.50), who used hanging as a method of self-harm (HR 5.17; Cl: 1.86, 14.35) and with organic disorders (HR 6.71; Cl: 2.61, 17.23) or disorders of adult personality and behaviour (HR 2.10; Cl: 1.03, 4.27). In males, the risk of suicide was higher in those who used motor vehicle exhaust gas (MVEG) as a method of self-harm (HR 3.48; Cl: 1.73, 7.01), and with disorders due to psychoactive substance abuse (HR 1.75; Cl: 1.14, 2.67). CONCLUSION Although all patients should be routinely assessed for risk and needs following hospital-treated self-harm including appropriate follow-up care, people who use MVEG or hanging as methods of self-harm are obvious candidates for close follow-up.
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Affiliation(s)
- Angela Clapperton
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Matthew J Spittal
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Jeremy Dwyer
- Coroners Prevention Unit, Coroners Court of Victoria, Melbourne, VIC, Australia
| | - Angela Nicholas
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Jane Pirkis
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Mehanović E, Rosso G, Cuomo GL, Diecidue R, Maina G, Costa G, Vigna-Taglianti F. Risk factors for mortality after hospitalization for suicide attempt: results of 11-year follow-up study in Piedmont Region, Italy. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1039-1051. [PMID: 37552335 PMCID: PMC11116226 DOI: 10.1007/s00127-023-02544-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/30/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE Suicide attempters are at high risk of premature death, both for suicide and for non-suicidal causes. The aim of this study is to investigate risk factors and temporal span for mortality in a cohort of cases admitted to hospital for suicide attempt. METHODS The cohort included 1489 patients resident in Piedmont Region, North West of Italy, who had been admitted to hospital or emergency department for suicide attempt between 2010 and 2020. Cox regression models were used to identify risk factors for death. The final multivariate model included gender, age, area deprivation index, family composition, psychiatric disorders, malignant neoplasms, neurological disorders, diabetes mellitus, cardiovascular diseases, chronic obstructive pulmonary disease, and intracranial injury or skull fracture. RESULTS During the observation period, 7.3% of patients died. The highest mortality was observed within the first 12 months after suicide attempt, and remained elevated for many years afterwards. Male gender, older age, high deprivation index of the census area, single-parent family, mood disorders, malignant neoplasms, diabetes mellitus and intracranial injuries or skull fracture were independent predictors of death. Risk factors for natural and unnatural causes of death were also identified. CONCLUSIONS The mortality risk of suicide attempters is very high, both in the months immediately following the attempt and afterwards. The identification of high-risk groups can help to plan outpatient care following the hospital discharge. Our findings urge the need to design strategies for the assistance and care of these patients at long term in order to reduce the unfavourable outcomes.
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Affiliation(s)
- Emina Mehanović
- Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy.
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Turin, Italy.
| | - Gianluca Rosso
- Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Gian Luca Cuomo
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Turin, Italy
| | - Roberto Diecidue
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco, Turin, Italy
| | - Giuseppe Maina
- Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Giuseppe Costa
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Turin, Italy
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Sharwood LN, Waller M, Draper B, Shand F. Exploring community mental health service use following hospital-treated intentional self-harm among older Australians: a survival analysis. Int Psychogeriatr 2024; 36:405-414. [PMID: 37960921 DOI: 10.1017/s1041610223000959] [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] [Indexed: 11/15/2023]
Abstract
OBJECTIVES This study aimed to examine the impact of community mental health (CMH) care following index hospital-treated intentional self-harm (ISH) on all-cause mortality. A secondary aim was to describe patterns of CMH care surrounding index hospital-treated ISH. DESIGN A longitudinal whole-of-population record linkage study was conducted (2014-2019), with index ISH hospitalization (Emergency Department and/or hospital admissions) linked to all available hospital, deaths/cause of death, and CMH data. SETTING Australia's most populous state, New South Wales (NSW) comprised approximately 7.7 million people during the study period. CMH services are provided statewide, to assess and treat non-admitted patients, including post-discharge review. PARTICIPANTS Individuals with an index hospital presentation in NSW of ISH during the study period, aged 45 years or older. INTERVENTION CMH care within 14 days from index, versus not. MEASUREMENTS Cox-proportionate hazards regression analysis evaluated all-cause mortality risk, adjusted for relevant covariates. RESULTS Totally, 24,544 persons aged 45 years or older experienced a nonfatal hospital-treated ISH diagnosis between 2014 and 2019. CMH care was received by 56% within 14 days from index. Survival analysis demonstrated this was associated with 34% lower risk of death, adjusted for age, sex, marital status, index diagnosis, and 14-day hospital readmission (HR 0.66, 95% CI 0.58, 0.74, p < 0.001). Older males and chronic injury conveyed significantly greater risk of death overall. CONCLUSIONS CMH care within 14 days of index presentation for self-harm may reduce the risk of all-cause mortality. Greater effort is needed to engage older males presenting for self-harm in ongoing community mental health care.
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Affiliation(s)
- Lisa N Sharwood
- Black Dog Institute, University of New South Wales, Sydney, Kensington, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- School of Engineering, University of Technology Sydney, Sydney, NSW, Australia
- School of Population Health, University of NSW, Sydney
| | | | - Brian Draper
- Eastern Suburbs Older Persons' Mental Health Service, Randwick, NSW, 2031, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales,Sydney, NSW, Australia
| | - Fiona Shand
- Black Dog Institute, University of New South Wales, Sydney, Kensington, NSW, Australia
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Chen WY, Pan CH, Su SS, Yang TW, Chen CC, Kuo CJ. Incidence and Risk Profiles for Suicide Mortality in Patients With Schizophrenia Receiving Homecare Case Management in Taiwan. Schizophr Bull 2024; 50:295-303. [PMID: 37163678 PMCID: PMC10919775 DOI: 10.1093/schbul/sbad067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Case management (CM)-based community therapy for patients with schizophrenia had little effect on reducing suicide mortality. We investigate the long-term suicide mortality outcome and associated risk factors in patients with schizophrenia receiving homecare (CM) in Taiwan. We enrolled a nationwide cohort of patients with schizophrenia who newly received homecare CM intervention (n = 13 317) between January 1, 2001, and December 31, 2015; their data were derived from Taiwan's National Health Insurance Research Database. We calculated the incidence rate of suicide methods. We examined the demographic and medical utilization profile for suicide and then performed a nested case-control study and multivariate regression to identify independent risk factors for suicide mortality. Among the 13 317 patients who received homecare CM intervention, 1766 died during the study period, of whom 213 died by suicide, which is the leading cause of unnatural death. Jumping from a high place, self-poisoning, and hanging were the top 3 suicide methods. Increased medical utilization was noted for both psychiatric and non-psychiatric services within 3 months of suicide mortality. Comorbidities of depressive disorder, nonspecific heart diseases, pneumonia, and gastrointestinal ulcers were identified as independent risk factors for suicide mortality. Suicide was the leading cause of unnatural mortality in patients with schizophrenia receiving homecare CM intervention in Taiwan. We noted the preferred suicide methods, high medical utilization, and comorbidities before suicide. Thus, we suggest that the CM team should assess lethal methods for suicide and ensure that patients adhere to psychiatry treatment for improving the current care model for this specified population.
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Affiliation(s)
- Wen-Yin Chen
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chun-Hung Pan
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Sheng-Shiang Su
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Tien-Wei Yang
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chiao-Chicy Chen
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chian-Jue Kuo
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Takeshita R, Muramatsu K, Matsuda S. The Current Status of Suicide and Medical Care System in Japan: An Analysis of 81,407 Patients Using the Diagnosis Procedure Combination Database. TOHOKU J EXP MED 2023; 261:291-297. [PMID: 37793882 DOI: 10.1620/tjem.2023.j081] [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: 10/06/2023]
Abstract
Japan has a high suicide mortality rate compared to other developed countries. To reduce suicide mortality in Japan, it is important to systematically analyze factors related to death of patients with suicide attempt. This study aimed to analyze the characteristics of patients with suicide attempt, and the factors related to their death using the Diagnosis Procedure Combination (DPC) data- a nationally representative inpatient database. We collected 81,407 cases of suicide attempt from 2016 to 2018 from DPC data and performed a multilevel logistic analysis of factors associated with death discharges. The analysis results showed that patients who received psychiatric liaison care had a lower mortality rate, but only 0.6% of surviving patients received psychiatric liaison care after admission. The odds ratio (OR) of death was high for hanging (28.86; p < 0.001) and jumping (16.28; p < 0.001), compared to wrist cutting. Patients without a psychiatric diagnosis were more likely to choose means such as hanging (14.1%) than those with a psychiatric disorder. The weekend cases had a higher OR of death than weekday (Wednesday as reference) cases (Friday 1.14, p = 0.011; Saturday 1.60, p < 0.001; Sunday 1.67, p < 0.001). Based on these findings, we suggest that improving the availability and quality of psychiatric care in acute care hospitals and primary care settings, as well as enhancing the emergency department system on weekends, could help reduce the mortality of suicide attempts.
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Affiliation(s)
- Rina Takeshita
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health
| | - Keiji Muramatsu
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health
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Grover C, Huber J, Brewer M, Basu A, Large M. Meta-analysis of clinical risk factors for suicide among people presenting to emergency departments and general hospitals with suicidal thoughts and behaviours. Acta Psychiatr Scand 2023; 148:491-524. [PMID: 37904016 DOI: 10.1111/acps.13620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/27/2023] [Accepted: 09/13/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Suicidal thoughts and behaviours (STB) are a common reason for presentation to emergency departments and general hospitals. A meta-analysis of the strength of clinical risk factors for subsequent suicide might aid understanding of suicidal behaviour and help suicide prevention. METHODS We conducted a meta-analysis of cohort and controlled studies on clinical risk factors and later suicide among people presenting to emergency departments and general hospitals with STB. Data were extracted from papers meeting inclusion criteria, published in Medline, PsycINFO, and Embase between 1 January 1960 and 10 October 2022 using papers located with the search terms ((suicide*).m_titl AND (emergency* OR accident and emergency OR casualty OR general hospital OR toxicology service).mp) or were indexed in PubMed and had titles located with the search terms (suicide* OR self-harm OR self-harm OR self-injury OR self-injury OR self-poisoning OR self-poisoning OR overdose OR para-suicide OR parasuicide [title/abstract]) AND (Emergency department OR emergency room OR Casualty OR general hospital OR toxicology OR accident and emergency [all fields]). Data about the association between clinical risk factors and suicide extracted from three or more studies were included in a random-effects meta-analysis of the odds of later death by suicide. The study was registered in PROSPERO and conducted according to MOOSE and PRISMA guidelines. RESULTS Seventy-five studies reported on 741,624 people, of which 19,649 died by suicide (2.65%). Male sex (odds ratio (OR) = 1.99) and age (OR = 2.01) were the most consistently reported risk factors. The strongest associations with subsequent death by suicide related to violent self-harm methods at the hospital presentation, including: unspecified violent method (OR = 4.97), any violent method (OR = 4.57) and the specific violent methods of drowning (OR = 4.32), hanging (OR = 4.26), and use of firearms (OR = 10.08). Patients categorised as higher risk using suicide prediction scales or any other method that combined risk factors had moderately increased odds of suicide (OR = 2.58). Younger age, Black and Hispanic ethnicity, overdose, a diagnosis of adjustment disorder, and the absence of any psychiatric diagnosis were protective against suicide. CONCLUSIONS Most risk factors for suicide among people who have presented with STB are not strongly associated with later suicide. The strongest risk factors relate to self-harm methods. In the absence of clear indicators of future suicide, all people presenting with suicidality warrant a thorough assessment of their needs, and further research is needed before we can meaningfully categorise people with STB according to suicide risk.
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Affiliation(s)
- Cameron Grover
- St. Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | - Jacqueline Huber
- St. Vincent's Hospital, Darlinghurst, New South Wales, Australia
- Faculty of Medicine, The University of Sydney, Camperdown, New South Wales, Australia
| | - Matthew Brewer
- St. Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | - Ashna Basu
- The Prince of Wales Hospital, Randwick, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of NSW, Kensington, New South Wales, Australia
| | - Matthew Large
- The Prince of Wales Hospital, Randwick, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, University of NSW, Kensington, New South Wales, Australia
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Lu FW, Conway E, Liang YL, Chen YY, Gunnell D, Chang SS. Space-time self-harm and suicide clusters in two cities in Taiwan. Epidemiol Psychiatr Sci 2023; 32:e37. [PMID: 37258458 DOI: 10.1017/s2045796023000513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
AIMS Suicidal acts may cluster in time and space and lead to community concerns about further imitative suicidal episodes. Although suicide clusters have been researched in previous studies, less is known about the clustering of non-fatal suicidal behaviour (self-harm). Furthermore, most previous studies used crude temporal and spatial information, e.g., numbers aggregated by month and residence area, for cluster detection analysis. This study aimed to (i) identify space-time clusters of self-harm and suicide using daily incidence data and exact address and (ii) investigate the characteristics of cluster-related suicidal acts. METHODS Data on emergency department presentations for self-harm and suicide deaths in Taipei City and New Taipei City, Taiwan, were used in this study. In all-age and age-specific analyses, self-harm and suicide clusters were identified using space-time permutation scan statistics. A cut-off of 0.10 for the p value was used to identify possible clusters. Logistic regression was used to investigate the characteristics associated with cluster-related episodes. RESULTS A total of 5,291 self-harm episodes and 1,406 suicides in Taipei City (2004-2006) and 20,531 self-harm episodes and 2,329 suicides in New Taipei City (2012-2016) were included in the analysis. In the two cities, two self-harm clusters (n [number of self-harm episodes or suicide deaths in the cluster] = 4 and 8 in Taipei City), four suicide clusters (n = 3 in Taipei City and n = 4, 11 and 4 in New Taipei City) and two self-harm and suicide combined clusters (n = 4 in Taipei City and n = 8 in New Taipei City) were identified. Space-time clusters of self-harm, suicide, and self-harm and suicide combined accounted for 0.05%, 0.59%, and 0.08% of the respective groups of suicidal acts. Cluster-related episodes of self-harm and suicide were more likely to be male (adjusted odds ratio [aOR] = 2.22, 95% confidence interval [CI] 1.26, 3.89) and young people aged 10-29 years (aOR = 2.72, 95% CI 1.43, 5.21) than their cluster-unrelated counterparts. CONCLUSIONS Space-time clusters of self-harm, suicide, and self-harm and suicide combined accounted for a relatively small proportion of suicidal acts and were associated with some sex/age characteristics. Focusing on suicide deaths alone may underestimate the size of some clusters and/or lead to some clusters being overlooked. Future research could consider combining self-harm and suicide data and use social connection information to investigate possible clusters of suicidal acts.
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Affiliation(s)
- Fang-Wen Lu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Erica Conway
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
- Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ya-Lun Liang
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ying-Yeh Chen
- Taipei City Psychiatric Centre, Taipei City Hospital, Taipei, Taiwan
- Institute of Public Health and Department of Public Health, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - David Gunnell
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol, Bristol, UK
- National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, UK
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
- Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Chen PH, Tsai SY, Pan CH, Chen YL, Chang HM, Su SS, Chen CC, Kuo CJ. Sex-specific risk profiles for suicide mortality in bipolar disorder: incidence, healthcare utilization and comorbidity. Psychol Med 2023; 53:1500-1509. [PMID: 34779754 DOI: 10.1017/s003329172100307x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Evidence on sex-specific incidence and comorbidity risk factors of suicide among patients with bipolar disorder is scarce. This study investigated the sex-specific risk profiles for suicide among the bipolar disorder population in terms of incidence, healthcare utilization and comorbidity. METHODS Using data from the Taiwan National Health Insurance Research Database between 1 January 2000 and 31 December 2016, this nationwide cohort study included patients with bipolar disorder (N = 46 490) and individuals representative of the general population (N = 185 960) matched by age and sex at a 1:4 ratio. Mortality rate ratios (MRRs) of suicide were calculated between suicide rates of bipolar disorder cohort and general population. In addition, a nested case-control study (1428 cases died by suicide and 5710 living controls) was conducted in the bipolar disorder cohort to examine the sex-specific risk of healthcare utilization and comorbidities. RESULTS Suicide risk was considerably higher in the cohort (MRR = 21.9) than in the general population, especially among women (MRR = 35.6). Sex-stratified analyses revealed distinct healthcare utilization patterns and physical comorbidity risk profiles between the sexes. Although female patients who died by suicide had higher risks of nonhypertensive cardiovascular disease, pneumonia, chronic kidney disease, peptic ulcer, irritable bowel syndrome, and sepsis compared to their living counterparts, male patients who died by suicide had higher risks of chronic kidney disease and sepsis compared to the living controls. CONCLUSIONS Patients with bipolar disorder who died by suicide had sex-specific risk profiles in incidence and physical comorbidities. Identifying these modifiable risk factors may guide interventions for suicide risk reduction.
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Affiliation(s)
- Pao-Huan Chen
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shang-Ying Tsai
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Hung Pan
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Yi-Lung Chen
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Counseling Psychology, Chinese Culture University, Taipei, Taiwan
| | - Hu-Ming Chang
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Sheng-Siang Su
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Chiao-Chicy Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Psychiatry, Mackay Medical College, Taipei, Taiwan
| | - Chian-Jue Kuo
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
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Abstract
INTRODUCTION Suicide by charcoal burning has accounted for more than 100,000 deaths. It has become an increasingly common suicide method in Hong Kong since first reported in 1998, and it has spread into South Korea, Taiwan, Japan and other countries. This systematic scoping review aimed to explore current evidence on trends, risk factors, impact of media and prevention strategies for this suicide method, and to identify research gaps. METHODS A search for articles published from January 1998 to June 2021 was conducted through electronic databases (MEDLINE, EMBASE, SCOPUS and PsycINFO) with the keywords (suicide*) AND (charcoal). Articles describing prevalence, trends, characteristics, risk factors and prevention strategies of charcoal burning suicide deaths were included. Non-peer-reviewed articles, non-English articles, commentaries/editorials/letters, poster abstracts, reviews, meta-analyses and studies that documented only charcoal burning suicide attempters/survivors were excluded. RESULTS Eighty-eight studies were identified, most from East Asia. Charcoal burning suicide rates in Hong Kong, Taiwan and Japan has passed the peak, while continuing to increase in South Korea. Risk factors are changing and not static. Media appears to play an important role in triggering and spreading information. Restricting access to charcoal, and raising public awareness have been effective in the short term in preventing charcoal burning suicide, but there is little information on their long-term effectiveness or sustainability. DISCUSSION More research is required to update the development and dynamic changes of charcoal burning suicide and the contributing factors. The evidence from this review may assist in detecting and intervening early for future novel suicide methods.
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Affiliation(s)
- Cheuk Yui Yeung
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Vera Yu Men
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Paul Siu Fai Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong SAR, China
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Geulayov G, Casey D, Bale E, Brand F, Clements C, Farooq B, Kapur N, Ness J, Waters K, Patel A, Hawton K. Risk of suicide in patients who present to hospital after self-cutting according to site of injury: findings from the Multicentre Study of Self-harm in England. Psychol Med 2023; 53:1400-1408. [PMID: 34344489 DOI: 10.1017/s0033291721002956] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND We compared the risk of death by suicide following hospital presentation for self-harm according to site of self-cut/stab. METHOD We included 54 999 self-harm presentations (involving 31 419 individuals) to hospitals in the Multicentre Study of Self-harm in England (1/1/2004-31/12/2014), with mortality follow-up to 31/12/2019. Information on method of self-harm was obtained through monitoring in hospitals. Information about mortality was obtained through linkage with NHS Digital. We assessed the association of site of self-cut with death by suicide using mixed effect models. RESULTS In total, 10 790 (19.6%) hospital presentations involved self-cutting/stabbing, 7489 of which (69.4%) were due to laceration to the arm/wrist alone, 1846 episodes (17.1%) involved cutting elsewhere on the body, and 1455 (13.5%) were due to laceration to unknown site. Controlling for confounders, presentation to a hospital following self-cut/stab to bodily parts other than wrist/arm was associated with greater chance of subsequent suicide relative to presentation after self-poisoning alone [adjusted odds ratio (aOR) 1.75, 95% confidence interval (CI) 1.03-2.96, p = 0.038]. The likelihood of suicide after presentation for cutting/stabbing the wrist/arm alone was comparable to that of patients who had self-poisoned alone. Presentations after laceration involving the neck were associated with a four-fold greater chance of subsequent suicide relative to self-poisoning (aOR 4.09, 95% CI 1.80-9.30, p = 0.001). CONCLUSIONS Patients who attend hospital after self-cutting/stabbing are a heterogeneous group in terms of characteristics, methods of cutting/stabbing and risk of subsequent suicide. Risk of suicide is greater in individuals who self-cut/stab to parts of the body other than the wrist or arm, especially the neck.
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Affiliation(s)
- Galit Geulayov
- Department of Psychiatry, Centre for Suicide Research, University of Oxford, Warneford Hospital, Oxford, UK
| | - Deborah Casey
- Department of Psychiatry, Centre for Suicide Research, University of Oxford, Warneford Hospital, Oxford, UK
| | - Elizabeth Bale
- Department of Psychiatry, Centre for Suicide Research, University of Oxford, Warneford Hospital, Oxford, UK
| | - Fiona Brand
- Department of Psychiatry, Centre for Suicide Research, University of Oxford, Warneford Hospital, Oxford, UK
| | - Caroline Clements
- Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Bushra Farooq
- Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Nav Kapur
- Centre for Mental Health and Safety, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Jennifer Ness
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Keith Waters
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Anita Patel
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Keith Hawton
- Department of Psychiatry, Centre for Suicide Research, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
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Siu WHS, Juang YY, Huang TM, Lin SR, Chung CC, Tu HT, Chen WM, Wang BH, See LC. Effectiveness of aftercare program for suicide ideators: Real-world evidence from National Suicide Surveillance System in Taiwan. Medicine (Baltimore) 2022; 101:e31192. [PMID: 36281121 PMCID: PMC9592350 DOI: 10.1097/md.0000000000031192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Aftercare programs' effectiveness for suicide ideators has seldom been reported. This study assessed rates and factors related to the recurrence of suicide-related episodes after the index suicidal ideation episode, index cases, and family members receiving aftercare. This is a secondary data analysis of 1787 suicidal ideation episodes from 1557 individuals reported to the National Suicide Surveillance System in New Taipei City, Taiwan, from January 2012 to June 2013 and followed up until September 2013. Among 1787 index suicidal ideations, 19.1% had recurrences of suicide-related episodes, including suicidal ideation (11.9%), attempt (6.7%), and death (0.5%) within 2 years after index ideation. These recurrences were significantly reduced after the index cases received aftercare twice, three, and four or higher. Family members receiving aftercare twice or more were associated with reduced suicidality in the index cases. Receiving aftercare among index cases was associated with being a woman, suicide due to occupation/finance, and reporting from suicide hotlines. Receiving aftercare among family members was associated with the index cases aged ≤ 19 years old, suicide reasons related to school, occupation/finance, and reporting from schools and hospitals. Aftercare programs for suicide ideators and family members of adolescent suicide ideators (aged ≤ 19 years old) decreased subsequent episodes of suicidal behavior.
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Affiliation(s)
- Wing Hin Stanford Siu
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Yeong-Yuh Juang
- Department of Psychiatry and Department of Palliative Medicine, Koo Foundation Sun Yat-Sen Cancer Center, Taipei City, Taiwan
| | - Tsuei-Mi Huang
- Public Health Department, New Taipei City Government, New Taipei City, Taiwan
| | - Sheue-Rong Lin
- Public Health Department, New Taipei City Government, New Taipei City, Taiwan
| | - Chia-Chi Chung
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Hui-Tzu Tu
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Wei-Min Chen
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Bi-Hwa Wang
- Department of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Lai-Chu See
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan City, Taiwan
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
- *Correspondence: Lai-Chu See, Department of Public Health, College of Medicine, Chang Gung University, 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 33302, Taiwan (e-mail: )
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Liu BP, Jia CX, Qin P, Zhang YY, Yu YK, Luo X, Li SX. Associating factors of suicide and repetition following self-harm: A systematic review and meta-analysis of longitudinal studies. EClinicalMedicine 2022; 49:101461. [PMID: 35747199 PMCID: PMC9126760 DOI: 10.1016/j.eclinm.2022.101461] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/26/2022] [Accepted: 05/04/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Longitudinal evidence for sociodemographic and clinic factors deviating risk for suicide and repetition following SH (self-harm) varied greatly. METHODS A comprehensive search of PubMed, Web of Science, EMBASE, and PsycINFO was conducted from January 1st, 2010 to April 5th, 2022. Longitudinal studies focusing on examining associating factors for suicide and repetition following SH were included. PROSPERO registration CRD42021248695. FINDINGS The present meta-analysis synthesized data from 62 studies published from Jan. 1st, 2010. The associating factors of SH repetition included female gender (RR, 95%CI: 1.11, 1.04-1.18, I2=82.8%), the elderly (compared with adolescents and young adults, RR, 95%CI: 0.67, 0.52-0.87, I2=86.3%), multiple episodes of SH (RR, 95%CI: 1.97, 1.51-2.57, I2=94.3%), diagnosis (RR, 95%CI: 1.60, 1.27-2.02, I2=92.7%) and treatment (RR, 95%CI: 1.59, 1.40-1.80, I2=93.3%) of psychiatric disorder. Male gender (RR, 95%CI: 2.03, 1.80-2.28, I2=83.8%), middle-aged adults (compared with adolescents and young adults, RR, 95%CI: 2.40, 1.87-3.08, I2=74.4%), the elderly (compared with adolescents and young adults, RR, 95%CI: 4.38, 2.98-6.44, I2=76.8%), physical illness (RR, 95%CI: 1.95, 1.56-2.43, I2=0), multiple episodes of SH (RR, 95%CI: 2.02, 1.58-2.58, I2=87.4%), diagnosis (RR, 95%CI: 2.13, 1.67-2.71, I2=90.9%) and treatment (RR, 95%CI: 1.36, 1.16-1.58, I2=58.6%) of psychiatric disorder were associated with increased risk of suicide following SH. INTERPRETATION Due to the substantial heterogeneity for clinic factors of suicide and repetition following SH, these results need to be interpreted with caution. Clinics should pay more attention to the cases with SH repetition, especially with poor physical and psychiatric conditions. FUNDING This work was supported by National Natural Science Foundation of China (NSFC) [No: 82103954; 30972527; 81573233].
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Affiliation(s)
- Bao-Peng Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Cun-Xian Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
- Corresponding author at: Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine of University of Oslo, Oslo, Norway
| | - Ying-Ying Zhang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Yao-Kun Yu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Xiao Luo
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Suicide Prevention Research, Shandong University, Jinan, Shandong, China
| | - Shi-Xue Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Corresponding author at: Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
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Lumpe M, Schurr J, Rabe C, Ott A, Zellner T, Rentrop M, Eyer F, Geith S. Socio-demographic and psychiatric profile of patients hospitalized due to self-poisoning with suicidal intention. Ann Gen Psychiatry 2022; 21:16. [PMID: 35681219 PMCID: PMC9185897 DOI: 10.1186/s12991-022-00393-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/07/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To identify the psychiatric profile of patients hospitalized due to self-intoxication associated with suicide-related behavior (SRB). METHODS In this retrospective single-center study, records of consecutive patients treated for suicidal poisoning in our Clinical Toxicology unit between 1st January 2012 and 31st December 2016, who received at least one psychiatric exploration during their inpatient stay, were analyzed with regard to epidemiological data, ingested substances, psychiatric and somatic comorbidities, suicidal circumstances and follow-up therapy. RESULTS Out of 1289 hospitalized patients, 1090 patients with complete data were analyzed. Mean age was 40.5 ± 17.2 years, 66.7% were female. 32.0% of patients had previously engaged in SRB, in 76.3% intention was suicidal. 64.7% of patients had a pre-existing psychiatric disorder (PD). Patients with a pre-existing PD more often displayed prior SRB than those without PD (40.7% vs 15.3%; p < 0.001; Fisher's exact test), used long-term/on demand medication (70.2% vs 38.9%; p < 0.001), distanced themselves from the current suicide attempt (65.9% vs 50.8%; p < 0.001) and had no detectable trigger (38.7% vs 18.1%; p < 0.001). Partnership conflict was the most commonly named trigger, and it was documented more often in patients without than in those with PD (41.6% vs 25.6%). After psychiatric reevaluation, most patients were diagnosed with mood disorders (29.7%) and stress disorders (17.0%); 32.8% of patients had a combination of two or more PDs. CONCLUSION Hospitalization due to self-poisoning is associated with pre-existing PD, prior SRB and access to psychiatric medication. Detection of these risk factors could allow timely introduction of effective preventive measures tailored to particularly vulnerable subgroups and appropriate relief. However, lack of a detectable trigger in many cases may hamper the identification of those at risk.
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Affiliation(s)
- Maja Lumpe
- Division of Clinical Toxicology and Poison Control Centre Munich, Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | | | - Christian Rabe
- Division of Clinical Toxicology and Poison Control Centre Munich, Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | | | - Tobias Zellner
- Division of Clinical Toxicology and Poison Control Centre Munich, Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | - Michael Rentrop
- Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,kbo-Inn-Salzach Clinic, Wasserburg am Inn, Germany
| | - Florian Eyer
- Division of Clinical Toxicology and Poison Control Centre Munich, Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stefanie Geith
- Division of Clinical Toxicology and Poison Control Centre Munich, Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany.
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Tu CY, Yen TH, Chang CM, Chen HY, Yen YC, Guo MC, Lu TH, Wu CS, Chen IM, Cheng HC, Huang WL, Chen CC, Eddleston M, Chang SS. Characteristics and psychopathology of 1,086 patients who self-poisoned using pesticides in Taiwan (2012-2019): A comparison across pesticide groups. J Affect Disord 2022; 300:17-26. [PMID: 34952117 DOI: 10.1016/j.jad.2021.12.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/09/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
Background Previous studies, mainly from low- and middle-income settings, showed that pesticide self-poisonings were mostly impulsive with low levels of psychopathology. We aimed to investigate whether pesticide self-poisoning in a high-income country showed similar profiles, and whether those with certain characteristics and psychopathology were more likely to use specific pesticides. Methods Data were extracted from hospital records of pesticide self-poisoning patients treated at eight major hospitals in Taiwan between 2012 and 2019. Multinomial logistic regression was used to investigate the association of interpersonal conflicts, triggers of self-poisoning, and psychopathology with the groups of pesticides ingested. Results A total of 1,086 patients who self-poisoned using pesticides were identified; 67.0% were male and 39.8% aged 65+ years. Approximately three quarters (75.7%) of patients who received psychiatric assessment had at least one psychiatric diagnosis, and the prevalence was 48.3% in all patients. No association was found between the pesticide groups ingested and interpersonal conflicts, most of the triggers, past psychiatric service use, or having psychiatric diagnoses. Limitations Data were collected from hospital records retrospectively. Only 60.3% of the patients received a psychiatric assessment. Conclusions The majority of patients who self-poisoned using pesticides and received psychiatric assessment in Taiwan had psychiatric illness. Patients who ingested different groups of pesticides were similar in their characteristics. The choice of pesticides used in self-poisoning more likely relates to availability rather than intentional selection. Psychiatric assessment and treatment are important in patients who self-poisoned using pesticides, while restricting access to highly hazardous pesticides is likely to prevent many deaths from pesticide self-poisoning.
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Affiliation(s)
- Chao-Ying Tu
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chia-Ming Chang
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hsien-Yi Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Chieh Yen
- Department of Psychiatry, E-Da Hospital, Kaohsiung, Taiwan; School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Ming-Chao Guo
- Department of Psychiatry, Camillian Saint Mary's Hospital Luodong, Yilan, Taiwan
| | - Tsung-Hua Lu
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Shin Wu
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; National Center for Geriatrics and Welfare Research, National Health Research Institutes
| | - I-Ming Chen
- Department of Psychiatry, National Taiwan University, Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hai-Ching Cheng
- Department of Psychiatry, National Taiwan University Hsin-Chu Hospital, Hsinchu, Taiwan
| | - Wei-Lieh Huang
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Cheng-Che Chen
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Psychiatry, National Taiwan University BioMedical Park Hospital, Hsinchu, Taiwan
| | - Michael Eddleston
- Department of Psychiatry, National Taiwan University BioMedical Park Hospital, Hsinchu, Taiwan; Center for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK; Pharmacology, Toxicology and Therapeutics, University and British Heart Foundation Center for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Shu-Sen Chang
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka; Institute of Health Behaviors and Community Sciences and Global Health Program, and College of Public Health, National Taiwan University, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan.
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15
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Chen YY, Yang CT, Pinkney E, Yip PSF. The Age-Period-Cohort trends of suicide in Hong Kong and Taiwan, 1979-2018. J Affect Disord 2021; 295:587-593. [PMID: 34509074 DOI: 10.1016/j.jad.2021.08.084] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The global age-standardized suicide rate fell by 32.7% between 1990 and 2016. The decrease was largely due to suicide rate reductions in China and India. High-income Asian regions did not see such reductions. The aim of the current study was to explore recent suicide rate trends in Hong Kong and Taiwan to decompose which factors - age, period or cohort - explain suicide rate changes in these two regions. METHODS Official mortality data for 1979-2018 in Hong Kong and Taiwan were collected. We utilized Web Tool from the NIH (National Institute of Health, USA) to analyze the Age-Period-Cohort (APC) effects. RESULTS We found marked age-effect that suicide rates increased with age in both genders in both places. Period effect related to the dissemination of charcoal burning suicide was found during 1999-2003 in Hong Kong and 2004-2008 in Taiwan. Increasing suicide rates in the middle- and young-age male cohorts were found in both regions. No increase in suicide risks in young female cohorts was observed. Older cohorts in Hong Kong and older female cohorts in Taiwan also had high suicide rates, but older male cohorts in Taiwan had low rate. LIMITATIONS The interpretations and observations at the population level might not hold at the individual level. CONCLUSIONS The high suicide risk in middle- and young male cohorts in both regions contribute to the persistent high suicide rates in these two regions. Special attention should be turn to the factors underlying such increasing trends.
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Affiliation(s)
- Ying-Yeh Chen
- Taipei City Psychiatric Centre, Taipei City Hospital, Taipei City, Taiwan; Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei City, Taiwan
| | - Chi-Ting Yang
- Department of Statistics and Actuarial Science, The University of Hong Kong, Hong Kong
| | - Edward Pinkney
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong
| | - Paul S F Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong; The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong.
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Ono Y, Ono N, Kakamu T, Ishida T, Inoue S, Kotani J, Shinohara K. Impact of closure of the in-house psychiatric care unit on prehospital and emergency ward length of stay and disposition locations in patients who attempted suicide: A retrospective before-and-after cohort study at a community hospital in Japan. Medicine (Baltimore) 2021; 100:e26252. [PMID: 34087914 PMCID: PMC8183698 DOI: 10.1097/md.0000000000026252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 05/19/2021] [Indexed: 01/04/2023] Open
Abstract
Suicide is an increasingly serious public health care concern worldwide. The impact of decreased in-house psychiatric resources on emergency care for suicidal patients has not been thoroughly examined. We evaluated the effects of closing an in-hospital psychiatric ward on the prehospital and emergency ward length of stay (LOS) and disposition location in patients who attempted suicide.This was a retrospective before-and-after study at a community emergency department (ED) in Japan. On March 31, 2014, the hospital closed its 50 psychiatric ward beds and outpatient consultation days were decreased from 5 to 2 days per week. Electronic health record data of suicidal patients who were brought to the ED were collected for 5 years before the decrease in in-hospital psychiatric services (April 1, 2009-March 31, 2014) and 5 years after the decrease (April 1, 2014-March 31, 2019). One-to-one propensity score matching was performed to compare prehospital and emergency ward LOS, and discharge location between the 2 groups.Of the 1083 eligible patients, 449 (41.5%) were brought to the ED after the closure of the psychiatric ward. Patients with older age, burns, and higher comorbidity index values, and those requiring endotracheal intubation, surgery, and emergency ward admission, were more likely to receive ED care after the psychiatric ward closure. In the propensity matched analysis with 418 pairs, the after-closure group showed a significant increase in median prehospital LOS (44.0 minutes vs 51.0 minutes, P < .001) and emergency ward LOS (3.0 days vs 4.0 days, P = .014) compared with the before-closure group. The rate of direct home return was significantly lower in the after-closure group compared with the before-closure group (87.1% vs 81.6%, odds ratio: 0.66; 95% confidence interval: 0.45-0.96).The prehospital and emergency ward LOS for patients who attempted suicide in the study site increased significantly after a decrease in hospital-based mental health services. Conversely, there was significant reduction in direct home discharge after the decrease in in-house psychiatric care. These results have important implications for future policy to address the increasing care needs of patients who attempt suicide.
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Affiliation(s)
- Yuko Ono
- Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, 7-5-2 Kusunoki-cho, Chuo-ward, Kobe, Hyogo
- Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi
| | - Nozomi Ono
- Department of Psychiatry, Hoshi General Hospital Foundation, Hoshigaoka hospital, 7 Kitasanten, Katahira-cho, Koriyama
| | - Takeyasu Kakamu
- Department of Hygiene and Preventive Medicine, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
| | - Tokiya Ishida
- Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi
| | - Shigeaki Inoue
- Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, 7-5-2 Kusunoki-cho, Chuo-ward, Kobe, Hyogo
| | - Joji Kotani
- Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, 7-5-2 Kusunoki-cho, Chuo-ward, Kobe, Hyogo
| | - Kazuaki Shinohara
- Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi
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García de la Garza Á, Blanco C, Olfson M, Wall MM. Identification of Suicide Attempt Risk Factors in a National US Survey Using Machine Learning. JAMA Psychiatry 2021; 78:398-406. [PMID: 33404590 PMCID: PMC7788508 DOI: 10.1001/jamapsychiatry.2020.4165] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Because more than one-third of people making nonfatal suicide attempts do not receive mental health treatment, it is essential to extend suicide attempt risk factors beyond high-risk clinical populations to the general adult population. OBJECTIVE To identify future suicide attempt risk factors in the general population using a data-driven machine learning approach including more than 2500 questions from a large, nationally representative survey of US adults. DESIGN, SETTING, AND PARTICIPANTS Data came from wave 1 (2001 to 2002) and wave 2 (2004 to 2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). NESARC is a face-to-face longitudinal survey conducted with a national representative sample of noninstitutionalized civilian population 18 years and older in the US. The cumulative response rate across both waves was 70.2% resulting in 34 653 wave 2 interviews. A balanced random forest was trained using cross-validation to develop a suicide attempt risk model. Out-of-fold model prediction was used to assess model performance, including the area under the receiver operator curve, sensitivity, and specificity. Survey design and nonresponse weights allowed estimates to be representative of the US civilian population based on the 2000 census. Analyses were performed between May 15, 2019, and June 10, 2020. MAIN OUTCOMES AND MEASURES Attempted suicide in the 3 years between wave 1 and wave 2 interviews. RESULTS Of 34 653 participants, 20 089 were female (weighted proportion, 52.1%). The weighted mean (SD) age was 45.1 (17.3) years at wave 1 and 48.2 (17.3) years at wave 2. Attempted suicide during the 3 years between wave 1 and wave 2 interviews was self-reported by 222 of 34 653 participants (0.6%). Using survey questions measured at wave 1, the suicide attempt risk model yielded a cross-validated area under the receiver operator characteristic curve of 0.857 with a sensitivity of 85.3% (95% CI, 79.8-89.7) and a specificity of 73.3% (95% CI, 72.8-73.8) at an optimized threshold. The model identified 1.8% of the US population to be at a 10% or greater risk of suicide attempt. The most important risk factors were 3 questions about previous suicidal ideation or behavior; 3 items from the 12-Item Short Form Health Survey, namely feeling downhearted, doing activities less carefully, or accomplishing less because of emotional problems; younger age; lower educational achievement; and recent financial crisis. CONCLUSIONS AND RELEVANCE In this study, after searching through more than 2500 survey questions, several well-known risk factors of suicide attempt were confirmed, such as previous suicidal behaviors and ideation, and new risks were identified, including functional impairment resulting from mental disorders and socioeconomic disadvantage. These results may help guide future clinical assessment and the development of new suicide risk scales.
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Affiliation(s)
| | - Carlos Blanco
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, Bethesda, Maryland
| | - Mark Olfson
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York
| | - Melanie M. Wall
- Department of Biostatistics, Columbia University, New York, New York,Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York
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Analysis of attempted suicide episodes presenting to the emergency department: comparison of young, middle aged and older people. Int J Ment Health Syst 2020; 14:46. [PMID: 32582367 PMCID: PMC7310195 DOI: 10.1186/s13033-020-00378-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 06/15/2020] [Indexed: 11/24/2022] Open
Abstract
Background Attempted suicide remains difficult for clinicians to predict with some established risk factors. We investigate the detailed characteristics of attempted suicide especially according to age and methods of suicide attempts. Methods A retrospective study was conducted to evaluate patients who visited the emergency department due to attempted suicide. A retrospective medical record review of all patients who presented to the emergency department (ED) of two tertiary teaching hospitals in Korea after suicide attempt between January 1, 2010, and December 31, 2017 was performed. Demographic information and detailed variables (methods and reasons of suicide attempts and variables regarding reattempts) were investigated. Total participants were classified into 3 groups according to age, young group, middle aged group and the older group, and each characteristics were compared. Results A total of 3698 patients were enrolled in this study. Deliberate self-poisoning (DSP) was the most common method of attempted suicide (66.5%) followed by cutting (24.4%), hanging (7.9%), falling (2.6%), and drowning (1.1%). In patients who had previous suicide attempts (n = 1029, 27.8%), attempted methods were likely to be concordant with previous attempted methods. The most common reason for suicide attempts was interpersonal relationship issues followed by socio-economic reasons. Older patients (n = 412, 11.2%) were significantly different from other 2 groups (n = 3286, 88.8%) regarding gender, suicide re-attempt, occupation, alcohol co-ingestion, previous psychiatric history, and discharge outcomes (all p-values < 0.001). Especially, in older patients, use of critical method and reason of physical illness were more common. Conclusion Our findings indicated that people who attempted suicide might have different sociodemographic and clinical factors depending on age group. Depending on age, it is necessary to apply additional suicide intervention programs in different ways.
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Ohbe H, Goto T, Yamazaki R, Jo T, Matsui H, Fushimi K, Yasunaga H. Clinical Trajectories of Suicide Attempts and Self-harm in Patients Admitted to Acute-care Hospitals in Japan: A Nationwide Inpatient Database Study. J Epidemiol 2020; 31:231-236. [PMID: 32249268 PMCID: PMC7878706 DOI: 10.2188/jea.je20200018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background For patients with suicide attempts or self-harm, acute-care hospitals often function as the primary or sole point of contact with the healthcare system. However, little is known about patient characteristics or clinical trajectories of suicide attempts and self-harm episodes among those admitted to acute-care hospitals. This study aimed to describe the characteristics of suicide attempts and self-harm among patients admitted to acute-care hospitals, and the clinical practices provided in these hospitals, using a nationwide inpatient database in Japan. Methods Using data from the Japanese Diagnosis Procedure Combination inpatient database from June 2015 to March 2017, we identified patients with emergency admission for suicide attempts or self-harm. We did not include patients with elective admission to psychiatric hospitals or outpatients. We described patient characteristics, treatments for physical injuries, psychiatric interventions, and discharge status. Results We identified 17,881 eligible patients during the 22-month study period. Overall, 38% of the patients did not have any psychiatric or behavioral comorbidities at admission. The most common suicide method was drug overdose (50%), followed by hanging (18%), jumping from a height (13%), cutting or piercing without wrist cutting (7.1%), poisoning (6.6%), and wrist cutting (5.4%). Suicide was completed by 2,639 (15%) patients. Among patients discharged to home, 51% did not receive any psychiatric intervention. In 468 acute-care hospitals (54%), no psychiatric intervention was provided during the study period. Conclusion We found that half of acute-care hospitals did not provide any hospital-based psychiatric care for patients with suicide attempts or self-harm.
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Affiliation(s)
- Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Tadahiro Goto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo.,Graduate School of Medical Science, University of Fukui
| | - Ryuichi Yamazaki
- Department of Psychiatry, The Jikei University School of Medicine
| | - Taisuke Jo
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
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Suicide following presentation to hospital for non-fatal self-harm in the Multicentre Study of Self-harm: a long-term follow-up study. Lancet Psychiatry 2019; 6:1021-1030. [PMID: 31706930 DOI: 10.1016/s2215-0366(19)30402-x] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/23/2019] [Accepted: 08/27/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Self-harm is the strongest risk factor for subsequent suicide, but risk may vary. We compared the risk of suicide following hospital presentation for self-harm according to patient characteristics, method of self-harm, and variations in area-level socioeconomic deprivation, and estimated the incidence of suicide by time after hospital attendance. METHODS In this ongoing Multicentre Study of Self-harm in England, the study population consists of individuals aged at least 15 years who had attended the emergency department of five general hospitals in Oxford, Manchester, and Derby after non-fatal self-harm between Jan 1, 2000, and Dec 31, 2013. Information on method of self-harm was obtained through systematic monitoring in hospitals. Level of socioeconomic deprivation was based on the Index of Multiple Deprivation (IMD) characterising the area where patients lived, grouping them according to IMD quintiles. Mortality follow-up was up to Dec 31, 2015, resulting in up to 16 years of follow-up. We calculated incidence of suicide since first hospital presentation by follow-up period and estimated the association between individual factors (age, gender, method of self-harm, IMD, and number of non-fatal self-harm presentations to hospital) and suicide using mixed-effect models. FINDINGS Between Jan 1, 2000, and Dec 31, 2013, there were 92 177 presentations to the study hospitals by 51 108 individuals. 1325 patients involved in 1563 self-harm episodes were excluded from the study because they had missing information on gender, age, or mortality. The resulting study sample consisted of 90 614 hospital presentations by 49 783 individuals. By the end of follow-up on Dec 31, 2015, 703 patients had died by suicide. The overall incidence of suicide was 163·1 (95% CI 151·5-175·6) per 100 000 person-years, and 260·0 (237·4-284·8) per 100 000 person-years in men and 94·6 (83·3-107·4) per 100 000 person-years in women. The incidence of suicide was highest in the year following discharge from hospital (511·1 [451·7-578·2] per 100 000 person-years), particularly in the first month (1787·1 [1423·0-2244·4] per 100 000 person-years). Based on all presentations to hospital, men were three times more likely than women to die by suicide after self-harm (OR 3·36 [95% CI 2·77-4·08], p<0·0001). Age was positively related to suicide risk in both genders, with a 3% increase in risk for every one-year increase in age at hospital presentation (OR 1·03 [1·03-1·04], p<0·0001). Relative to hospital presentations after self-poisoning alone, presentations involving both self-injury and self-poisoning were associated with higher suicide risk (adjusted OR 2·06 [95% CI 1·42-2·99], p<0·0001], as were presentations after self-injury alone (adjusted OR 1·36 [1·09-1·70], p=0·007). Similarly, relative to self-harm by self-poisoning alone, attempted hanging or asphyxiation (adjusted OR 2·70 [1·53-4·78], p=0·001) and traffic-related acts of self-injury (adjusted OR 2·99 [1·17-7·65], p=0·022) were associated with greater risk of suicide. Self-cutting combined with self-poisoning was also associated with increased suicide risk (adjusted OR 1·36, [1·08-1·71], p=0·01). Compared with those patients living in the most deprived areas, those who lived in the least deprived areas (first national IMD quintile) had a greater risk of dying by suicide (adjusted OR 1·76 [1·32-2·34], p<0·0001) after adjusting for gender, age, previous self-harm, and psychiatric treatment, as did those living in the second least deprived areas (adjusted OR 1·64 [1·20-2·25], p=0·002). INTERPRETATION Patients attending hospital for self-harm are at high risk of suicide, especially immediately after hospital attendance. Certain patient characteristics and methods of self-harm, together with living in areas of low socioeconomic deprivation, can increase patients' subsequent suicide risk. However, while specific risk factors can be usefully integrated into the assessment process, individual factors have poor utility in predicting suicide, so the needs and risks of all patients should be assessed to develop appropriate aftercare plan, including early follow-up. FUNDING UK Department of Health and Social Care.
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Wang M, Swaraj S, Chung D, Stanton C, Kapur N, Large M. Meta-analysis of suicide rates among people discharged from non-psychiatric settings after presentation with suicidal thoughts or behaviours. Acta Psychiatr Scand 2019; 139:472-483. [PMID: 30864183 DOI: 10.1111/acps.13023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To quantify the suicide rate among people discharged from non-psychiatric settings after presentations with suicidal thoughts or behaviours. METHOD Meta-analysis of studies reporting suicide deaths among people with suicidal thoughts or behaviours after discharge from emergency departments or the medical or surgical wards of general hospitals. RESULTS A total of 115 studies reported 167 cohorts and 3747 suicide deaths among 248 005 patients during 1 263 727 person-years. The pooled suicide rate postdischarge was 483 suicide deaths per 100 000 person-years (95% confidence interval (CI) 445-520, prediction interval (PI) 200-770) with high between-sample heterogeneity (I2 = 92). The suicide rate was highest in the first year postdischarge (851 per 100 000 person-years) but remained elevated in the long term. Suicide rates were elevated among samples of men (716 per 100 000 person-years) and older people (799 per 100 000 person-years) but were lower in samples of younger people (107 per 100 000 person-years) and among studies published between 2010 and 2018 (329 per 100 000 person-years). CONCLUSIONS People with suicidal thoughts or behaviours who are discharged from non-psychiatric settings have highly elevated rates of suicide despite a clinically meaningful decline in these suicide rates in recent decades.
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Affiliation(s)
- M Wang
- Faculty of Medicine, University of NSW, Kensington, Sydney, NSW, Australia
| | - S Swaraj
- Faculty of Medicine, University of NSW, Kensington, Sydney, NSW, Australia
| | - D Chung
- Faculty of Medicine, University of NSW, Kensington, Sydney, NSW, Australia
| | - C Stanton
- School of Psychiatry, University of NSW, Kensington, Sydney, NSW, Australia
| | - N Kapur
- Centre for Suicide Prevention, Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester and Greater Manchester Mental Health National Health Service Foundation Trust, Manchester, UK
| | - M Large
- School of Psychiatry, University of NSW, Kensington, Sydney, NSW, Australia
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Kim H, Park J, Kweon K, Ahn J. Short- and Long-term Effects of Case Management on Suicide Prevention among Individuals with Previous Suicide Attempts: a Survival Analysis. J Korean Med Sci 2018; 33:e203. [PMID: 30079004 PMCID: PMC6070468 DOI: 10.3346/jkms.2018.33.e203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 05/08/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This study examined the long-term preventive effects of a case management service on suicide reattempts, and clarified the factors related to suicide reattempts. METHODS We reviewed the medical records of suicide attempters who visited the emergency department of Ulsan University Hospital from August 28, 2013 to July 31, 2017. A 4-week case management service was provided to consenting participants, either face-to-face or by telephone. Using survival analysis, we analyzed differences in the time to the next emergency department visit for a suicide attempt according to whether participants completed the case management service. We also assessed which characteristics of participants were associated with suicide reattempts. RESULTS We found no overall difference in time to suicide reattempt between case-managed participants and controls over the entire observation period (median period: 19 months). However, in the first 24 weeks after the initial suicide attempt, the case-managed group showed a longer time to reattempt than did the control group (log-rank test = 4.243; P = 0.039). A higher risk of reattempt was found among participants with the medical benefit type of health insurance compared to those with national health insurance (hazard ratio [HR], 5.134; P < 0.001) and among participants aged 20-39 compared to those aged ≥ 60 (HR, 3.502; P = 0.05). CONCLUSION Case management had only short-term benefits (within 24 weeks of initial suicide attempt). Risk factors for suicide reattempts were having a medical benefit health insurance and being aged 20-39 years.
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Affiliation(s)
- Hyeonjae Kim
- Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jangho Park
- Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kukju Kweon
- Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Joonho Ahn
- Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Persett PS, Grimholt TK, Ekeberg O, Jacobsen D, Myhren H. Patients admitted to hospital after suicide attempt with violent methods compared to patients with deliberate self-poisoning -a study of background variables, somatic and psychiatric health and suicidal behavior. BMC Psychiatry 2018; 18:21. [PMID: 29368645 PMCID: PMC5784599 DOI: 10.1186/s12888-018-1602-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 01/11/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In Norway, there are about 550 suicides recorded each year. The number of suicide attempts is 10-15 times higher. Suicide attempt is a major risk factor for suicide, in particular when violent methods are used. Suicide attempts with violent methods have hardly been studied in Norway. This study describes demographic, psychiatric and somatic health in patients admitted to somatic hospitals in Norway after suicide attempt by violent methods compared with suicide attempters using deliberate self-poisoning (DSP). METHODS Patients admitted to somatic hospital after suicide attempt aged > 18 years were included in a prospective cohort study, enrolled from December 2010 to April 2015. Demographics (gender, age, marital and living condition, educational and employment status), previous somatic and psychological health were registered. Patients who had used violent methods were compared with patients admitted after suicide attempt by DSP. RESULTS The study included 80 patients with violent methods and 81 patients with DSP (mean age both groups 42 yrs.). Violent methods used were cutting (34%), jumping from heights (32%), hanging (14%), others (10%), shooting (7%) and drowning (4%). Patients with violent methods had more often psychosis than patients admitted with DSP (14% vs 4%, p < 0.05), less anxiety disorders (4% vs 19%, p < 0.01) and less affective disorders (21% vs. 36%, p < 0.05). There were no significant differences between the numbers of patients who received psychiatric treatment at the time of the suicide attempt (violent 55% versus DSP 48%) or reported previous suicide attempt, 58% in patients with violent methods and 47% in DSP. Patients with violent methods stayed longer in hospital (14.3 (mean 8.3-20.3) vs. 2.3 (mean 1.6-3.1) days, p < 0.001), stayed longer in intensive care unit (5 days vs. 0.5 days, p < 0.001) and were in need of longer mechanical ventilation (1.4 vs 0.1 days, p < 0.001). CONCLUSIONS Patients with violent methods had more often psychosis, less anxiety disorders and affective disorders than patients with DSP. Psychiatric treatment before the attempt and previous suicide attempt was not significantly different between the groups and about half of the patients in both groups were in psychiatric treatment at the time of the suicide attempt.
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Affiliation(s)
- Per Sverre Persett
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway. .,Regional Centers of Violence, Traumatic Stress and Suicide Prevention Eastern Norway, Oslo, Norway.
| | - Tine K. Grimholt
- 0000 0004 0389 8485grid.55325.34Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - Oivind Ekeberg
- 0000 0004 0389 8485grid.55325.34Department of Acute Medicine, Oslo University Hospital, Oslo, Norway ,Divisions of Mental Health and Addiction, Oslo, Norway
| | - Dag Jacobsen
- 0000 0004 0389 8485grid.55325.34Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - Hilde Myhren
- 0000 0004 0389 8485grid.55325.34Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
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Olfson M, Blanco C, Wall M, Liu SM, Saha TD, Pickering RP, Grant BF. National Trends in Suicide Attempts Among Adults in the United States. JAMA Psychiatry 2017; 74:1095-1103. [PMID: 28903161 PMCID: PMC5710225 DOI: 10.1001/jamapsychiatry.2017.2582] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/04/2017] [Indexed: 11/14/2022]
Abstract
Importance A recent increase in suicide in the United States has raised public and clinical interest in determining whether a coincident national increase in suicide attempts has occurred and in characterizing trends in suicide attempts among sociodemographic and clinical groups. Objective To describe trends in recent suicide attempts in the United States. Design, Setting, and Participants Data came from the 2004-2005 wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and the 2012-2013 NESARC-III. These nationally representative surveys asked identical questions to 69 341 adults, 21 years and older, concerning the occurrence and timing of suicide attempts. Risk differences adjusted for age, sex, and race/ethnicity (ARDs) assessed trends from the 2004-2005 to 2012-2013 surveys in suicide attempts across sociodemographic and psychiatric disorder strata. Additive interactions tests compared the magnitude of trends in prevalence of suicide attempts across levels of sociodemographic and psychiatric disorder groups. The analyses were performed from February 8, 2017, through May 31, 2017. Main Outcomes and Measures Self-reported attempted suicide in the 3 years before the interview. Results With use of data from the 69 341 participants (42.8% men and 57.2% women; mean [SD] age, 48.1 [17.2] years), the weighted percentage of US adults making a recent suicide attempt increased from 0.62% in 2004-2005 (221 of 34 629) to 0.79% in 2012-2013 (305 of 34 712; ARD, 0.17%; 95% CI, 0.01%-0.33%; P = .04). In both surveys, most adults with recent suicide attempts were female (2004-2005, 60.17%; 2012-2013, 60.94%) and younger than 50 years (2004-2005, 84.75%; 2012-2013, 80.38%). The ARD for suicide attempts was significantly larger among adults aged 21 to 34 years (0.48%; 95% CI, 0.09% to 0.87%) than among adults 65 years and older (0.06%; 95% CI, -0.02% to 0.14%; interaction P = .04). The ARD for suicide attempts was also significantly larger among adults with no more than a high school education (0.49%; 95% CI, 0.18% to 0.80%) than among college graduates (0.03%; 95% CI, -0.17% to 0.23%; interaction P = .003); the ARD was also significantly larger among adults with antisocial personality disorder (2.16% [95% CI, 0.61% to 3.71%] vs 0.07% [95% CI, -0.09% to 0.23%]; interaction P = .01), a history of violent behavior (1.04% [95% CI, 0.35% to 1.73%] vs 0.00% [95% CI, -0.12% to 0.12%]; interaction P = .003), or a history of anxiety (1.43% [95% CI, 0.47% to 2.39%] vs 0.18% [95% CI, 0.04% to 0.32%]; interaction P = .01) or depressive (0.99% [95% CI, -0.09% to 2.07%] vs -0.08% [95% CI, -0.20% to 0.04%]; interaction P = .05) disorders than among adults without these conditions. Conclusions and Relevance A recent overall increase in suicide attempts among adults in the United States has disproportionately affected younger adults with less formal education and those with antisocial personality disorder, anxiety disorders, depressive disorders, and a history of violence.
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Affiliation(s)
- Mark Olfson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
- The New York State Psychiatric Institute, Columbia University, New York, New York
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Rockville, Maryland
| | - Melanie Wall
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
- The New York State Psychiatric Institute, Columbia University, New York, New York
| | - Shang-Min Liu
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
- The New York State Psychiatric Institute, Columbia University, New York, New York
| | - Tulshi D. Saha
- Division of Biometry and Epidemiology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Roger P. Pickering
- Division of Biometry and Epidemiology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Bridget F. Grant
- Division of Biometry and Epidemiology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
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Carr MJ, Ashcroft DM, Kontopantelis E, While D, Awenat Y, Cooper J, Chew-Graham C, Kapur N, Webb RT. Premature Death Among Primary Care Patients With a History of Self-Harm. Ann Fam Med 2017; 15:246-254. [PMID: 28483890 PMCID: PMC5422086 DOI: 10.1370/afm.2054] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/16/2016] [Accepted: 12/30/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Self-harm is a public health problem that requires a better understanding of mortality risk. We undertook a study to examine premature mortality in a nationally representative cohort of primary care patients who had harmed themselves. METHODS During 2001-2013, a total of 385 general practices in England contributed data to the Clinical Practice Research Datalink with linkage to Office for National Statistics mortality records. We identified 30,017 persons aged 15 to 64 years with a recorded episode of self-harm. We estimated the relative risks of all-cause and cause-specific natural and unnatural mortality using a comparison cohort of 600,258 individuals matched on age, sex, and general practice. RESULTS We found an elevated risk of dying prematurely from any cause among the self-harm cohort, especially in the first year of follow-up (adjusted hazard ratio for that year, 3.6; 95% CI, 3.1-4.2). In particular, suicide risk was especially high during the first year (adjusted hazard ratio, 54.4; 95% CI, 34.3-86.3); although it declined sharply, it remained much higher than that in the comparison cohort. Large elevations of risk throughout the follow-up period were also observed for accidental, alcohol-related, and drug poisoning deaths. At 10 years of follow-up, cumulative incidence values were 6.5% (95% CI, 6.0%-7.1%) for all-cause mortality and 1.3% (95% CI, 1.2%-1.5%) for suicide. CONCLUSIONS Primary care patients who have harmed themselves are at greatly increased risk of dying prematurely by natural and unnatural causes, and especially within a year of a first episode. These individuals visit clinicians at a relatively high frequency, which presents a clear opportunity for preventive action. Primary care patients with myriad comorbidities, including self-harming behavior, mental disorder, addictions, and physical illnesses, will require concerted, multipronged, multidisciplinary collaborative care approaches.
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Affiliation(s)
- Matthew J Carr
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Carr, While, Awenat, Cooper, Kapur, Webb); Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Ashcroft); NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK (Ashcroft); Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Kontopantelis); Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK (Chew-Graham); West Midlands NIHR Collaborative Leadership in Applied Health Research and Care (CLAHRC), Birmingham, UK (Chew-Graham).
| | - Darren M Ashcroft
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Carr, While, Awenat, Cooper, Kapur, Webb); Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Ashcroft); NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK (Ashcroft); Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Kontopantelis); Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK (Chew-Graham); West Midlands NIHR Collaborative Leadership in Applied Health Research and Care (CLAHRC), Birmingham, UK (Chew-Graham)
| | - Evangelos Kontopantelis
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Carr, While, Awenat, Cooper, Kapur, Webb); Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Ashcroft); NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK (Ashcroft); Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Kontopantelis); Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK (Chew-Graham); West Midlands NIHR Collaborative Leadership in Applied Health Research and Care (CLAHRC), Birmingham, UK (Chew-Graham)
| | - David While
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Carr, While, Awenat, Cooper, Kapur, Webb); Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Ashcroft); NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK (Ashcroft); Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Kontopantelis); Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK (Chew-Graham); West Midlands NIHR Collaborative Leadership in Applied Health Research and Care (CLAHRC), Birmingham, UK (Chew-Graham)
| | - Yvonne Awenat
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Carr, While, Awenat, Cooper, Kapur, Webb); Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Ashcroft); NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK (Ashcroft); Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Kontopantelis); Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK (Chew-Graham); West Midlands NIHR Collaborative Leadership in Applied Health Research and Care (CLAHRC), Birmingham, UK (Chew-Graham)
| | - Jayne Cooper
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Carr, While, Awenat, Cooper, Kapur, Webb); Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Ashcroft); NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK (Ashcroft); Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Kontopantelis); Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK (Chew-Graham); West Midlands NIHR Collaborative Leadership in Applied Health Research and Care (CLAHRC), Birmingham, UK (Chew-Graham)
| | - Carolyn Chew-Graham
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Carr, While, Awenat, Cooper, Kapur, Webb); Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Ashcroft); NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK (Ashcroft); Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Kontopantelis); Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK (Chew-Graham); West Midlands NIHR Collaborative Leadership in Applied Health Research and Care (CLAHRC), Birmingham, UK (Chew-Graham)
| | - Nav Kapur
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Carr, While, Awenat, Cooper, Kapur, Webb); Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Ashcroft); NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK (Ashcroft); Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Kontopantelis); Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK (Chew-Graham); West Midlands NIHR Collaborative Leadership in Applied Health Research and Care (CLAHRC), Birmingham, UK (Chew-Graham)
| | - Roger T Webb
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Carr, While, Awenat, Cooper, Kapur, Webb); Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Ashcroft); NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK (Ashcroft); Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK (Kontopantelis); Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK (Chew-Graham); West Midlands NIHR Collaborative Leadership in Applied Health Research and Care (CLAHRC), Birmingham, UK (Chew-Graham)
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Mäki NE, Martikainen PT. Premature mortality after suicide attempt in relation to living arrangements. A register-based study in Finland in 1988-2007. Eur J Public Health 2017; 27:73-79. [PMID: 28177491 DOI: 10.1093/eurpub/ckw130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Netta E Mäki
- City of Helsinki Urban Facts, City of Helsinki, Finland
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Chen HM, Hung TH, Chou SY, Tsai CS, Su JA. Three-year mortality rate of suicide attempters in consultation-liaison service. Int J Psychiatry Clin Pract 2016; 20:254-9. [PMID: 27541986 DOI: 10.1080/13651501.2016.1213853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Suicide attempters might be sent to the emergency room for urgent medical intervention. Some with more severe physical morbidity may be hospitalised, and psychiatrists might be consulted for suicide evaluation. The aim of our study was to investigate the three-year all-cause mortality rate of hospitalised suicide attempters with regard to the effect of consultation-liaison services, and to identify any risk factors associated with mortality. METHODS Between 2002 and 2006, 196 inpatients from medical or surgical wards in a general hospital who had consulted psychiatrists because of suicide attempts were collected consecutively. We traced their mortality incidence during a three-year period, and calculated the mortality rate and time (days) to death. RESULTS Three-year all-cause mortality was 20.4%, and there was a higher risk of mortality in the first two years after the index suicide attempt. In the adjusted Cox regression model, associated risks included male gender, older age, diagnosis of depressive disorders and lack of psychiatric follow-up. CONCLUSIONS We found that hospitalised suicide attempters had higher all-cause mortality after discharge, and determined that psychiatric follow-up is helpful. More attention should be paid to those with potential risk factors, and timely intervention is suggested in order to reduce mortality.
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Affiliation(s)
- Hong-Ming Chen
- a Department of Psychiatry , Chang Gung Memorial Hospital , Chiayi , Taiwan ;,b Graduate Institute of Clinical Medical Sciences , Chang Gung University , Taoyuan , Taiwan ;,c Department of Nursing , Chang Gung Institute of Technology , Taoyuan , Taiwan
| | - Tai-Hsin Hung
- a Department of Psychiatry , Chang Gung Memorial Hospital , Chiayi , Taiwan ;,b Graduate Institute of Clinical Medical Sciences , Chang Gung University , Taoyuan , Taiwan ;,c Department of Nursing , Chang Gung Institute of Technology , Taoyuan , Taiwan
| | - Shih-Yong Chou
- a Department of Psychiatry , Chang Gung Memorial Hospital , Chiayi , Taiwan ;,b Graduate Institute of Clinical Medical Sciences , Chang Gung University , Taoyuan , Taiwan ;,c Department of Nursing , Chang Gung Institute of Technology , Taoyuan , Taiwan
| | - Ching-Shu Tsai
- a Department of Psychiatry , Chang Gung Memorial Hospital , Chiayi , Taiwan ;,b Graduate Institute of Clinical Medical Sciences , Chang Gung University , Taoyuan , Taiwan ;,c Department of Nursing , Chang Gung Institute of Technology , Taoyuan , Taiwan
| | - Jian-An Su
- a Department of Psychiatry , Chang Gung Memorial Hospital , Chiayi , Taiwan ;,b Graduate Institute of Clinical Medical Sciences , Chang Gung University , Taoyuan , Taiwan ;,c Department of Nursing , Chang Gung Institute of Technology , Taoyuan , Taiwan
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Chan MKY, Bhatti H, Meader N, Stockton S, Evans J, O'Connor RC, Kapur N, Kendall T. Predicting suicide following self-harm: systematic review of risk factors and risk scales. Br J Psychiatry 2016; 209:277-283. [PMID: 27340111 DOI: 10.1192/bjp.bp.115.170050] [Citation(s) in RCA: 255] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 03/21/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND People with a history of self-harm are at a far greater risk of suicide than the general population. However, the relationship between self-harm and suicide is complex. AIMS To undertake the first systematic review and meta-analysis of prospective studies of risk factors and risk assessment scales to predict suicide following self-harm. METHOD We conducted a search for prospective cohort studies of populations who had self-harmed. For the review of risk scales we also included studies examining the risk of suicide in people under specialist mental healthcare, in order to broaden the scope of the review and increase the number of studies considered. Differences in predictive accuracy between populations were examined where applicable. RESULTS Twelve studies on risk factors and 7 studies on risk scales were included. Four risk factors emerged from the meta-analysis, with robust effect sizes that showed little change when adjusted for important potential confounders. These included: previous episodes of self-harm (hazard ratio (HR) = 1.68, 95% CI 1.38-2.05, K = 4), suicidal intent (HR = 2.7, 95% CI 1.91-3.81, K = 3), physical health problems (HR = 1.99, 95% CI 1.16-3.43, K = 3) and male gender (HR = 2.05, 95% CI 1.70-2.46, K = 5). The included studies evaluated only three risk scales (Beck Hopelessness Scale (BHS), Suicide Intent Scale (SIS) and Scale for Suicide Ideation). Where meta-analyses were possible (BHS, SIS), the analysis was based on sparse data and a high heterogeneity was observed. The positive predictive values ranged from 1.3 to 16.7%. CONCLUSIONS The four risk factors that emerged, although of interest, are unlikely to be of much practical use because they are comparatively common in clinical populations. No scales have sufficient evidence to support their use. The use of these scales, or an over-reliance on the identification of risk factors in clinical practice, may provide false reassurance and is, therefore, potentially dangerous. Comprehensive psychosocial assessments of the risks and needs that are specific to the individual should be central to the management of people who have self-harmed.
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Affiliation(s)
- Melissa K Y Chan
- Melissa K. Y. Chan, MSc, Centre for Suicide Research and Prevention, University of Hong Kong, Pok Fu Lam, Hong Kong; Henna Bhatti, MSc, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Nick Meader, PhD, Centre for Reviews and Dissemination, The University of York, York, UK; Sarah Stockton, BA(Hons), National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK; Jonathan Evans, MRCPsych, Centre for Academic Mental Health, School of Social & Community Medicine, University of Bristol, Bristol, UK; Rory C. O'Connor, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, University of Manchester, and Manchester Mental Health and Social Care Trust, Manchester, UK; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK
| | - Henna Bhatti
- Melissa K. Y. Chan, MSc, Centre for Suicide Research and Prevention, University of Hong Kong, Pok Fu Lam, Hong Kong; Henna Bhatti, MSc, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Nick Meader, PhD, Centre for Reviews and Dissemination, The University of York, York, UK; Sarah Stockton, BA(Hons), National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK; Jonathan Evans, MRCPsych, Centre for Academic Mental Health, School of Social & Community Medicine, University of Bristol, Bristol, UK; Rory C. O'Connor, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, University of Manchester, and Manchester Mental Health and Social Care Trust, Manchester, UK; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK
| | - Nick Meader
- Melissa K. Y. Chan, MSc, Centre for Suicide Research and Prevention, University of Hong Kong, Pok Fu Lam, Hong Kong; Henna Bhatti, MSc, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Nick Meader, PhD, Centre for Reviews and Dissemination, The University of York, York, UK; Sarah Stockton, BA(Hons), National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK; Jonathan Evans, MRCPsych, Centre for Academic Mental Health, School of Social & Community Medicine, University of Bristol, Bristol, UK; Rory C. O'Connor, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, University of Manchester, and Manchester Mental Health and Social Care Trust, Manchester, UK; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK
| | - Sarah Stockton
- Melissa K. Y. Chan, MSc, Centre for Suicide Research and Prevention, University of Hong Kong, Pok Fu Lam, Hong Kong; Henna Bhatti, MSc, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Nick Meader, PhD, Centre for Reviews and Dissemination, The University of York, York, UK; Sarah Stockton, BA(Hons), National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK; Jonathan Evans, MRCPsych, Centre for Academic Mental Health, School of Social & Community Medicine, University of Bristol, Bristol, UK; Rory C. O'Connor, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, University of Manchester, and Manchester Mental Health and Social Care Trust, Manchester, UK; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK
| | - Jonathan Evans
- Melissa K. Y. Chan, MSc, Centre for Suicide Research and Prevention, University of Hong Kong, Pok Fu Lam, Hong Kong; Henna Bhatti, MSc, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Nick Meader, PhD, Centre for Reviews and Dissemination, The University of York, York, UK; Sarah Stockton, BA(Hons), National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK; Jonathan Evans, MRCPsych, Centre for Academic Mental Health, School of Social & Community Medicine, University of Bristol, Bristol, UK; Rory C. O'Connor, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, University of Manchester, and Manchester Mental Health and Social Care Trust, Manchester, UK; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK
| | - Rory C O'Connor
- Melissa K. Y. Chan, MSc, Centre for Suicide Research and Prevention, University of Hong Kong, Pok Fu Lam, Hong Kong; Henna Bhatti, MSc, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Nick Meader, PhD, Centre for Reviews and Dissemination, The University of York, York, UK; Sarah Stockton, BA(Hons), National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK; Jonathan Evans, MRCPsych, Centre for Academic Mental Health, School of Social & Community Medicine, University of Bristol, Bristol, UK; Rory C. O'Connor, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, University of Manchester, and Manchester Mental Health and Social Care Trust, Manchester, UK; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK
| | - Nav Kapur
- Melissa K. Y. Chan, MSc, Centre for Suicide Research and Prevention, University of Hong Kong, Pok Fu Lam, Hong Kong; Henna Bhatti, MSc, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Nick Meader, PhD, Centre for Reviews and Dissemination, The University of York, York, UK; Sarah Stockton, BA(Hons), National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK; Jonathan Evans, MRCPsych, Centre for Academic Mental Health, School of Social & Community Medicine, University of Bristol, Bristol, UK; Rory C. O'Connor, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, University of Manchester, and Manchester Mental Health and Social Care Trust, Manchester, UK; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK
| | - Tim Kendall
- Melissa K. Y. Chan, MSc, Centre for Suicide Research and Prevention, University of Hong Kong, Pok Fu Lam, Hong Kong; Henna Bhatti, MSc, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Nick Meader, PhD, Centre for Reviews and Dissemination, The University of York, York, UK; Sarah Stockton, BA(Hons), National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK; Jonathan Evans, MRCPsych, Centre for Academic Mental Health, School of Social & Community Medicine, University of Bristol, Bristol, UK; Rory C. O'Connor, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, University of Manchester, and Manchester Mental Health and Social Care Trust, Manchester, UK; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, London, UK
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Vancayseele N, Portzky G, van Heeringen K. Increase in Self-Injury as a Method of Self-Harm in Ghent, Belgium: 1987-2013. PLoS One 2016; 11:e0156711. [PMID: 27249421 PMCID: PMC4889035 DOI: 10.1371/journal.pone.0156711] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/18/2016] [Indexed: 11/24/2022] Open
Abstract
Background Self-harm is a major health care problem and changes in its prevalence and characteristics can have important implications for suicide prevention. The objective was to describe trends in the epidemiology of self-harm based on emergency department (A&E departments) visits over a 26-year period in Ghent, Belgium. Methods We analyzed data on all self-harm presentations from the three large general hospitals in Ghent between 1987 and 2013. We investigated trends in prevalence (events by year per 100.000), methods and alcohol use. Results Rates of self-harm steadily decreased during the 26-year study period. In general female rates of self-harm were higher than male rates. The mean patient age was 35 years. The most commonly used method of self-harm was self-poisoning by means of an overdose of medication (80.8%), followed by cutting (10.2%) and hanging (4.2%). Psychotropics (including antidepressants, benzodiazepines, barbiturates and other tranquilizers) were the most frequently used drugs (74.5%). A proportional increase in the use of self-injurious methods in self-harm was highly significant, more specifically in the use of hanging, jumping from heights and the use of other violent methods such as the use of firearms, jumping before a moving object or other traffic related injury. Conclusion This epidemiological study showed an increase in the use of high-lethality methods in self-harm which has important implications for suicide prevention. As restrictions in the availability of these methods are difficult or impossible to achieve, prevention programmes will have to emphasize the role of thorough psychosocial assessment and adequate follow-up care of self-harm patients.
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Affiliation(s)
- Nikita Vancayseele
- Department of psychiatry and medical psychology, Ghent University, Ghent, Belgium
- * E-mail:
| | - Gwendolyn Portzky
- Department of psychiatry and medical psychology, Ghent University, Ghent, Belgium
| | - Kees van Heeringen
- Department of psychiatry and medical psychology, Ghent University, Ghent, Belgium
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Carroll R, Thomas KH, Bramley K, Williams S, Griffin L, Potokar J, Gunnell D. Self-cutting and risk of subsequent suicide. J Affect Disord 2016; 192:8-10. [PMID: 26707346 DOI: 10.1016/j.jad.2015.12.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/27/2015] [Accepted: 12/07/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Some studies suggest that people who self-cut have a higher risk of suicide than those who self-poison. Self-cutting ranges from superficial wrist cutting to severe self-injury involving areas such as the chest, abdomen and neck which can be life threatening. This study aimed to investigate whether the site of self-cutting was associated with risk of subsequent suicide. METHODS We followed-up 3928 people who presented to hospital following self-harm between September 2010 and December 2013 in a prospective cohort study based on the Bristol Self-harm Surveillance Register. Demographic information from these presentations was linked with coroner's data to identify subsequent suicides. RESULTS People who presented with self-cutting to areas other than the arm/wrist were at increased risk of suicide compared to those who self-poisoned (HR 4.31, 95% CI 1.27-14.63, p=0.029) and this increased risk remained after controlling for age, sex, history of previous self-harm and psychiatric diagnosis (HR 4.46, 95% CI 1.50-13.25, p<0.001). We observed no such increased risk in people presenting with cutting to the arm/wrist. LIMITATIONS These data represent the experience of one city in the UK and may not be generalisable outside of this context. Furthermore, as suicide is a rare outcome the precision of our estimates is limited. CONCLUSIONS Site of self-injury may be an important indicator of subsequent suicide risk.
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Affiliation(s)
- R Carroll
- School of Social and Community Medicine, University of Bristol, Bristol, UK.
| | - K H Thomas
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - K Bramley
- Liaison Psychiatry, Bristol Royal Infirmary, Bristol, UK
| | - S Williams
- Liaison Psychiatry, Bristol Royal Infirmary, Bristol, UK
| | - L Griffin
- Liaison Psychiatry, Bristol Royal Infirmary, Bristol, UK
| | - J Potokar
- School of Social and Community Medicine, University of Bristol, Bristol, UK; Liaison Psychiatry, Bristol Royal Infirmary, Bristol, UK
| | - D Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Influential Factors for and Outcomes of Hospitalized Patients with Suicide-Related Behaviors: A National Record Study in Taiwan from 1997-2010. PLoS One 2016; 11:e0149559. [PMID: 26900930 PMCID: PMC4762692 DOI: 10.1371/journal.pone.0149559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 02/02/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Investigating the factors related to suicide is crucial for suicide prevention. Psychiatric disorders, gender, socioeconomic status, and catastrophic illnesses are associated with increased risk of suicide. Most studies have typically focused on the separate influences of physiological or psychological factors on suicide-related behaviors, and have rarely used national data records to examine and compare the effects of major physical illnesses, psychiatric disorders, and socioeconomic status on the risk of suicide-related behaviors. OBJECTIVES To identify the characteristics of people who exhibited suicide-related behaviors and the multiple factors associated with repeated suicide-related behaviors and deaths by suicide by examining national data records. DESIGN This is a cohort study of Taiwan's national data records of hospitalized patients with suicide-related behaviors from January 1, 1997, to December 31, 2010. PARTICIPANTS The study population included all people in Taiwan who were hospitalized with a code indicating suicide or self-inflicted injury (E950-E959) according to the International Classification of Disease, Ninth Revision, Clinical Modification. RESULTS Self-poisoning was the most common method of self-inflicted injury among hospitalized patients with suicide-related behaviors who used a single method. Those who were female, had been hospitalized for suicide-related behaviors at a younger age, had a low income, had a psychiatric disorder (i.e., personality disorder, major depressive disorder, bipolar disorder, schizophrenia, alcohol-related disorder, or adjustment disorder), had a catastrophic illness, or had been hospitalized for suicide-related behaviors that involved two methods of self-inflicted injury had a higher risk of hospitalization for repeated suicide-related behaviors. Those who were male, had been hospitalized for suicide-related behaviors at an older age, had low income, had schizophrenia, showed repeated suicide-related behaviors, had a catastrophic illness, or had adopted a single lethal method had an increased risk of death by suicide. CONCLUSIONS High-risk factors should be considered when devising suicide-prevention strategies.
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Kwok CL, Yip PSF, Gunnell D, Kuo CJ, Chen YY. Non-fatal repetition of self-harm in Taipei City, Taiwan: cohort study. Br J Psychiatry 2015; 204:376-82. [PMID: 24482442 DOI: 10.1192/bjp.bp.113.130179] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Repeat self-harm is an important risk factor for suicide. Few studies have explored risk factors for non-fatal repeat self-harm in Asia. AIMS To investigate the risk of non-fatal repeat self-harm in a large cohort of patients presenting to hospital in Taipei City, Taiwan. METHOD Prospective cohort study of 7601 patients with self-harm presenting to emergency departments (January 2004-December 2006). Survival analysis was used to examine the rates, timing and factors associated with repeat self-harm. RESULTS In total 778 (10.2%) patients presented to hospital with one or more further episodes of self-harm. The cumulative risk of non-fatal repetition within 1 year of a self-harm episode was 9.3% (95% CI 8.7-10.1). The median time to repetition within 1 year was 105 days. Females had a higher incidence of repeat self-harm than males (adjusted hazard ratio 1.25, 95% CI 1.05-1.48) but males had shorter median time to repetition (107 v. 80 days). Other independent risk factors for repeat self-harm within 1 year of an index episode were: young age, self-harm by medicine overdose and increasing number of repeat episodes of self-harm. CONCLUSIONS The risk of non-fatal repeat self-harm in Taipei City is lower than that seen in the West. Risk factors for repeat non-fatal self-harm differ from those for fatal self-harm. The first 3 months after self-harm is a crucial period for intervention.
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Affiliation(s)
- Chi-Leung Kwok
- Chi-Leung Kwok, BSc (ActuarSc), Paul S. F. Yip, PhD, Hong Kong Jockey Club Center for Suicide Research and Prevention, and Department of Social Work and Social Administration, University of Hong Kong, Hong Kong; David Gunnell, MD, PhD, School of Social and Community Medicine, University of Bristol, UK; Chian-Jue Kuo, Taipei City Psychiatric Center, Taipei City Hospital, and School of Medicine, Taipei Medical University, Taipei, Taiwan; Ying-Yeh Chen, MD, ScD, Taipei City Psychiatric Center, Taipei City Hospital, and Institute of Public Health and Department of Public Health, National Yang-Ming University, Taipei, Taiwan
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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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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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Hung GCL, Kwok CL, Yip PSF, Gunnell D, Chen YY. Predicting suicide in older adults - a community-based cohort study in Taipei City, Taiwan. J Affect Disord 2015; 172:165-70. [PMID: 25451412 DOI: 10.1016/j.jad.2014.09.037] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 09/14/2014] [Accepted: 09/20/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Older adults worldwide are at a greater risk of suicide than other age groups. There is a scarcity of prospective studies exploring risk factors for suicide in older people and their discriminative ability to identify future suicide. METHODS We examined a prospective cohort of senior Taipei City residents between 2005 and 2009 (N=101,764). Cox proportional hazards regression analysis was used to determine significant risk factors and to construct a predictive score. The accuracy of the derived score in the prediction was tested by Receiver Operating Characteristic analysis. RESULTS Male sex (Hazard Ratio [HR]=3.41, p<0.001), lower education (HR=3.31, p<0.001) and lower income (HR=2.52, p=0.01) were associated with an increased risk of suicide, as well as depressed mood (HR=1.44, p=0.02; per unit increase in a 4-point scale) and insomnia (HR=1.30, p=0.03; per unit increase in a 4-point scale). The derived prediction score yielded a sensitivity of 0.63 a specificity of 0.73 and an area under curve of 0.73. Removing depressed mood from the prediction model did not significantly alter suicide predictability (P=0.11). LIMITATIONS The dataset examined did not contain information regarding to important risk factors such as substance misuse and prescribed medications and the measures of mental health were relatively limited. CONCLUSION Prediction of suicide based on factors recorded in a routine health screen of elderly people was unsatisfactory; the strongest predictors were factors that cannot be easily altered. Further understanding of how the socioeconomic condition of seniors contributes to suicide may provide valuable insights for intervention targeting this growing population-at-risk.
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Affiliation(s)
| | - Chi-Leung Kwok
- Hong Kong Jockey Club Center for Suicide Research and Prevention, University of Hong Kong, Hong Kong; Department of Social Work and Social Administration, University of Hong Kong, Hong Kong
| | - Paul S F Yip
- Hong Kong Jockey Club Center for Suicide Research and Prevention, University of Hong Kong, Hong Kong; Department of Social Work and Social Administration, University of Hong Kong, Hong Kong
| | - David Gunnell
- School of Social and Community Medicine, University of Bristol, UK
| | - Ying-Yeh Chen
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Institute of Public Health and Department of Public Health, National Yang-Ming University, Taipei, Taiwan.
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Wang LJ, Huang YC, Lee SY, Wu YW, Chen CK. Switching suicide methods as a predictor of completed suicide in individuals with repeated self-harm: a community cohort study in northern Taiwan. Aust N Z J Psychiatry 2015; 49:65-73. [PMID: 25313258 DOI: 10.1177/0004867414553951] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Repetition of suicide attempts is common, but little is known about the relationship between switching methods of suicide attempt and the probability of completed suicide. This study aimed to determine the transition of methods chosen by individuals who repeat suicide attempts, and how the switched methods of suicide attempts influence the risk of suicide death. METHOD All consecutive individuals (n = 2052) with an episode of non-fatal suicide attempt registered in a surveillance database provided by the Department of Health of the Keelung City Government from 1 January 2006 to 31 December 2010 were enrolled and followed up until the end of 2011. The earliest attempt recorded in the database was defined as the index attempt. Data on the time of subsequent completed suicide and methods chosen for repeated self-harm during the follow-up period were analyzed by performing a Cox proportional hazards regression. RESULTS Of the total subjects, 374 (18.2%) had at least one other attempted suicide and 50 (2.4%) eventually died by suicide. Subjects who used highly lethal methods in the index self-harm tended to switch methods in the next suicide attempt (p<0.001). Switching to a more lethal method was a significant predictor of completed suicide (adjusted hazard ratio (aHR) 7.05, 95% confidence interval (CI) 3.52-14.14). In addition, subjects who used charcoal-burning in the index self-harm attempt had a higher risk of subsequent suicide death (aHR 3.47, 95% CI 1.57-7.68). CONCLUSIONS The findings in this study give us some insight into the patterns of methods in repeat suicide attempters. The intent behind switching methods of suicide attempt might be considered as an important item of clinical assessment of the seriousness of suicidal behavior.
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Affiliation(s)
- Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Chi Huang
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Yu Lee
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ya-Wen Wu
- Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Chih-Ken Chen
- Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan Chang Gung University School of Medicine, Taoyuan, Taiwan
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Bakst S, Braun T, Hirshberg R, Zucker I, Shohat T. Characteristics of suicide completers with a psychiatric diagnosis before death: a postmortem study of 98 cases. Psychiatry Res 2014; 220:556-63. [PMID: 25091231 DOI: 10.1016/j.psychres.2014.07.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 07/11/2014] [Accepted: 07/13/2014] [Indexed: 10/25/2022]
Abstract
The objective of this research was to classify the deaths of 98 victims of suicide in Tel Aviv, Israel between the years 2007 and 2010. This was done by examining background features and clinical characteristics among suicide completers with histories of a prior psychiatric hospitalization using logistic regression modeling. 34% of the sample (33/98) was given at least one psychiatric diagnosis upon discharge from a prior psychiatric hospitalization. Throughout their lifetime, those with psychiatric diagnoses were significantly more likely to have histories of mental health treatment (psychotherapy and psychotropic medication), psychopathology and suicidality among family members, prior suicide attempts and familial or emotional crisis as compared with those without a psychiatric diagnosis. During their last life phase, those with prior psychiatric diagnoses were also significantly more likely to have received psychotherapeutic treatment, expressed a lack of desire to live and presented with affective symptoms (e.g. depression, anxiety, adaptation difficulty and nervousness) as compared with those without such histories. Thus, focusing on high risk populations, such as those with psychiatric illnesses and deciphering the role of mental health treatment, familial predisposition, prior suicide attempt and sub-clinical symptoms in relation to suicide can inform future prevention practices.
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Affiliation(s)
- Shelly Bakst
- Israeli Center for Disease Control (ICDC), Ministry of Health, Ramat Gan, Israel.
| | - Tali Braun
- Israeli Center for Disease Control (ICDC), Ministry of Health, Ramat Gan, Israel
| | - Rachel Hirshberg
- Israeli Center for Disease Control (ICDC), Ministry of Health, Ramat Gan, Israel
| | - Inbar Zucker
- Israeli Center for Disease Control (ICDC), Ministry of Health, Ramat Gan, Israel
| | - Tamar Shohat
- Israeli Center for Disease Control (ICDC), Ministry of Health, Ramat Gan, Israel; Department of Epidemiology, Tel Aviv University, Tel Aviv, Israel
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Pan CH, Jhong JR, Tsai SY, Lin SK, Chen CC, Kuo CJ. Excessive suicide mortality and risk factors for suicide among patients with heroin dependence. Drug Alcohol Depend 2014; 145:224-30. [PMID: 25456334 DOI: 10.1016/j.drugalcdep.2014.10.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 10/21/2014] [Accepted: 10/22/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND The mortality risk is high among individuals dependent on heroin, and suicide is a severe consequence of long-term heroin use. We estimated the incidence of suicide mortality and its risk factors in a large Asian cohort with heroin dependence. METHODS A consecutive series of 2750 inpatients dependent on heroin admitted to a psychiatric center in northern Taiwan between 1990 and 2010 were retrospectively enrolled as the study cohort. These patients were linked to the Taiwan National Mortality Database to obtain each mortality event. We determined the Standardized Mortality Ratio (SMR) for each cause of death. Among the deceased, 69 deaths were due to suicide (cases); 138 controls were randomly selected using risk-set density sampling based on a nested case-control design. We collected clinical information from subjects' medical records. Multivariate conditional logistic regression was employed to explore the correlates of suicide mortality. RESULTS The findings showed a 7.9-fold SMR for all-cause mortality among heroin users compared to the general population while the SMR for suicide mortality was 16.2. Multivariate analysis showed that suicide attempt as the reason for the index admission (adjusted risk ratio [RR] = 4.29, p = 0.035) and depressive syndrome anytime during life (adjusted RR = 2.61, p = 0.019) were associated with the risk of suicide mortality. CONCLUSIONS Individuals dependent on heroin are more likely to die of suicide compared to the general population. We recommend that clinical psychiatric staff carefully gather information related to the identified risk factors to prevent suicide among heroin users.
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Affiliation(s)
- Chun-Hung Pan
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Jia-Rong Jhong
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Shang-Ying Tsai
- Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Shih-Ku Lin
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chiao-Chicy Chen
- Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Department of Psychiatry, Mackay Medical College, Taipei, Taiwan
| | - Chian-Jue Kuo
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
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Lee SH, Tsai YF, Chen CY, Huang LB. Triggers of suicide ideation and protective factors of actually executing suicide among first onset cases in older psychiatric outpatients: a qualitative study. BMC Psychiatry 2014; 14:269. [PMID: 25403893 PMCID: PMC4237773 DOI: 10.1186/s12888-014-0269-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 09/16/2014] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Suicide is a global issue among the elderly, but few studies have explored the experiences of suicide ideation in older Asian psychiatric outpatients. METHOD Older psychiatric outpatients (N = 24) were recruited by convenience from one medical centre and one regional hospital in northern Taiwan. Participants were recruited if they met these inclusion criteria: 1) ≥ 65 years old, 2) without severe cognitive deficit, 3) outpatients in the psychiatric clinics at the selected hospitals, and 4) self-reported first episode of suicidal ideation within the previous year. Data were collected in individual interviews using a semi-structured guide and analysed by content analysis. RESULTS Suicide ideation was triggered by illness and physical discomfort, conflicts with family members/friends, illness of family members, death of family members/friends, and loneliness. Participants' reasons for not executing suicide were family members' and friends' support, receiving treatment, finding a way to shift their attention, fear of increasing pressure on one's children, religious beliefs, and not knowing how to execute suicide. CONCLUSION Understanding these identified triggers of suicide ideation may help psychiatrists open a channel for conversation with their elderly clients and more readily make their diagnosis. Understanding these identified protective factors against executing suicide can help psychiatrists not only treat depression, but also enhance protective factors for their clients.
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Affiliation(s)
- Shwu-Hua Lee
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, 5 Fusing Street, Kwei-Shan, Tao-Yuan, Taiwan ,College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, Taiwan
| | - Yun-Fang Tsai
- School of Nursing, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, Taiwan.
| | - Ching-Yen Chen
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, 5 Fusing Street, Kwei-Shan, Tao-Yuan, Taiwan
| | - Li-Bi Huang
- Department of Nursing, Chang Gung Memorial Hospital at Linkou, 5 Fusing Street, Kwei-Shan, Tao-Yuan, Taiwan
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Wu CY, Huang HC, Wu SI, Sun FJ, Huang CR, Liu SI. Validation of the Chinese SAD PERSONS Scale to predict repeated self-harm in emergency attendees in Taiwan. BMC Psychiatry 2014; 14:44. [PMID: 24533537 PMCID: PMC3942520 DOI: 10.1186/1471-244x-14-44] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 02/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Past and repeated self-harm are long-term risks to completed suicide. A brief rating scale to assess repetition risk of self-harm is important for high-risk identification and early interventions in suicide prevention. The study aimed to examine the validity of the Chinese SAD PERSONS Scale (CSPS) and to evaluate its feasibility in clinical settings. METHODS One hundred and forty-seven patients with self-harm were recruited from the Emergency Department and assessed at baseline and the sixth month. The controls, 284 people without self-harm from the Family Medicine Department in the same hospital were recruited and assessed concurrently. The psychometric properties of the CSPS were examined using baseline and follow-up measurements that assessed a variety of suicide risk factors. Clinical feasibility and applicability of the CSPS were further evaluated by a group of general nurses who used case vignette approach in CSPS risk assessment in clinical settings. An open-ended question inquiring their opinions of scale adaptation to hospital inpatient assessment for suicide risks were also analyzed using content analysis. RESULTS The CSPS was significantly correlated with other scales measuring depression, hopelessness and suicide ideation. A cut-off point of the scale was at 4/5 in predicting 6-month self-harm repetition with the sensitivity and specificity being 65.4% and 58.1%, respectively. Based on the areas under the Receiver Operating Characteristic curves, the predictive validity of the scale showed a better performance than the other scales. Fifty-four nurses, evaluating the scale using case vignette found it a useful tool to raise the awareness of suicide risk and a considerable tool to be adopted into nursing care. CONCLUSIONS The Chinese SAD PERSONS Scale is a brief instrument with acceptable psychometric properties for self-harm prediction. However, cautions should be paid to level of therapeutic relationships during assessment, staff workload and adequate training for wider clinical applications.
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Affiliation(s)
- Chia-Yi Wu
- Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hui-Chun Huang
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan,Mackay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan
| | - Shu-I Wu
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan,Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei City, Taiwan
| | - Fang-Ju Sun
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chiu-Ron Huang
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shen-Ing Liu
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan.
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Chen WJ, Shyu SS, Lin GG, Chen CC, Ho CK, Lee MB, Chou FHC. The predictors of suicidality in previous suicide attempters following case management services. Suicide Life Threat Behav 2013; 43:469-78. [PMID: 23638619 DOI: 10.1111/sltb.12031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 02/24/2013] [Indexed: 11/30/2022]
Abstract
Suicide attempts constitute a serious clinical problem. People who have attempted suicide are at an elevated risk for additional suicide attempts, but there is limited evidence regarding the predictors of suicidality of suicide attempters following case management services. In the present study the indicators of suicidality after case management were examined. A total of 1,056 subjects who had recently attempted suicide were recruited from January 1, 2011, to June 30, 2011. The suicide prevention center of Kaohsiung City in Taiwan provided case management services and followed up on suicide attempt cases for 6 months. The salient factors for repeat suicide attempts were estimated using a logistic regression analysis. The results showed that multiple factors, including a "willingness to receive mental health services during a crisis," "social support," "a history of mental disorders," and "a history of suicide," could predict repeat suicide attempts with hazard ratios (0.58, 0.54, 3.84, 1.51) and 95% confidence interval (0.39-0.86, 0.36-0.83, 2.41-6.10, 1.03-2.21). The four factors mentioned above were the most accurate predictors of subsequent suicidality when case management services were utilized after 6 months of follow-up. The findings of our study could help clarify future strategies for suicide prevention.
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Affiliation(s)
- Wei-Jen Chen
- Kaohsiung City Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Graduate Institute of Counseling psychology and Rehabilitation counseling, National Kaohsiung Normal University, Kaohsiung, Taiwan
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Chen VCH, Chou JY, Hsieh TC, Chang HJ, Lee CTC, Dewey M, Stewart R, Tan HKL. Risk and predictors of suicide and non-suicide mortality following non-fatal self-harm in Northern Taiwan. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1621-7. [PMID: 23563393 DOI: 10.1007/s00127-013-0680-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 03/08/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate the risk and predictors of suicide and non-suicide mortality after self-harm in a Taiwanese population. METHOD Between July 2006 and June 2008, 3,299 individuals who harmed themselves were recruited to a population-based self-harm register in Taoyuan County, Taiwan. They were followed until December 2008, with record linkage for date and cause of death in a national mortality database. RESULTS In total, 115 individuals died, 52 through suicide. The risks of suicide and non-suicide mortality in the first year were 1.5 and 2.2%, respectively, representing an approximately 75-fold and 5-fold age- and gender-standardized increase compared with the general population in Taiwan. Male gender, rural residence, more lethal methods of self-harm and self-cited stressors for the index self-harm episode (unemployment, and chronic somatic illness) were independent risk factors for suicide mortality. Male gender, older age, rural residence and more lethal methods of self-harm were also independent risk factors for non-suicide mortality. The association between of unemployment as a cited reason for self-harm and later suicide was strongest in men and in those aged more than 45 years. CONCLUSIONS Relatively high rates of suicide and non-suicide mortality were found following self-harm. Suicide prevention needs to take into account of risk factors for fatal repetition of self-harm.
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Affiliation(s)
- Vincent C H Chen
- Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan
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Kim WJ, Song YJ, Namkoong K, Kim JM, Yoon HJ, Lee E. Does a copycat effect exist in the emergency department? Int J Psychiatry Med 2013; 45:59-72. [PMID: 23805604 DOI: 10.2190/pm.45.1.e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to examine the copycat effect of a famous actress's suicide on suicide attempts visiting the emergency department (ED) in Korea. METHOD We retrospectively reviewed the medical records of suicide attempt cases which had visited the EDs of two general hospitals. during the 6 months before and after a celebrity suicide. We obtained data pertaining to demographics, history of psychiatric illnesses and suicide attempts, method of the suicide attempts, discharge status, and follow-up compliance. RESULTS We identified 319 cases during the study period, of which 158 cases occurred before the celebrity suicide, and 161 occurred after the event. Following the celebrity suicide, suicide attempts with the similar age and the same method as the celebrity's suicide (hanging), presence of psychiatric history, and use of intensive and multiple methods increased. We observed that suicide attempts with the similar age and the same method of hanging were consistent with a copycat effect. Despite a decrease of discharge against advice (DAA) after the celebrity's death from 67.7% to 59.6%, DAA was still high, and the follow-up compliance at outpatient clinics was less than 50%. CONCLUSIONS A copycat effect was found in ED-visiting suicide attempts. Prevention of re-attempts should be initiated in the ED. A specific action guide should be established for suicide attempts in the ED, including cooperation between other hospitals, the community, and the media.
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Affiliation(s)
- Woo Jung Kim
- Department of Psychiatry, Armed Forces Capital Hospital, Seongnam, Korea
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Wu CY, Chang CK, Huang HC, Liu SI, Stewart R. The association between social relationships and self-harm: a case-control study in Taiwan. BMC Psychiatry 2013; 13:101. [PMID: 23531045 PMCID: PMC3621841 DOI: 10.1186/1471-244x-13-101] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 03/21/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Although suicide has been postulated as a result of social breakdown, relatively little attention has been paid to the association between social relationships and non-fatal self-harm. We sought to investigate the extent to which social factors correlate with self-harm in this case-control study. METHODS The primary outcome was self-harm with hospital presentation. Cases of self-harm from the Emergency Department in a general hospital in Northern Taiwan were recruited, and individually age-and-gender-matched control participants were recruited from non-psychiatric outpatient clinics at the same hospital. The Close Persons Questionnaire was administered and its social support and social network subscales were used to measure social relationships in the 12 months prior to the interview. Other covariates, comprising sociodemographic factors, major life events, physical and mental health, were adjusted in conditional logistic regression models. RESULTS A total of 124 case-control pairs were recruited. The mean (standard deviation) age of the case group was 34.7 (12.8) years and 80.6% were female. Higher social isolation score remained significantly associated with self-harm after adjustment (adjusted odds ratio per standard deviation increase 2.92, 95% confidence interval 1.44-5.95) and household size was negatively associated with the outcome (adjusted odds ratio per unit increase 0.54, 95% CI 0.32-0.94). CONCLUSIONS More limited social networks were associated with self-harm after adjustment for potential confounders. Enhancing social structure and effective networking of people with self-harm to community resources may be important for self-harm management in Asian societies and elsewhere.
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Affiliation(s)
- Chia-Yi Wu
- Department of Nursing, College of Medicine, National Taiwan University, 1, Section 1, Jen-Ai Road, Taipei, 10051, Taiwan
| | - Chin-Kuo Chang
- King’s College London (Institute of Psychiatry), London, UK, De Crespigny Park, London, SE5 8AF, UK
| | - Hui-Chun Huang
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan, 45, Min-Sheng Road, Tam-Shui, New Taipei City, Taiwan,Mackay Medicine, Nursing and Management College, Taipei, Taiwan, 92, Shengjing Rd., Beitou Dist, Taipei City, 11260, Taiwan
| | - Shen-Ing Liu
- Mackay Medicine, Nursing and Management College, Taipei, Taiwan, 92, Shengjing Rd., Beitou Dist, Taipei City, 11260, Taiwan,Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan, 45, Min-Sheng Road, Tam-Shui, New Taipei City, Taiwan
| | - Robert Stewart
- King’s College London (Institute of Psychiatry), London, UK, De Crespigny Park, London, SE5 8AF, UK
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